Tobacco and Vapes Bill

Daniel Kawczynski Excerpts

2nd reading
Tuesday 16th April 2024 Commons Chamber

[Sir Simon Clarke]

That would arguably be perfectly sensible, but it is different from a ban. The point is about the degree of harm. I strongly support the ban on illegal drugs, but I do so because cocaine, heroin and the like wreck lives and destroy communities. Tobacco does not do that, but we already have enough difficulty enforcing the existing bans that we have in place, which already stretch our resources to the utmost. Frankly, as we all know, we all too often fail to enforce those bans. Adding a new ban risks creating something that will be unworkable from the outset, while creating a huge black market in which criminal enterprise will thrive. Meanwhile, the state will have forgone the tax revenues—some £10 billion or £11 billion a year—that are ploughed back into our public services, including the health service, to combat the effects of smoking. That revenue simply will not be there anymore. We will likely still have people smoking, but we will have offset many of the revenue streams that allow us to combat it.

I simply do not understand how a Conservative Prime Minister thought it appropriate to bring forward legislation that is the opposite of why we are sent to this House, which is to defend and uphold the principle of individual choice and individual liberty. As we have heard, where this legislation has been introduced, it has already been repealed, as in New Zealand. I fear that in this country we will face a choice in the years ahead: either eventual repeal because the legislation does not work or, as my hon. Friend the Member for Rother Valley (Alexander Stafford) said, an outright ban, because of the sheer unworkability of trying to ascertain in practice whether the person in front of you in the queue is aged 39 or 40. We will doubtless simply see a Labour Government move towards an outright ban to make the situation simpler, tidier and neater. That would be a real red line, but we would have forgone the ability to make the principal case against it.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

My right hon. Friend says that drugs destroy lives, but tobacco does not. What about the people who are dying from emphysema and long-term lung cancer? Many families in the United Kingdom are seeing their relatives die a long, lingering death as a result of using tobacco.

[Sir Simon Clarke]

With respect to my hon. Friend, I said that those drugs destroy communities. There is a profound difference. The ripple effect of illegal drugs is to prompt real social harm to others, because those habits are so destructive that people steal and rob to fund them. Tobacco does not do that. It is obviously extremely bad for people, but it does not drive patterns of behaviour as destructive as those associated with crime. That is a fundamental difference, and it is why we should focus our efforts on stopping those trades, rather than on banning something that has been legal for hundreds of years. We all recognise it carries real medical harms, but it is not, I submit, our job to try to take it away from people. We should rely on education and the tax system, but we should not rely on legislation to tell other people what to do when they are grown adults in a free country.

Future of the NHS

Daniel Kawczynski Excerpts

Tuesday 24th October 2023 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered the future of the NHS.

It is a pleasure to serve with you in the Chair, Mr Pritchard. I am grateful for having been granted this debate, and I thank Members for attending.

The highly respected professor of epidemiology and public health Sir Michael Marmot said earlier this year:

“If you had the hypothesis that the Government was seeking to destroy the national health service—if that were your hypothesis—all the data that we’re seeing are consistent with that hypothesis.”

When asked if we are stumbling or sleepwalking towards a privatised healthcare system, he added:

“I have no special insight into what motivates Ministers, but they are not behaving as if they want to preserve our NHS”.

A few months ago, Professor Philip Banfield, the British Medical Association’s chair of council, said:

“This government has to demonstrate that it is not setting out to destroy the NHS, which it is failing to do at this point in time…It is a very common comment that I hear, from both doctors and patients, that this government is consciously running the NHS down.”

Professor Banfield also commented that the NHS is in a state of “managed decline” because recent Governments have made “a conscious political decision” to deny it adequate resources and not to tackle staff shortages. I think that he is absolutely right.

Legislative change brought in by the Conservative-Liberal Democrat coalition Government in 2012, and by the Conservatives in 2022, fragmented the NHS and increased opportunities for privatisation. The Health and Social Care Act 2012 allowed NHS foundation trusts to, in effect, earn 49% of their income from treating private patients, and the Health and Care Act 2022 allows representatives of private companies to sit on integrated care partnerships and so play a part in preparing the integrated care strategy for an area, influencing where huge sums of public money will be spent.

It is underfunding, however, that is proving to be the Conservatives’ greatest tactic when it comes to undermining the NHS. The report “The Rational Policy-Maker’s Guide to the NHS”, published in July by The 99% Organisation, presents statistics based on research by Appleby and Gainsbury on the average annual change in per capita health spending by UK Governments since 1979, adjusted for population and demographic factors. The stark differences in commitment to the NHS along party lines are clear to see.

Under Labour between 1997 and 2010, there was an average annual increase in per capita health spending of 5.67%. Between 2010 and 2015, the Conservative-Liberal Democrat coalition Government oversaw an average annual reduction of 0.07%. Between 2015 and 2021, under the Conservatives, there was an average annual reduction of 0.03%. This Conservative Government’s committed spend up to 2024 represents an average annual increase of just 2.05%.

Put simply, Labour in government has increased per capita health spending on average significantly more than Conservative Governments. Public satisfaction levels have reflected the success of that approach. Public satisfaction in the NHS was at its highest, at 70%, in 2010, the year Labour left office. In 2022, after over a decade of Conservative government, it fell to a record low of 29%. It is no coincidence that satisfaction plummeted following more than a decade of the Conservatives’ being in power and failing to give the NHS the funding it needs.

“The Rational Policy-Maker’s Guide to the NHS” uses respected international data produced by the Commonwealth Fund in 2014 to show that, among the countries studied, the UK’s has often been the best-ranked healthcare system for effectiveness, equity and efficiency. The report also demonstrates how the UK’s spending on healthcare, which by 2009 had caught up with that of many of our peers, has drifted back far below the average for a developed-world country. For example, we spend less as a percentage of GDP than Canada, Sweden, Belgium and the Netherlands.

Our spending has not kept pace with the combination of inflation, population growth and population ageing. If we continue to underspend, performance will continue to be poor. Nigel Edwards, the chief executive of the Nuffield Trust, points out in the foreword to the report that

“the inability of too many of those in policy-making circles to recognise that underfunding the NHS—quite apart from any moral arguments against it—is not an economically sustainable strategy. Since 2010, the focus has been containing expenditure; the results of this are now very evident”.

The report asserts that

“the fundamental business model of the UK NHS is better than that of any other in a high-income country,”

and it puts forward the view that

“the rational strategy is to recommit to the fundamental model of the NHS, fund it properly and introduce operational improvements over time”.

That makes a great deal of sense.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

The hon. Lady is saying that more money needs to be put into the NHS. It is receiving record investment this year—more than it has in its history. Where does she anticipate that extra money coming from? Does she want to move money from other Departments into the NHS, or to increase taxation, or to increase borrowing?

[Margaret Greenwood]

First, in challenging the hon. Gentleman’s opening remark, I refer him to the point earlier in my speech when I spoke about the Government’s current spending commitment. I also ask him to listen to the rest of my speech, as I will come on to the economy.

It is not the fundamental model of the NHS that is broken; it is the fact that it has been underfunded that has led to us to where we are now. As is clear for all to see, we are at a point of crisis. Waiting lists for routine treatments recently hit a record high of 7.75 million, with more than 9,000 people waiting for more than 18 months. It is truly devastating that last year, more than 120,000 people in England died while on NHS waiting lists for hospital treatment. That is double the number who died in 2017-18. There are over 125,000 staffing vacancies, including more than 43,000 vacancies in nursing and more than 10,000 medical staff vacancies. Many of the staff who are in post are burned out, with not enough colleagues to work alongside them.

The “Fit for the Future” report published by the Royal College of General Practitioners last autumn revealed that the situation in primary care is dire. It found that 42% of GPs in England are either likely or very likely to leave the profession over the next five years. As of August 2023, there were 27,246 fully qualified full-time equivalent GPs in England, 3.1% less than in 2019 and 7.4% less than in 2015. That downward trend simply cannot go on.

Last week, the Care Quality Commission rated almost two thirds of maternity services in England either “inadequate” or “requires improvement” for the safety of care and said:

“The overarching picture is one of a service and staff under huge pressure.”

Cancer Research UK has pointed out that cancer waiting time targets continue to be missed in England, and recent months have seen some of the worst performances on record.

[Margaret Greenwood]

I am not familiar with the centre that my hon. Friend speaks of, but I do believe that the NHS should control the assets and make sure that the service is there for people when they need it. I would like to hear more about the centre from him at another time.

By deliberately underfunding the NHS, the Conservatives have undermined it as a comprehensive, universal public service. Their desire to privatise the NHS has been evident for a very long time. It is a shocking agenda to essentially destroy our most cherished institution.

This determination to dismantle the NHS, which has been proven to be a world leader in terms of effectiveness, equity and efficiency, is not only immensely damaging to patients and the staff who work in the service, but damaging to the economy. Last year, an estimated 185.6 million working days were lost because of sickness or injury—a record high. Similarly, the Office for Budget Responsibility reported in July that the 15 to 64-year-old economic inactivity rate

“has increased in the UK by 0.5 percentage points”

since the covid pandemic.

[Daniel Kawczynski]

The hon. Lady is being very disparaging about the private sector. Has she ever worked in the private sector?

[Margaret Greenwood]

I have not worked in the health service in the private sector—

[Daniel Kawczynski]

Has she worked in the private sector?

[Margaret Greenwood]

I did write a book once, and the publisher was a private organisation. I am not disparaging the private sector. The point I am making is that the national health service is a public service.

[Daniel Kawczynski]

She has never worked in the private sector—

[Mark Pritchard (in the Chair)]

Order. If the hon. Gentleman wants to make another intervention, then he can try to do so. If the hon. Lady—

[Daniel Kawczynski]

The question is simple: has she ever worked in the private sector?

[Margaret Greenwood]

The answer, clearly, is yes, I have. What I am talking about is the national health service, which was set up as a public service—publicly run and publicly owned. That is what we are talking about here today. I am going to make more progress. [Interruption.] If the Minister wants to intervene, he can.

--- Later in debate ---

[Anna Firth (Southend West) (Con)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Wirral West (Margaret Greenwood) on securing this important debate. I want to put on record straightaway my thanks to all the hard-working hospital and ambulance staff at Southend Hospital, and to everybody working in the NHS across Southend and Leigh-on-Sea—they do a fantastic job.

I want to start with the question of money. I do not agree at all with the characterisation of this Government as one that does not invest in the NHS. This Government are putting record investment into our NHS. Using the latest figures for which we have comparable international data—I noticed that the hon. Lady was selective about the years she chose—public spending on healthcare in this country totalled £177 billion in 2018-19, the equivalent of 8% of GDP. That is more than both the OECD and EU14 averages. Healthcare spending has only gone up since then. We are now spending £182 billion, amounting to £3,409 for every man, woman and child in 2022. This is simply not a Government who are not investing in their NHS.

I think we would all accept that reform is always welcome. Any attempts to talk about reform are generally met by the Opposition with accusations of privatisation or of needing to spend yet more money. I cannot help but observe that the hon. Member for Wirral West does not disappoint: we have heard both those accusations this afternoon. Let me give a recent quote from a senior politician:

“The reason I want to reform the health service is…I want to preserve it. I think if we don’t reform the health service we will be in managed decline”.

I hope that the hon. Lady recognises those words, as they are the words of her own party leader.

This is what people get from a Conservative Government. It is a Conservative Government who have funded the NHS more and who promise reform, and that is the way we will get better outcomes for all our constituents. One thing I will say, though, is that that investment must make its way down to our individual hospitals and NHS services.

That brings me to my first point. My hon. Friend the Minister is well aware that £118 million of capital investment was promised to South Essex hospitals in 2017. The lion’s share—£52 million—of that was earmarked for Southend Hospital. The Minister is also aware that I have raised this issue—I have termed it the missing millions—in Parliament 10 times and with Ministers on numerous other occasions. It is utterly incredible that here we are, more than six years later, and that money has still not, finally, made its way down to my local trust.

[Daniel Kawczynski]

Is my hon. Friend aware that the state-run, socialist model of the NHS has meant that despite my local NHS trust in Shropshire securing more than £312 million for modernisation of A&E services seven years ago, construction has still not started in Shropshire? The socialists believe in state-controlled services, but they are the most inefficient imaginable.

[Anna Firth]

My hon. Friend makes an extremely valid point. It is how we get the investment through the state bureaucracy that is so important. I thank the Minister very much indeed for his support last year, when I secured an advance payment of £8 million, which is already going towards improvements at Southend’s emergency department in preparation for the winter. But I stress once again, using the famous words of Cuba Gooding Jr that I have already said in the main Chamber but have not yet said in this one: when, please, are the Government going to “show me the money”, because Southend Hospital and Southend residents deserve it?

I want to move on to the future of the NHS. The focus has to be on prevention and on community care. The old adage that prevention is better than cure is clearly the way forward, and I want to focus on some examples from Southend. I recently visited the fracture clinic at Southend Hospital, which is about to launch a new fracture liaison service next spring. That will be the first FLS in the UK to focus across one area: it will be a consistent service, providing consistent care, across Mid and South Essex. The figures show that, over five years, the FLS will help to prevent 550 fractures, save the trust £472,000 and also save 1,300 bed days every year. Every single pound that the NHS is investing in the FLS will save £3.26 for our NHS. Outstanding, groundbreaking, innovative services like that are the future of our NHS, and I will just remark again that it started in Southend West.

The second thing that I want to talk to the Minister about is community pharmacies, which already save 619,000 GP appointments every week; roughly 32 million appointments are saved per year. We must continue to move services out of secondary care and into the community, and community pharmacies are a perfect example. We have the brilliant Belfairs Pharmacy and French’s pharmacy in my constituency. Both are run by an inspirational pharmacist, Mr Mohamed Fayyaz Haji, known to us as Fizz. The Minister will be well aware of everything that community pharmacies can do, but Fizz provides cholesterol and blood pressure checks, health advice, prescribing, ear syringing, community phlebotomy, earlier diagnosis measures such as measuring prostate-specific antigen levels, electrocardiograms, and ultrasound screening for sports injuries and pregnant women. That is a model for community pharmacy around the country, which, again, has to be the future of our NHS.

The final point that I want to talk about is hospice care and care homes. In Southend West we have an average age that is 20% higher than England’s as a whole. The triple whammy of people living longer but not necessarily in good health, coupled with more and more people working full time, means that good quality nursing care and end-of-life treatment will increasingly become a necessity for all of us.

Hospices such as Havens Hospices in Southend perform an incredibly compassionate service for our community, which is incredibly good value. They could play a vital role in reducing pressure on the NHS. They are an exemplar, and the NHS should look at the hospice service and learn from it, just as it should look and learn from brilliant care homes such as Cavell Lodge, which is managed by Michael Daley.

Regrettably, awareness of the role and value of our hospices and care homes often does not come until the point that it is needed. Hospices in particular are funded primarily, as the Minister knows, through charitable giving. Havens Hospices need £124,000 each week to provide their services. Overall, UK hospices are budgeting for a deficit of £186 million per year. Hospices save the NHS money in the long term by reducing pressures on hospital beds, ensuring our hospice sector—I would also add our care sector—not only survives but thrives. It is a win-win for all us.

I do not believe that more money is the answer or has to be the future of the NHS. A focus on prevention, on more care in the community and on an integrated health service that takes full advantage of the learnings available in the charitable and sometimes private sector can provide solutions to reduce pressure on the frontline services. All of that is deliverable, but only a Conservative Government will deliver it.

--- Later in debate ---

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

I pay tribute to the doctors, nurses, porters, kitchen staff and many other hard-working people at the Royal Shrewsbury Hospital, who do an outstanding job for my constituency of Shrewsbury and Atcham. My concerns are with management of the NHS trust and the chief executive. My right hon. Friend the Member for Ludlow (Philip Dunne) and I, with others, secured £312 million seven years ago—the biggest investment in the NHS in Shropshire for decades—for the modernisation and reconfiguration of A&E services.

All Members of Parliament will recognise that there is nothing more important for their constituents than the safety and care of their families when they go to A&E. Imagine: we secured £312 million for that modernisation of our local hospital trust seven years ago, and still not a single brick has been laid. Those were not proposals envisaged by politicians or Ministers, but by 300 local surgeons, who were at the forefront of championing this modernisation and reconfiguration. Those 300 local surgeons are at the coalface of providing those services every day to our constituents. Yet, the NHS trust has allowed itself to be bullied by the Labour leader of Telford and Wrekin Council to prevent the changes taking place.

The Labour leader of the council does not have a single medical qualification, yet under the society we live in he can prevent those changes, which are propagated as being absolutely essential by local surgeons at the coalface of providing those services. There is no comprehension of the interdependence between these two hospitals for citizens across the whole of Shropshire and mid-Wales. Let us not forget that in Shropshire—you are a Shropshire MP and will know this, Mr Pritchard—

[Mark Pritchard (in the Chair)]

Order. For the record, while I am chairing, I am completely neutral. I take the hon. Member’s point, but this is a generic debate. He is talking about specifics, and the Chair is completely neutral.

[Daniel Kawczynski]

Yes. These two hospitals, 12 miles apart, cover the whole of Shropshire and mid-Wales, yet the Labour leader of Telford and Wrekin Council refuses to recognise their interdependence. No decision has been taken by the trust for seven years. I have attended hundreds of meetings with the local trust over that time to find out when it will finally take the decision to start construction. “It’s coming”, “It’s just around the corner” and “It’s nearly there”—that is what we have heard for the past seven years. That lack of accountability and transparency would never be tolerated in the private sector, and I speak as somebody who spent 13 years working in the private sector before becoming a Member of Parliament.

There is a massive turnaround of staff at the local NHS trust. I think I am on my seventh or eighth chief executive; there is no accountability, transparency or sense of urgency. Meanwhile, A&E services continue to deteriorate in our local hospital trust. Shropshire Community Health NHS Trust and Shrewsbury and Telford Hospital NHS Trust are the worst performing A&E trusts in the whole United Kingdom. As a Member of Parliament, I get heartbreaking letters from constituents about the difficulties that their family members have experienced in our local A&E services, because that £312 million has not been spent and implemented.

I speak as the only Conservative Member of Parliament to have been born in a communist country, where the state controlled everything. That is what my antipathy to this state control is rooted in. The socialist model created in the 1940s leads to inefficiency, poor value for money and corruption. We need to create the right regulatory and taxation framework to allow the private sector to thrive in this country. I completely disagree with the hon. Member for Wirral West (Margaret Greenwood); we need to allow private sector hospitals to thrive and to take on the NHS, and ultimately say to citizens, “If you need an operation, we will send you to a private hospital and pay for your operation there.” We cannot continue to allow this level of negligence, corruption and inefficiency, with £130 billion into the NHS just this year alone and horrendous outcomes. We need privatisation and competition for the NHS.

--- Later in debate ---

[Daniel Kawczynski]

I will repeat the question that I posed to the hon. Member for Wirral West, who instigated the debate. We are putting record levels of investment into the NHS. Where will the hon. Member for East Dunbartonshire (Amy Callaghan) get the extra money that she wants to put into the NHS?

[Amy Callaghan]

We look at progressive taxation measures in Scotland to generate income and revenue to put into our NHS, but we are experiencing cuts to Barnett consequentials because of how the British Government down here are spending money on the NHS, with investment in private enterprises as opposed to capital going directly into the NHS. We are experiencing real-term cuts to our funding despite our generating money through other means.

It will come as no surprise that the financial and staffing issues facing our NHS in Scotland are a result of being tied to this broken Union. We cannot afford to be in this financial Union. Our NHS cannot afford for us to be in this financial Union. I look forward to the day when Scotland is an independent nation within the European Union, with a fully funded NHS and no recruitment or staff retention issues because we have created an inclusive and welcoming environment for all.

Before I conclude, I will say that it is fitting, with World Stroke Day just around the corner, that I am standing here talking about the future of our NHS. I have a future because of our NHS. We must provide proper funding and staffing to ensure that there is a future for the NHS and the millions who will need it for generations to come.

[Preet Kaur Gill (Birmingham, Edgbaston) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Pritchard, and I add my thanks to my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing the debate. She is a committed campaigner for our national health service, and she set out clearly how the NHS faces an unprecedented challenge. We have heard powerful cases put forward about the need for reform, including from the hon. Member for Southend West (Anna Firth). My hon. Friend the Member for St Helens South and Whiston (Ms Rimmer) focused on the workforce strategy for the NHS. I also thank my hon. Friends the Members for Liverpool, Riverside (Kim Johnson) and for Lewisham East (Janet Daby), who talked about sickle cell disease and equality in the NHS, and the hon. Member for Strangford (Jim Shannon).

This debate on the future of the NHS is timely as it is our first opportunity to put to the test the Government’s new slogan, which was unveiled at their conference:

“Long-term decisions for a brighter future”.

Personally, I would say that 13 years is long enough. What has been the result of that? Where we once spoke of winter crises, we now face crisis in the NHS all year round. Patient outcomes are declining, public satisfaction is at a 40-year low and improvements in healthy life expectancy have stalled.

One in seven of us are now stuck on waiting lists. Some 2.6 million people of working age are out of work and long-term sick—a record high. Across swathes of the country, dental deserts mean that patients are pulling their own teeth out because they cannot get the care they need. This Government was the future once, and their record is historically bad.

As the CQC warned last week in its “State of Care” report, the risk is that healthcare in this country becomes a two-tier system, where those who can pay get treated and those who cannot have to wait. My party will never accept that. We will always defend the principle of an NHS that is there for everybody when they need it, free at the point of use.

As we have heard, we need a serious plan for investment and reform if the NHS is to realise that promise. If the Government cannot deliver, we will. We will train thousands more doctors and nurses so that the NHS has the staff it needs, armed with cutting-edge technology to treat patients sooner and faster. We will get doctors and nurses to help to address the backlogs and pull the NHS out of permacrisis. We will reform the system to shift more care to the community, fix the front door to the NHS, and deliver a prevention-first revolution to shift focus from the NHS as a sickness service to it being a genuine, holistic health and care service.

One thing that will define the future of the NHS is the disease burden of the country. Children in school today will live into the next century. Our NHS has been there for us for 75 years and will need to be there for 75 more, but it will not be there if we carry on as we are. The change we need to make is the shift to prevention. Right now the situation is scandalous, given the clinical time and need that is taken up with treating illnesses that could have been avoided in the first place. Many of the biggest killers, from cancer to heart disease, could be drastically reduced through healthier lifestyles and environments, yet as we saw with the latest child measurement programme statistics released last week, primary schoolchildren are some of the least healthy there have ever been. Nearly one in four children are now obese by the time they leave primary school, which is absolutely shocking. Some prevalence studies show that four in 10 obese children have evidence of fatty liver disease.

Yet more shocking is the fact that, while these children are bombarded with adverts for junk food, such as KitKat cereal, or are begging their parents to fork out more than £10 for a bottle of Prime energy drink, the Government have seemingly abandoned their plan to tackle junk food promotions and adverts targeting children. I ask the Minister: when will the Government publish the consultation into the pre-watershed junk food ads ban? Where is the secondary legislation that they promised? They said that the delay was to allow time to consult, yet the consultation has been done and is probably sitting in a drawer in Whitehall somewhere. What is the hold-up? Will the Minister back Labour’s plan to ban junk food ads before the watershed and to introduce free breakfast clubs serving healthy food at school, so that every child gets the best start?

The future of NHS dentistry is also hanging by a thread. Dentists are leaving the NHS every year. Huge parts of the country are dental deserts, where practices are not even taking on NHS patients. The No. 1 reason that children end up in hospital is to remove rotting teeth. It has been six months since the Government announced their dental recovery plan, but where is it? Their response to the excellent Health and Social Care Committee report into NHS dentistry is also overdue; when can we expect that?

In the meantime, Labour has set out our rescue plan. We will have 700,000 more urgent appointments a year to bring down the backlogs. We will target funding to train up dentists in left-behind areas, and, of course, we will have a national supervised toothbrushing scheme for schoolchildren, because we know that the cheapest intervention means not needing to see a dentist at all.

Securing the future of general practice is also integral to the future of the NHS as a whole. People trust their GPs, and the relationships that they build with their patients are irreplaceable, but despite the Government’s much-vaunted primary care recovery plan, record numbers of GPs are still leaving the profession. In 2019, the Government promised to deliver 6,000 extra NHS GPs. Will the Minister explain why that promise has been broken? How does he expect to move more care from acute settings to the community if general practice continues to decline at this rate? Where is his equivalent to Labour’s fully costed plan to recruit 8,500 mental health professionals, with support in every community and every school, to relieve the pressure on frontline GPs? And will the Minister say what proportion of the community diagnostic centres that have been set up in recent years are actually in the community, rather than in an existing healthcare site?

The Minister will surely acknowledge the point that there will be no sustainable future for the NHS without tackling the crisis in social care. Thousands of people are stuck in hospital beds who are medically fit to leave but are unable to do so, because the care that they need in the community is not there to support them. Can he explain how he expects to find a sustainable solution to that persistent problem without getting serious about pay and standards and addressing the chronic workforce shortage in the sector?

It is also a poor reflection of this Government’s long-term planning that the NHS is still stuck using creaking, outdated equipment, and has fewer scanners per person than Greece. Freedom of information responses from NHS trusts have revealed that half—48%—still have an MRI or CT scanner in operation past the recommended lifespan of 10 years. One in five trusts are using the same scanners that they had when the last Labour Government left office in 2010.

Does the Minister not agree that it is time for an upgrade? There are currently 1.6 million people waiting for diagnostic scans and tests in England—three times as many as when the last Labour Government left office in 2010. Slow, outdated equipment is part of the problem, so will the Minister follow Labour’s lead, with our “Fit for the Future” fund to double the number of CT and MRI scanners?

To really make the NHS fighting fit for the future, we should grasp the opportunities in the explosion of innovation in health technologies, too. Right now, a revolution is taking place in medical science, technology and data that has the potential to transform our healthcare. By using Britain’s strengths in life sciences and NHS data, we could transform the model of healthcare in this country using prediction, prevention and highly targeted precision medicine.

Today, genomic screening can spot predisposition to big killers such as cancer or heart disease. Let us imagine: if every family could choose to screen their baby’s genetic information, they would be empowered to give their child the healthiest start in life. Last month, I visited the Precision Health Technologies Accelerator at the University of Birmingham, part of the life sciences park that it is building there. Over time, it hopes that the campus will grow into a leading life sciences hub, bringing together the best of our university, business and the NHS, and creating more than 10,000 jobs in the process. That is really exciting.

The next Labour Government will build on the strength of our life sciences sector. The development of coronavirus vaccines shows us how industrial policy can work, with the state playing a crucial role in partnership with the private sector. Yet the Government scrapped the Industrial Strategy Council and, since 2019, the UK has dropped from second to ninth in global life sciences league tables for inward foreign direct investment. Where is the Government’s strategy to put the NHS at the front of the queue for cutting-edge innovations in the health sector and end the postcode lottery in the adoption of new treatments and diagnostics?

[Daniel Kawczynski]

Bearing in mind that the Shrewsbury and Telford Hospital NHS Trust is the worst-performing for A&E in the United Kingdom, will the hon. Lady commit, if there is a Labour Government, to backing the £312 million investment in our local trust—yes or no?

[Preet Kaur Gill]

I thank the hon. Gentleman for his question, but I do not have the level of detail to be able to make any such commitment. He needs to speak to the Minister to ensure that the valuable investment they have been able to obtain for people in Shrewsbury is actually realised. That is really a conversation for him to have with the Minister.

There is no doubt that the NHS needs serious reform if it is to serve for the next 75 years. Since the Prime Minister and Health Secretary made a pledge in January for 5,000 more beds in time for winter, the number of hospital beds in England has fallen by almost 3,000. After a promise to clear all patients waiting 78 weeks or more for treatment by April this year, which was a shockingly low bar, the number rose last month from 7,300 to 9,000 patients. Despite making it one of their flagship five pledges to cut waiting lists, the Government have again broken their own record this month, with the number of patients waiting now at 7.8 million.

This Government cannot be trusted with the future of the NHS. Whether it is the social care crisis or the RAAC—reinforced autoclaved aerated concrete—scandal, the Government have literally failed to fix the roof while the sun was shining. The NHS will not survive another five years of this. Labour’s 10-year plan of change and modernisation will build an NHS fit for the future, shifting the focus of healthcare from the acute sector into the community to boost prevention, diagnose conditions earlier and provide treatment closer to people’s homes.

In closing, I want to put on the record my deep thanks to all our NHS staff for going above and beyond for patients, and especially everyone at the University Hospitals Birmingham trust in my constituency, which is the largest trust in the country.

--- Later in debate ---

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for securing a debate on this important matter. A debate of this nature is almost impossible to respond to in a relatively short period of time—although it is slightly longer now. I could easily fill the 90 minutes on the future of the NHS, as I know could all hon. Members across the Chamber today. I will endeavour to respond to as many of the issues and themes raised as possible in the time left available to me and, if I can, before the Front Benchers in the main Chamber conclude and we are all summoned over to vote.

While we will not always agree on the best approach—in fact, I strongly disagree with so much of what the hon. Lady said in her opening speech—I can assure her and Members across the House that I share her passionate desire to see an NHS that delivers and continues to deliver excellent care to all its patients, both now and in the future. Similarly to the Opposition Front-Bench team, the Government believe that the NHS should be free at the point of delivery and that its offer should be comprehensive, with services provided based solely on need. Let me absolutely clear: that will never change. In response to the themes raised in the debate, I will start by focusing on three broad areas: funding, workforce, and finally transformation and innovation.

Turning first to funding, as my hon. Friends the Members for Shrewsbury and Atcham (Daniel Kawczynski) and for Southend West (Anna Firth) set out, we have invested record amounts in the future of our healthcare system. By the end of this Parliament, core spending will have increased from £140.5 billion in 2019-20 to £193 billion in 2024-25. For those good at maths, that is a cash increase of £52.6 billion or 37%. At the beginning of this debate, several of us got a little excitable when the issue of privatisation was raised, and you rightly shut us down, Mr Pritchard. People have managed to make their contributions, but this is perennial accusation levelled at the Government, so let me absolutely clear: it is not our policy and it is not our plan. The NHS is not, and never will be, for sale.

Look at the actual facts on this. In 2013-14, around 6.1% of NHS funding was spent on the independent sector. Now let us jump to 2021-22, when it was 5.9%. What we are doing, however, is using the independent sector to enable us to fully realise our healthcare system’s capacity, and of course to improve performance. This is an approach that I understand is supported by the shadow Secretary of State for Health, the hon. Member for Ilford North (Wes Streeting). It is an approach that is better for patients and for our NHS. We are giving our patients greater choice and control, and empowering them to shape and manage their own healthcare.

[Daniel Kawczynski]

I am very grateful to my hon. Friend for highlighting the extraordinary increases in Government funding for the NHS, but has he recognised during the course of this debate my concern that, seven years after securing the £312 million for modernisation of A&E services in Shropshire, not a single brick has been laid? How sustainable is this NHS model when the managers of our local trusts are so incapable of delivering the construction with what we have secured for them?

[Will Quince]

I hear my hon. Friend’s concern. I have met with him and other Shropshire MPs on this issue and committed to meet with him to discuss it again. We are very keen to resolve the situation.

Before I move on from privatisation, let me gently say to Opposition Members—some of whom raised it and some of whom did not—that patient choice and the ability to use the private sector has been part of the NHS since its formation. It is a fundamental part of the NHS constitution. Let us be clear what those who call for private sector involvement to be entirely removed from the NHS are calling for: they are calling for charities, independent sector providers, GPs, dentists and community pharmacies to be removed. So let us be very careful, and very clear about exactly what we are calling for, because the independent sector plays an important role.

Oral Answers to Questions

Daniel Kawczynski Excerpts

Tuesday 14th June 2022 Commons Chamber

[Gillian Keegan]

I am certainly happy to meet the hon. Gentleman to understand more about the issue. At the heart of it, I think, is prevention; we are trying to understand how we can prevent some of what causes greater illnesses later on for those who are in a care home or are receiving social care in their own home. That is certainly a big part of the strategy for our social care reforms.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

8. What steps he is taking to raise the quality of leadership and management across the health and social care sectors.

[Lucy Allan (Telford) (Con)]

16. What steps he is taking to raise the quality of leadership and management across the health and social care sectors.

[The Secretary of State for Health and Social Care (Sajid Javid)]

In health and care, strong leadership can make the difference between life and death. I have been clear that we can accept only the highest possible standards and that in some cases poor leadership has been tolerated for too long. That is why I have accepted in full the recommendations of General Sir Gordon Messenger’s independent review and will set out a delivery plan to begin what I think will be the biggest shake-up in health and social care leadership in a generation.

[Daniel Kawczynski]

Bearing in mind that the NHS will receive approximately £180 billion of taxpayers’ money this year, improving leadership and management in the NHS is extremely important, and nowhere more so than in the Shrewsbury and Telford Hospital NHS Trust. Despite the trust obtaining £312 million from the Treasury to improve accident and emergency services, a lack of coherent leadership has resulted in no decision being taken as to how the money will be spent. With rising costs in the construction industry, that is of great concern to us. Will the Secretary of State intervene with our local hospital trust to make sure that the money is spent as expeditiously and quickly as possible?

[Sajid Javid]

My hon. Friend is absolutely right about the importance of leadership. I am pleased to tell him that my Department has just received the strategic outline case for his local A&E’s Future Fit programme, which is currently being reviewed. As he undoubtedly knows, the business case process is led by the trust and is already supported by some early funding; I understand that the trust aims to present the full business case by 2023, with construction starting in the same year and to be completed by 2028. The Minister for Health will shortly visit Shropshire and will meet my hon. Friend and other colleagues.

Oral Answers to Questions

Daniel Kawczynski Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Sajid Javid]

The hon. Lady is right to raise the importance of doing everything we can to look after working-age people who need social care. As she will know, the total funding of social care from the state now constitutes most of the funding, and it is right that all needs are met through those funds. As for the new plan, everyone will benefit—no one will lose out from this versus the current system—so the vast majority of people will be better off, including working-age adults.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

The Minister has heard from my right hon. Friend and neighbour the Member for Ludlow (Philip Dunne) how essential it is that the £320 million we have secured for the Future Fit programme be released, so that construction can start. We are beginning to see a definite negative impact on A&E services because of the seven or eight years of delays. Please will the Minister do everything possible to ensure that the money is finally released and construction can start?

[Edward Argar]

I am grateful to my hon. Friend, and likewise to my right hon. Friend the Member for Ludlow (Philip Dunne), who has campaigned vigorously this issue. We now have the outline business case from the trust, and we are reviewing it at pace to ensure that we can deliver the investment in both of Shropshire’s hospitals that they need to continue to serve my hon. Friend’s and colleagues’ constituents.

Medical Cannabis: Alleviation of Health Conditions

Daniel Kawczynski Excerpts

Thursday 4th November 2021 Commons Chamber

[Christine Jardine]

I thank the hon. Member for his intervention. He is absolutely right; I could not agree more. We all thought it was done, but more importantly, and more upsettingly, so did the families of the hundreds of children, and adults, who would benefit—adults with conditions such as multiple sclerosis for whom it would be life-changing. They all thought it had been done and cannot understand why it is not. I have to be honest: I cannot understand why it is not either, and why it simply cannot be done. Will the Government please consider using observational trials instead of insisting on clinical trials, which are not appropriate?

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

The hon. Lady and I have locked horns on a number of occasions on the radio over the European Union, but I would like her to know that she has support on the Tory Benches, particularly when she talks about children and the conditions they are facing. I hope she will take comfort from the fact that she has support from all political parties in the House in trying to change the legislation on this very important issue.

[Christine Jardine]

I thank the hon. Member for his comments, and I do take comfort from that, but more importantly, the many hundreds of families watching to see what we do will take comfort from the fact that they have support on the Government Benches as well as the Opposition Benches. I ask the Government and the Minister to take that on board. Will they consider the suggestions that have been made today, as well as using discretionary funding to support those prescriptions that families are currently paying for until we can resolve this issue? Then we can finally achieve what the then Home Secretary and the Government wanted to achieve three years ago when they made cannabis for medical use legal. They did not intend that we would be here now with only three prescriptions issued.

Coronavirus Regulations: Assisted Deaths Abroad

Daniel Kawczynski Excerpts

Thursday 5th November 2020 Commons Chamber

[Matt Hancock]

Obviously the hospice sector, which often relies on charity shops in order to fund its services, has had a very difficult year. We therefore have put funding support in and we always keep that under review. I applaud the fact that our hospices are funded both from taxpayers and through a huge amount of philanthropy. It leads to a stronger sector that is rooted in the communities that it serves. Nevertheless, I acknowledge that that has led to some significant challenges this year. We have put more funding in and will, of course, always keep that open to review.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

It is very difficult to tell somebody who is in pain and suffering and who wants to die that the state is going to prevent them from doing that. As a Roman Catholic, I recently changed my mind on the issue because of my constituent Mr Noel Conway, who lives in Garmston near Shrewsbury. I said to him, “Why don’t you go to Switzerland?” and his answer will stay with me forever: “No, I’m an Englishman. I want to die in England.” It is extremely important that our citizens have that right. Will the Secretary of State do me the courtesy of agreeing to a short Zoom call with my constituent Mr Noel Conway, who is getting a national reputation as a leading campaigner on the issue?

[Matt Hancock]

I would be happy to have that meeting with Mr Conway. I have spoken to others in the same circumstances who have made the case strongly. The compassion of the case cannot be overstated. I also respect the fact that many hon. Members, as has been reflected today, have deeply held views. We should make sure that the conversation happens; that there is, rightly, a debate about the topic, as there is in many other countries right now; and that it is conducted in an evidence-based, sensible and compassionate way.

Covid-19

Daniel Kawczynski Excerpts

Monday 28th September 2020 Commons Chamber

[Simon Baynes (Clwyd South) (Con)]

It is a pleasure to follow my right hon. Friend the Member for Forest of Dean (Mr Harper).

I will make a few brief observations from the point of view of a Welsh MP for a constituency on the border of Wales and England. Last Friday, we took our younger daughter to start at university for the first time, having taken our elder daughter back to her university two weeks earlier to start her second year. Therefore, the debate about covid restrictions for students is a major reality for us as a family. As with so much else in this debate, it revolves around finding a balance between keeping people safe and letting life and the economy function with some degree of normality.

I believe that the Government have got the balance right with the measures announced last week by the Prime Minister. As an MP on the Welsh borders, I am very pleased that he prepared them in consultation with the Welsh Government and the other devolved Administrations. The differences between the measures taken by the UK and Welsh Governments to combat covid-19 are relatively narrow at present. That is a welcome situation for my constituents, for whom a disparity of measures creates many practical complications.

The Welsh Government’s approach to combating coronavirus means that the Labour Opposition in this House have a practical record, albeit in a devolved context, that deserves as much scrutiny as that of the UK Government. Such scrutiny shows that there is no monopoly among political parties on getting every measure right, whether it be on local lockdowns, testing or the delayed adoption in Wales of face coverings in shops and on public transport.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

I speak to my hon. Friend as a fellow Conservative MP whose constituency is on the English-Welsh border. He is making a very good speech, but does he acknowledge that some of the differences emanating from the Welsh Senedd, which contrast with legislation made here in London, have led to additional complications and confusion for constituents who, like ours, live on the border?

Oral Answers to Questions

Daniel Kawczynski Excerpts

Tuesday 28th January 2020 Commons Chamber

[Jo Churchill]

As I said, NHS England and NHS Improvement have already agreed, within the ring-fenced funding for public health, to fund the ongoing costs of drugs for PrEP going forward. There will be an additional allocation of funds to cover the PrEP roll-out completely[Official Report, 3 February 2020, Vol. 671, c. 1MC.].

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

5. What steps he is taking to ensure the take-up of new technology by the NHS to support effective delivery of its services.

[Alan Mak (Havant) (Con)]

24. What steps he is taking to ensure the take-up of new technology by the NHS to support effective delivery of its services.

[The Secretary of State for Health and Social Care (Matt Hancock)]

Using the best technology is good for patients, clinicians and the NHS. Work is under way to drive through the use of new technology, including electronic referrals and electronic prescribing, and to end the painfully slow logins in some trusts.

[Daniel Kawczynski]

My right hon. Friend will know that the Future Fit programme, if passed, would have brought not only £312 million but a lot of innovative, pioneering technology into the county of Shropshire. Unfortunately, as he knows, the programme has been blocked thus far by the Labour-controlled, medically illiterate Telford and Wrekin Council. Does he agree that investing in technology would help patients and clinicians and would save money in the long term?

[Matt Hancock]

Yes, I do. It is striking how much clinicians working on the frontline are desperate for improvements in the technology they use. Our announcement over Christmas that we will have a single login, which is seemingly so simple, brought enormous enthusiasm from clinicians who spend hours of their week doing things that most of us can do with the click of a button on the systems we use.

My hon. Friend has been an assiduous campaigner for health investment in Shrewsbury, both physical capital investment and investment in modern technology.

Adult Social Care in Shropshire: Government Funding

Daniel Kawczynski Excerpts

Wednesday 22nd January 2020 Westminster Hall

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

I beg to move,

That this House has considered Government funding for adult social care in Shropshire.

It is a pleasure to serve under your chairmanship, Mr Stringer. Before I start to outline the concerns we have about Government support for paying for adult social care costs in Shropshire, I will put forward two historical contexts to try to explain to the Minister a little as to why and how we got into this situation.

In 2004, the Labour-controlled Shropshire Council increased council tax in one year by 16.4%. That was the year before my hon. Friend the Member for The Wrekin (Mark Pritchard), my right hon. Friend the Member for Ludlow (Philip Dunne) and I were elected for the first time. I am sure they will recall, as I do, the palpable anger, fear and frustration of many people on low fixed incomes in the face of that massive tax increase. When our party came into office, we incentivised councils to freeze council tax because there had been so much frustration and such a backlash against the massive increases, not only in Shropshire, but in Labour-controlled councils up and down the country where there had been double-digit increases in council tax.

Our local council, which became Conservative in 2005, decided to dutifully follow the advice and froze council tax, not just for one year, but for seven years in a row—clearly to the delight of local ratepayers. The council is now telling me that the Government have not adequately filled the shortfall in revenue that it inevitably had to face as a result of the freezing of council tax. The Minister may correct me if I am wrong, but my understanding from Shropshire Council officials is that the additional support that was envisaged to come from Government tapered off quickly, leaving the council without additional support of, it now estimates, in the region of £20 million per annum.

Labour shadow Ministers always criticise repeated references to their management and stewardship of the economy, but let us not forget that in the good times the Labour party, when it was in office, borrowed £50 billion a year, sold off our gold reserves at rock-bottom prices and put all these new hospitals on private finance initiative contracts, with the result that we will pay exorbitant interest rates for decades.

When the financial crash came in 2008, the kitty was bare. I am not ashamed of repeatedly referring to that. People forget about it, but the Minister will remember the sheer gravity of the situation when we came to office. As a nation, in 2009-10, we were borrowing £152 billion a year.

[Mark Pritchard (The Wrekin) (Con)]

I commend my hon. Friend for securing this important debate. Does he agree that it is not only about the financial pressures on Shropshire Council but the domino effect of the under-provision of social care in Shropshire on the acute trust, and how that affects A&E waiting times? Finally, does he agree that there needs to be cross-party consensus and working together nationally? We do not need another review; we have had lots of those. We know what the problem is. We now need solutions, and that has to be done on a cross-party basis, but quickly.

[Daniel Kawczynski]

I thank my hon. Friend and neighbour for that intervention. I could not agree more.

When we came into office, we of course had to rein in expenditure, and all Government Departments had to have cuts. The cuts to local government have, of course, adversely affected our council. I am pleased that the country’s annual deficit is now below £28 billion a year, down from the £152 billion a year that we inherited. However, now that we are getting the finances under control in a more sustainable way, I urge the Minister to take the message back to the Treasury that we need to increase public funding of our councils, so that they can start to meet the huge rise in demand for adult social care in our county. I will explain why Shropshire is uniquely affected.

[Jim Shannon (Strangford) (DUP)]

Although it is absolutely the case that adult social care is very important in Shropshire, and in other parts of the United Kingdom of Great Britain and Northern Ireland, does not the hon. Member agree that we need to attract more workers into adult social care, because there seems to be a dearth of them, and help them to understand how rewarding it can be to make a real difference to the life of a vulnerable person? Also, does the hon. Member believe that we can do anything in this place to encourage more adult workers to be involved?

[Daniel Kawczynski]

Yes, very much so, and I am sure that some of my colleagues from Shropshire will take up that point in interventions. However, I will make a few quick points before I take another intervention.

During the 2017 general election, we gave the impression to the electorate that somehow they would have to sell their homes in order to pay for their long-term care. I have to tell the Minister that I had never come across such levels of bewilderment, frustration and anger on the streets of Shrewsbury as I did following that announcement, and have not done so subsequently. Whoever came up with that policy for the then Conservative Government was really out of tune with the thinking of many of our natural voters.

Even my own beloved mother—this is the first time I have referenced her in 15 years—Halina, who is a staunch Conservative supporter, said to me, “I haven’t made sacrifices all of my life, I haven’t done the right thing, paid the right amount of tax and done all the right things, for you now to force me to sell my home to look after my long-term social care needs.” I think my mother exemplified the strength of feeling across the United Kingdom.

I am convinced that that policy lost us our majority at the 2017 general election; it was certainly a major contributory factor. I am therefore very pleased that the Prime Minister has indicated that in this Parliament a solution will be found. However, as my hon. Friend the Member for The Wrekin said, we need radical, innovative thinking that has the support of our voters.

Shropshire MPs meet the council on a regular basis. We Shropshire MPs work as a team and hunt as a pack, and one of our greatest strengths is the unity between us all. In fact, we are seeing our council this Friday, 24 January, which happens to be my 48th birthday. I am looking forward to a few bottles of beer from my colleagues during the meeting.

[Mark Pritchard]

Shropshire Lad.

[Daniel Kawczynski]

Shropshire Lad. The clear message from Peter Nutting, the leader of our council, from the chief executive, and from the other senior councillors is that social care is their top concern. The Minister will know—she played a part in it as well—that in the last Parliament, MPs from rural shire counties worked constructively together to get a change to the funding mechanisms for our schools. Rural shire counties were unfairly discriminated against in comparison with inner-city, metropolitan areas. In this Parliament it is my intention, and that of many other Members, to make social care the No. 1 issue, because we have to listen to what our councillors are telling us.

There is no doubt in my mind that the black hole of approximately £20 million a year that the council faces is affecting not only adult social care costs but many other services in our county. The leader of the council has to take money away from repairing potholes, and all the other things for which the council is responsible, in order to manage the black hole that is staring them in the face.

[Mr Owen Paterson (North Shropshire) (Con)]

I congratulate my hon. Friend on landing the debate and on the powerful case that he is making. As he said, we have all been working very closely on the matter for some time. I think he would agree that the situation is going to get worse. Currently, 23% of Shropshire’s population are aged over 65. That will increase by 50%, to 33% of the population, by 2036, compared with the projection for England of 24%. That is an increase from 74,029 to 110,926.

I am sure that, like me, my hon. Friend is an avid reader of the Shropshire Star. On Monday there was a story titled, “Dramatic rise in dementia cases”, which reported that dementia cases have gone up by 57%. Dr Karen Harrison Dening of Dementia UK said:

“We are going to have a huge increase in population of older people, and one of the main risk factors of dementia is age. There is also going to be a reduction in the number of younger people who will be able to care for them.”

Would my hon. Friend like to comment on the inevitability of this getting worse?

[Daniel Kawczynski]

I would, but I will first give way to my right hon. Friend.

[Philip Dunne (Ludlow) (Con)]

I endorse what my right hon. Friend the Member for North Shropshire (Mr Paterson) has just said. In south Shropshire, the population of over-65s is currently 29%, compared with 19% of the population across the UK and 23% across the county, as he said, so the issue is particularly pressing in the south.

Today, there are twice as many people over the age of 90 as there were on the day when my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) and I were elected, nearly 15 years ago. However, it is not all gloom and doom about increasing demand, although that is a major problem. Shropshire is leading the way in this country in developing technologies to help cope with the growing pressure. I commend the Broseley project to him. It is one of the leading projects in the county, and in the country, trying to find technological solutions to keep people out of hospital or residential care. I encourage him to visit that project if he has not done so already.

[Daniel Kawczynski]

I am extremely grateful for those interventions from my hon. Friends and neighbours. I could not agree with them more. Shrewsbury is listed as one of the top 10 places to retire to in the whole of the United Kingdom because of the beauty of our town—we have more listed buildings than any other town in England. We have a larger number of senior citizens as a percentage of our total population, and that percentage is growing much faster than the national average. Governments of all political colours have poured money disproportionately into inner-city, metropolitan areas while leaving us in the rural shire counties as the poorer cousins, and it is vital that we now start to take action.

[Bill Wiggin (North Herefordshire) (Con)]

Will my hon. Friend give way on that point?

[Daniel Kawczynski]

I will give way for the last time, very quickly.

[Graham Stringer (in the Chair)]

Order. In half-hour debates on the Adjournment, people who speak have to have the permission of the proposer and of the Minister, and it is not good form to come in after the proposer has started speaking. I ask the proposer and the Minister whether Bill Wiggin has had permission to intervene.

[Bill Wiggin]

I am happy to withdraw my intervention, Mr Stringer.

[Daniel Kawczynski]

I will follow your lead on that, Mr Stringer.

In the financial year 2019-20, the social care budget for Shropshire Council was £103.1 million. That represents 48.2% of the council’s net budget, up from 32.6% in 2015-16, which is extraordinary: our council’s budget for just dealing with adult social care costs has gone up from a third of its net budget to practically a half. I find those figures staggering, and my colleagues from Shropshire agree. Since 2015-16, Shropshire Council’s adult social care budget has risen by an average of £7 million per annum. In the coming financial year, it is projected to rise by approximately £10 million; £6 million of that is inflationary, meaning that only approximately £4 million is due to increasing demand.

As has been said, Shropshire’s senior citizen population is rising at a much faster rate than the national average, and Shropshire Council has become more efficient, which is the point that my right hon. Friend the Member for Ludlow was making. The Local Government Association has assessed our council as being very well managed, and as implementing new and innovative policies in this regard. Shropshire Council has become more efficient and innovative in an attempt to control rising costs in social care. Of all initial inquiries into adult social care, 85% are signposted to external support, and of the remainder, only 14.8% enter paid services. In total, 2.25% of all inquiries enter paid services; in 2014-15, the comparable figure was 32%. The financial pressures on Shropshire Council go beyond single-year budget increases. The most recent available analysis shows that if our council were funded at the English average per head of population, it would have an additional £20 million in its base budget.

I am grateful to have had the opportunity to raise this issue, and look forward to hearing the Minister’s answers. I am pleased that all the MPs from the Shropshire Council area have attended this debate, and I am very grateful for their support. They know as well as I do the huge pressures that our council is under at the moment because of its lack of funding, and will share those pressures with the Minister. Our hon. Friend the Member for The Wrekin also mentioned serious problems with our local hospital acute trust, which we are trying to raise with the Secretary of State for Health and Social Care.

We in Shropshire are experiencing a unique combination of problems at the moment, meaning that our constituents are given services that are creaking at best. That is not something I feel comfortable with. We are the fifth-largest economy in the world; I read today that last year, we reduced our debt as a percentage of GDP by 0.9%, and I am delighted and thrilled that the International Monetary Fund is now forecasting that our country will grow at a faster rate than the eurozone over the next three years. We have turned a corner, so we can start to loosen the purse strings a little bit. We as Conservatives must demonstrate that we have a long-term solution to this issue, which affects so many of our constituents.

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) on securing this important debate on the funding of adult social care in Shropshire. He is a strong and consistent champion for both his county and his constituency on a range of issues but, particularly today on the subject of adult social care. As he mentioned, he and his colleagues hunt as a pack; they work very effectively together, and I am pleased to see him joined by his colleagues. I do not know what the collective noun is for a group of Shropshire MPs, but it is clearly something very robust and effective. I am pleased to see them all here, and grateful for all the points they have raised.

Clearly, adult social care is one of the biggest challenges we face as a country, but it is not just our country that faces it; it is a global issue. How do we face the challenges of an ageing population? We have to preface this by saying it is not a bad thing that people are living longer; we should be celebrating that. This is not doom and gloom, but we need to make sure that we are equipped to support people in later life. People are also living longer with much more complex conditions. Over half of local authority budgets are spent on working-age adults; although that cohort includes a lower number of people, it is also more expensive, and we need to make sure that we are looking after those people sufficiently as well and supporting local authorities to do so properly.

Successive Governments have wrestled with the challenges of how to deal with the issues caused by an ageing population and of adult social care. Frankly, they have all then put those challenges in the “too difficult” pile, because the solution is very difficult and potentially very expensive. Unfortunately, the sand has run through the hourglass and we no longer have the luxury of being able to put those issues aside; we now have to face the challenges of an ageing population and of adult social care head on. That is why the Prime Minister, on the steps of Downing Street on his very first day, committed to tackle them. We will therefore set out much more on this issue in due course.

My hon. Friend is absolutely right to highlight the fact that by 2040, one in four people in the UK will be aged 65 or over. However, it is important to remember that this is not just about older people, as the number of those aged below 65 who access long-term support is growing year on year. Central to all our thinking are all those magnificent adult social care professionals, the social care workers, social workers and nurses, as well as the army of unpaid carers—loved ones, friends and family—who do so much in Shropshire and the whole country to look after their loved ones.

[Daniel Kawczynski]

The Minister has just reminded me of one thing. Of course, we should pay tribute to the millions of citizens out there who are carers and who look after their elderly relatives in a voluntary capacity, as we looked after my beloved grandfather in the latter stages of his life. It is very important to acknowledge what they do. It is true, is it not, that the way in which a country treats its senior citizens is an indicator of what sort of society and culture prevails in that country?

[Caroline Dinenage]

That is absolutely right. It is because of the army of paid and unpaid carers that my hon. Friend mentioned that there are many reasons to be positive about the care people receive in Shropshire.

As of 1 January, 86.5% of care home beds in Shropshire were rated good or outstanding by the Care Quality Commission, which is much better than the national average, and 90.3% of care home agencies in Shropshire are good or outstanding. Moreover, in the 2018-19 adult social care survey of users, more than 90% of people receiving care in the county reported that they were satisfied with the care and support that they received. However, we know that there is still a long way to go.

My right hon. Friend the Member for Ludlow (Philip Dunne) spoke about how Shropshire leads the way in technology. If we are to face the challenges of adult social care and tackle what might be regarded as a crisis, we need to look at not just funding but harnessing all modern technology. We need to look at the workforce, and at modern models of care and methods of housing to make sure that we are harnessing the best in all those areas. He was a fantastic Health Minister and a brilliant co-chair of the all-party group on adult social care.

Last autumn, the most recent spending round announced further investment in social care for 2020-21. That will give councils access to an additional £1.5 billion for adult and children’s social care, which includes an additional £1 billion of funding and a proposed 2% council tax precept that will enable councils to access a further £500 million specifically for adult social care. The £1.5 billion is over and above the existing £2.5 billion of social care grants that were rolled over in the spending review and is part of the biggest increase in overall core spending power for local government since 2015—an increase of 4.4% in real terms in 2020-21. A key stakeholder, the Local Government Association, said that it was delighted that the spending round

“has delivered a funding package of more than £3.5 billion for our vital local services...This is the biggest year-on-year real terms increase in spending power for local government in a decade”.

For Shropshire, the settlement puts considerable new resources into social care. It will receive an additional £7.9 million in funding from the new social care grant and £11.5 million through the improved better care fund, which will drive the integration to stop pressure being put on acute health services. Shropshire will also have the opportunity to raise an additional £15.1 million through the dedicated adult social care precept. That additional funding is an important step towards putting adult social care on a fairer and more sustainable footing. We recognise that it is important for local authorities to have security, predictability and certainty about future funding for social care, which is why the funding beyond 2020-21 will be set out at the next spending review.

On Shropshire Council’s wider funding, my hon. Friend the Member for Shrewsbury and Atcham set out beautifully the challenges facing local councils up and down the country. All Government Departments and local authorities had to make tough decisions to deal with the parlous finances and extremely high borrowing that we inherited from the last Labour Government. He is right to say that that put huge pressure on local authorities, which were also trying not to put up council tax to deal with the problem. That is why the Government are committed to undertaking a review of the relative needs and resources.

The review will consider the drivers of local authorities’ needs, the resources available to them to fund services, and how to account for them in a way that draws a more transparent and understandable link between local circumstances and local authority funding. In the my hon. Friend’s area, for example, the rurality and the relative size of the ageing population would have to be taken into account. The Government are working closely with local government representatives and others to examine all elements of the review, including adult social care. The aim is to share the emerging results with the sector shortly, followed by a full consultation in the spring. I hope that he will find good news for Shropshire Council in that.

I finish by assuring my hon. Friend that my Department and the Government are by no means complacent. Fixing the issues with adult social care is a huge priority for us. As the Prime Minister said, the Government will deliver on their promises and bring forward a plan for social care this year. There are complex questions to address, but we have been clear on two things: everybody will have dignity and security, and nobody will be forced to sell their home to pay for their care.

Question put and agreed to.

Oral Answers to Questions

Daniel Kawczynski Excerpts

Tuesday 26th March 2019 Commons Chamber

[Caroline Dinenage]

The hon. Gentleman is absolutely right to draw the House’s attention to how vital local community services are in supporting people and to say that we really do need to invest in them. Clearly, these matters of investment are for local areas, which is why we allow CCGs to make these decisions, but I am more than happy to meet him to discuss the matter.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

Will the Secretary of State give an evaluation of the “Future Fit” programme? We have secured more than £300 million for investment in our local hospital trust. What is his understanding of where the “Future Fit” programme has got to?

[Matt Hancock]

I have called in the independent review panel and asked it to consider all the evidence, at the request of the local council, to ensure that we properly assess all the evidence. We have made the money available, but we must ensure that the plans are the best ones possible for both Shrewsbury and Telford.