NHS and Social Care 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, 7 months ago)
Commons ChamberI will give way in a moment. As the King’s Fund said, the reason there is a problem is quite simply because there is a
“mismatch between funding and activity”
affecting our hospitals. The response of Ministers, from the Prime Minister downwards, has been one of utter complacency. The Secretary of State told “Sky News” on Monday that things had only been
“falling over in a couple of places”.
When he came to the House on Monday to make his statement, he did not commit to extra emergency funding for social care and he did not promise that the financial settlements would be reassessed in the March Budget. It is worse than that, because while he was making his statement, his spin doctors were telling the Health Service Journal—this on the day when the winter crisis is leading the news and he is making a statement in the House—and letting it be known that there is “no prospect” of
“additional funding to support emergency care any time before the next election.”
So there is nothing for social care, nothing for emergency care, nothing to tackle understaffing and nothing to tackle underfunding—well thank you very much. What did we get as a response? We got a downgrade of the four-hour A&E target.
The Secretary of State shakes his head and says, “Nonsense”, but let me remind him of what he said in the House on Monday:
“we need to have an honest discussion with the public about the purpose of A&E departments.”
He began by saying he wanted to provoke a discussion. He has certainly provoked a backlash, not least by blaming the public, it seems, for turning up at A&E departments. He went on to say that the four-hour target
“is a promise to sort out all urgent health problems within four hours”,
but he added a little clarification, continuing:
“but not all health problems, however minor.”—[Official Report, 9 January 2017; Vol. 619, c. 38.]
That is what he said in the House, and now we have seen the letter from NHS Improvement to trusts a few weeks ago, which talks of
“broadening our oversight of A&E”.
On the four-hour standard, it said that it believed
“there is merit in broadening our oversight approach, beyond a single metric”.
So in the interests of that discussion the Secretary of State wants to engage in, perhaps he can answer our questions, although I know he avoided the questions on Sky yesterday. Does he recall that in 2015, when he asked Sir Bruce Keogh to review these matters on waiting times, Sir Bruce said:
“The A&E standard has been an important means of ensuring people who need it get rapid access to urgent and emergency care and we must not lose this focus”?
I beg to move an amendment, to leave out from “House” in line 1 to the end and add:
“commends NHS staff for their hard work in ensuring record numbers of patients are being seen in A&E; supports and endorses the target for 95 per cent of patients using A&E to be seen and discharged or admitted within four hours; welcomes the Government's support for the Five Year Forward View, the NHS's own plan to reduce pressure on hospitals by expanding community provision; notes that improvements to 111 and ensuring evening and weekend access to GPs, already covering 17 million people, will further help to relieve that pressure; and believes that funding for the NHS and social care is underpinned by the maintenance of a strong economy, which under this administration is now the fastest growing in the G7.”
I thank the shadow Health Secretary for bringing this afternoon’s debate to the House. He is right to draw attention to the pressures in the NHS, but, regrettably, I will have to spend much of my time correcting some totally inaccurate assertions that he has made, and that is a shame. This is an important debate for our constituents—for his and for mine—and for the NHS. The country deserves a proper debate, but that is difficult when we are given misinformation at a time when the NHS is under sustained pressure.
I am also very pleased to see the Leader of the Opposition in his place. I think that he has become rather a fan of my parliamentary appearances—[Interruption.] It is a Jeremy thing, he says—if only. I wish to address one part of my speech to him, because it is an area of policy for which he is perhaps more personally responsible.
Winter is always challenging period, and I want to repeat the thanks of the shadow Health Secretary and the thanks that I gave on Monday to NHS staff. According to NHS Improvement, on the Tuesday after Christmas the NHS had its busiest day ever. Earlier in December, it treated a record number of patients within four hours. Overall, as the Prime Minister said this morning, we are seeing 2,500 more patients within the four-hour standard every single day compared with what happened in 2010. As we discussed on Monday, the NHS made record numbers of preparations for this winter, because it is always a difficult time, including having 3,000 more nurses and 1,600 more doctors in full-time employment.
Let me address what the shadow Health Secretary said with regard to Worcestershire. I met colleagues from Worcestershire on Monday. A huge number of actions are now being taken, but we must say right up front that it is totally unacceptable for anyone to wait 35 hours on a trolley and that we expect the hospital to ensure that that does not happen again. There are plans in place to open additional bed capacity this week. We have already had capacity made available by Worcester Community Trust to support the flow. The trust has deployed its chief operating officer on the task of facilitating discharges. The trust is in special measures, so we have a big management change, and a new chief executive will be starting later on in the spring.
What is wrong with what the shadow Health Secretary has just said is the suggestion that winter problems are entirely unusual. As my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) said, the NHS had difficult winters in 1999, 2008, and 2009. He remembers difficult winters from his time as Health Secretary, but there are things that are different today. One of them is that, compared with six years ago, we have 340,000 more over-80s, many of whom are highly vulnerable or have dementia. We know that when people of that age go to an A&E at this time of year, there is an 80% chance that they will be admitted to hospital.
The Secretary of State talks about correcting the points that have been made so that the House has the right information. May I repeat the question that I asked him on Monday? What are the latest figures—he should have them up to this week—for the number of people who could be discharged but have to remain in hospital because there is no community support available for them? Can he give us that figure now? He said that he would write to me, but he must know that figure now.
Let me answer the hon. Gentleman’s question. I said that I would write to him, and I will do so. He may have noticed that there are other issues that we are dealing with, which is why I may not have had time to sign the letter. The £400 million extra for local authorities over the next two years will make a significant difference and he should recognise that.
I am attending this debate because there will be constituents in Bedford and Kent who are concerned about the headlines that they have read. I am pleased that the Secretary of State will correct some of the points that have been made. What our constituents want to know is what is being done, or what should be done. I listened for 33 minutes to the shadow Secretary of State—the Labour spokesman on the NHS—on this issue, and there was not a single new idea other than spending money. Will my right hon. Friend please provide some practical answers to the problems that are being raised in the papers?
I will give way, but first I want to make some progress.
I want to talk about something else that is different in our A&E departments today compared with six years ago. Although we are sticking to the four-hour target, we also insist on much higher standards of safety and quality.
On Monday, I congratulated Labour on the introduction of the four-hour target—I support it—but we should also remember that four years after that standard was introduced, we started to see some horrific problems at Mid Staffs, many of which were in the A&E department. Some were caused because people thought they would be fired if they missed the target. Robert Francis said that the failures at Mid Staffs were
“in part the consequence of allowing a focus on reaching national access targets.”
Therefore, although we retain targets, we will not allow them to be followed slavishly in a way that damages patient care.
I have already given way to the hon. Gentleman. There are many other Members who want to intervene.
That is why we have a new inspection regime that makes it harder to cut corners in the way that used to happen when beds were not being washed, there was poor infection control and ambulances were being used as waiting rooms.
I am grateful to the Health Secretary for outlining some of the steps that he is taking in the face of this immediate emergency. Does he also recognise that the major cause of the problems in A&E is simply a lack of staff? Consequently, does he regret the huge cuts to training budgets in 2010, 2011 and 2012, which are having a real impact now on the number of nurses and doctors in our NHS?
I agree that staff numbers are critical, but we have, since 2010, 1,500 more doctors in our A&E departments and 600 more consultants. Across the NHS, we have more than 11,000 additional doctors, so we do recognise the pressures that the NHS faces. Indeed, we have 1,600 more doctors than this time last year, so we are doing a great deal to solve the problem.
Does my right hon. Friend agree that we need to learn best practice in the NHS? The hospitals that manage to integrate health and social care, such as those in Wigan and Salford which have managed to create those beds, are providing examples of best practice from which the whole NHS can learn.
My hon. Friend is absolutely right. It is a mistake in this debate to try—as I understand Opposition parties want to do—to boil this all down to the issue of Government funding when there is actually a lot of variability in the country. At this time of year, which is always difficult, some hospitals are doing superbly well in extremely challenging circumstances. We have just heard about some of the hospitals that are doing well, and there are a number of them.
I will give way to as many people as I can, but I also want to address the substantive points made by the shadow Health Secretary. He talked about the four-hour target. In his motion and his speech, he made the totally spurious suggestion that we are not committed to that target. I remind him what my right hon. Friend the former Chief Whip quoted me as saying on Monday. I did not just commit the Government to the target; I said that it was one of the best things that the NHS does. However, I also said that we need to find different ways to offer treatment to people who do not need to be in A&E. It is hardly rocket science. When there is pressure in A&E, it is sensible—indeed, I would argue that it is the duty of the Health Secretary—to suggest that people who can relieve pressure on A&E by using other facilities do so.
Just yesterday at Crawley hospital, an acute care unit was opened, which is designed precisely to ensure that people who do not need to attend A&E are properly directed to the most appropriate care, which is good for them as individual patients and good for the whole system.
That is absolutely right. To back up my hon. Friend’s point, yesterday’s OECD report said that in Australia, Belgium, Canada, France, Italy and Portugal, at least 20% of A&E visits are inappropriate. NHS England’s figure is up to 30%, which is why we need the public’s help to relieve pressure and that is what I meant when I talked about an honest discussion.
The Secretary of State told us just a moment ago that there are now over 300,000 more people over the age of 80. Surely he would have known that information from census and Office for National Statistics data when his Government took over seven years ago, so why is it that we are now seeing on the front pages of our newspapers that one in four of our A&E wards is unsafe and that we have so many challenges across the country, including in my constituency?
We did know that information and that is why we thought it was totally irresponsible to want to cut the NHS budget in 2010, and not to back the NHS’s own plan in 2015. As a result, we have 11,000 more doctors. In the hon. Lady’s local hospital, 243 more people are being treated within four hours every single day.
I will make some progress and then give way. I could have put what I said on Monday another way. I could have said:
“We have to persuade those people not in medical emergencies to use other parts of the system to get the help they need”.
I did not actually say that, but I will tell the House who did. It was the then Labour Health Minister in Wales, Mark Drakeford, in January 2015. Frankly, when the NHS is under such pressure, it is totally irresponsible for the Labour party to criticise the Health Secretary in England for saying exactly the same thing that a Labour Health Minister in Wales also says.
The Secretary of State has sowed confusion in the House and in the country on this question this week, and he is doing so again today. If he is saying the same as my friend the former Health Minister in Wales—that we want to divert people who do not need to go to A&E from doing so—I am sure that everybody in this House would support him. But we suspect that he is saying that the four-hour wait target will be disapplied to some people turning up to A&E, and that that is the downgrading he is talking about. If that is the case, the Secretary of State should come clean, and he should be clear about whose job it will be to disapply the target to some people with minor ailments.
I did not say that because we are not going to do it. As we have had an intervention from a Welshman, let me tell the hon. Gentleman a rather inconvenient truth about what is happening in Wales. Last year, A&E performance in Wales was 10% lower than in England, and Wales has not hit the A&E target for eight years. We will not let that happen in England.
I noticed that the shadow Health Secretary quoted a number of people, but one that he did not quote was the Royal College of Emergency Medicine. I wonder whether that was because of what it said about Wales this week. It said:
“Emergency care in Wales is in a state of crisis…Performance is as bad, if not worse, as England, in some areas.”
There we have it: in the areas in which Labour is in control, these problems are worse.
May I reiterate the Secretary of State’s point about the four-hour target? During the Labour Government, I was working in the NHS. Significant pressure was put on us by managers to meet the four-hour target, negating clinical need. Patients were often prioritised according to meeting the target, rather than by clinical need. That was a disgrace.
That is exactly the problem we had with Mid Staffs. We had a culture in the NHS where people were hitting the target and missing the point. Although targets are important management tools in all organisations, it is important that they are followed in a sensible way that puts the interests of patients first.
I would just like to make another point about Wales while we have the privilege of having someone here who aspired to lead the Labour party, as the current leader of the Labour party is no longer in his place.
Something that Wales and England have in common is the need to ensure that, if we want alternatives to A&E, people are able to see their GPs. I have said many times that people wait too long to see their GPs. In all honesty, I think that the GP contract changes in 2004 were a disaster. The result was that 90% of GPs opted out of out-of-hours care. But we have been putting that right. Now 17 million people in England—about 30% of the population—have access to weekend and evening GP appointments. More than that, we have committed to a 14% real-terms increase in the GP budget by the end of this Parliament. That is an extra £2.4 billion and we expect that to mean an extra 5,000 doctors working in general practice.
I can see Wales from my constituency, to continue the theme. I received an email this morning from a very distressed senior NHS manager, who says:
“I truly despair that there will not be an NHS this time next year”—[Interruption.]
You need to listen on the Government Benches, and understand what your Secretary of State is doing to the health service. I will give a precis of what my constituent is talking about.
Apologies, Madam Deputy Speaker. I should not have used the word “you.”
My constituent has written to me saying:
“The NHS is in crisis, the government knows this, CCGs have failed, foundation trusts are failing. GPs are on their knees. So they’re”—
the Government—
“handing it back to local areas and saying, ‘you fix it, and by the way there’s no money.’ It’s a whole system reorganisation”,
and there is no money.
I will make some progress before giving way again.
The second part of the motion talks about funding. There is no doubt at all that we will need to look after 1 million more over-65s in five years’ time and we will need to continue to increase investment in the NHS and social care system. That is happening with an extra £3.8 billion going into the NHS this year. Can I just remind Labour Members that that is £1.3 billion more than they promised when they stood for election last year? I just say this: it is not enough to talk about extra funding—you have to actually deliver it. Labour Members have to answer to their constituents as to why, for two elections in a row, they have promised less money for the NHS than the Conservatives, and why, in the one area where they are responsible for the NHS, they have cut funding.
The Secretary of State is taking exactly the right, measured tone, which was absent earlier in the debate. We recognise that many trusts are under financial pressures, but some of these situations are historic, and in my area they reflect very poor private finance initiative contracts, which were thrust on them in a Gordon Brown sleight of hand.
An example of how we are spending money practically on the ground to make sure patients get a better deal is in Lincolnshire, where, because there is a shortage of GPs, the local health authority is offering £20,000 as a golden hello to new GPs. Is that not the way to manage resources, to attract the best medical talent into our areas and to help ensure that patients get the best care?
My hon. Friend is absolutely right, and I talked about these issues when I visited her in her constituency. The truth is that, to solve this problem, we are going to have to have a dramatic increase in the number of people working in general practice, which is why we are funding the second biggest increase in the number of GPs in the NHS’s history.
It is a great shame that the Leader of the Opposition is not here, because this is the bit that I wanted to address to him—his proposal to put extra funding into the NHS by scrapping the corporation tax cuts. That reveals, I am afraid, a fundamental misunderstanding of how we fund the NHS. Corporation taxes are being cut so that we can boost jobs, strengthen the economy and fund the NHS. The reason we have been able to protect and increase funding in the NHS in the last six years, when the Labour party was not willing to do so, is precisely that we have created 2 million jobs and given this country the fastest growing economy in the G7, and that is even more important post-Brexit. To risk that growth, which is what the Labour party’s proposal would do, would not just risk funding for the NHS, but be dangerous for the economy and mortally dangerous for the NHS.
I just want to understand exactly what the Secretary of State was saying on Monday about the four-hour A&E target. Is it conceivable that some of the people who are currently within the A&E target will, at some stage, fall outside the A&E target?
I am committed to people using A&Es falling within the four-hour target, but I also think that we need to be much more effective at diverting people who do not need to go to A&E to other places, as is happening in Wales, as is happening in Scotland and which, frankly, is the only sensible thing to do.
However, going back to the funding issue, I just want to make this point: for all the heat in this Chamber in debates on the NHS, probably the biggest difference between the two sides of the House is not on NHS policy but on the ability to deliver the strong economy that the NHS needs to give it the funding that it requires. I am afraid that the proposals in the motion today reveal that divide even more starkly.
We had the debate at the election about the need for a strong economy to pay for the NHS, and the public decided that the Conservative party won that argument. May I give my right hon. Friend another example, from yesterday, from his friend Jeremy—the Leader of the Opposition? He proposed to cap high pay, but the top 1% of taxpayers pay 27% of income tax revenues. That proposal would cut the funding available to the NHS and damage the services that hard-working members of staff produce.
Does my right hon. Friend agree that Opposition Members, rather than making meaningless and totally unfunded promises of more money for the NHS, contrary to their manifesto back in 2015, would do better to recognise demographic changes, such as the ageing population, and the need for the NHS to change, and support the locally developed plans for change in the national health service—the sustainability and transformation plans?
As the Government often point out, they want to hand decisions to local groups, but could the Secretary of State explain to worried patients in the south and west of Cumbria why local health services are suggesting the changes to A&E in the west and potentially the south? I know he has spent a lot of time looking at this area.
First, I would like to use this moment to congratulate the hon. Gentleman’s local trust on coming out of special measures last year and on the progress it is making. In a way, that is the answer to his point. His local trust was in special measures, and North Cumbria is still in special measures. We had some profound worries about patient care in both trusts, and we still do in the North Cumbria trust. That is why the status quo is not an option, but we understand the concerns of his constituents and many others about some of the proposals being made.
What does the Secretary of State make of the talk among professionals at the moment about the potential for a flu epidemic? What does he make of the comments by the doctor who wrote to me on Sunday saying that she is extremely concerned that staff are too busy to isolate patients who are coming in—who need oxygen—so that others do not potentially catch flu?
There is a concern at the moment about a growth in respiratory infections, and that is causing capacity constraints. We are watching what is happening on flu very carefully, but we have a record 13 million people vaccinated against flu, and I hope that that will put the NHS in a good position.
Money is of course important, but may I support the Health Secretary in not viewing these issues solely through that lens? My local trust, Sherwood Forest, which has some of the worst finances of any trust in the country—almost all due to a PFI deal signed by Gordon Brown—is actually improving. It is under pressure this winter, but the management have said it is definitely not in crisis. That is an example of a trust improving due to quality management, reform and good-quality processes.
That is absolutely the point, and the last point I want to make before concluding on funding is that we miss a trick—I think the shadow Health Secretary is in some ways more reasonable than his leader on these issues, which is probably terminal for his career—if we say that this is just about money. We forget the debate we went through on schools in this country 20 years ago, when there was, again, a debate about money, but we realised that the issue is actually also about standards and quality. That is what has happened in Sherwood Forest, and I congratulate the trust. It is important that we do not let debates about funding eclipse that very important progress that we need to make on standards.
I am going to conclude now because lots of people want to come in, I am afraid.
The shadow Health Secretary’s central claim—these are his words—was that the culpability for what is happening in the NHS “lies at the door of Downing Street”. I owe it to the country and this House to set the record straight on this Government’s record on the NHS. It is not just the fact that there are 11,000 more nurses and 11,000 more doctors; not just the fact that, on cancer, we are starting treatment for 130 more people every single day, and have record cancer survival rates; not just the fact that we have 1,400 more people getting mental health treatment every day and some of the highest dementia diagnosis rates in the world; and not just the fact that we are doing 5,000 more operations every day and that, despite those 5,000 more operations every day, MRSA rates have halved. We have an NHS with more doctors and more nurses, and despite difficult winters, with patients saying they have never been treated more safely and with more dignity and more respect.
Next year the NHS will be 70 years old. This Government’s vision is simple: we want it to offer the safest, highest quality care anywhere in the world. When we have difficult winters and an ageing population, of course that makes things more challenging, but it also makes us more determined. It means that we are backing the NHS’s plan; it means more GPs and better mental health provision; and it means an NHS turning heads in the 21st century just as it did when it was founded in the 20th century.