NHS Long-Term Plan

Debate between Jeremy Hunt and Philippa Whitford

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

My hon. Friend asks two important questions. As she knows, we have committed to phase out capital-to-revenue funding, because if we are to make the NHS sustainable in the long run, we urgently need to make capital investment in estates, technology and a whole range of new machinery, including cancer-diagnostic machinery and so on, and we will not be able to do that if we continually have to raid capital funds for day-to-day running costs. That was one of the main reasons why we decided that we had to put revenue funding on a more sustainable footing. My hon. Friend is absolutely right about that.

Transformation funding is also important, because when the five year forward view was published, pressures in secondary care and the acute sector meant that a lot of transformation funding was sucked into the hospital sector and we were not able to focus on the really important prevention work that can transform services in the long run. I am very sympathetic to the idea that we need, if not a formal ring fence, a pretty strong ring fence for transformation funding, so that the really exciting progress that we see in some parts of the country can start to spread everywhere.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I echo the comments made about the approach of the NHS’s 70-year anniversary across the four countries of the UK, having myself spent a fair chunk of those 70 years—perhaps slightly longer than I care to admit—working in the NHS.

Like most people present, I imagine, I absolutely welcome the additional funding, which has been described as bringing the UK to the same level of spending as France by 2023. In that description is, though, the admission that we do not spend the equivalent of what France spends right now. Indeed, we saw a deficit of almost £1 billion in 2017-18, despite transformation funding being sucked in to try to clear that deficit.

I echo what the hon. Member for Totnes (Dr Wollaston) said: is transformation funding on top of this funding? If it is just revenue funding, will there be a separate announcement about transformation funding? The Secretary of State also mentioned the need for prevention, yet we do not see any mention of money for public health. That is where we need to be doing prevention.

It is said that we need a 3.9% increase in social care spending, but that is not identified in the statement. If the Green Paper is to come only in the autumn, social care may not get real funding until next year. With the demographic challenge that the Secretary of State mentioned, that is just too far away. The NHS has faced, on average, an uplift of 1.2% over the past eight years, according to the King’s Fund. Taking it up to 3.4% brings it more in line with the traditional uplifts that we have seen, and yet, in actual fact, with an ageing population, the pressure is even higher. Hopefully, this will stop the slide of the NHS, but the NHS Confederation says that it is not possible to transform on this kind of money. It is, therefore, important that these other projects are looked at separately and are funded separately.

As for where that money is to come from, I do not know how the Prime Minister kept a straight face when she talked about the Brexit dividend. The Institute for Fiscal Studies says that there will not be a dividend. The Office for Budget Responsibility talks about a £15 billion drop in public service and finances. I want to know how the rise will be funded. Will it all be just borrowing and tax rises? The Government should be honest about how they will fund this rise.

[Mr Hunt]

First, may I thank the hon. Lady for doing something that the shadow Health Secretary did not do, which is to welcome this £20 billion annual rise in the NHS budget? I completely agree with her about the importance of prevention, the importance of social care and the importance of making sure that we sustainably invest in transformation funding. The think tanks do disagree on what level of rise is necessary. Lord Darzi and the Institute for Public Policy Research said 3.5%; we are on 3.4%, which is not far off that. The IPPR went a little higher, but, like the hon. Lady, Paul Johnson said that this will stop the NHS going backwards.

With respect to overall funding levels for the NHS, the United Kingdom currently funds the NHS at the western European average as a percentage of GDP. That is not as high as France or Germany and it is true that, by the end of this five-year period, our funding will end up at broadly similar levels to those of France today, although of course it may change them over the five-year period.

I gently say to the hon. Lady that if that is a worry for her, she needs to explain to NHS users in Scotland why, when NHS spending has increased by 20% in England over the past five years, it has increased by only 14% in Scotland because of choices made by the Scottish National party. For every additional pound per head invested in the NHS in England only 85p has been invested in the NHS in Scotland. I hope that she makes a pledge, as I hope Labour does with its responsibility for Wales, that every extra penny that she gets through the Barnett formula will go to the NHS, because that is what the voters in Scotland want.

Breast Cancer Screening

Debate between Jeremy Hunt and Philippa Whitford

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

Yes, and I can reassure my hon. Friend that GPs will be briefed and that people will be referred for additional support to clinically trained staff at Macmillan Cancer Support and Breast Cancer Care. We have to be transparent with patients, however, about the absence of a clear clinical consensus on the efficacy of scanning for women in their 70s. The fairest thing is to explain that different people have different views and allow them to come to an individual choice, and that is what we are doing. It will of course cause considerable distress to those given that dilemma, but if anyone wants a scan, we will do that scan.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I thank the Secretary of State for my advance briefing, but, as a breast surgeon and co-chair of the all-party group on breast cancer, I gently take issue with his comment that we do not need to diagnose breast cancer early because of the changes in treatment. I would not like that message to stand: diagnosing early is still crucial.

Obviously this is horrendous for the women involved, but it will also create anxiety for women who are not aware whether they are involved and who might not have been part of the trial. Reassuring them will be a challenge. I welcome the independent review into how it happened and how it went so long without being picked up, and I am interested to know what will happen with the trial now—the loss of almost 500,000 women from it might have a major impact.

Given the normal pick-up rate of breast screening, approximately 2,500 cancers would have been picked up across England in the last round. As the Secretary of State says, this issue did not apply in Scotland, but some of the women affected might have moved and settled in Scotland, so when did he inform the Scottish Government?





The Secretary of State said that the Department knew in January. As far as I can establish, officers in Scotland were informed of a minor issue in March, were told only last week that it was actually more major, and were not told that it might affect women who now live in Scotland. There has clearly been preparation and talk about funding in England, but how many women who live in Scotland have been identified, and what efforts have been made to track them down? What preparations for funding or the expansion of services have been made for Scotland and, indeed, for the other devolved nations?

As was mentioned by the hon. Member for Leicester South (Jonathan Ashworth), radiology, and particularly breast radiology, is a huge shortage specialty. What funds will be provided to ensure that it can be delivered without messing up the normal system?

Will women who do not receive a letter in the next few weeks be able to telephone, or can the Secretary of State really guarantee that if they have not heard by the end of the month, they are clear? As a doctor, I find that a bit scary.

[Mr Hunt]

The hon. Lady has asked some important questions. I am sorry if what I said was not clear, but I do not think I said that there was no need to diagnose early. It is obviously incredibly important for cancer to be diagnosed as early as possible. What I said was that I had been advised that in many cases, because of advances in breast cancer treatment, it would not make a difference to the particular women affected in this case. I fully accept that in some cases it will, and of course it is very important to diagnose all cancers as early as possible.

I will find out from Oxford University the dates on which it expects to report the full outcome of the AgeX trial. Obviously we all want to hear the results as soon as possible. I will also inform the hon. Lady of the exact date on which Scottish Government officials were informed. Let me reassure her that if there are any additional costs to the Scottish health system, it will of course be recompensed.

We do not think that major pressures will be created in the Scottish screening programme, and we are confident that we will be able to contact everyone in the UK who is registered with a GP—whether in Scotland, Wales, Northern Ireland or England—by the end of May. We have had very productive discussions with Scottish officials about the IT exchange that will be necessary to ensure that women living in Scotland also receive their letters by the end of May. We cannot guarantee that every single one of them will have been contacted by then—some will have moved abroad, and some will not be registered with a GP for whatever reason—but we think that we can contact the vast majority, and the helpline will be open for anyone to call if they think they may have been affected.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 20th March 2018 Commons Chamber

[Mr Hunt]

I will re-look at the issue and the response that the hon. Gentleman was given. The issue is that there is unevenness and unfairness in the rates charged to GPs whose surgeries belong to NHS Property Services. We are trying to make this fair across the country, but we also want to make sure that no GP surgeries close.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

With an ageing population, I, too, welcome the aim of integrating health and social care and developing population-based planning, as we have done in Scotland with health and social care partnerships, but the outsourcing of health service contracts to private providers in NHS England has led to more fragmentation rather than integration. Will the Secretary of State agree that we need to repeal section 75 of the Health and Social Care Act 2012 so that local commissioners can develop patient-centred services and not fear litigation if they do not put them out to tender?

[Mr Hunt]

We want to encourage the NHS to move towards more integrated services, and part of that is about contractual structures, but part of it is about funding, and I gently point out to the hon. Lady that 8% of the NHS budget in England goes to general practice and only 6.6% in Scotland, which is why there is an even bigger problem with GP surgeries closing in Scotland.

[Dr Whitford]

The many and varied new integrated care structures developing in NHS England have no statutory basis, yet in the future will control the entire health budget for a population. Does the Secretary of State accept that with another major NHS reorganisation we need debate and legislation in this place to get the structure and governance right?

Maternity Safety Strategy

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

I do not have that information to hand, but I will find out for my hon. Friend and let her know.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Last month’s debate on baby loss has been mentioned, and I too took part in it, although I have thankfully been spared the pain suffered by some Members of the House. Such a debate really helps to bring out for everyone on both sides of the House how important this issue is, and I do not think there will be anyone who does not welcome this statement and the ambition it shows.

In Scotland, we had a higher stillbirth, neonatal and perinatal death rate in 2012, but our new chief medical officer was actually an obstetrician, and that may have led to the change of focus in 2013, when she established the maternity and children quality improvement collaborative and the national stillbirth group—all as part of the Scottish patient safety initiative—as well as the neonatal managed clinical networks across Scotland. That has enabled us to drop our stillbirth rate by more than a quarter, and to drop our neonatal death rate by 50%.

This has been achieved despite the challenges we face of really difficult geography, including getting people off islands. It is easy to spot the woman who has a history of difficult births or to spot a woman with comorbidities, such as obesity or diabetes, but anyone who has been involved in birth knows that even the healthiest pregnancy can go wrong at the last minute. For us, as in rural parts of the north and west of England, there are transport issues in relation to how women with problems during labour are identified and transported if a higher specialism is required, and those issues must be looked at.

This is very much about the provision of neonatal services, including the movement of patients, and the availability of expertise and of neonatal intensive care units. However, as came out several times during the debate on baby loss, another issue is that of pre-term birth and stillbirth, so this is also about trying to change some of those things. After Scotland’s recent review in February, the focus will be on the consistent monitoring of growth, as a failure to thrive can identify a third of impending stillbirths; the continuity of care, which the Secretary of State has referenced; and especially smoking. Although the Secretary of State mentioned getting smoking rates down—and in Scotland, sadly, they are higher—the rate in the most deprived communities is more than four times that in the least deprived communities. That has an impact on every level of child loss.

Finally, on research, it is important that we learn, for example from the new information about women sleeping on their side in the last trimester. We need to fund the research to learn those things and then share the information—

[Mr Speaker]

Order. I have the highest regard for the hon. Lady, who is a considerable medical authority. I gave her a little leeway, but I say very gently that not only did she exceed her time by a minute, but she pursued her usual, rather discursive approach. In these situations, what is required is a question or a series of questions with a question mark or a series of question marks, rather than general analysis. We will leave it there for now. I say that in the most good-natured spirit to the hon. Lady.

I call Antoinette Sandbach.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

The hon. Gentleman is right to bring that up. One thing we can do a lot better is to improve the opportunities for flexible working. We have announced that we will be making new flexible working arrangements available to all NHS staff during this Parliament. We are also expanding programmes to encourage people who may have left the profession to come back into nursing.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I think everyone would welcome an expansion of nurse training places, but the Council of Deans of Health stated in June that no new extra places had been funded either in universities or, crucially, in hospitals, where 50% of the course is carried out. Will the Secretary of State clarify when that funding will be made available?

[Mr Hunt]

Next year.

[Dr Whitford]

Obviously we know that it takes quite some time to train a nurse, and one in 10 posts in England is vacant—that is twice the rate we face in Scotland. We also know that there is a 51% increase in nurses leaving the profession, a 96% drop in those coming from the European Union, and a limit on the use of agency staff, so where does the Secretary of State expect NHS England to find the 40,000 nurses it needs right now?

[Mr Hunt]

Let me just remind the hon. Lady that there are 11,300 more nurses on our wards than there were just four years ago, so we are increasing the number of nurses in the NHS. She mentions what is happening in Scotland. I gently remind her that nearly double the proportion of patients are waiting too long for their operations in Scotland as in England.

Oral Answers to Questions

Debate between Jeremy Hunt and Philippa Whitford

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

Over those three Parliaments, I have learned to expect questions from my hon. Friend in a similar vein, and I commend him for his persistence in championing that cause. As he knows, I think the most important thing, with all such issues, is to follow the scientific advice.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

When the Government removed the nursing bursary and introduced tuition fees, the Secretary of State said that it was being done, as he has repeated this morning, to fund 10,000 extra student nurse places. The universities are saying that no extra places have been commissioned, however, so when will we see an expansion of student nurse training?

[Mr Hunt]

I always welcome the hon. Lady’s forensic interest in matters south of the border, but given that Scotland has just seen its first fall in life expectancy for over 100 years, she might want to think about her own constituents. With respect to the number of nurses, we now have more than 50,000 nurses in training, and we are confident that we will deliver a big increase in the supply of nurses to the NHS.

[Dr Whitford]

We still have a nursing bursary and we have no tuition charges, so the Secretary of State may want to explain why universities claim there are no additional places. In addition, we are losing almost half of junior doctors at the end of their foundation years. What action is the Secretary of State taking to find out why?

[Mr Hunt]

At the heart of this is the need to open up avenues for more flexible working for both doctors and nurses. If the hon. Lady followed what we have done in England—by successfully pioneering such working, we have reduced agency spend by 19% in a year, whereas it is still going up in Scotland—she might find the NHS in Scotland has more money to spend on her own constituents.