Department of Health and Social Care
Geoffrey Clifton-Brown Excerpts(1 month, 2 weeks ago)
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Sir Geoffrey Clifton-Brown (North Cotswolds) (Con)
Thank you, Madam Deputy Speaker, for granting us the opportunity to debate this supplementary estimate, which provides an opportunity for all Members of this House to look at the Public Accounts Committee’s report on health and discuss how the money might be spent on different priorities.
As the Chair of the Public Accounts Committee, I am honoured to introduce the first estimates debate on the supplementary estimate of the Department of Health and Social Care. I made this application jointly with the hon. Member for Oxford West and Abingdon (Layla Moran), the Chair of the Health and Social Care Committee, and my right hon. Friend the Member for Salisbury (John Glen).
As Members of this House will know, the Public Accounts Committee is one of the oldest Committees of this House. It exists to protect taxpayers’ money and ensure that their pound is being used effectively. It goes back, I think, to about 1867. Unlike other Committees, we do not take evidence from Ministers; instead, we take evidence directly from permanent secretaries and the most senior civil servants and public sector officials. The National Audit Office provides us with audited accounts and value for money reports, and we produce reports of our own with recommendations to Government to which they must formally respond as part of the Treasury minute.
At this point, I pay tribute to Amanda Pritchard, who has recently announced that she will be stepping down as chief executive of NHS England this summer. She oversaw the NHS at a time when it was under so much pressure post pandemic, and I wish her well in her future endeavours. I also congratulate Chris Wormald on his promotion to Cabinet Secretary. These vacancies at the head of NHS England and the Cabinet Office provide an opportunity for completely fresh thinking within the NHS.
Layla Moran (Oxford West and Abingdon) (LD)
I echo the hon. Gentleman’s thanks to Amanda Pritchard for her time at the head of NHS England. While I also welcome the appointment of Dr Penny Dash as its new chair, the hon. Gentleman is right to say this is a really important moment in the future of the national health service.
Sir Geoffrey Clifton-Brown
I thank the Chair of the Health and Social Care Committee for her endorsements of the worthy work that all these individuals have put into the health service.
The Department of Health and Social Care is one of the highest spending Departments in the UK, with a total departmental expenditure limit standing at a huge £210.1 billion. I am not sure anybody believes that the NHS is working at optimal productivity. NHS England is the largest quango with the highest budget in Whitehall; however, when allocating funds, it is also one of the few Departments that is making life and death decisions that affect the lives of literally millions of patients and their families. I think it does, therefore, deserve the highest level of scrutiny, which is part of what we are doing today.
Before even getting on to the figures, the NAO confirmed that the level of productivity in the NHS has dropped by around 23% since the pandemic. I simply say that unless that is sorted, any reform that the Government announce will be sucked into the black hole of the NHS without commensurate value for money or results.
Sir Geoffrey Clifton-Brown
I do not want to give way to too many people; otherwise, you will reprimand me for taking too long, Madam Deputy Speaker. However, I am, of course, happy to give way to the hon. Lady.
Leigh Ingham
On that point specifically, I was at my local hospital—County hospital, in Stafford—a couple of weeks ago, where I noticed that staff were still using paper to make notes on patients. One of the biggest barriers to the NHS being more efficient is the inability to have effective digital systems. Does the hon. Gentleman agree that the investment that has been announced in the move from analogue to digital in the NHS is long overdue?
Sir Geoffrey Clifton-Brown
I agree entirely with the hon. Lady. She has obviously been reading my speech— I will cover the announcement later in my speech, at which point she will hear exactly what it says.
As I say, the NAO has confirmed that productivity levels have dropped by 23%. I welcome the Government’s commitment to a 10-year plan for the NHS. We have also repeatedly warned that, with an ageing and increasingly sick population, the NHS will struggle to cope with the ever-increasing multiple complex demands of our population.
I wish to split this speech into three sections: how productivity could be improved in the NHS; funding; and, as the hon. Member for Stafford alluded to, technical advancements and a shift into community care.
The Department of Health and Social Care’s day-to-day spending—RDEL—is set to increase by £10.9 billion—from £187.9 billion to the main estimate as produced today of £198.5 billion. The capital spending is, however, set to decrease by around £1 billion, from £12.5 billion to £11.5 billion—a decrease of 8%. That is worrying as it shows that more and more funds are being redirected from long-term investment—for example, in the new hospitals to which the previous Government had committed themselves. I welcome the new Treasury guidelines that have stopped the practice of the past few years of redirecting up to £1 billion from capital spending to day-to-day spending. That should help to make more money available.
The NHS estate, as we all know from our constituencies, is in desperate need of investment, and our capital investment programme is running behind schedule. The problems with reinforced autoclaved aerated concrete have only added to the necessity of upgrading our hospitals, and I hope the Minister will listen to this plea.
The latest NAO report on the DHSC annual report and accounts shows that local systems, such as integrated care boards and NHS providers, reported a year-end overspend of £1.4 billion. This has nearly doubled from £621 million in 2022-23. This was despite an extra £4.5 billion of additional funding during 2023-24, which was to support pay deals for non-medical staff, mitigate any impacts from industrial action and provide money to address the costs of new pay arrangements for doctors and dentists.
What I do not think is acceptable is the glacial pace of agreeing priorities and approving final budgets for the local systems. In November, our Committee was shocked to hear that, in the past two years, those local systems—ICBs and others—had not had their financial plans approved by the Department until June and May respectively. That is up to three months after the start of the financial year. How can our poor local systems plan efficiently when these final allocations and guidance are so late? If the Department’s own accounts were finalised much sooner, our local systems would be able to have the money allocated in a more timely way, making wastage and inefficient spending less likely.
I welcome the Secretary of State’s prognosis that the NHS is far too big and complicated. There should be a shift towards allowing NHS trusts more control of their own budgets, as clarified in the 2025-26 priorities and operational planning guidance published in January. Moving more funds directly to NHS trusts, ICBs and local systems will improve accountability and give them a level of flexibility about how their funds should be better spent, rather than just focusing on targets and directives. For example, if they were to run a surplus because they had run their operation so well, they could reinvest the money in desperately needed capital projects rather than returning it to Whitehall. That must also go hand in hand with a need to improve productivity. Between 1996 and 2019, the NHS averaged a measly 0.6% a year increase in productivity.
Since the pandemic, productivity has now fallen by 23%. In March 2024, the Conservative Government announced that the NHS would receive £3.4 billion of capital investment for digital improvements between 2025-26 and 2027-28, which begins to address the point that the hon. Member for Stafford mentioned. As part of that investment, NHS England committed to achieving ambitious average productivity improvements of 2% per year through to 2029-30. However, those digital improvements, presaged by that additional £3.4 billion, have not yet been fully actioned.
Chris Vince (Harlow) (Lab/Co-op)
I thank the hon. Gentleman for his speech and, importantly, for his scrutiny of the NHS. He reflected on the fact that productivity has worsened since the pandemic. Does he not think that is to do with the mental health of staff? To support our NHS professionals to be as productive as possible, should we not be considering looking after their health, including their mental health?
Sir Geoffrey Clifton-Brown
The hon. Gentleman is exactly right. The NHS employs an enormous number of staff—more than 1 million people, I think—and their conditions of work are really important if we are to retain them. That does mean that their mental health needs close attention, especially when they have problems. If the NHS cannot help with mental health issues, who can? The hon. Gentleman has hit on a really important point.
One reason that productivity is not improving more is that there are 19% more staff in the NHS, but they are seeing only 14% more patients. At our hearing, NHS officials stated that this was due to more complex and acute health needs, meaning longer stays in hospital. I also understand that it was due to staff sickness, absences and the then ongoing workforce industrial action that affected most patients last year, making targets more difficult to meet. I do not know about other hon. Members, but I am still getting emails from constituents whose appointments and operations were cancelled at the last minute due to that industrial action and who are still waiting for their procedures to be rearranged.
Along with staff, technology plays a big role in improving efficiency and productivity. The 2025-26 priorities and operational planning guidance stated that the NHS organisation
“will need to reduce their cost base by at least 1% and achieve 4% improvement in productivity.”
I understand that these figures are hard to pin down due to the NHS still negotiating with bodies such as the ONS on the definition of productivity and how it can be measured. I say to the Minister that, even if the numbers are disputed, we have still not seen a plan for how these productivity gains can be achieved, and the Committee believes that NHS England has produced unrealistic estimates. We need to have a realistic estimate from the Department of what productivity gains can be achieved over the next few years.
Without significant productivity gains, the NHS will not substantially reform waiting times and achieve the best value for the large amount of money that we spend on it. On average, there is a 4% real terms increase in our spending each year, when the economy is growing by only 1%, which is unsustainable in the long term. If we go back to 2013, the Health Secretary had set the NHS a challenge of going paperless by 2018. Clearly, as we all know, that has not happened, because the NHS is still using fax machines. In a digital age of AI, that lack of modernisation produces a risk to both patients and employees in the NHS. Investing in better technology would help with the Government’s ambition to shift more care into the community.
Community healthcare can take many forms, from GP surgeries and community hospitals to pharmacies, dentists and social care. I fear that when we talk about the NHS budget, we predominantly focus on hospital care, rather than the care that most of our constituents need every day. Indeed, Lord Darzi’s report, which was commissioned by the Government last year, said that
“the NHS budget is not being spent where it should be—too great a share is being spent in hospitals, too little in the community, and productivity is too low”
This is where I would like to pay tribute to our GPs and all their staff across the country, especially in the North Cotswolds. Our GP surgeries are usually the first point of contact with our NHS, from antenatal services to blood tests and vaccinations. They also offer a number of services that could be termed preventive care.
As a Committee, we questioned NHS officials on their prioritisation of preventing ill health rather than treating it, thus avoiding much more expensive hospital interventions in the future and a much better patient experience. Their reply was that they had little additional headroom to grow preventive services, yet the public health grant used by local authorities to commission preventive measures, such as health visitors and drug and alcohol services, is expected to fall in value next year by £193 million, despite the Government’s commitment to maintaining it in real terms. I cannot stress enough how I believe that we should be paying much more attention to prevention rather than cure; it is just so important.
NHS England said that, rather than moving funds, there should be a focus on the role of GPs and how they can advise their patients. However, according to the Royal College of General Practitioners, although more than 90% of patients’ direct experience of the NHS is through primary care and GP practices, less than 10% of the total budget is currently spent on primary care. I say gently to the Minister that we are getting our priorities wrong there.
As a Committee, we have recommended that the Government clearly define what counts as health prevention spending within the next six months and track that spending annually. ICBs should be given more flexibility in how they spend their money, which might include redirecting services to more community settings that are closer to patients. It might also include redirecting funds to help manage discharges from hospital. According to the House of Commons Library, the latest data shows that last year an average of 12,340 patients a day remained in hospital despite being clinically fit to be discharged. Even though there is a slight decrease of 1.2% from last year, more can be done to ensure that patients who are well enough can leave hospital for the community and be closer to their families. That will require better working between social care and hospitals.
Andrew George (St Ives) (LD)
The hon. Member is making a powerful case for reform and review. This morning, the Health and Social Care Committee was looking at the very issue of delayed discharge of medically fit patients. Does he not accept that we need more integration? If only a quarter of those delayed discharges are down to a lack of social care packages, that means many patients cannot be discharged because they have a primary healthcare condition that needs to be taken care of, so we need integration and not just social care reform.
Sir Geoffrey Clifton-Brown
The hon. Member makes an extremely powerful point. I am coming to the conclusion of my speech, which is on precisely that point.
The social care system is not working in this country. It is a political football that keeps being passed from one Government to another. I understand that the Government have committed to another review of adult social care and that we should not expect results until at least 2028; for many of our elderly patients, that will be too late. The funding of social care is rising exponentially. There needs to be more focused and joined-up thinking from the DHSC, NHS England and local authorities on how they can support those who need help to be discharged from hospital in a timely manner and live in their own homes for a longer period than they might otherwise be able to do. It should not be a postcode lottery, as exists now.
With more joined-up thinking between different parts of the NHS, the patient experience could be better. However, without substantial increases in productivity, increased spending on preventive care and public health, and a better functioning social care system, our NHS will never be able to operate at the optimal level with world-leading standards.
Several hon. Members rose—
Mr Clive Betts (Sheffield South East) (Lab)
It is a pleasure to follow the Chair of the Public Accounts Committee, the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown). Although we sit on opposite sides in the Chamber, we now spend most of our time in this place on the same side of the table in the Committee. I congratulate him on his appointment and the work he is doing as Chair.
The clear remit from the Secretary of State is to move to prevention, community care and digital services; that is how it is laid down. When we had the officials from the Department and NHS England before the Committee, we said that we thought they were complacent about the NHS’s finances. I thought that there was no sense of purpose or long-term strategy to deliver on the Secretary of State’s objectives; that was the worrying thing.
Let us look at the immediate problems. We have a service where trusts and others can run up deficits and seemingly there is no consequence. Unlike local government, which has to balance the books or go to the Government for approval to capitalise losses, that does not happen in the NHS. We have the problem in South Yorkshire that Doncaster hospital runs at a loss every year—I am not blaming the hospital, because it has an old building that needs massive refurbishment, or probably complete rebuilding, and it has not had the resources—and those losses go into the wider ICB system and put pressure on other hospitals and trusts not to distribute any surplus they might make to community services in Sheffield but to fund others’ losses. That is no way to incentivise a proper financial arrangement.
The hon. Member was absolutely right on moving towards community services, which is about not just getting people out of hospital but stopping them going into hospital in the first place. That certainly could be done. GPs hold 90% of appointments and get 10% of the funding. That is clearly wrong; we have got to switch that.
On social care, about eight years ago the Health and Social Care Committee and the Housing, Communities and Local Government Committee produced a joint report to which 22 Members of Parliament signed up, but we are still here talking about the funding. Louise Casey is a great appointment as she has a great “get up and go” attitude, but I am sure she could be asked to get up and go a bit before 2028, because that is a long time to wait for any response.
We should be looking a lot more at moving services out of hospitals. There is a proposal around—and I say “around” because the NHS does not tend to act quickly—a diagnostic centre at Crystal Peaks in my constituency. The south-east of Sheffield is a long way from the two teaching hospitals, so to put services such as MRI scans, ultrasound scans, X-rays and CT scans there and to have GPs working with consultants who come to see patients in their clinics in the community would save money and provide a better patient service. But that seems to get locked up in discussions about NHS financing and commissioning, and who gets paid what to see who and when. We have got to unravel that and recognise that services can be made to improve significantly.
On digitalisation, the example of fax machines is of course legendary, but the other week I had to change a hospital appointment a couple of times—the service was really helpful in changing it—and I got not merely three emails and three texts but three letters with a first-class stamp on them, all for one appointment. That is a complete waste of money. I have talked to the hospital in Sheffield, which is bringing in new IT systems to cover the whole of the hospital operation, but that does not link into the GP systems. It is just nonsense that in this day and age we have that sort of unjoined-up thinking.
I will raise a couple of other issues. The consultant who has been treating me for the last seven years—successfully at this stage—for my myeloma has got an idea. People have so much chemotherapy to go through—probably at least six different sessions, twice a week—and for those sessions they have to go into the day ward. That is all right for some people—my timetable was helpfully rearranged to suit me coming down here and going back—but for many that is not possible, particularly if they have to go to a specialist unit that is many miles away. He has developed an idea for home chemotherapy, which works and is good.
Sir Geoffrey Clifton-Brown
I am sorry to intervene on my deputy, who does an excellent job on the Public Accounts Committee. In the last Parliament, before he joined the Committee, we went to Denmark, where they do precisely what he is talking about: give chemotherapy treatment to people in their homes where they have a history of not reacting to it.
Mr Betts
Absolutely. Obviously, it is done with a clinician’s approval and with the patient’s agreement. The idea has been around for two years now, but again it is lost in the labyrinth of NHS discussions, boards and committees. Come on—let us do it now. It is a good idea, which is actually cheaper and benefits the patient. Why cannot these ideas be got up and moving much more quickly?
I absolutely agree with the comments made by the Chair of the Public Accounts Committee on public health. It is like an afterthought. The grant for public health comes out at least two, three or four months after the main grants for the NHS and local Government—it is like the money down the back of the sofa that the Treasury finds at the last minute—and over the years it has been cut significantly in real terms. Public health in Sheffield does an absolutely great job, working with NHS Sheffield Place. It has done some really good work in deprived communities to increase and improve community care in the north of Sheffield. That is the sort of initiative we ought to pursue, and we should give the ICB the wherewithal to support and engage with that.
Finally, we ought to build equality of treatment into our aspirations. In Sheffield, from one end of the city to another, life expectancy changes by 10 years. That is simply not acceptable. However, for child vaccinations, GPs get paid by the number of vaccinations they do, so those GPs with the easy patients to reach—probably those in the wealthier areas—get a lot more money for doing vaccinations than those struggling to engage with deprived communities. That sort of initiative from the NHS is wrong and we need to correct it.
Sir Geoffrey Clifton-Brown
I shall be brief. I thank the Minister for her very comprehensive reply, and I congratulate her on her new role. I also congratulate everybody who spoke in this debate; there were some excellent speeches. Can I ask the Minister to thank her officials for appearing before my Committee? It is very much appreciated. I also thank the members of the PAC, a very hard-working Committee that produces two major reports a week, and in particular my deputy, the hon. Member for Sheffield South East (Mr Betts).
To sum up, as I said in my speech, productivity is the key to long-term reform of the NHS. Increasing funds at 4% per year in real terms when the economy is growing at only 1% in the long term is unsustainable, so something has to be reformed in the health service. As I did in my speech, I ask the Minister to consider producing a productivity plan, so that, without all the arguments with the Office for National Statistics and everybody else, we can see the DHSC’s best estimate for productivity gains over the next five to 10 years, and can start to see how such goals will be met. In such a productivity plan, modern digital technology will be really important. The Minister skated over one word that I am really concerned about, which is “cyber”. We had a wake-up call with WannaCry two or three years ago. The NHS has some very important personal data, so it is vital that we move towards modern machines that can withstand cyber-attacks better than some of the analogue equipment in the NHS.
It has been a great debate, and I am sure that the Minister will have plenty to think about.
Question deferred (Standing Order No. 54).
Future of the NHS
Geoffrey Clifton-Brown Excerpts(2 years, 2 months ago)
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Matt Hancock
I am very grateful to the right hon. Member for that intervention. I am not surprised that he agrees with what I said about the moral case for a universal healthcare system, nor that he makes the case against any use of profit in the NHS. I was going to come on to exactly that point, because it is bunkum to suggest that the NHS has ever in its history provided services without the use of private companies. That has happened throughout the long and proud history of the NHS, and it is absolutely vital to its functioning—always has been, always will be, under Governments of all stripes. I will come on to explain why.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
My right hon. Friend is being generous with his time. Is there not a fourth argument for a universal healthcare system, which my right hon. Friend was very keen on when he was Secretary of State: the ability to introduce new technologies, new procedures and new drugs? All of those things are much easier when one has a big bulk of patients to draw data from.
Matt Hancock
Two of my arguments for what the NHS needs to do better in the future are responses to precisely the two points that have just been made. I cannot decide which order to go in, but both are absolutely vital. I agree with my hon. Friend, and disagree with the right hon. Member for Islington North (Jeremy Corbyn).
Given the pressures on the NHS, in order for it to succeed in the future, all of us who care about the NHS must have a hard-headed view of what needs to happen for it to function long into the future. One of those things, which I think is absolutely central, is the use of technology, so I will come to that point first. Today, the NHS has more clinicians in it than ever before. Contrary to what the hon. Member for Jarrow said, it has a higher budget than ever before. It has more nurses and more doctors than ever before, it is delivering more service than ever before, and it takes up a higher proportion of our national income than ever before. That has all happened under a Conservative Government that believes in the NHS. Those are the facts.
Matt Hancock
I wish that I had been able to drive forward the use of technology even more than I did. I pushed it as hard as I could, but if I could have gone further, I would. It is about not just efficiency for the health service, but a better service for patients and the research agenda. Another advantage of a universal service is that, because almost everybody in the country is within the NHS system, we can do amazing research to find out what treatments work better. If we can get high-quality data into the hands of researchers, they can discover new drugs or new procedures to save lives.
Yesterday, for instance, I signed up and had my bloods taken for Our Future Health, which is a wonderful programme run by Sir John Bell that aims to sign up 5 million people—ill and healthy—to give, with consent, their health data and blood to a large-scale research programme to find out what keeps people healthy. That is for 5 million people, but we can use the NHS effectively —with proper consent and privacy—to save future lives, which is yet another benefit of a universal healthcare system.
My second point—I will make three—on what the NHS needs to do more of in the future is about efficiency. The Prime Minister was right in the summer to float the idea that if someone misses too many appointments without good reason, they should be charged for them. One of the problems for efficiency is that many appointments are missed, which wastes clinicians’ time. It was right to consider that idea, but I would be totally against people having to pay for the first appointment.
Sir Geoffrey Clifton-Brown
I am grateful to my right hon. Friend for giving way again. I had to have a procedure the other day that I imagine cost the NHS quite a lot of money. When I was talking to the consultant, she told me that some days, she had a 50% no-show rate, which must cost the NHS several thousand pounds.
Matt Hancock
I hear such stories all the time. We should separate out free at the point of use from not abusing the service. Of course, people miss appointments for good reasons, but too often they do not have a reason. We should be thoughtful about how we address that.
On the point of the right hon. Member for Islington North about the use of the private sector, the NHS has bought things from the private sector throughout its entire life. Who built those fax machines? It was not the NHS. The NHS buys stuff—everything from basic equipment to external services. GP contracts are not employment contracts but contracts with a private organisation. Most of those private organisations are not for profit; nevertheless, they are private organisations and always have been.
The previous Labour Government expanded the use of the private sector, of course, to deliver a free-at-the-point-of-use service. Patients, in large part, do not care whether they get their service from the local Nuffield or the local NHS—it does not matter. What matters is that they get a high-quality service at the right time and as quickly as possible.
I was delighted that the shadow Secretary of State for Health and Social Care, the hon. Member for Ilford North (Wes Streeting), recently set out that Labour’s policy would return from what I regard as a totally impossible, mad, hard-left agenda of saying that we should not have the private sector in the NHS—even though it has always been there and always will be—to the position that Labour held when it was last in office and used the private sector for the delivery of services where that was in the best interest of taxpayers’ money and patient outcomes. That has been done over and over again, and that contracting is important.
To be in favour of the NHS being free at the point of use, and to be against NHS privatisation, does not rule out the NHS delivering services as effectively as possible whether through employing people or using contracts. The nature of the delivery is secondary to the importance of it being free for us all to use, for the reasons that I have set out.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
I am delighted to catch your eye in this important debate, Madam Deputy Speaker. I commend the hon. Member for Jarrow (Kate Osborne) on having obtained it, and the hon. Member for Blaydon (Liz Twist) on the sincere way in which she made her points. I share one point of absolute agreement with her, which I will make in my speech: the health service cannot function without enough properly trained staff.
I listened to the speech from the former Secretary of State for Health, my right hon. Friend the Member for West Suffolk (Matt Hancock), with great care. I absolutely agree—I doubt a single Member of the House disagrees—that we all want forevermore a universal health service free at the point of delivery. I commend his arguments and agree why that should be.
The health service was dealt a terrible blow during covid and we need to catch up from that. Two-year waiting lists are falling, but we need to improve on 18-month waiting lists. According to data from September 2022, the overall number of people working full-time in the NHS increased by 2.7%, or 36,000 people, compared with the previous year—a point made by my right hon. Friend the Member for West Suffolk. However, there are 130,000 job vacancies, and we need to try to fill those. The latest data published by NHS Digital up to September shows that there are almost 4,000 more doctors and 9,300 more nurses working in the NHS compared with September 2021. But compared with 2015, we have 1,622 fewer fully qualified GPs today. We are seeing the consequences play out in the health service.
Working in healthcare can be very rewarding. However, for many working with staff shortages, it can be incredibly tiring and stressful. The care that they want to provide to all patients is not always possible, and talented individuals are pushed to leave for new opportunities. As well as pay, employment conditions are critical. That is particularly true in the social care sector. In my constituency, double the number of people are in hospital today, clinically fit to be discharged but not able to leave hospital because there are not enough social care workers. We need to look critically at how to bolster that social care system.
The recovery of the NHS is very important to many of my constituents in the Cotswolds, who regularly contact me with concerns about accessing the treatment they require in a timely manner. As I have said, waiting lists in January fell for the first time since the start of the pandemic. Elective care was delivered for 70,000 more patients in November compared with the same month before the pandemic, as the waiting list dropped by almost 30,000 compared with the previous month. However, there were around 7.2 million incomplete treatment pathways as of December 2022, with 406,000 people waiting more than a year for a consultant-led referral to treatment.
There is much work to be done to be caught up from the pandemic. We all know that there are problems in the NHS, but I do not think we have had anything like the pandemic since the second world war. Actually, the health service is to be hugely commended on what it did during the pandemic: the speed with which it was able to administer vaccines, the tremendous care that saved the lives of my constituents and those of every other Member of Parliament. That was to be wholly applauded.
The key to combating waiting times and revitalising the NHS is to recruit more staff, especially filling those frontline positions, and increasing retention. That will enable us to get greater flow through our healthcare system and reduce the waiting time for all treatments, including the critical cancer pathway. We urgently need to invest to train more doctors and nurses, instead of relying on recruiting talented people from poorer countries. It is no good Opposition Members crowing about the training that was provided when they were in office. I seem to remember when Tony Blair was Prime Minister that he shut some of the nurse training centres.
I think it might be of interest to the House that two weeks ago I went on a Public Accounts Committee visit to Denmark, to inform the Committee on the hospital construction programme that we are about to embark on in the UK and ongoing work on the Department of Health and Social Care. Some of the things that we discovered on that visit could be introduced into the health service, and some chime with what my right hon. Friend the Member for West Suffolk said.
Denmark faced many of the same issues as we do now: an ageing population, an ageing workforce within the healthcare system, increased chronic disease, workforce shortages and new needs for educating staff in the latest technology and ways of working. However, it has completely reformed its approach to healthcare in the past 15 years and created a model from which I believe we can learn a great deal. It has closed dozens of old hospitals and is in the process of building 16 brand-new hospitals. Most are completed and the remainder are scheduled to be finished within the next five years. Critically, it has reduced the number of beds by 20%, instead opting for a policy of far greater out-patient treatment and treatment at home. Even quite complicated procedures, such as chemotherapy, are delivered in the home. GPs are absolutely the key to this system, and are described as the gatekeepers for the rest of their entire healthcare system. It was made clear that the policy decision, made in 2007, was not an easy one. They have faced significant cultural resistance from some residents who are now required to drive for up to an hour for care.
The overall vision was for patients to spend as little time in hospital as possible. Today in Denmark people spend an average of 3.5 days in hospital compared to six in the UK. The aim is to discharge people either to their home, or to the municipality nursing or residential homes, as quickly as possible. The system makes great use of telemedicine wherever possible. The increase in care was possible as the number of GPs within the healthcare system was increased by 50%.
Another important change in Denmark, which chimes with what my right hon. Friend the Member for West Suffolk said, was the health digital revolution. Ninety seven per cent of the population now have good broadband connections, and all citizens have a unique reference that covers a number of Government services, including tax and health. The whole healthcare system has been transformed into a digital and paperless system. Access to medical records is strictly controlled, but is available to the relevant physician treating the patient, with their consent. Those physicians update the records in real time. As my right hon. Friend said, appointments are made online through an app, eliminating a vast number of letters and phone calls.
Relevant to our building system for the 40 new hospitals is that the Danes have now produced a standardised hospital design. That was not easy, as different specialties have different requirements. For example, most Danish hospitals have introduced four different-sized but standardised theatres. There are no hospital wards; instead, all rooms are single, with their own bathroom and a bed for a relative to stay overnight or longer. That standardised design will enable hospitals to be built cheaper and more quickly, and it will eliminate the elementary problems that sometimes arise even when our hospitals are newly built.
As I have said, in the UK there is a pledge to build 40 new hospitals at an estimated cost of £1 billion each. While we have many similarities with the Danes—we are fortunate that we both enjoy a universal, equal and free healthcare system—the success of the Danish system comes from its ability to treat many patients outside of hospitals. In the UK, hospitals are often viewed as an inevitability for many people requiring treatment; in Denmark, they are the last resort. I believe there are some real lessons we could learn from the Danes. We need to do so, because it is clear that we cannot continue as we are.
Our health system is limping on, and the cost to the taxpayer is increasing. According to recent figures, £277 billion was spent on healthcare in 2021. That is 11.9% of our total GDP. Some people complain that this is out of kilter with other countries in the world. Certainly, health spending in the United States is 17.8% of GDP, but that is accomplished through both insurance and public finance. Our figure is comparable to the 12.8% of GDP spent in Germany, and the 10.8% spent in Denmark. Both the United Kingdom and Denmark do not have enough doctors, nurses, and, in particular, social care workers. For a health service to run efficiently, it must have sufficient staff who are well motivated and trained.
Liz Kendall
May I gently say to the hon. Gentleman that I know what is best for his constituents and the people of Wales, which is a Labour Government in Westminster as well as a Labour Government in Wales delivering the changes that we are seeing? If he looks at Labour’s record when we were in government in Westminster, he will see the improvements that were made. May I also gently suggest that he focus on the lack of a workforce plan and the lack of a proper social care plan from his own Government, rather than trying to make these petty points?
Our plan will reform health and care services to speed up treatment by harnessing life sciences and technology to reduce preventable illness, and by cutting health inequalities. As a first step, we will carry out the biggest expansion of the workforce in the history of the NHS, doubling the number of medical school places, creating 10,000 more nursing and midwifery training places, recruiting 5,000 more health visitors, and doubling the number of district nurses. We will pay for this by scrapping the non-dom tax status, because we believe that people who come to live in the UK should pay their fair share of tax here. We read today in The Times that the NHS itself backs Labour’s plan, so why do the Government not back it?
Sir Geoffrey Clifton-Brown
I listened very carefully to what the leader of the hon. Lady’s party said on the “Today” programme this morning. He said that any proposals he would include in his manifesto for the next general election would be properly costed. Has the hon. Lady properly costed the proposals that she has just outlined, and if so, how much will they cost?
Liz Kendall
Yes, we have properly costed these proposals, because we—unlike the hon. Gentleman’s party, which announced huge amounts of borrowing without saying anything about where the money would come from under the former Prime Minister’s plans—will only set out our commitments when we can say where we will get the money from. We will get it by cancelling that non-dom tax status, and I urge the hon. Gentleman to encourage the Chancellor to follow that example in his Budget. I hope that when the Minister responds he will put the House and, more importantly, the public out of our misery. and just adopt Labour’s plan. If he does, he will surely have the backing of the Chancellor, who said only a few months ago that he very much hoped that the Government would adopt our proposals,
“on the basis that smart governments always nick the best ideas of their opponents.”
The truth is that Labour is proposing the solutions to the problems that the country faces because the Conservatives cannot be trusted to fix the mess that they have caused. Instead of introducing the long-term reforms that the country needs, they are constantly lurching from crisis to crisis—always reacting, always behind the curve. Every year there is a winter crisis, with more elderly people ending up stuck in hospital because they cannot get the social care and other local services that they need in the community or at home. Every year, people struggle to get the proper mental health support they need, so they end up reaching crisis point, which is worse for them and more expensive for the taxpayer. Every year, people are left hanging on the phone for hours and hours trying to get a GP appointment until there is no choice but for them to end up in A&E. Every year, there is a sticking plaster and never a cure. In contrast, Labour is calling for a 10-year plan of investment and reform to deal with the root causes of the challenges that we face and to build a care system fit for the future.
We will fix the front door to the NHS in primary care, recruiting more doctors to deliver better access to GPs, ensuring that patients can see the doctor they want in the manner they want—whether that is face to face, over the phone or online. We will fix the exit door out of the NHS and into social care, including by delivering a new deal for care workers so that they get the pay, the training and the terms and conditions that they deserve, which will mean that we can deal with the problem of delayed discharges.
We will recruit 8,500 mental health workers to provide faster treatment and also the support in schools that young people need, which will stop them from getting to crisis point, too. We will enshrine the principle of home first. Ultimately, what we need is a fundamental shift in the focus of care out of hospitals, into the community and more towards prevention. The big challenge that we face is an ageing population, with more people living with one, two, three, four or more long-term conditions. We must get that shift towards prevention. We must enable and support people to take more control over their health and care. We must have one team, with one point of contact, because people do not see their needs in the health or care silos. That is what Labour will deliver. When I first became an MP, I remember seeing in my own constituency people with the telemedicine that they needed to manage long-term conditions, such as chronic obstructive pulmonary disease. I remember visiting Totnes where there was a single, joined-up health and care team. I remember the sexual health and other support services from public health teams that Labour put in place, all of which, in my constituency, have disappeared.
I know from my time working for the last Labour Government that we cannot solve all the problems that the Tories have created overnight, but I also know—and Labour’s record in Government proves this—that with vision, determination and a clear plan, which is drawn up with the staff who provide the services and, crucially, with the users and their families, the NHS and our care system can be transformed. We have done it before. We stand ready to do it again, and Members on the Labour Benches will work day and night to deliver it.
Contact in Care Settings
Geoffrey Clifton-Brown Excerpts(2 years, 5 months ago)
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Liz Saville Roberts (Dwyfor Meirionnydd) (PC)
Diolch yn fawr iawn, Lefarydd.
My mother Nancy had a stroke sometime between Christmas eve and Christmas day at the close of 2020. There was no warning, no time to prepare for this catastrophic event. Overnight she lost her autonomy, her independence and her agency in her own life. She went into the local district hospital and was transferred from there at the beginning of January 2021 to a community hospital specialising in stroke rehabilitation. She remained there until the end of that February. She came back to live with us for a couple of months, with twice daily home carers, while I, her only child, was still able to vote here and speak in debates without having to be physically present in the House of Commons. She had to move into residential care because the period when I could balance caring and parliamentary duties came to an end.
Last November she had a fall and knocked her head. The anti-stroke medication resulted in bleeding on her brain. She was discharged from hospital back to the residential home at very short notice. Just before Christmas she fell again and broke her hip. She died in hospital four weeks later. These are the bald facts of the event. It was my mother’s misfortune to be old and in need of clinical services during the first covid winter. It was the misfortune of all of us as a family that my mother fell ill at a time when covid infection control demanded the absolute isolation of stroke patients. Many of the key workers with whom we interacted over those 13 months were extraordinary.
During the last month of my mother’s life, dementia specialist nurse Delyth Fon Thomas put me in contact with John’s Campaign. She explained to me that, in the last month of my mother’s life, family contact was a right rather than an optional favour. She was the first person in authority to mention that, and she put me in contact with Julia of John’s Campaign, who is, I am glad to say, with other campaigners here in the Public Gallery.
Look up the long list of hospitals and other organisations that have signed up to John’s Campaign. They recognise that a key family member is more than a visitor—they are a carer as much as anyone on the payroll. But, I say to Members, try to get that information volunteered to you, try to find out what your rights are, because they are not given to you on a plate. People such as Delyth confounded the cliché of monolithic public sector organisations, which may well prioritise institutional interests and risk aversion to the detriment of those services that we trust them with providing. I think that, as private individuals, many people will have had that experience.
None the less, despite Delyth’s help, I only touched my mother’s hand once during the critical six weeks after her first stroke. Yes, we could arrange to speak to her through a glass window as she sat in a hospital stairwell and we stood outside in the car park, peering in. She could not hear us—incidentally, her hearing aid had been kept in a cabinet all the while and the batteries had run out. Yes, we could phone and arrange to speak over an iPad, but she could not hear us; she could not understand us. There were no hugs.
Health authority infection policy vetoed family bonds of love as a health hazard to be minimised. Of course, at the onset of covid, we had to adapt and learn quickly about how to cope with an unfamiliar, life-threatening and highly infectious virus. We put in place measures such as lockdowns and visiting restrictions at hospitals and care homes, because that was the best that we could do; that is all we knew back in 2020. We had to learn as we went along, but have we truly learned the most important lesson of all? Treating the elderly and people with dementia as units of flesh and bone by meeting the barest minimum of their physical needs is wrong. We are social animals: take away our social support and we fail to thrive. Denying family contact causes immediate welfare harm to patients and longer-term harm to family members.
That is the context in which we must apply the abstract terminology of legislation: the Equality Act 2010 recognises the basic principle that the needs of disabled people should be assessed and reasonable adjustments made to meet those needs. People with dementia and cognitive impairments are disabled. Then there is the matter of human rights, which have been touched on. Article 2 of the European convention on human rights places an obligation on the state to secure the right to life. Article 8 protects the right to private and family life, but how these are balanced in care settings is critical, and how we shift that balance as we move along is also critical. It is also surprising that the Human Rights Act 1998 applies only to publicly funded residents in care homes.
This evidently unjust inconsistency is why the Government must step in. Why should the owners of private care homes, especially in England where local authority care is far less available than in Wales, be able to make such immense decisions, and possibly prioritise convenience over residents’ and families’ rights? Indeed, if we start from the point of view of people in need of care, the care setting itself should not depend on whether it is in the public or the private sector. If the individual has a right, that right goes with them throughout their lives—whether they be in hospital, at home or in residential or nursing care. A right is not a right if its only guard dog is guidance.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
On a point of order, Mr Deputy Speaker. I made a speech in the previous debate on the national food strategy and food security and I inadvertently forgot to declare my interest in the Register of Members’ Financial Interests as a farmer and a Fellow of the Royal Institution of Chartered Surveyors, for which I wish to apologise to this House and to put the record straight.
Mr Deputy Speaker (Mr Nigel Evans)
I thank the hon. Member for his point of order and for making it at the earliest possible opportunity. That is now on the record.
Dignity in Dying
Geoffrey Clifton-Brown Excerpts(3 years, 4 months ago)
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Mr Mitchell
My hon. Friend is right, but I used to be a junior social security Minister, and I know that social security law means that the Government—society—already have a way of determining a period six months before the end of someone’s life. We can of course reflect on this, and on whether there is a better way of doing it, but that facility in fact already exists.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
How would my right hon. Friend’s Bill prevent relatives or others from putting pressure on the person to ask for this procedure to be put in place?
Mr Mitchell
My hon. Friend makes a very good point, and I will come directly to that.
My aim in this debate is not to persuade all colleagues of the rightness of this cause but to make two clear points: first, that this is a debate about the real-life consequences of our blanket ban on assisted dying; and secondly, that there are real examples from overseas of how it can be done better.
In the past several days, we have seen the rules on international travel tighten once again; in the space of a week, the Swiss Government closed their borders to travellers from the UK unless they undertook a quarantine of 10 days, before changing the rules back a few days later. The dismay that that has caused people seeking an assisted death in Switzerland is overwhelming, with their having to spend their final days confined to a hotel room, scrambling to update plans when time and energy are in such short supply, and unable to have all—or perhaps any—of their loved ones there to accompany them. The already cruel situation where British citizens can have the death they want only if they travel to another country becomes yet more unacceptable when even that most exceptional option can be withdrawn with such short notice. That is not to blame Switzerland; it is the fault of our own failure as a country to provide that option at home, preferring to outsource our compassion to another country.
Last year, I raised the question of travel during the pandemic with the Secretary of State for Health and Social Care. He confirmed that the ban on travelling overseas did not apply to those travelling for an assisted death in another country. That announcement was a welcome relief to many, although it once again highlights our heavy reliance on other jurisdictions to provide our own citizens with the deaths that they want.
Covid-19 Vaccinations: 12 to 15-year-olds
Geoffrey Clifton-Brown Excerpts(3 years, 7 months ago)
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Nadhim Zahawi
I think it worth reminding the House that ventilation guidance has been there from the very beginning for schools and school leavers to implement, but the roll-out is happening as we speak. Our colleagues in the Department for Education are working right now to get those pieces of equipment into schools as quickly as possible.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
I have great respect for my hon. Friend as the vaccines Minister, but I find what he has announced this evening deeply troubling. I think it will pit parents against parents and parents against teachers, with a poor child stuck in the middle wondering what to do. There will be very little benefit to the child, and there is a lack of long-term data on the potential harm. However, what concerns me above all is that the Gillick doctrine of treating children without parental consent will become the norm for a range of medical procedures.
Nadhim Zahawi
Let me, again, slightly push back on that. It is not teachers who are being asked to do this; it is our clinicians, who are well trained and incredibly capable because they do the same thing year in, year out for the purpose of school-age vaccination programmes. They will be offering the vaccines, and ensuring that parents have enough time to read the information and then give their consent before a vaccination takes place.
This is very much not about a situation involving division. I think—I hope—my hon. Friend agrees that throughout the vaccine deployment programme that we began in earnest back on 8 December last year with Pfizer-BioNTech and continued on 4 January with the AstraZeneca vaccine, we have endeavoured never to stigmatise anyone and to provide as much information and transparency as possible, which has led to the highest level of vaccine positivity in the world. I believe that according to the Office for National Statistics data on vaccine positivity in the UK, more than 90% of adults have said that they are very likely to take the vaccine, or have already taken it.
Covid-19 Update
Geoffrey Clifton-Brown Excerpts(3 years, 10 months ago)
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Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
Mr Speaker, this is an unexpected surprise, and I am sure it is for the Secretary of State as well. I am sure that he will be interested in my question. Ultimately, these decisions are a matter of judgment. Can he publish that data on the risk to the health service and the risk to individuals of death, as opposed to those on the social harm and the harm to businesses? Can he therefore tell us why this judgment has been made?
Matt Hancock
The best thing that I can point my hon. Friend to is the slides that were presented by the chief medical officer today. I will see whether there is anything further that we can publish, but as a general rule, we publish all the data on which these judgments are made. Central to the judgment today is the fact that we are seeing a rise in hospitalisations, especially over the past week, and especially among those who are unvaccinated or have just had a single jab. Those people are not largely those who are unvaccinated out of choice; it is those who are unvaccinated because they have not yet had the opportunity because they are younger.
Until about a week ago, hospitalisations were basically flat. We thought that the link might have been completely broken between cases and hospitalisations or that it might be a lag. Sadly, hospitalisations then started to rise. For deaths, we have not yet seen that rise, which I am very pleased about; hopefully they will never rise, in which case the future will be much easier. It may still be that there is an element of it that is a lag, and we will be looking out for that very carefully over the couple of weeks ahead, but nevertheless our goal is to get those vaccines done in the five weeks between now and 19 July in order to make sure that this country is safe. I will commit to publishing anything further that we can that underpinned the decision, but I can honestly say to my hon. Friend that most of it is already in the public domain.
Covid-19 Vaccine Update
Geoffrey Clifton-Brown Excerpts(4 years, 2 months ago)
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Nadhim Zahawi
I am grateful and incredibly encouraged by the hon. Gentleman’s brilliant initiative, taken with many colleagues across the House, to deliver that brilliant video of south Asian MPs from different political backgrounds and traditions all recommending that, when people’s turn comes, they should take the vaccine.
We have been working across Government. In the Cabinet Office, the covid disinformation unit was set up in March. It works online with the digital platforms to ensure that we identify disinformation and misinformation to them. They should be taking that down immediately. My message to all of them, whether Twitter, Facebook or any of them is this: “You must, must be responsible and play your part in taking this disinformation down as soon as we flag it up to you.”
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con) [V]
I am sure my hon. Friend would like to join me in paying huge tribute to the NHS colleagues and volunteers who have rolled out the vaccine with such speed in Gloucestershire. However, is he able to tell the House whether there will be any clarity about when the nine priority categories are likely to be completed? Will that inform the Government on how they can produce a road map for a roll-out of the wider economy, as my businesses in the Cotswolds are desperate for clarity on that matter?
Nadhim Zahawi
I am grateful to my hon. Friend for his question. I will certainly join him in thanking the NHS family and army of volunteers. They have done phenomenally well. I can tell him that in his STP in Gloucestershire, 94% of the over-80s have received their first dose—that is pretty good going. He will know that we have built a deployment infrastructure than can deploy as much vaccine supply as we are able to bring in. A couple of Saturdays ago, we reached a record of just shy of 600,000 doses in a single day. That is, I guess, a demonstration of the capability of the infrastructure. We continue to grow it, as I announced today. It is very much dependent on vaccine supply. We have good visibility from here to the end of March, with more volume coming through beyond that. My focus should—I hope he agrees—be on the mid-February deadline to vaccinate those top four cohorts of the most vulnerable. That is 88% of mortality and, if we can get them done by mid-February, we will have achieved a real milestone in our fight against this virus.
Covid-19
Geoffrey Clifton-Brown Excerpts(4 years, 3 months ago)
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Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
There was a time when I did not think that I was going to get on, but I am back, so thank you, Mr Deputy Speaker.
The first vaccine dose has now been supplied to more than 2.2 million people. That is larger than the whole of the rest of Europe put together—a brilliant start to this huge programme to vaccinate a significant proportion of the United Kingdom’s people. I thank our healthcare workers in Gloucestershire, who have been working very hard since Christmas to meet the four priority groups by mid-February. I understand that most care home residents and workers will be vaccinated by the end of this week—a fantastic achievement.
We must make a comprehensive plan this year for our schools. I received a number of detailed questions from my constituents on the curriculum to be adopted. For example, is Ofqual considering the idea of grades being announced earlier this year to provide certainty and time if needed to appeal the grades? Will some form of mini-exam or coursework on the content learned be expected to help in grading accurately? What will be the plan for students who do not take normal exams, for example, those on apprenticeships, or the new T-levels being trialled at Cirencester College? We now have enough information to make those decisions. We should make them and adhere to them. Clarity must be provided for schools, parents and pupils, with all Government communications and websites being clear and not contradictory.
The vaccine programme has the makings of being a great British success, as we build on a strong medical manufacturing base in future. We are now world leaders in the new ribonucleic acid technology, which should enable vaccines to be made for not just covid but a wide range of viruses. From yesterday’s Public Accounts Committee session on the vaccine programme, the immense skill and knowledge of Kate Bingham and her taskforce were well and truly apparent. When they started their work in May they were not sure whether they would be able to develop a vaccine, let alone where it would come from. Yet the vaccine trial has now been successfully launched, with 267 million doses contracted from five companies at a cost of £2.9 billion. It is an amazing achievement.
The strong message of recovery now needs to come from the Government, encouraging everyone to take up the vaccination so that we can enable individuals, schools, hospitals and, above all, businesses to have a well-overdue return to normal life.
Covid-19 Update
Geoffrey Clifton-Brown ExcerptsMonday 19th October 2020
(4 years, 6 months ago)
Commons ChamberRead Full debate Immigration and Social Security Co-ordination (EU Withdrawal) Act 2020 View all Immigration and Social Security Co-ordination (EU Withdrawal) Act 2020 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Commons Consideration of Lords Amendments as at 19 October 2020 - (19 Oct 2020)
Matt Hancock
I am really proud to have been part of the Government who introduced the national living wage to increase the level of support for the lowest paid across the whole United Kingdom. That is one example of the UK Government working to improve the support and pay available for the lowest-paid people in Scotland and across the whole of the rest of the United Kingdom, alongside the unprecedented economic support that my right hon. Friend the Chancellor has put in during this crisis.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
I wholly applaud my right hon. Friend’s approach of localised lockdowns, but does he agree that in an area such as Gloucestershire, where, mercifully, the number of cases is still relatively low, the tracking and tracing and advice on self-isolating could be improved by involving both national and local resources?
Covid-19
Geoffrey Clifton-Brown Excerpts(5 years, 1 month ago)
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Matt Hancock
Yes. First, let me pay tribute to the 111 call handlers and the clinicians who have done an amazing job over these past few weeks. I do not know what we would have done without them. Secondly, the three-hour turnaround of the script changes was an unbelievable task for those who implemented it. They did a magnificent job to turn it round so quickly, and I, of course, applaud them for doing so, and would wish them to be able to turn it round even quicker, but they did an amazing job doing it as fast as they did.
Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)
The Secretary of State’s announcement today will mean that large numbers of elderly and vulnerable people will be required to self-isolate. Will the Government therefore co-ordinate all the volunteering organisations because large numbers of people will be required to deliver necessities to those vulnerable groups?
Matt Hancock
Just as we have introduced a national effort for ventilators, so we are introducing a national effort for volunteers, and my right hon Friend the Secretary of State for Digital, Culture, Media and Sport is leading that drive.