National Health Service Funding Debate
Full Debate: Read Full DebateJeremy Hunt
Main Page: Jeremy Hunt (Conservative - Godalming and Ash)Department Debates - View all Jeremy Hunt's debates with the Department of Health and Social Care
(7 years, 9 months ago)
Commons ChamberIn a few moments.
We have spotted the Secretary of State’s conjuring act because we have seen this Tory trick before—robbing Peter to pay Paul. The result of this trick is cuts and underfunding, more pressures flowing through to the frontline, and, as the NAO said,
“Financial stress…harming patient care”.
In all our constituencies we see ever-lengthening queues of the elderly and the sick waiting for treatment. Across the board, we see the worst performance data since records began.
What world is the Secretary of State living in? Half a million patients have waited for four hours or more in A&E in the past three months—the worst performance for this time of year for more than a decade—and he says it is nonsense. Some 350,000 of our constituents are waiting longer than the promised time for elective treatment—some have been waiting more than a year—and he says it is nonsense. Delayed discharges from hospitals are at record levels, and he says it is nonsense. The number of people waiting for 12 hours or more on trolleys has increased by over 700% since 2011-12.
I beg to move an amendment, to leave out from “House” to the end of the Question and add
“welcomes the Government’s investment, on the back of a strong economy, of significant additional funding and resources each year for the NHS during the 2015 Parliament; notes that this settlement was frontloaded at the specific request of the NHS in NHS England’s own plan to deliver an improved and more sustainable service, the Five Year Forward View; and further notes that the NHS will receive a real terms increase in funding in each year of the Spending Review period, while the Labour Party’s Manifesto at the last election committed to only an extra £2.5 billion a year by 2020, far less than the NHS requested.”.
As I did in last week’s debate on social care, I start by recognising the fantastic work done by NHS staff up and down the country. This autumn, I met a mental health nurse who told me how she had had to cope with the pressure of one of her patients throwing himself off a bridge the day after a consultation. I am sure that all Members have stories of the incredible dedication of NHS staff—not just people doing their jobs, but people putting their heart and soul into their work, staying late, going the extra mile, and sacrificing home time and holidays to be there for patients. As I did last week, I also recognise the 50,000 NHS staff from EU countries, including 26,000 low-paid staff, who do a brilliant job. Today we have heard concerns about funding, A&E—
Will the Secretary of State give way?
I will give way in a moment, but I just want to finish this sentence, if I may.
We have heard concerns about funding, A&E performance, waiting times and morale, and I want to answer them all. There are many pressures in the NHS, but I also want to recognise some successes, because one of the things that is most damaging to morale is not giving credit where it is due.
Can the Secretary of State explain why he has made scores of redundancies in north Staffordshire? In my 15 years as an MP, I have never seen the local NHS in such a meltdown, with a scorched-earth policy of cuts and closures, and more to come with next year’s still-secret STP. When will the Government realise that pressures on social care and the NHS are such that those services are unsustainable without decent further funding and investment?
As the hon. Gentleman knows, those things would certainly be unsustainable if we had followed the Labour party’s investment plans at the time of the previous general election. If he wants to know what is happening to staff, let me tell him that in the period I have been Health Secretary, we have got 5,000 more doctors and 10,000 more nurses. That is what happens when we have a Government who are prepared to invest in the NHS.
The shadow Health Secretary talked about A&E—he is right to say that we are not hitting the target, and we are doing something about that—but he did not tell the House that, since Labour left office, we have recruited 1,200 more doctors for A&E departments, which is a 25% increase, including a more than 50% increase for consultants. Every day, we are seeing 2,500 more people within four hours.
Will the right hon. Gentleman give way?
I am a junior doctor in A&E, of which the right hon. Gentleman speaks, and I can say that morale is at an absolute all-time low. We have a recruitment and retention crisis in A&E. We are losing all the fantastic staff whom we have been able to recruit because this Government are not recognising and accepting the fantastic workforce on our A&E frontline. All the doctors are leaving.
With respect, the hon. Lady might be on the wrong side of the House, because I started my speech by recognising the brilliant work done by doctors and nurses, something that the shadow Health Secretary conspicuously failed to do. Let us look at her own hospital: since 2010, St George’s has—[Interruption.] I do not know whether she is interested in hearing my response to her intervention. Since 2010, her hospital has had 884 more nurses and 240 more doctors, and her CCG had a £10 million funding increase this year.
I thank the right hon. Gentleman for allowing me to speak again. I shall refer at length to St George’s hospital in my speech, but it is very unfair of him to bring it into this debate. It is because of this Government that St George’s hospital is operating at a £50 million deficit. It is because of this Government that we are now in special measures. It is—
Order. The hon. Lady is hoping to catch the eye of the Chair later in the debate. As it is, there will be a five or four-minute time limit, so Members who intervene must do so very briefly and not very frequently. If they do not do so, I am afraid that they may not be called to speak.
The shadow Health Secretary also did not talk about cancer. In 2010, we had the lowest cancer survival rates in western Europe. Since then, we have referred for cancer tests 2,200 more people every day, and 100 more people are starting cancer treatment every day. The cancer charities say that this is saving 12,000 lives a year. On mental health, he did not mention the fact that we are treating 1,400 more people every day, with record dementia diagnosis rates.
Would not Opposition Members be a little more straightforward and honest about the wider context if they admitted the demographic challenge that this Government face, as they would have faced? The number of over-60s will increase by 50% in the next 15 years. Should they not also admit that the private finance initiative was an appalling millstone—£64 billion —to bequeath to this Government? That has had an impact on frontline care.
My hon. Friend is absolutely right to raise that point. People will be astonished to hear Labour Members wasting their time talking about a privatisation of the NHS that is not happening when they were responsible for PFI, the worst possible privatisation that has done such enormous damage.
Another point that the shadow Health Secretary did not mention was the quality and safety of care in our NHS that Labour left behind. The Francis report revealed massive problems—short staffing, a culture of denial and cover-ups—and they were not just at Mid Staffs but, as we now know, at Basildon, Morecambe Bay and many other trusts. Since we have been in office we have changed that. We have put 31 hospitals into special measures, which is more than 10% of hospitals across the entire NHS, and we have recruited record numbers of doctors and nurses.
I want to tell the House about one hospital that was put into special measures. Care was unsafe at Wexham Park in Slough—so much so that fewer than half the hospital staff were prepared to recommend the care provided there to their own friends and family—but it has gone from having six of its eight clinical areas rated as requiring improvement or inadequate, to having all eight of them rated as good or outstanding. It has come out of special measures, as have 15 hospitals in total, and we should all commend the staff who have worked incredibly hard to turn around those hospitals.
The right hon. Gentleman has the nerve to talk about the inheritance from a previous Administration, when what we inherited in 1997 was people dying on waiting lists of more than 18 months for heart operations.
I have often from this Dispatch Box been prepared to praise some of the achievements of the last Labour Government. They did bring down waiting times, but they did not focus on the quality and safety of care.
What we now know from the CQC’s new regime, which has just finished its first round of inspections, is that 56% of our hospitals are good or outstanding. One could say that it is disappointing to know that 44% of hospitals are not, but to those who would use that as a political weapon I say this: we are the only country in the world brave enough to set up an independent inspection regime, and if we want to have the safest, highest quality care, the first thing we need to know is where it is good and where we need to improve it. I thank the chief inspector of hospitals, Professor Sir Mike Richards, for his outstanding work in raising quality.
The right hon. Gentleman talks about the inspection regime, but I think I am right in saying that it was not something he and his Government introduced. The Care Quality Commission was introduced by a Labour Government, as far as I am aware. As I know from North Middlesex hospital, hospitals end up in special measures because they are underfunded and under-supported, and cannot get the doctors they need.
The right hon. Lady is right that the Care Quality Commission was set up by the last Labour Government, but it did not have independence from the Government in its inspection reports. When we legislated for that, Labour tried to vote it down. We got it through and changed the inspection system, and it is working extremely well.
I want to move on to the substance of the debate, which is about the funding of the NHS. I congratulate the hon. Member for Leicester South (Jonathan Ashworth) on his courage—indeed, his chutzpah—in confronting the issue of funding, despite inheriting a Labour policy to cut NHS funding by £5.5 billion a year by the end of the Parliament. He is right that there has never been greater financial pressure—we have had the financial crisis in 2008, the deficits and the growth in demand from the ageing population—but he must accept that that makes it all the more extraordinary that Labour wanted to cut the NHS budget in 2010 and to cut it from the current levels in 2015. I simply say that we could, as a Government, have chosen to cut NHS funding from this year’s level by £1.3 billion, as under Labour’s plans, but we would have had to lay off 11,000 doctors or 40,000 nurses.
The problem with the Conservatives’ script is that they talk about NHS funding, but they completely neglect social care. There can be no debate about the fact they have cut social care every year for the last six years, taking support away from half a million older people, many of whom are now trapped in hospital beds. Greater Manchester says that it has a shortfall of about £80 million in social care; the figure is £1 billion nationally. Has the Secretary of State raised this issue with the Chancellor? Has he made an emergency bid for funding? Will there be more money for social care this year?
That is not the problem with our script; it is the problem with the right hon. Gentleman’s script, because as shadow Health Secretary he sanctioned a policy that would have given the NHS £1.3 billion less this year, and at the last election the then shadow Chancellor said he would give not a penny more to local authorities, whereas we are seeing social care funding go up by £600 million this year. More money is going into the NHS and the social care system under a Government who are committed to funding them both.
What is especially wrong with the argument made by the shadow Health Secretary, whom I welcome to his place for his first Opposition day debate, is his suggestion that the Government have not honoured their promises to the NHS. What did the independent commentators say at the time of last year’s spending review? Simon Stevens, whom he quoted, said
“our case for the NHS has been heard and actively supported.”
NHS Providers, which he quoted, said it was
“a good settlement for the NHS.”
The King’s Fund, which he quoted, said it was
“a good settlement for the NHS”.
In fact, because of the Government’s commitment to the NHS, we are spending 10% more on it as a proportion of GDP than the OECD average—that is more than Norway, Finland, Korea, Australia and New Zealand.
Does my right hon. Friend agree that without that investment since 2009-10 to last year there would not have been the 1.6 million more operations within the NHS that benefit all our constituents?
My right hon. Friend is right. I congratulate him, because he was part of the shadow Health team that persuaded the then shadow Chancellor and Leader of the Opposition that we needed to make that investment, thanks to which the NHS is doing 5,000 more operations every single day.
My right hon. Friend has been very gracious in taking interventions from all sides, and also in citing independent voices. Has not the independent King’s Fund also pointed out that the sustainability and transformation plans that he is overseeing are the “best hope” of securing long-term improvement for both health and care in this country? Does he agree that the Opposition should pay rather more attention to those independent experts, rather than repeating their own press releases?
My right hon. Friend is right that just occasionally we should listen to experts—but only very occasionally. In the spirit of listening to experts, and as the Leader of the Opposition is here, I will tell my right hon. Friend something else the King’s Fund has said that he will agree with, which is that
“claims of mass privatisation were and are exaggerated.”
Let us not go chasing down rabbit holes.
The result of this Government’s commitment to the NHS is that real-terms spending per head has gone up by 4.6%, which is double the rate in Scotland and three times the rate in Wales. The hon. Member for Leicester South also mentioned the National Audit Office. He did not mention that the numbers quoted in the NAO report are last year’s figures. He chose not to mention this year’s numbers, which were published last week. They show that 40 fewer trusts are in deficit. Yes, a year ago, half of trusts were missing their financial plans, but now 86% are hitting those plans.
The latest figures, from Friday, show that the deficit will fall 73% from last year, and even lower than the year before. Why is that? It is because of a sustained effort by the NHS to tackle the problem. [Interruption.] The Opposition do not want to hear this, but the truth is that the NHS is gripping the very problem the shadow Health Secretary called a debate on. Agency spend, one of the biggest challenges, is on track to go down from £3.7 billion to less than £3 billion. The rates paid for agency nurses are down 18% on a year ago, and for locum doctors they are down 13%. Our procurement changes are on track to save half a billion pounds. The money we raise from international visitors is up three times, from £84 million to £289 million.
It is important that we focus not just on the level of spending but on where we spend the money. With long-term conditions such as diabetes, is it not essential to focus on preventive work, which in the long term will save the national health service a huge amount of money?
I congratulate my right hon. Friend on the calm and dignified way he is dealing with this debate, as compared with the Opposition. May I put in a plug for local community hospitals, not just in my constituency but right across the country, and how vital their retention is for good quality care in the future?
Since the Secretary of State thinks community hospitals are so important, will he guarantee that the Richardson in Barnard Castle will stay open?
I will make some progress, but I will find time to give way to hon. Friends who I know want to come in.
I want to pick up on a particularly extraordinary comment made yesterday by the shadow Health Secretary. He said:
“aggressive efficiency targets have contributed to deficits”.
That is a curious thing to say, first because his own spending plans would have meant £5.5 billion more efficiencies. If he thinks our plans are aggressive, I just wonder how he would describe Labour’s approach. Secondly, I know we are all Corbynistas now, but basic economics suggests that efficiency plans do not increase deficits, but reduce deficits. That is what we need to do in the NHS, because we want the money to go to patient care.
There is another danger in the shadow Health Secretary’s argument, a trap that is very easy not just for him but for many commentators to fall into: the suggestion that this is a uniform problem across the NHS that it is powerless to grip without further Government intervention. The reality is that there is huge variation across the system. The deficits at good or outstanding trusts are five times less than the deficits at other trusts. If all trusts had the same financial performance as the good or outstanding ones, we would have a surplus of nearly half a billion pounds. Half the deficits are from just 22 trusts. We see this variation on a very specific level. For example, the amount paid for a pair of surgical gloves, which are very important to all hospitals, is £1.27 in some hospitals and just 50p in others. As for waiting lists, of 1,000 people who are waiting more than a year for their treatment, which is unacceptable, there is just one person from an outstanding trust who has been waiting that long. Some 93% are from trusts that require improvement or are inadequate. This is why we have a huge programme to support and improve those trusts and deal with the challenges they face.
On financial management, does the Secretary of State recognise that in Labour-run Wales agency staff spend has increased 60% in the past year? That compares with the tough measures taken in England to crack down on wasteful spending.
The Secretary of State is trying to blame hospitals for the deficit, but the point is that the spend on agency staff has ballooned in England over the past six years. The reason is that the Government, and their predecessor, cut nurse training places and left hospitals in the grip of private staffing agencies. It is therefore simply not fair of the Secretary of State to stand at the Dispatch Box and blame hospitals for a problem of the Government’s making.
I am not blaming hospitals. We are supporting hospitals to deal with the problem. The root cause of the problem, set out in the Francis report, was hospitals covering up bad problems. We said no to that and said that we were going to sort it out by having more nurses on our wards. That is why, in the four years that I have been Health Secretary, we have had 10,000 more nurses on our wards.
Does my right hon. Friend agree that the public are finally starting to see through the usual Labour smokescreen that is high on rhetoric and low on alternative solutions, with very patchy and poor delivery when Labour is given the chance? My right hon. Friend’s approach to the health service—a quiet delivery of change and proper funding—is what the public are looking for.
It is noticeable that the two potential solutions we have heard have been from Opposition Back Benchers—the right hon. Member for Leicester East (Keith Vaz) and the former shadow Chief Whip, the right hon. Member for Doncaster Central (Dame Rosie Winterton)—and not from the Opposition Front Bench. My hon. Friend makes an important point.
The shadow Health Secretary is right to hold the Government to account for the funding of the NHS and the social care system, but it is a big mistake to distil all issues around the NHS into the simple issue of money. That subcontracts the responsibility for safe, high-quality care to politicians. If we are going to be the safest and the best quality system in the world, that has to be everyone’s job, everyone’s focus and everyone’s commitment—politicians, yes, but managers, doctors, nurses, porters, healthcare assistants and every single person working in NHS.
On the way forward, we first need to move to accountable care organisation models and the “Five Year Forward View”, including the STP process. The shadow Health Secretary called STPs “secret plans”, but in fact 28 of the 44 have been published and the rest will be published before Christmas. Many in the House, on both sides, objected to the Health and Social Care Act 2012 because they felt it did not do enough to support integrated care. Well, now we have a process that is bringing together the NHS and the social care system, acute trusts and primary care, at a local level. That is a big prize and we should support it, not try to make political capital out of it.
In Stoke-on-Trent, the CCGs sit on the STP group. We have still not seen the report, but we have seen an executive summary. When the STP group suggests one thing, the CCG undermines it by closing community hospitals and cutting community beds. They are not working together; they are working against each other.
That is exactly what we need to sort out. We have the STP process to stop people doing their own thing, instead of having a co-ordinated, well-planned strategy. If we stick with this process, embrace innovation and technology and retain a relentless focus on safety and quality of care, in this Parliament we will see a million more people accessing mental health treatment every year; 5,000 more doctors working in general practice and a transformation of services through GPs; a new four-week cancer waiting time standard that will save 30,000 lives a year; more failing hospitals turned around; the weekend effect tackled; more doctors and nurses; and an NHS staying true to the promise made to patients in 1948 that safe, high-quality care would be there for everyone, regardless of income. That is what this Conservative Government will deliver, and I urge the House to support the amendment.