NHS Spending

Gareth Thomas Excerpts

Wednesday 6th July 2016 Commons Chamber

[Mr Hunt]

We are currently doing the analysis the hon. Gentleman is concerned about, but I should just say to him that I accept the Home Secretary’s assurance and confidence that we will not end up in a situation where EU nationals, upon whom we absolutely depend in the health and social care system, and who do an absolutely outstanding job, would not be allowed to remain in the UK. She has said she is very confident that we will be able to negotiate a deal whereby they are able to stay here as long as they wish and to continue to make the important contribution they do, and I accept that assurance.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

Further to the point made by the hon. Member for Angus (Mike Weir), will the Secretary of State give the House an assurance that he will release that analysis and that it will be sufficiently comprehensive to allow us to see a regional breakdown of the significance of EU nationals working in our health service?

[Mr Hunt]

I will take away the hon. Gentleman’s request, and I will, of course, try to be as transparent as possible with Parliament about all the analysis and research we do on these topics.

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[Mr Hunt]

First, may I welcome the hon. Lady to her place as a doctor and as someone who knows a great deal about NHS matters? Although I am sure we will not agree on every health matter, it is always valuable and a great asset to have someone with medical experience in the House, and I am sure she will make a huge contribution in that respect. She is absolutely right to say that what happens in the social care system has a direct impact on what happens in the NHS, and that we cannot—as, in fairness, happened under Governments of both colours over many years—look at the NHS and the social care system as completely independent systems when we know that inadequate provision in the social care system has a direct impact on emergency admissions in A&E departments. She is right to make that point.

Let me make a broader point in concluding my comments. I think that there would be agreement across this House on the huge pressure on the NHS frontline at the moment, and that there is recognition of some fantastic work being done by front-line doctors and nurses to cope with that pressure. I shall give a couple of examples of the extra work that is happening, compared with six years ago. The A&E target is to see, treat and discharge people within four hours. Every day, we are managing to achieve that, within the four-hour target, for 2,500 more people than six years ago. On cancer, we are not hitting all our targets, but every single day we are doing 16,000 more cancer tests, including 3,500 more MRI scans, and treating 130 additional people for cancer. There are some incredible things happening.

However, we all recognise, and this perhaps lies behind the Opposition’s concerns in bringing this motion to the House, that in healthcare we now deal with the twin challenges of an ageing population, in that we will have 1 million more over-70s within the next five years—a trend that is continuing to grow—and of the pressure of scientific discovery, which means we have new drugs and treatments coming down the track. They are exciting new possibilities but also things that cost money. I for one, as Health Secretary, believe that as soon as economic conditions allow, we will need to start looking at a significant increase in health funding. That is why it is incredibly important, as we go through the next few years negotiating our new relationship with Europe, that we work very hard to protect the economic base that we have in this country, the economic success that we have started to see, and the jobs that do not just employ a lot of people but create tax revenues for this country. It is incredibly important that we pilot the next few years with a great deal of care, because what happens on the economy will have a huge impact on the NHS.

[Mr Gareth Thomas]

rose—

[Mr Hunt]

I have almost concluded, but I will give way one last time.

[Mr Thomas]

I am grateful to the right hon. Gentleman for giving way, and, if he will forgive me for saying so, temporarily fond of him as a result, because he is allowing me to raise a particular constituency concern. Northwick Park hospital, which serves my constituents, currently has a deficit of almost £100 million and is having to axe 140 staff posts as a result of the lack of funding for my local clinical commissioning group, by comparison with other parts of London. Will he undertake to look specifically at the issues facing Northwick Park hospital and Harrow clinical commissioning group as his further analysis of the need for additional spending in the NHS is taken forward?

[Mr Hunt]

I am very happy to do so. I have visited that hospital, where the challenges very much reflect what the hon. Member for Tooting (Dr Allin-Khan) said about links to the social care system. It was clear to me that the staff in the A&E department are working incredibly hard getting people through it, but struggling to discharge people from the hospital, which is why they were not hitting their target.

I have just been handed a note by a ministerial colleague, Mr Speaker, which I hope you will indulge me and let me read out, because I have never been handed such a note before. It says: “Apparently everyone wants to go and watch Wales play, so Whips happy if you felt you wanted to shorten your remarks.” On that basis, I will conclude by thanking the shadow Health Secretary for bringing this motion to the House and for her comments in support of it.

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[Joan Ryan]

As we have heard, Brexit will present us with many problems, particularly with health care provision. Not only are we not getting large sums of money, but we will actually be worse off. We will face many challenges because of that decision, and if the promise of £350 million led people to vote in a particular way that will undermine the funding we receive, that is a desperate state of affairs.

People feel badly let down by the leave campaign’s empty pledges on the NHS over the past few months, and residents in Enfield are deeply disenchanted by the Government’s failure to fulfil their recent promises to our local health service. Before the 2010 general election, the then Leader of the Opposition—actually, he was then Prime Minister of the coalition Government—stood outside Chase Farm hospital in my constituency and vowed to protect its A&E and maternity units. By 2013, his Government had shut both departments. Many of us warned at the time that closing Chase Farm’s A&E department would put huge strain on other local health services, including North Middlesex University Hospital NHS Trust, which is the subject of the CQC report that I referred to earlier. We were right, and almost three years since the decision to close Chase Farm’s emergency department, the NHS in Enfield has reached breaking point.

Earlier today the Care Quality Commission published its report into the standard of care at North Middlesex hospital, following a spot check by its inspection team in early April. It found that the closure of Chase Farm’s A&E has led to significant increases in patient numbers attending the emergency department at North Mid. Despite being one of the busiest A&E departments in the country, North Mid’s urgent and emergency services have been graded as “inadequate”, and patient safety has been compromised. Patients who arrive at the emergency department are not seen quickly enough by clinical staff, and they are waiting too long to be seen by a doctor. Some blue-light patients are being brought in, and hard-pressed nurses are dealing with them because no doctor is free to treat them.

[Mr Gareth Thomas]

My right hon. Friend is making a strong case for her constituents and their hospital. Does she recognise that although the situation she describes at North Middlesex hospital is particularly bad, such things have also been witnessed in many other parts of London, not least in north-west London where the London North West Healthcare NHS Trust has shut an accident and emergency department at Central Middlesex hospital? As a result, there has been a big increase in pressure at Northwick Park hospital, which serves my constituents.

[Joan Ryan]

Absolutely. North Middlesex is just the first hospital to reach absolute crisis point, but I am well aware that other hospitals, particularly in outer London, are heading down a similar path and facing real difficulties. If we consider A&E waiting times, we see that hospitals are sliding into that difficult scenario.

Junior doctors and trainees have been left unsupervised in North Middlesex hospital’s A&E department at night, without competent senior support—in fact, no consultant has been available from 11 o’clock onwards. My hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) referred to such cases. In one instance, one commode was available for 100 patients in the whole of the emergency department. Staff raised concerns about the lack of vital medical equipment, including missing leads for cardiac machines so they could not get an instant read-out. Trolleys in the resuscitation area lacked vital equipment. There was an oppressive, overbearing culture at the hospital that meant staff did not feel confident in raising concerns, and they even stopped reporting incidents of staff shortages, as management had not responded to them in the past.

The CQC report reinforces the findings of Health Education England and the General Medical Council. At a high-risk summit in May, the GMC threatened to withdraw junior doctor post-graduate trainees if the numbers of A&E staff and middle-ranking doctors and consultants were not increased. That would effectively close the busiest emergency department in London. This is an unprecedented situation. The future of North Mid A&E has been put at risk. Even medical trainees at the hospital are not prepared to recommend the A&E for treatment to their friends and family. In interviews with Health Education England, they said that that was

“because they felt the department was unsafe.”

My constituents have had to suffer the consequences of shocking mismanagement and a lack of leadership at North Mid. The chief executive is now on leave and I understand she is stepping down. Although there is a lack of leadership, she cannot be held solely responsible for what has happened. The Prime Minister and the Health Secretary have told us repeatedly that the NHS is safe in their hands, yet huge pressures have been placed upon North Mid due to a lack of central Government funding. Patient care has suffered further as a direct result of the hospital not having enough equipment, consultants, doctors and nurses. It has had to spend large parts of its budget on locums and agency nurses.

What is the Government’s solution to ensuring that hospital departments, such as those at North Mid, do not remain dangerously understaffed? Is it to divert a large amount of funding to help to solve this situation and put patients first? No: they decide to go to war with junior doctors over their contracts and abolish NHS bursaries for student nurses, while we have hospitals going abroad to try to recruit staff. That is an insult to dedicated professionals who deserve our admiration, respect and support. The Government’s actions will discourage the future frontline staff we so desperately need.

The NHS is facing a huge financial challenge, so a commitment to spend an extra £350 million a week, or even £120 million a week, on the NHS in lieu of our EU membership was clearly a very attractive offer to our constituents. NHS England needs to plug a funding gap of £30 billion a year by 2021 and a few months ago it was revealed that nearly every hospital in the country was in deficit. We are obviously not going to get £350 million or £120 million a week and I think that that was always known by the leave campaigners. In fact, the Government are seeking to suck out £5 billion in savings through the sustainability and transformation programme. I know that savings and efficiencies, particularly in back-office services, can and must be found, but not at the expense of patient safety.

My hon. Friend the Member for Lewisham East (Heidi Alexander), the former shadow Health Secretary, warned that the scale of savings required could

“not be delivered without putting patient care at risk… These ‘efficiencies’ will mean cuts to staff, cuts to pay, rationing of treatments. And it will be patients who suffer.”

Her analysis is spot on. We have witnessed the disastrous effects of this course of action in Enfield. We need more investment in North Middlesex University hospital, and in the NHS in general, not less. I join my parliamentary colleagues on the Labour Benches in calling on the Government to increase spending on our NHS. It is most regrettable that, given the urgent need for more funding and the very real and justifiable concerns of people in Enfield, they should have been led to believe Brexit could possibly mean major new funding for the NHS.

In closing, I think I corrected myself wrongly. In the run-in to the 2010 general election, the current Prime Minister was, of course, the Leader of the Opposition, and he made a promise to keep our hospital open, which, when he became Prime Minister, he then closed. That kind of behaviour is very similar to what the leave campaigners did in promising money that does not really exist. It is hoodwinking the voter and it is not acceptable. It desperately undermines the voters’ faith in politics and democratic processes.

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[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

It is a pleasure to follow my hon. Friend the Member for Bristol South (Karin Smyth). I will be unashamedly parochial and pursue the point that I made in an intervention on the Secretary of State about the future finances of the Harrow clinical commissioning group and the London North West Healthcare NHS Trust. It includes Northwick Park hospital, which serves my constituents. I should declare an interest in that I have been operated on and indeed members of my family have been born at Northwick Park hospital, with which I therefore have a particular affinity, as do my constituents.

[Joan Ryan]

My hon. Friend is right to remain parochial and focused on his hospital. One of the scandals of North Middlesex is that all the local MPs have been kept in the dark about all the serious faults that were known to the hospital and to NHS officials. None of that was shared with the local MPs.

[Mr Thomas]

My right hon. Friend made a very powerful speech about North Middlesex hospital. I am pleased to say that I have a positive relationship with the managers at North West London Hospitals Trust as they have always made themselves open and available to answer my questions. I hope that they will read Hansard and see my right hon. Friend’s warning in relation to the difficulties that she has had with previous managers at North Middlesex hospital and will do even more to provide transparency in our area.

Let me talk now about my concerns about the finances at Northwick Park. Back in 2014-15, North West London Hospitals Trust had a deficit of some £55.9 million. That had risen to £100 million by the beginning of this financial year. The trust management board is optimistic that it can get that deficit down over the course of the next financial year to just over £88 million, which is an enormous sum in its own right and will, if that figure is achieved, still be without question one of the biggest deficits in the NHS in England. To achieve that target, it has committed to axe 140 posts. My concern, and the concern of many of my constituents, is that services at Northwick Park and indeed in other parts of the trust will be affected despite the intentions of the management.

The situation at Northwick Park has been compounded by the decision to close a number of accident and emergency departments in north-west London in recent years. In particular, the decision to close Central Middlesex hospital has undoubtedly had an impact, increasing the pressure on the services at Northwick Park hospital. Although it was great to see some new investment at Northwick Park—we now have an upgraded accident and emergency department—no extra beds were created in the hospital, which is a major concern.

I recognise that time is a concern, so let me underline my last point, which is about the funding of Harrow clinical commissioning group. In the past three years for which parliamentary figures were available, it has received the lowest funding of any London CCG. The Secretary of State was very generous in offering to go away and review that situation. I ask the Minister who is due to reply to this debate whether he would be willing to receive a deputation of local general practitioners and me to discuss the funding of Harrow CCG, which is one of the causes of the difficult financial situation at Northwick Park hospital that serves my constituents.

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[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

First, may I apologise to the House for not being here at the beginning of the debate? I did, however, see the contributions of the hon. Member for Hackney North and Stoke Newington (Ms Abbott), who set up a powerful case in support of the Opposition’s motion, and of the hon. Member for Central Ayrshire (Dr Whitford).

I would not dispute the motion’s central contention. We have just had an enormous public debate—as the hon. Member for Ellesmere Port and Neston (Justin Madders) made clear, a debate of a magnitude that this nation has not seen for decades. A central claim in that debate—a claim on which the referendum hinged—was that there would be an additional £350 million for the NHS to spend every week, were we to withdraw from the European Union. To be very clear about that claim, it is not one that any Member who supported Vote Leave can run away from. It was emblazoned not just on the bus, but in even more explicit language on a poster, which said:

“Let’s give our NHS the £350 million”—

not “some of” or “a part of”, but “the” £350 million—

“the EU takes every week”.

Members will know my position in this debate. It is not my purpose to revisit the arguments for one side or the other, but Members on both sides of the House, of this great debate and of the referendum campaign have a duty to hold to account the people who made those claims, because the referendum was won partly on the basis of them, and people will expect results.

I would like to put on record the nature of our contribution to the European Union every week, so we can be clear not about the claims, but about the facts. The simple fact is that it is wrong to take one year’s contribution as typical, because our contribution varies from year to year. Over the past four years, our gross contribution has in fact been £313 million a week. If we were to deduct the rebate, which is £69 million a week, and public and private sector receipts, which are a further £108 million a week, our net contribution per week is actually £136 million, worked out on a rolling average from 2010 to 2014. I would therefore suggest to those on both sides of the House, and on both sides of the campaign, that the figure needs to be challenged and challenged again.

Any money that might or might not be coming to the NHS needs to be seen within the framework of that claim. It is important for us at this stage not to move away from the claims made in the great referendum campaign. It is important that we bring the country together, but that does not mean that we should not bring some sort of scrutiny to those claims over the next few years, when the effects of Brexit will be played out and when our constituents will feel those effects in their pockets and in the security of their families, although some will say that that will be to the positive and others to the negative.

In the next few years, we will have to take consistent measures to bring scrutiny to the claims that were made. However, it is not just the money that is important in terms of Brexit. I, too, am concerned that we bring scrutiny to bear on the other issues facing healthcare, whether the regulation of medicines, research funding—universities have expressed real concern about that in just the past couple of days—or workforce supply. In that respect, I would like to reiterate the support that my right hon. Friend the Secretary of State for Health expressed for the migrant workers who have come to this country to serve our NHS. Many of them provide skills we cannot provide in our own country, and their dedication to our national health service is equal to that shown by those serving it who were born in this country, and I would like to personally thank them for their contribution and service.

On that issue, I think we can have some agreement across the House. Where, I am afraid, I part company from Opposition Members, however, is on their comments about the claim that was made by Vote Leave—as the hon. Member for Aberdeen North (Kirsty Blackman) made clear, it was also made by Labour Members of Parliament. That claim has not been made by Her Majesty’s Government; nor is it one that can be attached to the Department of Health.

In addition, it has been said that the money released by Brexit, even if it were to materialise, would be backfilling what the Opposition claim to be a deficit in NHS funding. That description could not be further from the truth, and I would advise Opposition Members to look at the OECD’s latest figures, which were released earlier this week. They clearly demonstrate that healthcare funding in this country is now just above the average for the EU15. It has moved up from being below average, and we are now achieving parity with countries such as Spain, which has a fantastic healthcare system that is much admired around the world, and indeed Finland. Given that position, we should surely praise this Government and the previous coalition Government, who protected healthcare funding, even when the Labour party suggested we do the opposite.

In 2010, the Prime Minister said healthcare funding would be protected, even though the Labour Chancellor of the Exchequer before the 2010 election suggested it should be cut. Under this Secretary of State and this Prime Minister, NHS spending has undergone its sixth biggest rise in the history of the NHS, despite the fact that we have been contending with the biggest financial crisis this country has faced in its peacetime history since the great depression in the 1930s. The financial environment of the NHS therefore bears positive scrutiny, compared with the situation in other leading countries in the European Union and with the history of Government funding for the NHS. Of that, the Conservative party is justly proud.

That does not mean, however, that there are no pressures within the NHS. I would like to pick up on some of the comments made by hon. Members, which I know they have made earnestly because they care very much for their local health systems. The hon. Member for Copeland (Mr Reed), who is a doughty campaigner for West Cumberland hospital and for healthcare provision in his area, knows that I will meet him again and again—I hope, soon, in Cumbria—to discuss the issues that he has in his locality. We are a receptive ear, but we must always pay attention to clinical advice as it pertains to his local area and not to the political exigencies that might exist. Rightly, we have removed political decision making from the disposition of services. That is precisely why the reconfigurations in the constituency of the right hon. Member for Enfield North (Joan Ryan) took place. It is always easy in government to try to make political decisions on matters that should be the preserve of clinicians, but that is the wrong thing to do, because one makes decisions for reasons of political expediency rather than clinical reasons. That is why we rely on the success regime in the hon. Gentleman’s constituency and in the whole of Cumbria, as we do in other parts of the country, to provide a clinical consensus and the arguments for change that local clinicians will wish to see.

The hon. Member for Bristol South (Karin Smyth) has an expertise unrivalled in this House in the management of finances at a local area level. She is right to say that Brexit poses particular problems for staffing of NHS and social care services, procurement and medicines. As a member of the Public Accounts Committee, she has provided very good criticism of how the NHS has been running its finances, which has not been good enough over the past five, 10 or 15 years—indeed, for many years. This Secretary of State and this team are doing a great deal to correct that. She is right, for instance, to point out that NHS Property Services has not worked as well as it should have done in the past. I hope that in the months and years ahead she will see reforms that give her greater pleasure than dealing with NHS Property Services gave her in her previous role.

The hon. Member for Harrow West (Mr Thomas) described the problems at his local hospital, as did the right hon. Member for Enfield North in relation to North Middlesex hospital, which I have discussed with her. Both hospitals suffer similar problems to other hospitals on the outside rim of London—discernible and discrete problems that we are endeavouring to correct and to provide solutions to. I hope that the right hon. Lady has seen, in the movement over the past few days, our determination to sort out the problems at North Middlesex. As the Minister responsible for hospitals, I do not want to leave this job without having given stability and certainty to the hospitals outside London that they have not had for many years.

[Mr Gareth Thomas]

I intervene merely to underline the request for a meeting with the Minister to discuss the finances of Northwick Park and, crucially, of the clinical commissioning group in my area.

[Ben Gummer]

Of course I will give the hon. Gentleman a meeting. If the issue is about general practitioners, I will refer him, if he does not mind, to my right hon. Friend the Minister for Community and Social Care. However, I will certainly meet him to discuss finances and hospitals. I will arrange both meetings on behalf of his constituents.

I thank hon. Members for this short but constructive debate. It is the first stage in the necessary scrutiny of the claims that were made by both sides in the EU referendum. We are now going to see, in the months and years ahead, who was right. I hope very much that I and the people on my side were wrong, because if so, it will be easier to deliver the spending commitments made by Vote Leave. I fear not, however, in which case we will have some very difficult years ahead. However, people can be sure that in this Government they have a Secretary of State, a ministerial team, a Prime Minister and a party that will continue to commit the funds that are necessary to the NHS, so that we improve on our position in the European averages. We will continue to fund it better than any previous Government to provide for the ambitious designs for this, our national health service, which we all care so much about.

Question put and agreed to.

Resolved,

That this House notes that the Vote Leave group during the EU referendum campaign claimed that an extra £350 million a week could be spent on the NHS in lieu of the UK’s EU membership contribution; further notes that senior figures who campaigned, including the hon. Member for South Northamptonshire, the hon. Member for Uxbridge and South Ruislip and the Rt hon. Member for Surrey Heath have subsequently distanced themselves from that claim; and calls on the Government to set out proposals for additional NHS funding, as suggested by the hon. Member for South Northamptonshire on 4 July 2016.