Defending Public Services
Debate between Heidi Alexander and Andrew Murrison(8 years, 6 months ago)
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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.
NHS Bursaries
Debate between Heidi Alexander and Andrew Murrison(8 years, 6 months ago)
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Heidi Alexander
Thank you, Mr Speaker. I will leave my comments on that matter there.
In the past few months, Ministers and I have had a number of exchanges across the Dispatch Box about the unnecessary and dangerous fight the Government are picking with junior doctors. You might think that having totally alienated one section of the NHS workforce, Ministers would think twice about doing it again, but you would be wrong. Not content with junior doctors, the Government are now targeting the next generation of nurses, midwives and other allied health professionals: podiatrists, physiotherapists, radiographers and many more. Instead of investing in healthcare students, and instead of valuing them and protecting their bursaries, which help with living costs and cover all their tuition fees, the Government are asking them to pay for the privilege of training to work in the NHS: scrap the bursary, ask tomorrow’s NHS workforce to rack up enormous debts, and claim that this is the answer to current staff shortages.
Dr Andrew Murrison (South West Wiltshire) (Con)
The hon. Lady is making a spending commitment. Why then, only a few months ago, did she stand on a manifesto that opposed the Government’s £10 billion investment in the NHS?
Heidi Alexander
The Labour party has always made it clear that it would have given the NHS every penny it needs.
Given the approach to healthcare students I have outlined, most people would think the Government had taken leave of their senses. They would be right.
NHS and Social Care Commission
Debate between Heidi Alexander and Andrew Murrison(8 years, 9 months ago)
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Heidi Alexander (Lewisham East) (Lab)
It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford), and I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing the debate today. I thank all the right hon. and hon. Members who have contributed to the debate. It has been an important and well-informed one.
Many hon. Members have spoken about the seriousness of the financial challenge facing our health and care system. They are right to do so. Many hon. Members have also been right to say that we need a big, honest national debate about what excellent care services look like and how we might pay for them. I have been the shadow Secretary of State for Health now for just four months. In that time, it has become obvious to me that the NHS and care system is facing unprecedented challenges—huge hospital deficits, care home providers on the brink of failure, older people in hospital because they cannot get the support that they need at home, more critically ill people waiting longer than ever before for ambulances and large chunks of the workforce so demoralised that they want to up sticks and leave for the southern hemisphere.
For many people who use the NHS, this picture may sound unfamiliar. For the majority, the NHS still provides excellent care and it is important to recognise that and to thank the thousands of dedicated staff who ensure that that happens. But the system fails many others, and the risk is that it starts to fail more and more people as time goes on.
When I was asked to do this job, I knew that the NHS and care system was under pressure. I knew that demographic change and the march of technology, both in and of themselves good things, were placing demands on a system designed for a different century. As a constituency MP, I have visited isolated older people, many feeling like prisoners in their own home, surviving with the help of a meagre care package or the support of family and friends if they are lucky. As a local authority councillor, I saw the soaring demand for adult social care, and the woefully inadequate budget to deal with it. Demand is growing because our population is ageing but also because advances in medicine enable babies who previously might not have survived to live not only into childhood but into adulthood.
On a personal level, I knew that in my own family, my grandmother had spent the last few years of her life in and out of hospital on an almost weekly basis, driven as much by crises of loneliness as by a deterioration of her chronic obstructive pulmonary disease. I knew that my other nan was forced to sell her home to pay for her care when she developed vascular dementia, meaning that all but £23,000 of her £140,000 estate disappeared. All these things I knew before I became the shadow Secretary of State, but it was only when I visited hospital after hospital up and down the country in the past few months that my eyes were really been opened.
The image of frail, elderly people, perched alone on beds in emergency admissions units or in rehabilitation wards is the abiding picture that stays with me following my first four months in this job. It made me feel uncomfortable. As a childless 40-year-old woman, I asked myself whether that would be me in 50 years. Was it the best place to be? Was it the best we as a country could do? The image may have been uncomfortable, but the numbers say it all. One in four hospital beds are occupied by people with dementia. Half of all people admitted to hospital are aged over 65. More than 300,000 people aged over 90 arrive at A&E by ambulance every year.
When we get older—and it will come to all of us, hopefully—hospital will sometimes be necessary, but it should not become the norm. I know that we have to address this problem. The system needs to be redesigned so that it gets the right sort of support to people at the right time and in the right place to prevent problems from escalating.
We have to be honest, however, about the fact that this involves a price tag. While savings can still be made and there will be ways to make the system more efficient and less wasteful, there are simple underlying pressures that cannot be wished away. With every day that goes by, more older people are living with increasingly complex and often multiple conditions. Some say that family members need to step up and care for elderly relatives, but others say that that is unrealistic. New drugs and treatments also become available every day, yet at not insignificant cost. It might be tempting to brush these uncomfortable truths under the carpet, but we cannot, and we would fail generations to come if we were to do so.
That brings me on to the proposal that we are debating: the establishment of an independent, non-partisan commission to determine what a long-term financial settlement for the NHS and social care system might look like. I understand the superficial attraction of the proposal. I have been stopped on the street and in the gym by people I have never met who say, “Why can’t the politics be put to one side when it comes to the NHS?” I understand that sentiment, as politicians are not always the most popular bunch and we are too often seen to be advancing our own parties’ interests rather than those of the public. However, the way in which we fund elderly care is the most deeply political question that our country faces in the next decade, and it is political because it is about who pays and who benefits.
While the NHS is a universal, taxpayer-funded system that is free at the point of use, social care provision is a mixed bag. Those with money pay for care themselves, while those without rely on councils to provide what support they can. There has been a “make do and mend” approach to social care in recent times, but our changing population means that that is no longer an option.
I spoke earlier about my nan, a woman of limited means who experienced catastrophic care costs because she developed dementia. My family is not a rich family, but we are not a poor family either—we are like many families up and down the country. When I was growing up, my dad decided to take us on a two-week holiday to Spain each year instead of paying into a pension. He has never bought a brand-new car in his life, but he never let his children go without either. The costs of care faced by my nan and my family fell randomly. Is it right that a woman of limited means who dies of dementia at the age of 85 passes nothing meaningful on to her family when a wealthy man who dies of a heart attack at the age of 60 does? What about those who plan their financial futures having invested in expensive tax advice to avoid the costs of care? These are deeply political questions.
If the NHS and care system are to be adequately funded in the future, the truth is that a political party needs to be elected to government having stood on a manifesto that sets out honestly and clearly how we pay for elderly care, and how we fairly and transparently manage the rising costs of new treatments, drugs and technology. No matter how well researched, intentioned or reasoned an independent commission’s recommendations may be, someone at some point will have to take a tough decision.
Given the cross-party work that has been done in this area in the past, I think that I can be forgiven for being cautious. Let us take the discussions that took place between by my predecessor, my right hon. Friend the Member for Leigh (Andy Burnham), and the then Conservative and Liberal Democrat Opposition prior to the 2010 election. Just weeks before the election, the Conservatives pulled the plug on those talks, and accusations of “death taxes” were suddenly being hurled around. So much for a grown-up debate to answer the difficult questions. Take also the attempt at cross-party agreement in the previous Parliament which led to some of the Dilnot proposals on capping the costs of care. Those proposals were in the Conservative party’s manifesto, but were swiftly kicked into the long grass just weeks after the election.
I am not sure that attempts to take the politics out of inherently political decisions have worked. Even in the case of something straightforward—a new runway, for example—an independent commission has not exactly led to consensus on how to proceed. It has just led to more delay. As the well-respected Nuffield Trust has said, “Experience shows that independent commissions into difficult issues can have little impact if their recommendations do not line up with political, local or financial circumstances.”
How we pay for elderly care is one of the most difficult decisions facing our generation. It will require political leadership. A political party needs to own the solutions and be determined to make the case for them. I am not ashamed to say that I want the Labour party to lead that debate. I want us to build on some of the excellent work that has already been done in this area, in particular the work of Kate Barker and the King’s Fund. I want the Labour party to spend time talking to people up and down the country about the kind of health and care service they want to see, and to have a frank and honest discussion about what some of the different options to pay for that service might be.
I must be honest, though, and say that I think it was a profoundly political decision in the previous Parliament to cut the amount of money available to councils to pay for adult social care. I say gently to the right hon. Member for North Norfolk that he stood at the Government Dispatch Box and defended the cuts that his Government were making to social care. He dismissed many of warnings that my hon. Friend the Member for Leicester West (Liz Kendall) was making when she was the shadow Care Minister about delayed discharges, cuts to home care, and reductions in other vital services, such as meals on wheels and home adaptions. It is neither realistic nor right to pretend that we do not have fundamental differences on this issue. Any attempt at finding consensus must begin with an acknowledgement of the damage done to social care over the past five years.
Dr Murrison
I am grateful to the hon. Lady for giving way, particularly as I was not in at the very beginning of her remarks. It is most gracious of her. I have been listening carefully and she is making a powerful case. Then she came over all partisan. Does she not accept that fundamental to spending on healthcare, as with the rest of our public services, is a sound economy? Does she accept that this Government have had to make some extremely difficult choices in order to get that economy back on track?
Heidi Alexander
I accept that difficult choices have had to be made, but some of those choices have impacted enormously on some of the most vulnerable people in our society. The hon. Gentleman was not in the Chamber for the beginning of my speech, when I recognised the seriousness of the problem and the need for urgent action to tackle it. I want to find a solution that works and delivers the change that is needed.
The public are crying out for honesty in this debate. They understand the pressures created by rising demand and new technologies, and they want to be treated like adults. To suggest that this can be all neatly sewn up by an independent commission with the politics taken out of it sounds attractive, but I worry that it will not deliver. For the millions of people who depend on our NHS and social care system, I agree with the right hon. Member for North Norfolk that we cannot afford to have another Parliament where we fail to grasp the nettle. I know his proposal is well intentioned, but I fear that it is not the answer.
Junior Doctors’ Contracts
Debate between Heidi Alexander and Andrew Murrison(9 years ago)
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Heidi Alexander
As I have already said, there is absolutely no clarity. The hon. Gentleman might do well to read the article that appeared in The Guardian on 4 October, written by the former Health Minister, who quite clearly states that he has concerns about the fact that the new contract might be used as a lever to find some of the £22 billion of efficiency savings that the NHS needs to find over the next few years.
Dr Andrew Murrison (South West Wiltshire) (Con)
Will the hon. Lady give way?
Heidi Alexander
I will not give way, as I am going to make some progress.
Junior doctors are not just the first-year trainees fresh out of medical school. They are also the senior house officers and registrars with 12 or 15 years of experience. Junior doctors account for almost half of all doctors in hospitals and the vast majority already work nights and weekends. The responsibilities they carry are huge. Take the junior paediatric doctor working in accident and emergency who emailed me last week. Some of the things she does, I could never ever do. In her email, she said:
“I am in charge of teams resuscitating dying children regularly. I have had to make the decision to stop resuscitating a dying child. I have had to tell parents that their child is going to die. I have been the only doctor trying to stick a tiny breathing tube into a baby born 16 weeks early and weighing 600g at 3 in the morning.”
How is it right that she should face the prospect of being paid less? She is not asking to be paid more. She is just asking to be paid the same and to keep the safeguards that prevent her from being stretched even further.
Heidi Alexander
I am grateful to my hon. Friend. He makes a very valid point about the impact on recruitment and retention of doctors in the capital.
Heidi Alexander
Tired doctors make mistakes. It is obvious but it is true. Nobody wants to return to the bad old days of junior doctors too exhausted to provide safe patient care. It is bad for doctors, it is bad for patients and it is bad for the NHS. So why are this Government hellbent on forcing through these unsafe changes?
The Secretary of State claims that the changes are about making it easier for hospitals to ensure that the staff needed to provide safe care at the weekends and on nights are available. Is he saying that there are not enough junior doctors on hospital wards and in A&E departments at these times currently? If so, how many more junior doctors would be present at these times as a percentage increase on current staffing levels if the new contract goes through? If the changes are about increasing the cover at weekends and nights, surely it means less cover at other times of the week unless he finds more money for more doctors.
I understand the arguments for increasing consultant cover at weekends and nights. I understand it is vital that patients who are admitted on a Sunday get to see a consultant as quickly as those admitted on a Tuesday, and I am pleased that the BMA’s consultants committee is negotiating with the Government on improving levels of consultant cover. Indeed, everyone in the NHS supports the principle of seven-day services. But this debate is about junior doctors. Junior doctors are already working evenings and weekends. So why has the Health Secretary tried to make this a row about seven-day services?
Let me quote some of the claims that the Secretary of State has made in recent weeks. In response to a question on the junior doctor contract from my hon. Friend the Member for Wirral South (Alison McGovern), he said:
“someone is 15% more likely to die if admitted on a Sunday than on a Wednesday because we do not have as many doctors in our hospitals at the weekends as we have mid-week.”
In response to a question that I asked him about junior doctors, the Secretary of State said that the overtime rates that are paid at weekends
“give hospitals a disincentive to roster as many doctors as they need at weekends, and that leads to those 11,000 excessive deaths.”
He went on to say:
“there are 11,000 excess deaths because we do not staff our hospitals properly at weekends.”—[Official Report, 13 October 2015; Vol. 600, c. 150-1.]
The authors of the research that the Secretary of State has been quoting said that it would be “rash and misleading” to claim that the deaths were all avoidable. Yet the Health Secretary has got dangerously close to doing just that. Indeed, he has gone so far down that route that some people do not think that our hospitals are properly staffed at the weekend. I know of elderly patients delaying their visit to hospital because they do not think that there will be enough doctors there. That leads to more complicated treatment, longer patient recovery time, people’s lives being put in danger and a bigger bill for the NHS to cap it all off. That is appalling. Don’t get me wrong: I am as committed as anyone to high-quality care, available 24/7, 365 days a year, but the Secretary of State needs to be careful with his words. He should look in the mirror and ask himself whether his soundbites are true to the conclusions of the study he references.