Defending Public Services

Heidi Alexander Excerpts

Monday 23rd May 2016 Commons Chamber

[Mr Hunt]

That is not true, but we do all accept that there is financial pressure throughout the system. The question that is always ducked by Labour Members is how much greater that financial pressure would have been under Labour’s plans, which involved giving the NHS £5.5 billion less every year than was promised by the Government. I just point out that when Labour Members condemn the £22 billion of efficiency savings as “politically motivated”, as the shadow Health Secretary did in March, they cannot have it both ways. Her manifesto offered the NHS £5.5 billion less every year compared with what this Government put forward—

[Heidi Alexander (Lewisham East) (Lab)]

indicated dissent.

[Mr Hunt]

The hon. Lady shakes her head, but let us consider what the King’s Fund said in the run-up to the election:

“Labour’s funding commitment falls short of the £8 billion a year called for in the NHS five year forward view.”

It was there in black and white: Labour was committing to a £2.5 billion increase in the NHS budget, not the £8 billion that this Government committed to. The hon. Lady cannot have it both ways. If this figure was £5.5 billion, the efficiency savings needed would be not £22 billion, but £27.5 billion, which is a 25% increase. That would be the equivalent of laying off 56,000 doctors, losing 129,000 nurses or closing down about 15 entire hospitals.

--- Later in debate ---

[Heidi Alexander (Lewisham East) (Lab)]

I start by thanking the Health Secretary for joining us today. I know that he does not always choose to respond to me when I bring matters to this Chamber, so I am grateful to him for being here. I am conscious that, if the Cabinet deckchairs shift around after the referendum, this may be our last parliamentary exchange. If that turns out to be the case, let me put on record my best wishes for whatever he goes on to do, but may I gently suggest that a future career in resolving employment disputes may not be for him?

The topic of this debate is defending public services, and as the House would expect, I shall focus my remarks on what is happening to our health and care service. Listening to the Health Secretary today, one could be forgiven for thinking that all is well. One would have no idea that hospital finances are at breaking point, waiting lists are approaching a record high, and the NHS is facing a workforce crisis with endemic understaffing and broken morale. Put together, the triple whammy of challenges on the finances, quality of care and the workforce put the NHS in a very precarious position. Let me take each of those challenges in turn.

First, on the finances, the right hon. and learned Member for Rushcliffe (Mr Clarke) called it sterile nonsense, but it is fundamental to whether hospitals and GPs can continue to deliver the care needed for our ageing and growing population. One of the Health Secretary’s favourite soundbites recently has been to claim that the Government are giving the NHS the sixth biggest funding increase in its history. Indeed, he has made that claim six times in this Chamber over recent months, so I was surprised that it did not feature in his speech today. However, I think I may have an explanation for that omission. Last week the King’s Fund and the Health Foundation, two well-respected independent think-tanks, looked into his claim. I have a copy of their analysis, which states:

“We’re afraid to say, although perhaps not surprised . . . that we have a very different figure.”

They go on to say that, rather than being the sixth largest funding increase in NHS history,

“we find that . . . this year it is in fact the 28th largest funding increase since 1975”.

[Mr Jeremy Hunt]

I completely defend the methodology that we used to come up with our figure, but does the hon. Lady not see the irony? She is criticising a £3.8 billion increase in NHS funding this year, when Labour’s own plans at the election last year were for a £2.5 billion increase—£1.3 billion less than this Government have delivered.

[Heidi Alexander]

I am grateful to the Secretary of State for that intervention. He might want to rake over the last general election but he clearly does not want to talk about the crisis in NHS finances today, with a £2.45 billion deficit among hospitals at the end of this year, cuts to public health spending, and £4.5 billion coming out of the adult social care budget over the past five years. I am quite happy to debate NHS finances with him. The truth is that the NHS is getting a smaller increase this year than it got in every single year of the previous Labour Government.

The King’s Fund and the Health Foundation concluded:

“Getting public spending figures right is important, otherwise they can mislead and detract from the real issues. The fact is that the NHS is halfway through its most austere decade ever, with all NHS services facing huge pressures.”

[Sir Simon Burns]

May I recommend that the hon. Lady read a recently published book by Tom Bower which shows the utter failure of the Blair Government, who pumped billions of pounds into the NHS over a period of years but had no control over it and made no attempt to increase productivity, so that from 1998 performance flatlined for six years, and the then Health Secretary was forced to bring back health policies that they had abandoned in ’97?

[Heidi Alexander]

I am grateful for the reading advice from the right hon. Gentleman, but I simply say this: I am very happy to defend the record of the previous Labour Government, who trebled the NHS budget and had the highest-ever public satisfaction ratings and the lowest-ever waiting lists.

We should be crystal clear about the crisis that we face today. The decade from 2010 to 2020 is set to be marked by the biggest sustained funding squeeze on the NHS ever. As a percentage of GDP, spending on health is set to fall from 6.3% in 2009-10 to just 5.4% by the end of the decade.

[Mrs Maria Miller (Basingstoke) (Con)]

People who are listening to this debate will want some clarification. Is the hon. Lady denying the fact that if Labour were in government it would not have increased NHS spending in the way that this Government have done? I think she needs to be clear on that point.

[Heidi Alexander]

We were very clear at the last election that we would have had an emergency Budget to put every penny that the NHS needs into its funding.

I was talking about the reduction of NHS spending as a proportion of GDP. In terms of real funding, the House of Commons Library has shown that, if spending as a percentage of GDP had been maintained at Labour levels, by 2020, £20 billion more would be being spent on the NHS each year. That demonstrates the scale of underfunding that we have already seen and just how tough the coming years are going to be. That is not to mention the deep cuts to adult social care, which have piled the pressure on to hospitals, and the £22 billion-worth of so-called efficiency savings that this Government have signed up to. I have yet to meet anyone who works in the NHS who thinks that efficiencies on this scale are possible without harming patient care.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I do not disagree with the hon. Lady that there are big pressures on the horizon, but can she say how much, beyond Simon Stevens’ predicted costs, her party is now pledged to spend on the national health service, because so far all we have heard is prevarication?

[Heidi Alexander]

I am not going to be drawn into giving figures here at the Dispatch Box today. Yesterday the Life Sciences Minister was tweeting that we need a big public debate about funding of the NHS.

Three days ago, the scale of this crisis was laid bare. NHS Improvement, the body responsible for overseeing hospitals, published figures showing that NHS trusts ended 2015-16 with a record £2.45 billion deficit—I repeat, £2.45 billion. To give hon. Members some context, that is treble the deficit from last year. What is the key cause? It is the spiralling agency spend because of staff shortages. When this Government talk about more money going in, let us remember that, before that money gets to the frontline, the bulk of it will be spent on paying off the bills from last year.

[John Redwood]

Will the hon. Lady give us an idea of how much extra money and how many more personnel she thinks we need to deal with current levels of migration?

[Heidi Alexander]

I am grateful to the right hon. Gentleman for that intervention. I actually think that the health service benefits more from migrants than the amount migrants cost it.

I want to tell all Conservative Members that Labour Members are not going to take any lessons about NHS spending from the party that has created the biggest black hole in NHS finances in history. It has got so bad that the Health Secretary cannot even guarantee his Department will not blow its budget. It is chaos: Ministers blame hospital bosses, hospital bosses blame Ministers and all the while patients are paying the price.

Faced with this crisis, we might have thought that the NHS would get more than a passing reference in the Queen’s Speech, but that was not the case. What is the Government’s answer when it comes to the NHS? Fear not: they will introduce a Bill to crack down on health tourism. With all the problems the NHS is facing, this Government want to focus Parliament’s time on debating a Bill that risks turning NHS staff into border guards.

Let me be clear: if such measures are about getting the taxpayer a better deal and ensuring fairness in the system, we will not oppose them. However, I must ask, given everything that is happening in the NHS right now, whether Ministers’ No. 1 priority is really to introduce legislation to charge migrants and their children for going to A&E. If so, my fear is that we will see the kind of dog-whistle politics that was so rejected by the people of London earlier this month, and which I hope will be rejected again on 23 June. The truth is that the cash crisis in the NHS is not the fault of migrants; it is the fault of Ministers.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

I genuinely believe and have no doubt that the hon. Lady is committed to the NHS and I share her desire for a wider public debate, but does she agree that, to have a meaningful debate and to add value to her critique, she needs to set out what she sees as the financial requirements of the NHS, otherwise such a debate will not be very helpful?

[Heidi Alexander]

I am grateful to the hon. Gentleman for his intervention, but he will just have to watch this space.

As I was saying, the truth is that the cash crisis in the NHS is the fault not of migrants, but of Ministers. Cuts to nurse training places during the last Parliament have created workforce shortages and led to a reliance on expensive agency staff. Cuts to social care have left older people without the help and support they need to remain independent at home, putting huge pressure on NHS services. The underfunding of GPs has left too many people unable to get timely appointments, which means they are often left with nowhere to turn but A&E. The financial crisis is a massive headache for NHS accountants, but we all know it can mean life or death for patients. Waiting time targets, which exist to ensure swift access to care, have been missed so often that failure has become the norm.

[Alex Chalk (Cheltenham) (Con)]

The hon. Lady is making a very political attack. In that context, would she care to explain why the performance for accident and emergency admission is far worse in Labour-run Wales than it is in England?

[Heidi Alexander]

I would have thought better of the hon. Gentleman, but it is clear Conservative Members want to talk about anything other than their record in England. A&E performance is currently the worst since records began, taking us back to the bad old days of the 1980s, when patients were left waiting on trolleys in hospital corridors. The figures speak for themselves.

[Mr Jeremy Hunt]

May I ask the hon. Lady to consider again what my hon. Friend the Member for Cheltenham (Alex Chalk) said? If A&E performance is the fault of Conservative politicians in England, is it not also the fault of Labour politicians in Wales, where it is 11% worse?

[Heidi Alexander]

From memory, I seem to think the budget going to the NHS in Wales has been cut in Westminster.

Let us have a look at the figures. In March 2011—[Interruption.] The Health Secretary would do well to listen to these figures, because I am about to tell him the record of his term in office. In March 2011, 8,602 patients waited more than four hours on trolleys because no beds were available. Four years later, the figure was up sixfold, to 53,641. In March 2011, just one patient had to wait longer than 12 hours on a trolley. Four years later, 350 patients suffered that experience. The NHS waiting list now stands at almost 3.7 million people—the equivalent of one in every 15 people in England. Only 67% of ambulance call-outs to the most serious life-threatening cases are being responded to within eight minutes.

I could reel off more statistics, but I will instead read a letter that I received the other week:

“Dear Ms Alexander,

I recently had the misfortune of using the A&E at my local hospital in Margate. My wife feels that I was lucky to escape with my life.

My experience has convinced me that our health service has never been more under threat than since Mrs Thatcher.

The fact that I was sent home after 4 hours without seeing a doctor and returned by emergency ambulance with a now perforated appendix I blame mostly on the conflict between the Health Secretary and the Junior Doctors. Had this been resolved he would have been able to concentrate on the woeful lack of resources our NHS faces.”

Take the experience—[Interruption.] The Parliamentary Private Secretary to the Health Secretary says, “Show us the letter”. I have it here, and I got the permission of the individual who wrote to me before referring to it.

Let me refer to another example—the experience of Mr Steven Blanchard at the Swindon Great Western hospital last November. He said in an open letter to the Swindon Advertiser:

“We arrived at 6.40pm and were asked to sit with about 15 others in the unit. It became apparent this was a place of great suffering and misery…Firstly, there was a lady who was doubled up in pain who had been promised painkillers three hours before and I witnessed her mother go again and again to reception until she was begging for pain relief for her near hysterical daughter.”

Another old lady

“who had been left on her own by her son…was sat picking at a cannula in her arm trying to pull it out…A very frail and sick old man was sat in a wheelchair and he had been in the unit since 8am. He kept saying over and over ‘a cup of tea would be nice’…then I watched as urine trailed from him and fell on to the floor beneath the chair…At 10.30pm he was taken to a ward after 14 hours.”

Mr Blanchard said that he and his partner were finally seen at 1.20 am, and stated:

“Never before have I seen people crying out of desperation…I don’t know what is to blame or whether it’s lack of money or lack of staff but this place was what I can only describe as ‘hell on earth’.”

That is what is happening in our NHS in 2016, and such stories are becoming more common. Ministers may not like to hear it, but they need to start taking responsibility.

[Mr Kenneth Clarke]

There are always pressures in the giant national health service as demand grows and expectations rise, and there always will be. The hon. Lady could have made this speech as an Opposition spokesman 10, 20, 30 or 40 years ago. After 20 minutes, she has not yet suggested a solitary policy proposal as an alternative to the Secretary of State’s, and she has not said whether she agrees with him about seven-day working and all the rest of it. She is describing sad incidents in which things have obviously not been ideal or as they should be, but does she have anything to suggest by way of policy that may contribute to helping the NHS in future?

[Heidi Alexander]

Having had these exchanges over the Dispatch Box for the past nine months, it strikes me that the reality of what people are experiencing in hospitals is sometimes missing from these debates, and that is why I thought it important to quote from those letters.

On workforce challenges, nothing sums up this Government’s failure on the NHS more than the way that they have treated NHS staff. We have had pay freezes, cuts to training places, and the first all-out doctors strike in 40 years—a strike that the Health Secretary did not even try to prevent; in fact he provoked it. He has spoken about seven-day services, but he said little about how he proposes to improve weekend care without the extra resources and staff that the NHS will need. We can only assume that his plan is to spread existing resources more thinly, asking staff to do even more and putting patients at risk during the week.

The Health Secretary also failed to say what experts think about his approach. For example, Professor Sir Bruce Keogh said that the NHS was making good progress towards improving weekend care, but that that became “derailed” when the Health Secretary started linking seven-day services to junior doctors. Fiona Godlee, editor of The British Medical Journal, said that, by picking a fight with doctors, the Health Secretary has set back NHS England’s established programme of work on improving services at weekends. Not only does he have no plan to deliver a seven-day NHS, but he has ripped up the plan that was already in place to improve weekend care. You couldn’t make it up, Mr Speaker.

The Health Secretary often reads out his usual list of stats on staff numbers, but to know what is really happening we must look beyond the spin. A recent survey of nurses by Unison found that almost two-thirds believe that staffing levels have got worse in the past year, and 63% said that they felt there were inadequate numbers of staff on the wards to ensure safe and dignified care—that figure was up from 45% the year before. Whether GPs, nurses or midwives, numbers of staff have not kept pace with demand.

Analysis by the House of Commons Library shows that, in the Labour Government’s last year in office, there were 70 GPs per 100,000 of the population, but that figure has now fallen to just 66. In Labour’s last year, there were 679 nurses per 100,000 of the population, but there are now just 665. No wonder that doctors and nurses feel pushed to breaking point. If we do not look after the workforce, patients will suffer. There was nothing in the Queen’s Speech to help the workforce—no U-turn on scrapping NHS bursaries, no plan to train the staff the NHS so desperately needs, and no plan to improve working conditions.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

My hon. Friend’s point about the workforce is important. Does she share my concern about those attacks on doctors and nurses, and the undermining of numbers? If we break the doctors we will in turn break the NHS, and it is a lot easier to get public support to privatise a broken NHS, than an NHS that is well, healthy and working as it should.

[Heidi Alexander]

My hon. Friend makes a good point, and motivated staff are essential to providing high-quality care.

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

Under the last Labour Government, new medical schools were set up—including Hull York medical school—to train the additional doctors that we knew the NHS needed. The Queen’s Speech is a missed opportunity because there is no announcement about increasing capacity in those new medical schools that Labour brought in.

[Heidi Alexander]

My hon. Friend is, as always, entirely right.

The Government have run out of answers and they have run out of people to blame. Whichever way we look at it—funding, quality of care or staffing—theirs is a record of failure. That will be the Health Secretary’s legacy. He rightly said “Never again” to Mid Staffs, but his time in office has been marked by tragedy and failure at Southern Health. He talks about patient safety, but his actions have made the NHS less safe.

The Government have failed patients and staff. They have proved the old saying true: we simply cannot trust the Tories with the NHS.