NHS and Social Care Funding

James Heappey Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

We stood on a manifesto that would have delivered more doctors and nurses for our NHS; the hon. Gentleman stood on a manifesto that said the Conservatives would cut the deficit and not the NHS. They are cutting the NHS and failing on the deficit.

I have a few direct questions for the Secretary of State about Royal Worcestershire hospital. I was grateful for his remarks on Monday, but I want to press him a little further. It has been reported that NHS England was warned of a bed crisis as early as 22 December. Will he update the House on what urgent meetings he is having on Royal Worcestershire? When will we be closer to knowing the outcome of an inquiry? In that context, there is a proposal in the sustainability and transformation plan for the Worcestershire area for a significant reduction in the number of acute beds. The Secretary of State will say that these are local plans and so on, but in the context of the issues in Worcestershire, will he comment on whether he thinks that is the right proposal to follow?

On STPs more generally, the NHS is going through a winter crisis, and it is about to go through another top-down reorganisation—[Interruption.] Someone says it is bottom-up, but it is not; we know it is coming from the top. Those making the STPs are being told that they have to fill a financial gap of £21.764 billion—that is the reality that STPs throughout the country now have to face. We have seen the plans, so we know that that is going to mean a number of community hospitals being closed, a number of A&Es being downgraded, and acute beds being lost.

In places such as Devon, where the STP talks of an over-reliance on hospital beds, the implication is that beds will be lost. Closures and downgrades are being considered throughout Somerset, with their priority list of vulnerable services including maternity and paediatrics. In London, a city with the very worst health inequalities, the STPs are expected to deliver better health outcomes for the city’s growing 10 million residents with £4.3 billion less to spend. Will the Secretary of State explain to the House how he expects the NHS to perform in future winters, when we have a growing elderly population and STPs are pursuing multibillion-pound cuts to beds, A&Es and wider services?

[James Heappey (Wells) (Con)]

I was recently briefed by an excellent and well-respected local GP and a clinical psychiatrist, who were the authors of our county’s STP. Will the shadow Secretary of State explain how on earth they are responsible for a top-down reorganisation?

[Jonathan Ashworth]

Because they were being told by NHS England, which was in turn told by the Secretary of State.

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[Maria Caulfield (Lewes) (Con)]

I appreciate the opportunity to speak in this debate. For the record, the last time I was in an NHS hospital was when I was working a night shift on Saturday. I declare an interest in that I am a nurse who has worked during this year’s winter crisis, but I have also worked during winter for the past 20 years.

[James Heappey]

I apologise for intervening so early in my hon. Friend’s speech, but the hon. Member for Dewsbury (Paula Sherriff) is too busy congratulating herself on her own speech to note that my hon. Friend was working in an NHS hospital on Saturday night.

[Maria Caulfield]

I thank my hon. Friend, but that is obviously not of interest to Labour Members. I have been a nurse for over 20 years and have seen 20 years’ worth of winter crises. They are not unusual. There is no doubt that there is more pressure this year than ever before—we have heard about record numbers of people attending A&E—but there have been winter crises under many previous Governments. It was not unusual when I worked in A&E for patients to be treated in corridors or on chairs—wherever there was space. It was not unusual for ambulances to be queued up around the block, waiting for hours to unload patients—[Interruption.] I still work in the NHS and disagree with the chuntering from the Opposition Benches.

--- Later in debate ---

[James Heappey (Wells) (Con)]

The Wells constituency faces some real challenges in healthcare. We have an ageing population, and demand for the local NHS is growing rapidly. There is no doubt that our primary healthcare system is under considerable strain, as is our adult social care system. Our hospitals, too, face record demand. However, to call this a crisis does a disservice to those in the clinical commissioning group and our local hospital trust who have worked so hard to prepare for the incredible challenges that they face this winter.

Demand in the four A&Es that serve my constituency was significantly higher in the week between Christmas and the new year than in the same week the previous year. In two A&Es, demand almost doubled. I know that the A&E staff had to work extraordinarily hard to meet that demand and I know, too, from some constituents who contacted me that some people were not seen within the time that they might expect. However, I have heard from others who arrived at A&E expecting bedlam, only to be seen in well under four hours. Indeed, during last year’s Christmas recess, I spent the early hours of Christmas eve in Weston general hospital’s A&E with my then three-year-old. Like this year, the Labour Front Benchers were claiming crisis, yet I saw some incredible clinicians doing an incredible job well within the required timelines. Moreover, an outpatient appointment needed in the week between Christmas and new year was easily arranged and kept. My personal experience is just one of the millions of experiences within our NHS each year, but I highlight it because if we are to have an honest, factual debate about our health system, we should caution against the emotion of individual experiences, for there will always be at least one that illustrates whatever point we seek to make.

Further into the hospital system, three of the four hospitals that serve the Wells constituency had more beds available in the last week of 2016 and the first week of 2017 than they did in the corresponding period in the previous year. Although occupancy at Taunton and Yeovil was 81% and 82% respectively last week, it is true that occupancy in Bath was 93%, and in Weston-super-Mare 100%. Make no mistake: occupancy levels such as those are a cause for real concern. But it is also important to note that although things are tight, so far the trusts are managing. However, I know that in all four of those hospitals, particularly in Weston, far too many beds are blocked by those who would be discharged if care at home could be arranged.

The Government have made more money available for adult social care and have given councils greater flexibility to increase council tax in the interim, but Somerset County Council and our local NHS organisations are justifiably still very concerned. I encourage the Government to look again at the local government funding settlement and adjust it to ensure that the funding gap between urban and rural areas does not widen and that funding for adult social care clearly and fully reflects the places in the country where the demographic is most top-heavy and where rurality increases the costs of delivering that support.

Finally there is the challenge that we face locally in primary healthcare. Local practices have assured me that anyone requiring an emergency appointment is seen on the day. However, it is true that my constituents are too often expected to wait a week or more if they ask to see their regular GP. Quite understandably for those with longstanding and complex health issues, they expect to see the doctor they know, so these waits are unacceptable, but it is wrong to connect the waits solely with funding. The greater challenge in Somerset is not the primary healthcare budget, which has risen for each of the past three years, but our ability to recruit new GPs.

The Secretary of State has worked hard to deliver more GPs into the whole system, but now rural CCGs such as Somerset’s will need to look at what initiatives could be developed to encourage new GPs to ply their trade in rural general practice. Furthermore, we must listen to and support those responsible for our STPs. We have called again and again for politicians to keep our noses out of NHS planning. Now that we have and local clinicians are now at the helm, the Opposition dismiss their work as well because it is politically expedient to do so.

The STP in Somerset has been written by people who really know their craft. When I asked them whether they would have written the plan as it is, even if there were no resource constraints, they told me that they would. They say that the demand has changed and that the thinking on public health has changed, and they tell me that the clinical view of how and where people should recover after they have been in hospital has changed too. Things will change still further over the years ahead.

Some of the things that the STP proposes are very challenging to me and some will be very unpopular with the community I serve, but the analysis is based on an expertise that far outstrips mine, so unless I am being implored now to reassert the supremacy of politicians in these matters—we have, after all, apparently had enough of experts—I think we owe it to the clinicians empowered to now design and run our local healthcare systems to scrutinise, of course, and to support them. Moreover, those clinicians deserve to do that work without the partisan hullabaloo being stirred up by the Opposition. Our inboxes give us a great feel for how things are. Our conversations with constituents, clinicians and patient participation groups, such as the one in Cheddar that I will see tomorrow night, shape that view, too. To claim that all is perfect right now is not true, but to claim that there is a crisis is not true either. Our population and the practice of medicine are changing. This debate needs to happen—not in a partisan furore, but in an honest, constructive and supportive way.