National Health Service

Diana Johnson Excerpts

Wednesday 21st January 2015 Commons Chamber

[Mr Hunt]

I will make some progress because I want to answer some of the questions asked by the right hon. Member for Leigh. One reason for the pressure I have outlined is that people increasingly expect to get medical care 24/7, just as they are able to bank, shop and book their holidays 24/7. The NHS cannot be King Canute and try to stop that—I am not blaming patients, but that is how patient expectations are changing, and we need to give them better alternatives to turning up in A and E.

Over the past two years, we have expanded weekend and evening GP appointments for more than 5 million people. We have also rolled out the 111 service, which now handles—these are the facts—three times more calls every year than its predecessor, NHS Direct. The right hon. Gentleman criticised 111, so let us look at the facts. Of those who call 111, 30% say they would have gone to A and E but decided not to as a result—that is 2 million journeys to A and E and around 600,000 ambulance call-outs avoided because of 111. Unlike NHS Direct, one third of all 111 centres can now access a summary of people’s GP records, and that will apply to nearly all 111 centres this year. Not only can people talk to a doctor or nurse, as they did with NHS Direct, but if they give consent they can do something that they could never do under NHS Direct and talk to someone who knows about them and their medical history.

Another big challenge facing A and Es is the increasing complexity of the illnesses that people are presenting with, including many older people with conditions such as dementia, diabetes or asthma. Such people often end up being admitted to hospital rather than treated and sent home, and that is not just challenging for the system; it is often wrong for the individual. A busy A and E can be the worst possible place for a frail, older person with dementia, which is why in our vision for the NHS every vulnerable person has a doctor who is continually responsible for their care, whether or not they are in hospital, and who ensures that they have proper care wrapped around them, thereby reducing the likelihood of emergency hospital admissions. Too often, that does not happen. Too often, the buck stops with no one. That is why, this year, we reversed the 2004 decision and brought back named GPs with personal responsibility for everyone aged 75 and over. That is helping 4.5 million people. With 800,000 of the most vulnerable people, we are going even further, giving them guaranteed rights to prompt and proactive care from their GP.

On social care, for too long, some of the most vulnerable people in our country have suffered from disjointed care with NHS and social care systems that, rather than talk to each other, constantly try to pass the buck. For the first time from this April, we have required all local authorities and NHS organisations to work together to plan care in a joined up and seamless way, as part of the better care programme.

[Diana Johnson (Kingston upon Hull North) (Lab)]

Will the Secretary of State give way?

[Mr Hunt]

I am going to make progress.

When that happens, we should see, for the first time ever, not an increase but a reduction in emergency hospital admissions. For patients, that will mean something important: a doctor or nurse will be in charge of every person in the social care system; medical records will be shared, so that people get safer and more joined-up care; and joint teams will work together across the NHS and social care systems, rather than the silos and boundaries that have plagued the system till now.

The Government have never pretended that the challenges facing the NHS are straightforward, but with more doctors, more nurses, more operations and safer care than ever before, we have shown our commitment to that most precious institution. We have put our money where our mouth is, with protection for the NHS budget during cuts, financial help this winter and support for the NHS’s plan for the future. More important than the money are the values behind it: our passion for the highest standards of compassionate care for every person who needs the NHS. Good care, not clever politics, is the future for our NHS.

--- Later in debate ---

[Frank Dobson (Holborn and St Pancras) (Lab)]

Whatever people like or dislike about the language, I do not think anyone could deny that the NHS at the moment is struggling to care for patients in the way that the hard-working staff in the NHS would like to be able to care for them and to deal with them as promptly as they would like. Everyone recognises that the NHS is managing to cope only because of its amazingly dedicated staff doing amounts of work and quality of work far above the call of duty. I have to say that a nurse from one of the two great hospitals in my constituency, to which the Secretary of State referred, said to me, “If he says how wonderful we are and then defends us not getting a pay increase, I will throw up.” I do not think she intended doing it in front of patients, but the hypocrisy of the approach she describes seems to me to be indefensible.

This situation is not entirely novel. A and E has been facing difficulties and has been overstretched in many parts of the country, even during the summer. That is largely because too many people are having to go to A and E or are being taken to A and E because they cannot be looked after properly at home. That is one of the main reasons. If people are kept in, there are not enough beds. I noticed that the Secretary of State quoted the King’s Fund. Having been interested in health care in London for 40-odd years, all I can say is that the main contribution of the King’s Fund has always been to demand reductions in the number of hospital beds; then, where there are not enough of them, it comes up with a million reasons why there are not enough—none of them being that there are too few beds; it is always some other factor rather than the shortage of beds itself that it manages to blame.

The reason why people, particularly the elderly and the physically and mentally disabled, have to go into hospital is that they cannot be safely looked after at home. Once they are in hospital and occupying a bed, they cannot safely be discharged home. So, they are brought in because there is no adequate care at home, and they cannot go back out of a hospital bed because there is no adequate care at home. The Government simply cannot get away from the fact that there have been massive reductions in care at home, particularly for the elderly. Logic suggests that if there are more elderly people who are chronically ill, there should be an expansion of the service to meet the increased need. In fact, however, services have been contracting.

The excellent work done by my hon. Friend the Member for Leicester West (Liz Kendall) a fortnight ago—just a small aspect of it—demonstrated that there had been almost 200,000 fewer people getting meals on wheels. I do not know whether the Government ever deigned to consider the impact of that, but if old people who previously relied on meals on wheels were not getting them, they were probably no longer being properly fed, and if they were not being properly fed, they were more likely to need nursing care. If no additional care was available, they were more likely to go to A and E and, once they had gone into a hospital bed, they were less likely to be safely discharged simply because they were no longer getting meals on wheels.

The meals on wheels service does not have the function only of providing food. On every day that a person gets meals on wheels, somebody is checking how they are doing, and it gives those who are lonely some human contact. The disappearance of all those meals on wheels will undoubtedly have led to more elderly people having to go to A and E, and fewer elderly people being able to be treated safely at home.

[Diana Johnson]

I am listening carefully to what my right hon. Friend is saying. He has the perspective of a London MP. In Hull over the Christmas period, we had the longest wait for A and E in the country—and this at the same time as we have seen a quarter of the local authority budget being cut, which impacts on social care. It seems to me that the two are very closely related. Does my right hon. Friend agree?

[Frank Dobson]

I entirely agree with that. The fact is that the services that can be provided at home need a higher priority than they have had in the past—under any Government. They need more staff with more time, because many of the people attempting to provide a service are given a quarter of an hour to dash in, help somebody wash or cook and then dash out again to rush along to somewhere else. If one person takes up more than a quarter of an hour, they will be late for the next person they are supposed to be looking after. What is more, all these people get lousy pay. In fact, the level of pay that such people get is a disgrace.

We also need a massive improvement in the co-ordination of services between hospitals, GPs, health visitors, nurses and the people providing those practical cleaning services and so forth. This will cost more. Anyone who pretends that we will not have to pay some more to get a service that works to replace one that does not is either just misleading themselves or—in the worst version—misleading other people.

Previous Governments have not expanded the services in line with the need, but the recent response of this Government has been to contract the service available, which is indefensible. Proposals under the new regime—if that is the right term, Madam Deputy Speaker—have brought about fragmentation, competition and binding legal contracts between various providers of these services. If anybody thinks that will improve co-ordination, they are again either deceiving themselves or attempting to deceive the rest of us.

In this country and in this House, we have to wake up to the fact that if we want a first-class service, we are going to have to pay a first-class fare. That was something I wrote in a long and entirely personal memorandum to the Prime Minister, not long before I foolishly resigned as Health Secretary. I pointed out that a massive increase in investment was needed. I am quite proud of some of the things I did when I was Health Secretary. That might have been the most important thing I did, because about two years later, the Government put an extra £40 billion into the health service. To be fair to the Prime Minister, I received a note from him saying, “Your long personal note triggered what we did.” I felt pretty glad about that.

When we talk about these issues, we need to bear in mind that our NHS is easily the most cost-effective system in the developed world. The total we spend on health care is 9.4% of gross domestic product: the Germans spend 11.3%, the French 11.6% and the United States, which has an insurance system like the one the leader of UKIP wants to introduce here, spends 16.9% of their GDP on health, and life expectation there is lower than ours.

The other really startling point, when we get people such as the King’s Fund and others demanding reductions in the number of hospital beds, is that for every 1,000 people we have three hospital beds, while the French have more than six and the Germans eight and a half. So far as I know, there is no daft consensus in either of those countries to get down to the British level.