Childhood Obesity Strategy: Chapter 2
Helen Goodman Excerpts(6 years, 5 months ago)
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Steve Brine
I am very pleased that my hon. Friend made that very helpful contribution. I am a Conservative—I said so in my opening remarks—but at the end of the day this is a publicly funded health service that we all believe in and all love. If we want it to celebrate its 140th birthday, we need to protect it, and that means getting serious about prevention and stopping people coming into the service and getting sick. Everyone in the House—Conservative, Labour and everyone in between—should get behind that.
Helen Goodman (Bishop Auckland) (Lab)
As I understand it, a six-year-old will be 18 before the Minister’s proposed ban on the promotion of unhealthy food at supermarket checkouts will come into effect. Surely this is meant to be a crisis, not a long-term plan.
Steve Brine
I thought for one fleeting moment that the hon. Lady and I were going to agree. I do not recognise that that six-year-old will have to wait another 12 years for the measure to be consulted on and put in place, so I think the hon. Lady might need to check her math.
NHS Outsourcing and Privatisation
Helen Goodman Excerpts(6 years, 6 months ago)
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Jonathan Ashworth
We have always said that, and I do not know why Government Members are so surprised about it. Indeed, the Prime Minister, thinking she had a humdinger, quoted me at Prime Minister’s questions, but I was decidedly nonplussed by her response to my right hon. Friend the Leader of the Opposition.
Perhaps the biggest area in which private contracts have gone out is in community services, where the private sector has taken over 39% of contracts compared with the 21% in the NHS. NHS Providers said last week:
“The fragmentation of the community sector is…due to the private provider share of the community…service market being much larger than in other sectors”.
It also said:
“it is almost always a legal requirement for commissioners to go out to tender competitively for community services. Tendering for contracts is therefore much more competitive in the community sector than in the acute sector, and contracts are sometimes won on cost savings, rather than improvements in the quality of care.”
We have seen this time and again. For example, Serco was awarded a £140 million contract in Suffolk, but could not meet key response times, such as the four-hour response time for nurses and therapists to reach patients at home 95% of the time. Before Serco took over the contract, the target was achieved 97% of the time.
Jonathan Ashworth
I did say that I would not take any more interventions. I apologise to my hon. Friend; I know her intervention would have been excellent.
How about the seven-year contract worth £70 million per annum to Virgin Care that was awarded in November 2016 across Bath and Somerset, with services including health visitors, district nurses, speech and language therapists, occupational therapists, physiotherapists and social workers? The first few months were beset with IT problems, and there were problems with payroll transfers and delays in paying staff. How about the dermatology contract in Wakefield, which again went to Virgin Care? The IT systems did not work, and it was not consultant-led. Satisfaction fell by so much that GPs refused to refer, and again the contract had to come back in-house.
In fact, Virgin Care is now picking up over £1 billion of NHS contracts, and when it does not win a contract and believes something is wrong with the tendering process, it becomes increasingly aggressive in the courts. Most recently, and disgracefully, it sued the NHS in the Secretary of State’s own backyard and forced it to pay out £1.5 million. That money should be spent on patients in Surrey, not go into the coffers of Virgin Care.
The legal action by Virgin Care reveals a bigger truth. Not only does the Health and Social Care Act lead to many community health contracts going to the private sector, but the regulations underpinning the Act are dysfunctional, which results in millions being wasted on increasing numbers of failed privatisation projects. Perhaps the most prominent example is the 10-year contract worth £687 million for end-of-life and cancer care in Staffordshire that has had to be abandoned, costing CCGs over £840,000—money that should have been spent on patients.
That is why we are raising concerns about the proposed accountable care organisation model, which is currently subject to judicial review. We favour integration and accountability, and we agree that services should be planned around populations and, indeed, that funding should be allocated by means other than an internal market. We favour a strategic hand in the delivery of services and greater local collaboration, and our vision is one of planning and partnerships.
However, the existence of piecemeal contracts and the contracting out of services is a major barrier preventing the real integration of health and social care. The enforcement of competition obstructs collaboration and the proper, efficient organisation of services. A model in which billions of pounds of NHS and local authority funds can be bundled up and go through a commercial contract for 10 years is not accountable and neither, depending on the level of funding, will it deliver the level of care we expect, while it could also go to the private sector. What sense does it make to offer binding long-term contracts for delivering a vast range of services over 10 years? Surely the lesson of PFI is not to guess the future, not to write healthcare contracts for services 10 years hence and not to get locked into a deal when so much will change in the delivery of healthcare over the next 10 years.
This is a tired, outdated, failing approach. Quite simply, privatisation has failed. Almost every day in the NHS, we hear of a further investigation, a further failure, a contract handed back or a problem uncovered—from scandalous failures in patient transport, to poor standards in private hospitals, to millions wasted on huge tendering exercises that go nowhere, to Circle failing to manage Hinchingbrooke, to Capita failing to manage vital patient records, to Interserve failing to clean hospitals and deliver meals, to Virgin Care suing the NHS for £1.5 million.
I challenge the Tories to point in this debate to a significant success in outsourcing to offset that total mess. No Tory can tell us that the competition and markets in the Health and Social Care Act have led to shorter waits, innovations in care or better services. The reality is that the NHS and the provision of healthcare are too important to be left to the chasing of market forces. The principles on which our NHS was founded seven decades ago are being betrayed by this Government, and the staff and patients of the NHS are being betrayed with it. There are longer waiting times, intolerable pressures on staff, daily stories of human heartbreak and operations cancelled.
On the 70th anniversary of the NHS, the staff can hold their heads up high, but the Government should bow their heads in shame. In this anniversary year, it will fall again to this party—the party that founded the NHS and that believes in the NHS—to rebuild and restore a public universal national health service.
Oral Answers to Questions
Helen Goodman Excerpts(6 years, 6 months ago)
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Helen Goodman (Bishop Auckland) (Lab)
Durham police tell me that when there is a problem on social media, particularly Facebook, it can take six months between their asking for action and the social media company tackling it. Will the Secretary of State speak to the Home Office to get the system changed and speed it up?
Oral Answers to Questions
Helen Goodman Excerpts(6 years, 9 months ago)
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Stephen Barclay
As my hon. Friend will be aware, we announced further funding in the Budget and the autumn statement. On the specifics of Telford, which she has raised on a number of occasions, I am very happy to have further discussions with her.
Helen Goodman (Bishop Auckland) (Lab)
Stephen Barclay
I am not aware of the specific case the hon. Lady highlights, but I am happy to look at it and to understand why she feels the rents are disproportionately high. This relates to the point I made earlier in response to the hon. Member for West Lancashire (Rosie Cooper), which was about the variance in the system and how we ensure that we obtain best value for money. The reality of the debate on health is that the Labour party simply sees it in terms of how much is put in, whereas Conservative Members recognise that we need to both invest more in the NHS and make sure we get the best outcomes. That is the key dividing line between the parties.
Patient Transport Services: Northern Lincolnshire
Helen Goodman Excerpts(6 years, 10 months ago)
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Andrew Percy (Brigg and Goole) (Con)
I welcome the Minister of State, Department of Health and Social Care, my hon. Friend the Member for Gosport (Caroline Dinenage), who will respond to tonight’s debate. It is, I think, her first time in action as a Health Minister. Although this subject is not directly part of her departmental portfolio, we are grateful to her for coming to respond to the debate.
I obtained the debate to draw attention to the appalling standard of the patient transport services that Thames Ambulance Service Ltd has been providing to my constituents in north Lincolnshire. That concern is shared by other local Members of Parliament—indeed, all of us, not just across north Lincolnshire but through to the City of Hull, where Thames Ambulance Service also provides patient transport services. A common theme that constituents have raised with me and my team is that they themselves raised these concerns with Thames Ambulance Service but received no satisfactory response from the company. Having loved ones stranded when at their most vulnerable, following chemotherapy, or learning that elderly relatives with severe dementia or Alzheimer’s have been stranded or forgotten in very low temperatures, is of course very emotive for family members. Their questions to Thames Ambulance Service often go unanswered, in a thoroughly unacceptable way.
Helen Goodman (Bishop Auckland) (Lab)
The hon. Gentleman is making a very good speech. The service is also a problem in the rural parts of my constituency. Old people are now refusing to go to hospital appointments because they are worried about whether they can get there and get back, because the transport is so bad. Does he agree that this is fundamentally a health issue?
Andrew Percy
I am sorry to learn that the experiences extend also to County Durham, because going to hospital is stressful enough in and of itself, particularly if one is very elderly or very vulnerable, as many people who use these services are, but especially so if one is not sure whether one will get home at the end of one’s treatment or after an appointment.
This is not, of course, a reflection on the frontline staff of Thames Ambulance Service, who are doing their very best in very difficult circumstances. I will come on to what some of the whistleblowers who have contacted us from that service have told us.
Medicines Regulation
Helen Goodman Excerpts(7 years ago)
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Helen Goodman (Bishop Auckland) (Lab)
I beg to move,
That this House has considered the future of medicines regulation.
What a pleasure it is to see you in the Chair, Mr Davies. I am very pleased that you have been elevated to the Panel of Chairs. Yesterday, the European Parliament agreed to move the European Medicines Agency from London to Amsterdam. Today, we are asking the Minister to tell the British Parliament what will happen to medicines regulation in this country after we have left the European Union. My concern arises from the fact that I have a GlaxoSmithKline plant in Barnard Castle in my constituency that employs 1,200 people. Winston Churchill decided that production should take place in the middle of the Durham countryside, so it would not be hit by Hitler’s bombs; I certainly hope that it will also survive the Government’s Brexit.
Nick Thomas-Symonds (Torfaen) (Lab)
I congratulate my hon. Friend on securing this timely and important debate, and declare an interest as the chair of the all-party parliamentary group on off-patent drugs. Does she agree that, irrespective of what happens with the Brexit negotiations, the Government should guarantee that any patient who needs access to drugs will not wait any longer as a result of Brexit?
Helen Goodman
In one sentence, my hon. Friend gets to the nub of the issue; I will probably take 20 minutes to reach it. He is absolutely right. The problem is that the Government did not make a plan, and as yet have not resolved how they will regulate medicines from 1 April 2019. I have been asking about that for a year. We have had no clear explanation, no policy statement, and no impact assessment. The Government refused to debate the matter in the course of the legislation for triggering article 50. We have not been able to debate it properly as part of the scrutiny of the European Union (Withdrawal) Bill, which is in Committee today, in parallel with our debate.
We are therefore extremely interested to hear what the Minister will say, especially as two months ago there were leaks from the Department of Health that the Secretary of State was flirting with the idea that we should leave the EMA and join the American Food and Drug Administration. I was particularly surprised that that was being floated, because the Association of the British Pharmaceutical Industry has said consistently that it thinks that we should be aligned with EMA standards. Alignment with Europe on regulation of medicine does not simply mean having the same rules on exit day; it means having a mutual recognition agreement with the EMA, and continued alignment of future regulations as they change, which they inevitably will.
Jim Shannon (Strangford) (DUP)
I congratulate the hon. Lady on what she is saying. Obviously, as a Brexiteer, I probably have a very different opinion about what will happen on 31 March, but that is by the bye. Does she agree that it is imperative that the phenomenal work done by the Medicines and Healthcare Products Regulatory Agency and the EMA, which she referred to, can continue? Ensuring that we are able to supply safe and effective medication not simply to the UK but to all nations worldwide must be high on the priority list of the Brexit team. That is something that she and I very much agree on.
Helen Goodman
The hon. Gentleman truly is a gentleman, and I agree with him entirely. We want to see continued UK participation in EU regulatory and medicine safety processes as well. The ABPI has also said, reasonably enough, that it wants to maintain trading terms equivalent to being a full member of the customs union, and to have a common system for VAT.
In May, the EMA and the European Commission issued a statement saying that if the United Kingdom does not stay in the single market, stick with the EMA, or join the EEA—the European economic area—but goes for a clean break, drugs made in the United Kingdom will no longer be authorised for use in the European Union, and drugs made in the European Union will no longer be authorised for use in the UK. Tackling that would involve costly and time-consuming checks. It could even mean that the availability of drugs would diminish dramatically.
What response have the Government made to that statement? What practical steps have Ministers taken? All we have seen is a letter from the Secretary of State for Health and the Secretary of State for Business, Energy and Industrial Strategy to a newspaper, which said that they want a “close working relationship” with the EU, and that patient safety matters, as does certainty, long-term stability, and innovation. The letter said that Ministers will set up a regulatory system with competitive fee pricing. This afternoon, we would like the Minister to explain that.
Currently, the UK Medicines and Healthcare Products Regulatory Agency—MHRA—contributes to the EMA’s work, and the UK pays approximately a fifth of the overall costs. It is universally acknowledged that the MHRA could not take on the task of licensing all drugs without astronomical costs for the industry and the taxpayer.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Is part of the problem not that there appears not to have been a specific assessment of all the health-related impacts of leaving the EU?
Helen Goodman
I agree entirely. We tabled amendments when the article 50 legislation went through requesting impact assessments on many things, including the effect of possibly leaving the EMA, and we have not heard about them. That is extremely alarming, because it gives the impression that Ministers are basing decisions not on fact and analysis, but on prejudice and assertion—not a very good basis when it comes to health or economics.
This issue matters because life sciences and pharmaceuticals is one of the UK’s most successful industries. The combination of first-class scientific research in our universities and high-quality manufacturing means that we have been exceptionally successful. The life sciences employ 220,000 people—of which pharmaceuticals accounts for 90,000—in good quality, well-paying jobs. They are careers, not gigs. The industry is innovative and internationally competitive. In fact, it has the highest manufacturing gross value added, which means that every employee contributes £330,000 to the British economy every year. The value of our exports is £30 billion. Obviously, the industry wants to continue in those collaborations and develop new medicines.
One of the major costs in pharmaceuticals is research and development; another is complying with regulations. Inspections take several days, and internationally there are two dominant regulators: the EMA, which looks at about a quarter of all drugs globally, and the American FDA, which looks at about a third. Clearly, we do not want regulatory complexity, because that would simply add to costs. As Andrew Witty, the former head of Glaxo said, when the regulatory systems of 27 European countries were unified into one, that was a big deal.
Ministers need to keep in mind that the pharmaceutical industry is international and highly mobile. There is world-class production in France, Switzerland and America, and generics are made across the globe, in China and India. Senior executives answer to their shareholders; if it is cheaper to move, they will, so we need to do everything we can to keep costs down in this country. Quite honestly, I cannot understand why Ministers do not just commit to staying in the EMA—it is so obviously the cheapest and simplest solution—but their crazy ideological obsession with escaping the European Court of Justice means, to quote the Secretary of State for Brexit, “putting politics above prosperity”.
What is even worse is that Ministers are cutting across their own stated principles and are creating a highly uncertain environment. Business needs certainty to invest. For example, in my constituency, a new production facility was started a year ago. It will cost £120 million and will take four years to come into production. We are now only 16 months away from 1 April 2019, but yesterday, AstraZeneca wrote to Members of Parliament to say that it needs a transition period of two to three years.
The Prime Minister made things worse—I do not think she intended to, but she undoubtedly did—when, in her Florence speech, she said there would be a transition period. Everybody imagined that there would be time to look at what the post-Brexit regime would be, to have clear negotiations and to make a plan—to go through everything in a systematic way. Her insistence on putting the March date into legislation shrank that time overnight, from 40 months to 16 months.
Industry is taking decisions now. One plant has already closed in Southampton. GSK is implementing its contingency plans nationally, which include relocating some members of staff to other European Union countries. In Barnard Castle and Ulverston, it is reviewing the production of cephalosporins, which my hon. Friend the Member for Barrow and Furness (John Woodcock) will talk more about later in the debate.
But this is not just about jobs; it is also about health. Every month, the United Kingdom sends 45 million medicine packets to Europe and we receive 37 million medicine packets from Europe. Some 80 million people need those medicines. Border delays in the medical supply chain will affect not just the final product but intermediate production, especially where we are talking about time and temperature-sensitive drugs, such as for cell and gene therapy. More than 2,600 final products have some stage of manufacture in the UK. Delays as they cross the border during production could mean the loss of lives. That is why the Association of the British Pharmaceutical Industry and its European counterparts wrote a joint letter to Monsieur Barnier, the European negotiator, and the Brexit Secretary of State, to sort this out promptly. Ministers should put patients and public health first, and should start co-operating with the European Union on solving this problem. Given the long lead times, they need to speed up the work and sort out the transition phase.
I have seven questions for the Minister. Will he rule out introducing a freestanding, new, regulatory structure? Will he rule out incorporating the MHRA into the American FDA? Will he confirm the Government’s stated aim of keeping British regulation aligned with the EMA’s European regulation? Will he tell us what moving the EMA and setting up a new regime will cost? Will he set out the legal basis for our continued co-operation and participation in the EMA system from 1 April 2019? Will he say how he intends to legislate? And will he commit to more than another 90-minute debate on an affirmative statutory instrument? If he cannot even do that, half of the debating time that Parliament will have on this important subject will be this afternoon.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
I will do my best, Mr Davies.
I congratulate the hon. Member for Bishop Auckland (Helen Goodman) on securing this debate. Medicine regulation is a critical issue that I know she has raised many times in the House. This is probably the quietest Westminster Hall debate that I have responded to, but that does not mean that it is not one of the most important—there are competing issues in the main Chamber today. The fun that we are missing!
Modern medicine is transforming. We are moving from an era in which drugs and devices were mass produced and marketed to millions of patients globally, to one in which new medicines and therapies will increasingly be designed and personalised for individual patients. The chief medical officer’s annual report earlier this year on genomics was a landmark piece of work, and it set out how that will revolutionise our ability to diagnose and treat illness in the future. It is within that context that we discuss medicines regulation. Put simply, if the future regulation of medicines does not keep up with the pace of development for those medicines, patients in the UK, and internationally, will not have access as quickly as they should to transformational new treatments. That would be a bad thing.
While answering as many questions as I can, let me outline the world-leading work of our domestic medicines regulation, the Medicines and Healthcare Products Regulatory Agency, as well as our plans for the future in the context of Brexit. The MHRA has been our national regulator for more than 30 years, and it has acted as the lead regulator for more than 3,500 medicines now on the EU market. It is recognised globally as an authority in licensing, inspections and batch release and through its pharmacovigilance—a great word—and medical devices regimes. It plays a leading role in protecting and improving public health through the regulation of medicines, medical devices and blood components for transfusion services. In addition, the agency hosts two organisations that, although little known, play an important role in supporting the development and use of medicines. The agency’s clinical practice research datalink uses anonymised NHS clinical data to keep patients safe and aid the development of new drugs, and the National Institute for Biological Standards and Controls develops global standards for the use and control of more than 90% of biological medicines used globally.
Helen Goodman
When preparing for this debate, it occurred to me that some of these issues apply also to animal health. Is there any responsibility for animal health in these institutions, or do we need to ask DEFRA Ministers about that separately, on another occasion?
Steve Brine
I think it is the latter, but I will check and come back to the hon. Lady on that point.
Steve Brine
Thank you; I am not feeling unwell at all.
In the event that it is not possible to reach a deal that secures ongoing, close collaboration between the UK and Europe, we will set up a regulatory system in the UK that protects the best interests of patients and supports industries so that they can grow and flourish, as set out in the letter in the Financial Times. We will ensure that our system is robust and does not impose any additional bureaucratic burdens. Our successful past should give us confidence in achieving a prosperous future, whatever form that takes. I want to be clear that that is not a threat to the EU27. I must be honest and transparent in saying that if it is not possible to secure close collaboration, we will of course look to put in place an effective system and work with international partners in a way that best protects patients and supports industry and innovation.
I will attempt to answer some of the many questions that the hon. Member for Bishop Auckland put to me. I can rule out a free-standing structure incorporated into the FDA. She asked how much the EU expects us to pay towards the cost of relocating the EMA. The arrangements for withdrawing from the EU, including any financial settlement, is a matter for the withdrawal agreement, as she knows, as part of the ongoing article 50 process. The Government are absolutely committed to working with the EU to determine a fair settlement for Britain’s exit and the best deal for UK taxpayers. As part of the exit negotiations, the Government will discuss with the EU and other member states how best to continue co-operation in the field of medicines regulation, in the best interests of business, citizens and patients in the UK and the EU. I do not think that it would be appropriate, nor is it possible, for me to prejudge the outcome of those negotiations. There are many who would love that crystal ball, but I do not have it.
Helen Goodman
One can envisage a situation in which medicines are assessed in the European Union and in the UK and there is an agreement for mutual recognition between those institutions. That, one can picture. But what I cannot understand, if we are not all in one system, is how—down the track when medicines are used—if something goes wrong, the Europeans can have a claim on us or we could have a claim on them if we do not share the ECJ institutional machinery.
Helen Goodman
I am grateful to all hon. Members who took part in the debate. The Minister clearly understands why medicines regulation matters and shares our interest in making it work, but I and other hon. Members asked many questions and, to be honest, the only conclusive answer that he gave was that we will not join the American FDA. I would therefore be grateful if officials provided us with written responses to those questions. I know that the Minister does not deal with this area on a day-to-day basis, but I am concerned that the Department seems to have made little progress since 4 July, which was four months ago. That will not do. Hon. Members present would like a private meeting with Lord O’Shaughnessy, the Minister’s colleague in the Lords with day-to-day responsibility for this area, who obviously was not able to participate in this debate, so that we can press him on some of the details.
Question put and agreed to.
Resolved,
That this House has considered the future of medicines regulation.
Health and Social Care
Helen Goodman Excerpts(7 years, 9 months ago)
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Dr Wollaston
My right hon. Friend makes an extremely important point: it is about not only the overall budget but the distribution. I think we would all agree, on both sides of the House, that deprivation must be properly weighted, but he is absolutely right that age and the resulting need for services is one of the key drivers of need. That is probably not adequately reflected in the way resources are currently distributed.
There is undoubted evidence of the impact of the financial position on patient care. Unfortunately, this whirl of hospitals having to cancel routine procedures has a further impact on their ability to meet their financial targets, because of the reduction in their income. I hope Ministers will not simply consider this as a short-term issue; more importantly, they must look at how we can fund these things sustainably in future. They must not look at health and social care in their separate siloes but see them as a single system and genuinely look at how we are going to take things forward.
If we do not address this problem, we need to be honest with our constituents about the consequences. People talk about a collapse in the NHS. I do not believe that that will happen, but what we will see is a continuing deterioration in performance, with a real impact on the quality of care, which will put lives at risk. The safety, which is essential to our patients and which the Department of Health has prioritised, is increasingly in danger of slipping.
A number of Members have commented on sustainability and transformation plans. In principle, they are extremely important as a way not only of acting as a road map for the Five Year Forward View, but of enabling us to return to a much more logical way of planning for integrated health and care. Hopefully, they will enable us to get away from endless contracting rounds in the NHS and move towards genuine planning. I am afraid that what has undermined them has been inadequate local consultation, inadequate working with local authorities, and, crucially, inadequate funding. If we do not have the funding to put in place the transformation of services, we will see these plans fail. Increasingly, those plans are being seen as a vehicle for cuts—
Dr Wollaston
I say to the hon. Lady that, genuinely, these plans offer us an opportunity to produce a transformative process, but they are being undermined by a number of critical points, and we should address them.
Meg Hillier
I agree with the hon. Lady. My own hospital does the same, taking on healthcare assistants and bringing them up through the system. The challenge is: how many people will be put off without that bursary payment? We need a clear answer from the Minister about what analysis was done of the impact on the workforce of that change. The amount of money involved is relatively small compared with the challenges and problems of not being able to provide a health service if we do not have enough nurses.
Helen Goodman (Bishop Auckland) (Lab)
I am pleased to follow my hon. Friend the Member for Bradford South (Judith Cummins), who spoke with great feeling about her constituents’ needs, as she always does.
If my constituents were here and saw the estimates, they might be a bit disappointed. A few weeks ago, we had an interesting public meeting. They said to me, “Helen, it’s marvellous: because of Brexit, we’re going to get £350 million extra for the NHS every week, and our A&E department can be reopened.” There seems to be no mention of that in the estimates.
Under our local sustainability and transformation plan, there is a proposal to close the A&E department at Darlington hospital, which would be an unutterable disaster for my constituents. We are continually told that the purpose of the STP is to improve services, but I really wish the local NHS managers would stop pretending. They have also told us that by 2020 there is going to be a funding shortfall of £281 million, so nobody believes it is about improving services; everybody believes it is about managing on limited resources.
I appreciate that pressures on the health service are increasing because of the ageing population, but this level of austerity in the health service is unnecessary. The British economy is bigger now than it has ever been; it is 14% bigger than it was in 2010. Other hon. Members have pointed to the disparity between spend in the UK, which is $3,235 per capita per year, and in Germany, which is $4,800 per capita per year. In the UK, there are 2.8 hospital beds per 1,000 people, whereas in Germany, the figure is 8.3. It does not need to be like that.
I wish to focus on the needs of rural communities, which we have not spoken about this evening. Were the A&E department in Darlington to close, it would be an extremely serious problem for the people to the west of Darlington, and at the top of Teesdale. People are already travelling 30 miles to get to hospital. The response times of the North East ambulance service are not what they should be. People often wait 20 or 30 minutes for an ambulance to arrive, which means that it could be an hour before they get into the hospital.
One of my local councillors has done an absolutely brilliant piece of analysis, looking at the journey times that would be needed were people to have to go to the James Cook university hospital in Middlesbrough. At the moment, someone living in Bishop Auckland would take 25 minutes to get to hospital. It would go up to 39 minutes. If they live right up in the top of the dale, the journey time is 39 minutes. That would go up to 64 minutes. The STP managers running the review say that they want to treat cardio-vascular and trauma patients in specialist centres where a critical mass of staff can maintain their skills. That sounds reasonable enough, but my constituent Judy Sutherland asked them, “What proportion of emergency journeys are not cardio-vascular or trauma cases?” The answer was 94%. So, for acute asthma, adrenal crisis, anaphylactic shock, appendicitis, diabetic coma, meningitis and renal failure—the list goes on—there would be no benefit to being in a specialist centre.
The extra mortality from the longer travel time goes up quite dramatically. In Bishop Auckland, it goes up by 2.4%, Barnard Castle by 3%, and in Middleton in Teesdale by 3.2%. That is why the pretence that this is about improving the quality of healthcare is not believed by my constituents. They are tired of being told that services should be nearer to home when, in fact, they are being pushed further and further away. There is a question mark over the Richardson community hospital in Barnard Castle. The A&E and the maternity services have been taken out of the hospital at Bishop Auckland. When that was done, we were told that it would be absolutely fine, because people would be able to go to the Darlington A&E, but now that A&E is under threat. People in rural communities are facing this constant process of attrition.
Peter Heaton-Jones (North Devon) (Con)
I have similar challenges in my rural constituency of North Devon. The STP is looking at the same issues that the hon. Lady is raising, and they, too, will lead to long travel distances. As Ministers know, that is something that I have raised with them and brought up in this House on a number of occasions. Does the hon. Lady agree that the challenges that the STP is trying to address have not happened in the past 18 months or the past six years; they have built up over many years and over many different Governments?
Helen Goodman
The proposal to close Darlington A&E has come up only under this Government. It was not proposed under the coalition Government or the previous Labour Government. This Government must take responsibility for what is happening now.
On Saturday, I went to Alston in Cumbria. The people there are also running a campaign to stop their local hospital closing, because they will then have to go to Carlisle, which is 34 miles away. That is a long way, especially in Cumbria, where the weather is absolutely terrible and the road is often blocked. Ministers need to take more account of this big rural issue. People in Alston are also worried that there will be a cynical saving—the hospital in Copeland—and that they will face even bigger cuts. Perhaps the Minister will give us an assurance about that. The interaction between health and social care is well understood. We all know that cuts to social care mean a worse quality of care and less time for individuals.
Helen Goodman
I would rather not because of the speaking limit.
Cuts also mean pressure on the NHS. Durham has faced really big cuts to social care. Between 2011 and 2017, it has had to make £186 million of savings. Child and adult care services comprise 63% of the total budget in the area, and adult social care cuts have been £55 million. The much vaunted precept raises only £4 million, and we have another £40 million of cuts to come. Even taking into account the better care funding, cuts by 2019-20 will come to £170 million. That means that there will be no social care in whole villages in my constituency. We are told that the Chancellor is minded to do something about it. Will he make up the full £4.6 billion that was cut in the last Parliament?
We have discussed the long term, which we do need to think about. The discussion about social insurance is important and significant, but we should also think about which institutions we would be asking people to put their money and their savings into. A lot of private sector organisations are, frankly, ripping people off with fees of £600 and £900 per week, even in my constituency in the north, where costs are not the highest. With fees like that, we do not even see highly trained people with expertise in dementia, but the same workers on minimum wages with low levels of training. We need to look at a stronger mutual approach and cut exploitative private sector contractors out of adult social care.
Mr Speaker
I remind the remaining speaker that the Front Bench wind-ups need to start at 9.28 pm, so speeches need to conclude relatively promptly.
Oral Answers to Questions
Helen Goodman Excerpts(7 years, 11 months ago)
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Mr Hunt
I hope that I can reassure my hon. Friend about this because the reality is that we increased the number of GPs by 5% in the previous Parliament, and in this Parliament we are planning an increase of another 5,000, which will be the biggest increase in GPs in the history of the NHS, and will go along with considerable extra resources.
Helen Goodman (Bishop Auckland) (Lab)
I will focus on the half of the question that the hon. Member for Gainsborough (Sir Edward Leigh) missed out. The other day I had a meeting with some constituents who told me that they were so pleased that we were leaving the European Union because it meant that the extra £350 million could be used to reopen the A&E department at Bishop Auckland. Has the Secretary of State found that £350 million yet?
Mr Hunt
The hon. Lady might have noticed that I personally did not talk very much about that £350 million. Whatever resources we have post-Brexit will have to be set in the overall economic context, but of course the great thing is that, post-Brexit, that will be a decision for this Parliament.
National Health Service Funding
Helen Goodman Excerpts(8 years ago)
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Jonathan Ashworth
I will give way in a few moments.
By 2017, NHS spending per head will level out, and, head for head, by 2018 NHS spending will be falling under this Conservative Government. Trusts ended last year in deficit for the second year running—they were £2.45 billion in deficit and they are reported to be heading for a deficit of around £670 million at the end of this financial year.
Helen Goodman (Bishop Auckland) (Lab)
Is this the explanation for the secret plan in County Durham to cut the number of beds for frail elderly people by 20%?
Jonathan Ashworth
My hon. Friend makes a very important point. I will be coming on to those secret plans as I develop my speech.
We will be spending less on the NHS as a proportion of GDP than our European neighbours such as Germany, France and the Netherlands. The NHS maintenance budgets have been repeatedly raided, with billions that had been allocated to capital routinely being switched to revenue to plug gaps.
Helen Goodman
Since the Secretary of State thinks community hospitals are so important, will he guarantee that the Richardson in Barnard Castle will stay open?
Dr Sarah Wollaston (Totnes) (Con)
It is a pleasure to follow my hon. Friend the Member for Central Ayrshire (Dr Whitford).
I want to touch briefly on the importance of clear data, the current financial position, and the need to agree on a settlement for the future in this House rather than continuing to have such confrontational debates.
I can see how the £10 billion figure has been arrived at: by adding an extra year, starting from 2014-15, and by transferring budgets to NHS England. When the Secretary of State refers to the NHS, he is actually referring to NHS England. He is not including public health. He is not, for example, including Health Education England. However, it is crucial that they are considered. As my hon. Friend the Member for Central Ayrshire said, when we talk about transferring money from public health to the NHS England budget, we are cutting off our ability to control the increase in future demand. We face significant challenges, which we will not address unless we invest in those future services.
We sometimes talk about public health as if it were not frontline care, but it is. We are talking about, for instance, services to help people with addictions and sexual health services—really important costs for the NHS. There is also the challenge of the reduction in Health Education England’s £5 billion budget, £3.5 billion of which is spent directly on the wages of health service doctors who are undergoing training, but also delivering frontline services. Cuts to Health Education England cut us off from future sustainability, because that is the budget that trains, retains and sustains our existing workforce. This is all crucial to frontline services.
The other way in which the £10 billion figure has been arrived at is by changing the baseline from which we calculate real-terms increases. I would say that it has never been more important than it is now for the public to have confidence in the data that we use. Trying to return us to talking about total health spending is not trying to be awkward; it is trying to be honest with the public. It is difficult to argue that more funding for health and social care is necessary if a £10 billion increase has been claimed. It is important that we continue to use the same consistent baselines that have been used in the past, so that the public can see what has happened to total health spending.
I welcome the front-loading of the settlement, and I welcome the fact that the NHS has been relatively protected in comparison with other departments, but the scale of the increase in demand is extraordinary. When Simon Stevens talked about welcoming the increase that had been granted, he made it clear that it was dependent on a fair settlement for social care and a radical upgrade in public health, and those two aspects are lacking.
I think that both sides are correct. I can see how the Secretary of State has arrived at the £10 billion figure, but whenever that figure is used we should also present a figure that refers to total health spending in the way in which it has always been referred to in the past. I think that that would help to build the Secretary of State’s case for an increase in funding as we go forward.
Like others, I hope that we shall see an uplift for social care in the autumn statement, because the impact of social care on the NHS is now profound. There cannot be a Member in the House to whom it has not been made clear by people who come to his or her surgery that the state of the care system is in collapse and providers are in retreat. Even those who can afford to pay are finding it difficult to gain access to care.
Helen Goodman (Bishop Auckland) (Lab)
In my constituency there are some villages where no social care is available because none of the private providers can afford to deliver it. Does the hon. Lady, in her role as Select Committee Chair, know whether that applies in other parts of the country as well?
North East Ambulance Service
Helen Goodman Excerpts(8 years, 6 months ago)
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Helen Goodman (Bishop Auckland) (Lab)
I am most grateful to my hon. Friend for securing this extremely important debate. I am very concerned about the management. That was highlighted to me when I wrote a letter to the North East Ambulance Service about ambulance services in Teesdale. I got a letter back headed, “Ambulance services in Weardale”. The worst thing that happened was to Violet Alliston, whose partner rang three times in an hour. No ambulance came, and she died. That is obviously totally unacceptable.
Mrs Hodgson
I thank my hon. Friend for that very sad example, which I fear and predict will be one of many—perhaps not all with such a tragic ending—that we will hear this afternoon.
The correspondence I have received about ambulance waiting times in my constituency makes it clear this has been a persistent problem since 2012. I was first told about the problem with waiting times by the league chairman of the Wearside football league after he raised concerns with the North East Ambulance Service directly about numerous incidents. In his correspondence, he said that waiting times for football players who had broken their leg had continually gone over 70 minutes. In one case, after a player broke his leg, the league chairman called 999 at 11.40 am, but he was called back and informed that no ambulance was available and that he should take the player by car. He rang 999 back and complained that that went against what trained first aiders were told about not moving people with broken bones. An ambulance then arrived at 1 pm—80 minutes after the initial call—and the young man was taken to hospital.
Ever since that case, I have received a range of correspondence from other constituents highlighting failures and shortcomings in ambulances going out to emergencies. An issue particular to my local area—I do not think it is replicated in other parts of the region, although we may hear differently when other colleagues speak—is that ambulances struggle to get to certain parts of my constituency due to confusion in finding the address. That has been repeatedly brought to my attention by my constituent, Mr Walker, who for the past two years has highlighted the difficulty that ambulance crews have getting to the Usworth Hall estate in Washington. When a shocking murder took place in the area in 2014, the ambulance did not arrive for more than an hour and the man died.
An example of that failure happened when a woman was in labour and her sister-in-law had to deliver the baby because the ambulance went to the wrong street. The children of the woman in labour had to search the streets for the ambulance. When they found it, they guided it by foot, as they were not allowed on board, for more than a mile to where it should have been.
I could give many other examples. It has been a persistent issue for the residents of Usworth Hall, who, through Mr Walker, have highlighted their concerns and their exasperation at those problems. On each occasion, I forwarded their concerns to the North East Ambulance Service, which looked into each issue. To its credit, it has tried to address them. That was highlighted in a letter to me in July 2014, in which it explained that it had set up an electronic flag system for all residents in Usworth Hall and had a duty manager from its control room go out and survey the area for problems. However, Mr Walker contacted me again at the beginning of April and informed me that an ambulance was parked outside his house one evening. When he went out to speak to the staff, he found that they were lost and supposed to be in another street.
Paramedics understandably do not have the local knowledge that residents have, but sat-nav equipment is provided to help ambulances get to the right destination at the right time.