Future of the NHS

Debate between Daniel Kawczynski and Margaret Greenwood

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?

--- Later in debate ---

[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—

[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.