Future of the NHS

John McDonnell Excerpts

Thursday 23rd February 2023 Commons Chamber

[Kate Osborne (Jarrow) (Lab)]

I beg to move,

That this House has considered the future of the NHS, its staffing and funding.

The national health service is a beloved national institution. Everyone in the country and in this House will have interacted with the NHS and have their own personal connections and stories that they can reflect on, from the birth of their children to the death of a loved one or seeing a general practitioner about a health condition. It is undeniable to most of us that the NHS is in crisis. It is being pushed into an avoidable and unprecedented collapse after 13 years of Conservative mismanagement.

All our constituents will have been impacted in some way by the crisis, a crisis so bad that nurses have taken strike action for the first time in NHS history. Ambulance workers and other NHS staff have also taken action, and this week British Medical Association junior doctors voted with a 98% majority to do the same. I thank all my constituents who work in the NHS, particularly those who got in touch about this debate, including paramedics from the North East Ambulance Service who tell me that on a daily basis they are unable to hand over patients because of delays in A&E and lack of beds, and how frustrating it is that many of the calls are for people who need social care or cannot get a GP appointment, rather than the acute calls that they are best placed to deal with.

That highlights the impact the crisis in social care is having on the NHS. Half of all people arriving in A&E by ambulance are over 65 and one third are over 75. The lack of adequate social care for basic daily needs is storing up problems and leaving older people less able to care for themselves, or arriving in hospital with preventable health problems, adding to the pressures in A&E and bed provision. People who work in the NHS have had enough of being failed by this Government’s mismanagement. The country deserves better.

NHS dentistry is on its knees, with patients facing a growing crisis of access and resorting to DIY dentistry. The NHS was in crisis pre-pandemic and the Government’s failures and mismanagement have made the situation far worse. For Ministers to dismiss the crisis as winter pressures, or even to flat-out deny that there is a crisis, is frankly absurd.

[John McDonnell (Hayes and Harlington) (Lab)]

The crisis in dental and mental health is affecting our children at the moment. In some of our constituencies, it is a direct result of the lack of local provision. We are feeding a generation of problems as a result of that failure.

[Kate Osborne]

I absolutely agree with my right hon. Friend. The problems for our children further down the line are worrying, but of course, they are preventable if the right action is taken.

The Conservatives blame everything else—the weather, the pandemic and even NHS staff—but their 13 years of failure have left the health service in crisis. At Prime Minister’s questions yesterday, the Prime Minister boasted about

“record sums into the NHS…and…a clear path to getting people the treatment they need in the time they need it.”—[Official Report, 22 February 2023; Vol. 728, c. 222.]

He is not living in the real world. Every briefing and communication that we have received has cited delays in treatment and the devastating impact that they have, as well as the decade of underfunding. It is hard not to agree with the British Medical Association, which called the Prime Minister “delusional”.

The last Labour Governments allocated, on average, a 6% rise in the NHS budget every year. Successive Conservative and coalition Governments have since allocated a rise of only 1% a year. The Prime Minister can talk about “record sums” all he wants, but he is fooling no one. In reality, the settlement is not enough, and it is nowhere near what previous Labour Governments invested. This crisis can be laid firmly at the Government’s door.

There are so many awful headlines and statistics, and I will delve into some of them, but let me say from the outset that we must all remember, when we talk about the 7 million people on waiting lists, or the 500 avoidable deaths every week, that we are talking about people. There are faces behind those statistics: the faces of women who cannot get urgent gynaecological treatment, the faces of children who cannot access mental health support, the faces of families whose loved ones have died—lives that could, should and would have been saved if this Government cared about communities and invested in our NHS.

When we talk about 133,000 NHS vacancies, we are talking about people who have left their work in the NHS because they cannot cope financially or emotionally, we are talking about the rest of the workforce working harder to pick up the slack, we are talking about the NHS being unable to recruit because of poor wages and conditions, and we are talking about the impact that that has on patients.

The only way to solve the NHS staffing crisis is by sorting out pay. The Government agreed yesterday to negotiate with the Royal College of Nursing, and nursing strikes have been paused for those negotiations to happen. The Government could have agreed to negotiations months ago, but they chose not to. Negotiations with the RCN alone will not solve the staffing crisis. Junior doctors have voted by 98% to strike, but the Health Secretary has not even offered a meeting. Negotiations with one section of the NHS workforce are not sufficient; all unions representing NHS staff need to be negotiated with. The Government must make a pay offer that is not linked to efficiency savings and productivity, because NHS staff are already working unacceptably long shifts.

An offer—such as the one we saw on Tuesday—of 3.5%, when inflation is at least triple that and NHS workers’ pay is worth less than it was a decade ago, is, as Sharon Graham of Unite the Union said, a “sick joke”. Christina McAnea of Unison announced further strike days next month. The Government are failing to resolve this dispute; instead, they are attempting to blame workers for putting patients in danger. Patients will never forgive the Conservatives for refusing to negotiate and using patients as bargaining chips.

The staffing crisis must be urgently addressed. The impact of waiting times on individuals can be severe and the consequences irreversible. Two hundred people in my Jarrow constituency have Parkinson’s disease. Parkinson’s UK is concerned about people waiting longer than two years for a diagnosis. Similarly, the MS Society has said that more than 13,000 people have been waiting more than a year for a neurology appointment. Those delayed diagnoses and treatments have a hugely detrimental impact on the individuals concerned.

Delays in cancer diagnosis and treatment are life-threatening. For years, the Government have missed cancer targets because of a lack of concerted action on matched funding. In South Tyneside and Sunderland NHS Foundation Trust, only 73% of people were treated within the target of two months following a cancer referral, and only 61% of people are treated within that target nationally. The UK is being left behind, and people are dying avoidable and preventable deaths. That is why we need a workforce strategy—yes, to pay people properly, but also to enable the NHS to save people’s lives.

Labour has a workforce strategy, while the Government have not even committed to fully funding their promised workforce plan. The Chancellor praised Labour’s plan, so why does he not put his money where his mouth is by implementing it? Labour will deliver a new 10-year plan for the NHS, including one of the biggest ever expansions of its workforce.

--- Later in debate ---

[John McDonnell (Hayes and Harlington) (Lab)]

I want to get back to some statistics; I am sorry if I am going to bore the House, but I want to get back to some of the harsh reality. I know that subjective judgments have been made, but we cannot get away from some of the stats. I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing the debate and on an excellent speech, particularly in light of the fact that it was the Durham miners’ gala fundraising dinner last night.

I come back to the some of the harsh stats because I want to deal with why we need to address the funding crisis more effectively than we are at the moment. Some of these stats have been used already but I am still shocked by this: we have 7.1 million patients on waiting lists, which is almost double the level in 2010; and the average ambulance response time for patients in category 2 is now 48 minutes, which is half an hour more than it was a short while back, with the target of 18 minutes. I have met our local ambulance drivers and paramedics, and I know that category 2 is the heart attacks and strokes. I had a heart attack about 10 years ago and I do not want to be waiting for 45 minutes, as we are talking about the difference between life and death for some of us.

On A&E waiting times, the NHS target is 95% of people being seen within four hours, but the current level is 40%. Most Members will have visited the A&E departments in their local hospitals. One of our local people described them as being like a warzone at times, given the number of injuries and scale of suffering. Members have mentioned the public satisfaction issue, but on the GP front—again, this comes just from working with local doctors—1 million people are waiting for more than a month. There are currently 4,500 fewer GPs than there were a decade ago. I understand what the Government and ex-Ministers are saying about the recruitment of more GPs, and I understand what my hon. Friends have said about a lot of that investment being from some time when the Conservative party was not in government.

I have been trying to look at the repairs backlog as well, because we have been promised a new hospital at Hillingdon. I am really pleased about that because I have been campaigning for one for years. We will be getting a new hospital, eventually, but that is largely because our existing one is in such a dangerous state; we are worried about the main structure collapsing at any stage and we have had to do temporary repairs. The repairs backlog has grown by 11%, to £10.2 billion-worth of backlog.

There is another figure that I have been worried about. Let me make it clear that I have been on the picket lines with nurses and in the campaigns. When talking to them on the picket lines, we get the true reality of what people are having to deal with, but I wanted to get behind the anecdotes and get to the stats. They show that one in five NHS trusts and health boards is providing food banks for staff, with a further third looking to provide them in the future. It must surely be shocking to everyone that NHS staff are having to rely on food banks —these are professionals.

If we look at the underlying causes of that, we see that this is about pay. I looked at the pay of the paramedics I was talking to and I found that it has gone down by £2,400 in real terms in the past year—that comes from some TUC analysis. There are now 3,000 ambulance staff vacancies in England. I went on to look at issues associated with nurses’ pay. The average nurse’s take-home pay is more than £5,000 less in real terms than it was in 2010—again, that comes from number crunching by the TUC, but all of this is verified elsewhere as well. There are nurse shortages, with 47,000 vacancies. The most worrying thing, which has been touched on to a certain extent by others, is that one in nine nurses left the profession in the past year, which is the highest level in a year in the recorded history of the NHS. That says something about morale. We have heard that the talks are scheduled for 1 and 3 March, and I am hoping that they will resolve the current dispute. However, it is difficult to see how it can be resolved unless all the unions are engaged in those discussions.

A few years ago, there was a junior doctors pay dispute. My right hon. Friend the Member for Islington North (Jeremy Corbyn) and I were on the picket lines and at the demonstrations for that as well. So I was looking at what has happened with the junior doctors, who are represented by the BMA. As someone has said, 98% have voted for strike action, on a turnout of 77%. I do not think we have seen those levels of turnout in recent history in these ballots for industrial action. Again, I have been trying to get behind the reason for that. BMA analysis shows that the pay of junior doctors has been cut by more than a quarter since 2008. It looks as though we are going to have a walkout for 72 hours in March, which, obviously, will have an impact on the service. When I talk to junior doctors, they tell me that they do not know what else they can do. They are beginning to struggle to survive on the wages they are getting. In constituencies such as mine, a west London, working-class, multicultural community, most of them will never be able to get onto the housing ladder to buy a property; in fact, because of the level of rents, many will struggle even to fund the rents there. Trying to come at this question as objectively as possible, it must come back to underfunding. There is no other reason that I can see.

[Rob Roberts]

I appreciate the right hon. Gentleman giving way and the tone in which he approaches the debate. He talks about funding, but Labour left office in 2010 and there was no argument about the fact that funding was not sufficient at the time of the last Labour Government. The King’s Fund says that statistics show that funding has increased or at least kept pace in real terms since then, so how is it not sufficient now?

[John McDonnell]

That is an extremely valid point that must be addressed. When some of us were doing health economics in the 1980s and onwards, we were always told that the level of funding required just to maintain a standstill operation for the growing ageing population was at least 4%. What happened under Labour was a 6% annual rate of funding.

I will be honest with the hon. Gentleman: when I was on the Government Benches and Labour was in government, I was asking for more. Gordon Brown, to give him his due, had a sense of humour; I always used to produce an alternative Budget, so he described me as the shadow Chancellor even when I was not. I did that on the basis that I thought 4% was not enough and, while 6% was right, we needed to go further, because it was about not just the ageing population but the increased levels of morbidity we were experiencing. In addition, as the hon. Gentleman mentions, new treatments come on board and are more expensive.

Even though I was looking for increased investment, beyond what Labour was doing then, Labour was not just keeping pace with the 4%, but was going beyond it at 6%. To be frank, although the hon. Gentleman swore in the Chamber earlier, he should have heard some of the language I used in 2010, because I was quite angry as well. Those of us who were there will remember that in 2010, investment dropped to 1%. We were saying to George Osborne, who was the Chancellor at the time, “You are going to reap the whirlwind here for dropping the level down to 1%, because it means an erosion of the services that are provided.”

In addition, that investment did not recognise our ageing population or the other emerging issues with morbidity. I understand that the covid inquiry will include analysis of the resilience of the health service to cope with the covid pandemic. I believe that a number of those representatives are seeking to have George Osborne appear before that inquiry, because he bears responsibility for that under-investment.

Other hon. Friends have mentioned mental health, and I agree that it has been the Cinderella service. When I looked at mental health funding, I found that it has increased at a faster rate than overall NHS funding—at times nearly 3% as against 1%. However, that follows years of small increases or real-terms funding cuts, and the number of NHS mental health beds is down by 25% since 2010.

Curiously enough, I was on a bus in my constituency yesterday with a former mental health nurse, who described to me the implications of that and the consequences for the individuals concerned. Community mental health nurse numbers were also impacted upon. Some of us will have dealt with the results of that in our constituencies; in my constituency, I have to say, it has meant dealing with suicides as well.

[Jeremy Corbyn]

Is my right hon. Friend aware that the impact of an inadequacy in healthcare provision falls on A&E departments, which take in people who have mental health crises but are ill-equipped to cope with them; on neighbourhoods that cannot cope with people going through crises; or on the police, who have to intervene simply to look after someone for whom there ought to be mental health provision. We fail to invest in mental health provision at our peril.

[John McDonnell]

Anyone who has talked with them will have heard local police officers say that they have become social workers, mental health workers and so on. In many instances, they are doing the best job that they can, but they need expert support, including from health workers in the community.

I looked at the figures, and there are now 1.6 million people on the waiting list for specialist mental health services. One of my concerns, which was raised in a debate some months ago, is what is happening with CAMHS —child and adolescent mental health services. Delays in treatment have increased massively since 2019, and waiting lists are getting longer. I have looked at the stats: 77% of CCGs froze or cut their CAMHS budgets between 2013-14 and 2014-15, which was the crunch year; 55% of the local authorities in England that supplied data froze or increased their budgets below inflation; and 60% of local authorities in England have cut or frozen their CAMHS budgets since 2010-11. Again, that is staggering.

To come back to mental health nurses, in 2010, we had 40,297 of them; we are now down to just 38,987. That does not seem a significant drop, but it is still a drop. As a number of Members on both sides of the House have mentioned recently, we are going through a mental health crisis—one that affects young people and young men in particular, as my right hon. Friend the Member for Islington North has pointed out.

Let me come to the stats on social care. Age UK estimates that more than 1.5 million people aged 65 and over have some form of unmet or under-met need—[Interruption.] Excuse me—[Interruption.] Thanks a lot; I could do with something stronger.

[Alex Cunningham]

That can be arranged later.

[John McDonnell]

That’s right.

The social care figures are startling. Some 1.5 million people aged 65 and over have some form of unmet care need. There are 165,000 vacancies in the social care sector across England and Wales—a 52% increase in the last year. The Health Foundation estimates that an extra £6.1 billion to £14.4 billion will be required by 2030-31 to meet the demand. As others have said, that has meant delayed discharges from the NHS, and—as I mentioned on Tuesday—it places a huge burden on unpaid carers, who are living on the pittance of the £70-a-week carer’s allowance.

The Institute for Government published a report today in which it basically argues for social care overhaul. It describes how social care has been overwhelmed in recent years and states that 50,000 fewer posts are filled than a year ago—the highest vacancy rate ever in social care. Then, there are the stats on what has happened as a result of under-funding—and I am afraid that it is because of under-funding; we cannot get away from that fact. I would be saying the same thing on these statistics no matter which party was in power. We need to go further in the coming month’s Budget.

[Rob Roberts]

The right hon. Gentleman is being very generous with his time. He will know, having been shadow Chancellor, that in the devolved Administrations, there is £1.20 in Wales for every £1 in England, and slightly more in Scotland. The results—I could say they are worse, but I will not—are measurably the same. Is it a problem only of funding, or is it one of structure?

[John McDonnell]

I am sure that the hon. Gentleman has made that point before. I looked at the Nuffield Foundation report on Wales a couple of years back. I do not think that Wales has had a good deal out of the Barnett formula over the years, and although the Government have addressed some of that over the past year, they have not done enough. The Nuffield Foundation said that Wales has not only an ageing population, but higher levels of morbidity, so the funding does not match the need. A whole debate needs to take place about moving forward. When I was shadow Chancellor, I talked about a review of the Barnett formula. That frightened a number of people, but it is needed. In fact, I think there is a need for a Barnett formula for the north of England as well. [Hon. Members: “ Hear, hear!”] I thought that might raise a response.

There is a long-term funding crisis that we have to address. I look forward to next month’s Budget for some resolution of this matter. Where can the money come from? I know that a lot of people say we should never make unfunded commitments. To be honest, I was the first shadow Chancellor who produced a Budget and a manifesto that was fully funded and costed, in the “Grey Book”, so I want to look at some ideas and just throw them out there.

On Tuesday, we heard that, as a result of the higher level of tax receipts received than the Office for Budget Responsibility predicted, the Chancellor now has £30 billion of headroom that he did not have previously. Some of that £30 billion needs to be invested in the NHS, and particularly social care. I would also like to see some of that money invested in relieving poverty, which is one of the major causes of ill health in this society.

We need to do something on capital gains tax. If we taxed capital gains at the same rate as earned income and charged national insurance on it, we would get £25 billion extra. Let me throw in a few others. If we lifted the higher national insurance rate, so that instead of 3.25% above £50,000, it was paid at what everyone else below that level pays—13%—that could raise us £15 billion. I cannot for the life of me see why dividends are not taxed at the same level as earned income. If we did that, we could raise £8 billion. Those on the Labour Front Bench have put forward the idea of scrapping non-dom status. Again, I claim copyright on that one. That would raise between £1 billion and £3 billion.

The Government have implemented a windfall tax on the excess profits of energy companies, and they should extend that, as those on the Labour Front Bench have advocated. Some Members may have read the recent reports on bank profits and the return of extremely excessive bank bonuses. There is an argument for a windfall tax on bank profits during this extremely difficult period. This is a time when we should all bear the burden of the challenges that we face. Taxing the bankers’ bonuses needs to come back on the agenda, and I deeply regret that the Government removed the cap on bankers’ bonuses, which we supported.

With regard to the City, I have been an advocate of the financial transaction tax for a number of years. All it does is close some of the loopholes in terms of stamp duty. If we look at the work on this recently by Advani and others, we see the potential. With limited changes, we could raise £8 billion to £10 billion.

It is time to start looking at how we tax wealth in this country more effectively. If we look at the proposals that have been produced by various think-tanks over the last year or so, a 1% tax on people who have assets over £10 million could raise an additional £10 billion. This is not revolutionary stuff. It is straightforward and pragmatic, making sure that we have a fair taxation system.

Those on the Labour Front Bench have argued strongly that we have to go for growth, as have the Government. I fully agree, but that needs a rapid programme of investment in the public sector, with matching private sector investment. If we can increase growth by just 1%, we usually match Governments receipts at the same time by 1%, which would mean about £7.7 billion, and for 2% it would mean £15.4 billion. In addition to the short-term taxation measures, redressing the imbalances in our taxation system at the moment, that would enable us to achieve the growth that will give us a stable form of income to meet the needs of our NHS and social care system.

We cannot continue with an NHS and a social care service that is paid for on the backs of people we are exploiting in long hours, undermining their morale by not paying them properly, and at the same time making them face challenges that are both heartrending and certainly not what many of them signed up for. The NHS workers I have met just want to provide a decent service in a caring environment that is fully funded, where their profession is respected by being properly paid. I hope that we can achieve that sooner, rather than later.

NHS Strikes

John McDonnell Excerpts

Monday 6th February 2023 Commons Chamber

[Will Quince]

Yes, yes—but where exactly is the funding coming from? The hon. Gentleman rightly pushes me on the elective backlog and he rightly pushes me on urgent and emergency care, but every 1% is £700 million that I would have to find from our NHS budget. That is exactly why we have to ensure that the pay review body makes the recommendation from April that is affordable to the NHS and recognises and rewards NHS staff, taking account of recruitment and retention and some of the challenges that we face, but that is fair to taxpayers too. That is why I would encourage the unions to get involved and take part in that pay review body process, so we can get it right.

[John McDonnell (Hayes and Harlington) (Lab)]

The Minister says that opposition is the easiest job. Well, we are hoping he is soon performing it. When he opened his response this afternoon, he said that the Secretary of State was at a Cobra meeting, but would it not be more worthwhile if he negotiated and met the unions themselves? In advance of the next meeting for discussions of wages, maybe he could visit a picket line, because if Conservative Members visit the picket lines, they will find groups of staff—nurses and ambulance workers—who are extremely distressed. I have met many of them who were in tears—tears because they are worried about the patients whom they want to support, but also tears because many of them cannot survive doing the service they want to provide due to their low wages. Unless negotiations are started soon, the Government could do irreparable damage to the national health service, so the Secretary of State needs urgently to leave the Cobra meeting, sit down with the unions and start negotiating.

[Will Quince]

The right hon. Gentleman says that many who work in the NHS are worried about patients: I spend every single day worrying about patients; I spend every single day ensuring the NHS has the resources it needs to provide the level of care and service our constituents rightly expect. I have a budget, and that budget has already taken into consideration a 4.75% on average pay award, with more than 9% for some of the lowest earners. There is an independent pay review body process for a reason; it is only two months away, in April, and I encourage the unions to take part in it. Of course I meet with unions, and of course I do and will meet with nurses and those who work in our NHS. I believe some of the points the right hon. Gentleman makes are correct, and I know those who work in the NHS genuinely want to ensure we are attracting and retaining the very best; that is all the more reason for us to get it right, and the way to get it right is the independent pay review body process.

NHS Dentistry: Salford and Eccles

John McDonnell Excerpts

Monday 19th December 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

Let me start by congratulating the hon. Member for Salford and Eccles (Rebecca Long Bailey) on securing this important debate. I share her frustration and am aware that some areas in the country face serious difficulties with access to NHS dental care. She used some powerful examples, which are exactly the kinds of things that we are trying to fix.

As we recover from the pandemic, activity is going back up again and we want it to go up faster. Dentistry is an important part of the NHS. We are committed to addressing the challenges that NHS dentistry faces in some parts of the country. We are continuing to take important steps to improve access for patients. There are variations around the country, which was already an issue before the pandemic.

The specific risks from covid in dentistry, for obvious reasons given the nature of the treatment—looking down people’s throats and breathing in the same air—resulted in the need to reduce the amount of care that could be delivered, in line with infection prevention and control measures to keep patients and the workforce safe. The pandemic placed further pressure on the system. However, NHS dentistry provision has been increasing gradually and safely. I am pleased to say that NHS England asked all dental practices to return to 100% of their contracted activity in July this year. Many practices are already delivering at that level and, in some cases, beyond. I will go on to talk about delivering beyond.

To support the industry during this testing time, we took unprecedented action and provided over £1.7 billion in income protection, to ensure that NHS dentist capacity was retained and services were provided and available after the pandemic. We made an additional £50 million available for NHS dental services at the end of last year, to increase capacity in NHS dental teams. Appointments were given to those in most urgent need of dental treatment, including vulnerable groups and children. As a result of that funding, I am pleased that say that an additional 1,110 patients were seen in Salford. To support the provision of urgent care, more than 170 urgent dental care centres remain open across the country. One of those centres is in the Salford locality, as the hon. Lady knows.

Across the nation, the system is recovering and delivery of dental care is increasing. In 2021-22, 24,272 dentists performed NHS activity—an increase of 539 on the previous year. In the 12 months to 30 June this year, 5.6 million children were seen by an NHS dentist, compared with 3.9 million children in the same period the previous year. That represents a 43% increase.

[John McDonnell (Hayes and Harlington) (Lab)]

There have been reports in a number of our constituencies of almost a dental health epidemic. Can the Minister explain whether there will be targeted resources for a number of our constituencies where there is such a high level of child dental ill health?

[Neil O’Brien]

I am exploring how we can best target the places with the most acute problems. There are problems in a lot of different places, and we are thinking about that actively at the moment. I will come back to that as I make progress.

Draft Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022

John McDonnell Excerpts

Tuesday 6th December 2022 General Committees

[John McDonnell (Hayes and Harlington) (Lab)]

I have a simple question for the Minister. We have received a number of representations, and it is important to acknowledge the consultation that has taken place. Page 6 of the explanatory memorandum states:

“The Department received 1634 responses to the consultation from individuals and organisations…Over 70% of responses to the consultation were from dental care professionals.”

It goes on:

“Many respondents were supportive of improvements being made to the regulators’ international registration processes”.

It does not say “most”. What was the balance between supportive and oppositional responses to the proposals that the Government have taken forward? It would be helpful to know how many of the representations the Government have taken into account.

[Will Quince]

I take your instruction on the passing of notes, Mr Bone; it will not happen again.

Let me answer a number of the points made by the hon. Member for Enfield North, starting with dentistry more generally. Our aim is to ensure that everyone has timely access to NHS dentistry and that dentistry is an appealing career choice. In too many parts of our country, people do not have access to a dentist in the way that they should. In July this year, we announced a package of improvements designed specifically to increase access to dental services across England. That includes better remuneration, guidance on how patients should expect to attend for check-ups, and measures that enable dentists to make better use of staff in their dental teams. Of course, training has to be part of that. Health Education England undertook a three-year review of education and training as part of its 2021 “Advancing Dental Care” review. It is now implementing its four-year dental education review programme to improve recruitment and retention.

The hon. Member for Enfield North rightly raised internationally trained staff, who have been part of our NHS since its inception and continue to play a vital role. We are doing everything we can to invest in growing our domestic workforce and move towards a more sustainable domestic supply. We are training more, retaining more and encouraging staff who have left to return. Having said that, ethical international recruitment remains a key element of achieving our workforce commitments. As the hon. Lady will know, we have recently recommitted to publishing our NHS long-term plan, which is a commission for NHS England. As the Chancellor of the Exchequer set out in the autumn statement, it will be independently verified.

The hon. Member for Coventry North West asked about the performers list. Although it is not directly relevant, Mr Bone, perhaps you will indulge me for one moment, so that I can explain what we are doing. The Department is currently reviewing the National Health Service (Performers Lists) (England) Regulations 2013—that is, the route by which a dentist can become registered to undertake NHS services—to identify where regulatory requirements could be streamlined and simplified while maintaining the high professional standards that ensure patient safety. Any proposed legislative changes will be subject to consultation.

I think the question raised by the right hon. Member for Hayes and Harlington follows a number of emails that we received overnight. These related to the essence of this statutory instrument, which is about closing a loophole. I understand why people are exercised about that. I do not know the exact figures from the consultation, but it is on that exact point where we expect there will have been a higher percentage that we disagreed with, but I am happy to write to the right hon. Member and the Committee with the exact percentages of people who responded in a particular way. On that one point, I will go into detail because, although we recognise the opposition to that proposal, we intend to take forward this amendment in the interests of patient safety.

[John McDonnell]

Will the Minister write to us, with regard to not that specific proposal, but the generality? If we could receive a breakdown on that, that would be really useful. Can he say at this stage—sometimes, inspiration does come via notes—whether the majority were in favour or opposed?

[Will Quince]

My understanding is that, on this particular point around dental care professional registration with the GDC, the majority were opposed. That is the one major point where we disagreed with the consultation response.

If it is helpful to the right hon. Member for Hayes and Harlington, I will explain why. The change introduces fairness and consistency between UK and international routes because UK dentists cannot qualify or apply to join the DCP register using their dentistry qualification in other countries. I make clear that international dentists already registered as DCPs with the GDC will still be able to maintain their registration following these changes, but the amendment will allow the GDC to process applications from dentists to join the register as DCPs that are received until this order comes into force, which is likely to be in the spring. It guarantees that any live DCP title applications—I suspect those are the driver of some of the emails we received last night—submitted before the legislation has passed will still be processed.

Although we recognise that the majority of respondents to the consultation disagreed with the proposals and many argued that international dentists are already qualified, or have enough clinical experience, to work as a DCP, others also highlighted that in some cases overseas qualified dentists work as dental care professionals outside the UK, and in many countries there is not a separate job title for dental care professionals.

However, in the UK the GDC recognises dentists and DCPs as distinct professions; they undertake similar but different tasks. I understand from the GDC that the majority of such applications from international dentists are, in any event, unsuccessful. This reinforces that one of the GDC’s priorities must be on ensuring that only suitably qualified people join the profession here in the UK, in the interest of patient safety.

I hope that my answers to those questions—notwithstanding the exact point on the numbers and percentages of people that objected on particular points, which I will write to the Committee about—will provide sufficient reassurance. The order promotes flexibility for the General Dental Council and the Nursing and Midwifery Council as independent statutory regulators to fulfil their duties in developing and maintaining robust and proportionate international registration processes. I commend the order to the Committee.

Question put and agreed to.

Childhood Cancer Outcomes

John McDonnell Excerpts

Tuesday 26th April 2022 Commons Chamber

[John McDonnell (Hayes and Harlington) (Lab)]

I thank the hon. Member for Gosport (Dame Caroline Dinenage) for her terrific work in securing this debate, which provides us with the opportunity to raise incredibly moving individual cases. The hon. Member for Stroud (Siobhan Baillie) is no longer in the Chamber, but many of us also feel tearful, unaided by pregnancy. We raise these individual cases so that we can build the lessons learned into policy.

We are inspired by the courage and determination shown in these cases. I was lobbied by Sonia Kean—she is not my constituent, but she is lobbying terrifically hard—and she has been through this experience with her son, who had to tackle cancer again after it returned. She is working hard on behalf of a range of families to further this debate.

These debates are good because we are able to draw on the experience of colleagues such as the hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey). They also give us an opportunity to thank people, and we have heard about the many charities that are working so hard. We should thank them on the record.

It is not often done in this place, but I thank the hon. Members for St Ives (Derek Thomas) and for Scunthorpe (Holly Mumby-Croft) for the work of the all-party parliamentary group on brain tumours and its inquiry on research. Its report will be significant in influencing the flow of not only research but the funding behind it, too.

I agree with the hon. Member for Gosport that we need a mission-based approach, one element of which is research, but I want to put another proposal on the table. Many people working in different areas of cancer are arguing for greater investment in research, and they have been given confidence by the way in which research has enabled us to tackle covid by bringing together the pharmaceutical companies, the research bodies, Ministers and others. There might be an opportunity for a summit of pharmaceutical companies, research bodies and others to give a new impetus to developing the research we need to tackle childhood cancers. If we can do it on covid, we can also advance to a much higher plateau on childhood cancer through such an initiative.

Eye Health and Macular Disease

John McDonnell Excerpts

Tuesday 11th January 2022 Westminster Hall

[John McDonnell (Hayes and Harlington) (Lab)]

I join others in thanking the hon. Member for Strangford (Jim Shannon) for securing the debate. I congratulate him on providing a service to us all by securing so many debates on so many relevant issues. I concur with the previous speaker, the hon. Member for Hendon (Dr Offord), that it is time for a national strategy; we have been calling for one for a while.

Like my hon. Friend the Member for West Ham (Ms Brown), I will talk about refractive surgery. I completely concur with the hon. Member for Strangford, and the general tone of the debate, about the need for longer-term, stable investment, and the worries that we all have about the postcode lottery in access to eyesight assessment, and services to tackle any problems that are identified. Part of the problem of the postcode lottery is that people who have concerns about their eyesight can become desperate and resort to alternative methodologies, one of which has been refractive surgery.

Refractive surgery is often successful, but there is always a risk. We are talking about both laser surgery and lens replacement, in larger numbers every year. It is a growing issue. Thousands upon thousands are receiving refractive surgery, basically from three main companies: Optical Express, Optimax, and Optegra. Tragically, of those thousands, many hundreds are now experiencing serious problems. They have failed to find a solution to their eyesight problems by turning to surgery, but in many instances have been harmed by the surgery itself.

I have been campaigning on this issue for over a decade. I have worked with other MPs and campaigners. We have had private Members’ Bills, ten-minute rule Bills and debates in the House. I pay tribute to the external campaigners. Sasha Rodoy from the My Beautiful Eyes Foundation has brought together literally hundreds of cases, providing people with support and exposing some of the appalling practices. My hon. Friend the Member for West Ham referred to the GMC. There are specific examples of where the GMC guidelines are ignored, resulting in real harm. The guidelines basically say that the surgeon undertaking the surgery should meet the person who is to be operated on. There should be a proper assessment of their suitability for the surgery, and advice should then be provided.

Over the past decade, we are finding too many examples of where the assessment has been given largely by salespeople rather than clinically qualified staff. Often, the person will not see the surgeon until the day of surgery. Owing to the oligopoly of the companies involved, the pressure of meeting sales targets seems to be more important than achieving good outcomes for the clients or patients involved. Inadequate advice then leads to unsuitable judgments and people undergoing surgery that damages their eyesight.

My hon. Friend the Member for West Ham mentioned one tragic case, but there are so many others: paramedics who can no longer pursue their career; police officers who are unable to drive professionally any more; and, as hon. Members may have seen in the media, one health worker who took his own life as a result of the distress.

When things go wrong, the companies often deny responsibility. Sometimes they accept that they need to do something, but they will often delay appointments with the surgeon beyond 12 months and then refuse to accept any responsibility, with people having to be sent off to the NHS for treatment. I want to raise the same issue with the Minister as my hon. Friend the Member for West Ham. It would be really helpful if we ensured that the NHS collated the information about the work it has to undertake and the investment it has to put in to correct the damage and harm caused by those private companies. There was even one company that went into administration and therefore denied all responsibility and liability to patients, only for it to restructure itself and form a new company to continue providing the same services.

On the complaints, I have to say there have been numerous complaints to the GMC and the General Optical Council. Unfortunately, it is often judged that the case does not meet the seriousness threshold and therefore little or no action is taken by those bodies to regulate and monitor companies that are not abiding by basic guidelines. We have discovered that people are operating without being professionally qualified even in cases that are coming up this year. Those shocking examples demand a response now, after all these years.

I am happy to meet with the Minister or, as I know she is busy, with her colleagues and officials to talk through the review that needs to be undertaken into the operation of refractive surgery, as well as what needs to be done to improve regulation and to ensure that the harms caused by the operations largely being carried out by private companies are addressed and that people are supported in the very distressing situations they have found themselves in.

--- Later in debate ---

[Steven Bonnar (Coatbridge, Chryston and Bellshill) (SNP)]

I commend the hon. Member for Strangford (Jim Shannon) for bringing forward this debate on a hugely important subject. Macular disease is the biggest cause of sight loss in the UK, with up to 40,000 people developing wet age-related neovascular macular degeneration every year, with wet macular degeneration being the worst of all known eye diseases.

Age-related macular degeneration is a common condition that affects the middle part of a person’s vision. It usually affects people in their 60s and 70s, rising to a rate of around one in 10 people aged 75 and above. However, it can strike at any age. It can happen in one eye or both and, as we have heard from the hon. Member for Great Grimsby (Lia Nici), it affects the middle part of a person’s eye. AMD can make things such reading, watching television, driving or even facial recognition difficult. Other symptoms can include seeing straight lines as wavy or crooked—which was how the hon. Lady established that she had a problem—objects looking smaller than normal, colours seeming less bright, or seeing things that are not even there.

AMD is not painful and does not affect the appearance of the eye. It does not cause complete or total blindness, but it can make everyday activities incredibly difficult. Without treatment, vision may worsen gradually over several years, which is known as dry AMD, or quickly over a few weeks or months, known as wet AMD. The exact cause is unknown; it has been linked to high blood pressure, being overweight, smoking or having a family history of AMD.

I am sure Members agree that the figures and statistics prove the seriousness of the disease, and why pre-emptive measures should and must be taken. I am proud that that is exactly why we are leading the way in optometry in Scotland. We are currently the only country in the UK to provide free, universal, NHS-funded eye care examinations. Since 2006, adults in Scotland have been able to attend a free eye health check biannually, with children under the age of 16 and adults over the age of 60 entitled to an annual visit. That proves that the Scottish Parliament is committed to delivering a world-leading eye care service for its people.

An NHS eye examination in Scotland is more than just a sight test. It provides a general eye health check that can detect early signs of sight-threatening conditions and other general medical conditions, including diabetes, high blood pressure, cardiovascular disease, tumours, dementia, or even arthritis. Optometrists in Scotland deliver a system of eye care services in which all areas of the ophthalmic workforce are truly at the top tier of their professional competency and expertise. That enables higher quality, safe, effective and person-centred eye care services to be delivered in the community and closer to people’s homes, freeing up hospital services to focus on the most complex eye conditions and urgent patient cases.

Community optometrists are already the first point of contact for any eye problems and they can diagnose and treat a number of conditions without the patient requiring an appointment with their GP or an ophthalmologist, easing pressures on an already burdened health service. An increasing number of community ophthalmologists are also registered independent prescribers and can issue patients with an NHS prescription to treat their eye problem or condition.

I was fortunate enough to be able to visit one of the opticians in my constituency of Coatbridge, Chryston and Bellshill just yesterday. Tuite Opticians in Coatbridge is a family-owned optician currently run by Eamonn Tuite, which has been at the heart of our town since 1973. Tuite understands the needs of the community it serves and always goes the extra mile to ensure the best healthcare and support are provided to all service users. As a result, it not only provides eye examinations in the practice, but also a bespoke service for the housebound, ensuring minimum fuss is required by the patient for such a vital check. I am pleased to be able to place on record my gratitude to the optometrist Stephen Kirley, who took the time to explain to me in great detail the impact of macular degeneration on individuals and why early intervention is so important in treating the disease.

That all lies within and is covered by the free eye test and the fantastic policy of the Scottish Government. By ensuring there are no barriers to accessing eye care, optometrists such as Stephen have a positive impact on patients’ health needs. In return for every eye test carried out, the Scottish Government provide practices such as Tuite with a fee to cover the cost of its work and ensure the business can continue to support as many in the community as possible.

Tuite Opticians was kind enough to carry out my own eye test yesterday and I sure all Members will be happy to learn that I have a clear bill of health—all the better for keeping a beady eye on this Government.

[John McDonnell]

I went for my eye test yesterday. I could not get an appointment in Hayes, my constituency, so I went to Uxbridge. Unfortunately, at the same time the Prime Minister did an official visit to the eye test and disturbed it. How inconsiderate could he be?

[Steven Bonnar]

That is so surprising. This Prime Minister is known for his consideration of others.

I put my thanks to Tuite Opticians on the record, not only for having me, but for its tremendous commitment to the wider community of Coatbridge for over 30 years.

Adult Social Care

John McDonnell Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

My right hon. Friend makes a very good point. My grandmother was in a care home with dementia; the thought of not being able to see family has been one of the very difficult things throughout the pandemic. I pay tribute to all the care workers, who in some cases took the place of family during the height of the pandemic and were there with their loved ones day and night.

My right hon. Friend is absolutely right that it is very important that visitors can go into care homes, but of course care homes also have to make sure that they are safe, and we need to get the balance right. We have updated the guidelines for visitors and ensured that there is a named essential care giver who always has access to their loved one in care. We have recently updated that guideline, but obviously we will keep it under review as we learn more about the new variant.

[John McDonnell (Hayes and Harlington) (Lab)]

The Minister has talked about a 10-year vision, but most unpaid carers are just trying to see how they can get through the next week, or the week after that, or the week after that. As has already been pointed out, there are 11 million unpaid carers in the country, many of whom depend entirely on carer’s allowance, a legacy benefit. They never gained the additional £20 of universal credit, and they are living in poverty. What is there in this strategy that will assist unpaid carers and lift them out of poverty?

[Gillian Keegan]

I agree with the right hon. Gentleman. Unpaid carers are an essential part of the system, and I want to pay a massive tribute to all the people who have been offering care, usually to their loved ones, during this period. As the right hon. Gentleman suggests, during the pandemic many vital services on which carers generally rely, such as respite or day care services, have not always been fully open to everyone, so I have urged all local authorities and providers of those services to ensure that they are.

The White Paper provides for money to help local providers to develop the services that carers would appreciate. There is a specific fund for them to work with carers, and there will obviously be input into that as well. We will ensure that we build services to support this vital sector, and, in addition, carer’s allowance will rise to just over £67 in April 2022.

Motor Neurone Disease (Research)

John McDonnell Excerpts

Monday 12th July 2021 Westminster Hall

[John McDonnell (Hayes and Harlington) (Lab) [V]]

I thank the hon. Member for Linlithgow and East Falkirk (Martyn Day) for the eloquent way he introduced this debate. I will try to be as brief as possible so that everyone can get in. I want to address my remarks to the Minister directly. She has heard why we are here. More than 100 of my constituents signed the petition, and quite a few of them, including myself, have had experience of motor neurone disease affecting either family or friends. It is a brutal, savage condition, but we meet people all the way along the road dealing with this dreadful condition, and they all work on the basis that there will be light at the end of the tunnel, and the light that we see now at the end of the tunnel is research.

Like others, I have been using the Government’s figure of £54 million investment without realising that only £5 million was directly targeted. The sense I get from people at the moment, and from the associations and charities that work in this field, is one of optimism that we could be close to a breakthrough in identifying how to predict, prevent, treat and cure this condition. The sense I get is that a little more money, distributed effectively and invested wisely, could tip us over the edge in tackling this condition.

I say to the Minister that the problem we face is fragmented funding sources and the lack of certainty and predictability about the scale of investment that will really help us to bring the science together and tackle the issue effectively. We will assist her in lobbying the Treasury. We are at that stage in the spending review process when departmental bids are going in and hard negotiations are well under way. We will help her in those negotiations, because not only do we believe that we are on the cusp of a breakthrough but it chimes with everything that has been said by the Prime Minister, the Chancellor and successive Health Secretaries about how we need to invest in life sciences, link with the pharmaceutical industry, and in that way become world leaders.

In the context of the overall spending review, this is not a great deal of money to be asking for on such a critical issue, which affects so many of our constituents and their families in a heartbreaking way. We will support the Minister as much as we can in her submission on this matter. The £50 million that we are talking about over a five-year period is a drop in the ocean in comparison with some investments in other conditions. Many of us believe that we are clearly on the edge of something big that could, again, chime with what the Prime Minister has been saying about how we can be world leaders in the field of life sciences research.

I urge the Minister to take on board everything that has been said by this cross-party group of Members. Behind us, literally hundreds of thousands of people are looking to the Government for the small step forward that could provide us with such an immense breakthrough.

Children and Young People’s Mental Health

John McDonnell Excerpts

Wednesday 16th June 2021 Westminster Hall

[John McDonnell (Hayes and Harlington) (Lab) [V]]

I thank the hon. Member for Twickenham (Munira Wilson) for not just securing the debate but superbly setting the scene.

I want to reinforce the message that has just come so eloquently from the hon. Member for Bath (Wera Hobhouse) with regard to eating disorders. I saw the recent paper by Dame Til Wykes and other scientists and campaigners, supported by the Government’s national adviser, Chris Whitty. They discussed the end goals for mental health research. The first end goal was halving the number of children and young people experiencing persistent mental health problems.

Eating disorders are just one of the serious persistent problems that start early and often persist into adulthood. As the paper sets out, they are associated with extremely poor outcomes, so it is appropriate to try and stop these disorders persisting from an early age. It makes sense for the individuals and their families, but also for the NHS, in terms of reducing costs, and for the economy overall, because people can contribute so much more fully to society.

What came out of that paper is the decision that we need to implement what we know already, but also support more research to improve recovery. As the hon. Member for Bath said, we already know that eating disorders are a growing problem. Some of the statistics are startling. The NHS 2019 health survey for England found that 16% of adults aged 16 and over screened positive for a possible eating disorder. In recent years, we have seen a fourfold increase in eating disorder hospital admissions, and waiting lists are at an all-time high. Hon. Member after hon. Member is finding this in their constituency, particularly when they are approached by distressed parents.

It is estimated that one in three young people experiences an eating disorder. Because these disorders occur among so many young people, they are still sometimes viewed as almost a teenage girls’ illness—a diet, a lifestyle choice or something a person grows out of. Yet, the statistics on their severity are shocking. It is reported that eating disorders have the highest death rates among all mental health disorders, and the rate of suicide is 23 times higher in people with eating disorders, compared with the general population—one in five deaths in eating disorder patients is reported to take place because of suicide, and I pay tribute to the work my hon. Friend the Member for Blaydon (Liz Twist) and her all-party parliamentary group on suicide and self-harm prevention are doing. According to the reports that we receive as constituency MPs, these serious consequences result from eating disorders partly because of the lack of access to psychiatrists who are fully trained in eating disorders and who specialise in eating disorder treatments.

As the hon. Member for Bath said, evidence is emerging that there has been a significant rise in people with eating disorders during the covid pandemic. Those in recovery have been set back, and new eating disorders have developed among a wider range of the population. From what I hear from my constituents, there is a vicious cycle of a lack of awareness, a lack of training and a lack of research funding at the scale needed. Let me just quote the parents from one family, who said: “Tell them right now the support, the treatment and the understanding is just not out there for us.”

Concerns have also been expressed about what some people consider unhealthy messages being pushed by the Government’s obesity strategy, which is being developed at the moment. I hope that more consideration will be given to consulting organisations that represent people with eating disorders in the development of that strategy.

I want to pay tribute to Hope Virgo. Many will have heard of her campaign “Dump the Scales”, which has been calling so effectively through the media for proper investment in eating disorder treatments. Just this week, Hope told me she has received numerous letters from parents whose children have been naso-gastric-fed on general wards, with no psychological support in some health settings.

F.E.A.S.T., a global website campaign, is reporting thousands of people contacting it through Eating Disorders Support UK, and 5,000 have signed up for its 30-day support scheme. Hope Virgo is the founder of the Hearts, Minds and Genes eating disorder coalition, which is the first coalition to declare a state of emergency around eating disorder treatment, and I am pleased that it is now meeting the Department of Health and Social Care. This serious issue needs ministerial support to drive through the new programme, and I hope that pathways and support will be developed within a timescale that recognises its urgency and seriousness.

[Sir Gary Streeter (in the Chair)]

The winding-up speeches will begin at 3.28 pm. Jim Shannon has five minutes.

Covid Contracts: Judicial Review

John McDonnell Excerpts

Wednesday 24th February 2021 Commons Chamber

[Edward Argar]

Again, I have huge respect for the hon. Gentleman, who is normally measured and tempered, but I fear on this occasion that he has not done himself justice in the points he makes. As I have made clear, and as has been made clear, all contracts that were awarded were assessed by an eight-stage process run by the civil service—checking due diligence, appropriateness, ability to deliver and price—and not by Ministers. On the specific contract he mentioned, it has been made clear that the Secretary of State had no involvement in the award of that contract or its assessment.

[John McDonnell (Hayes and Harlington) (Lab) [V]]

I think the whole tenor of the discussion today demonstrates a need for greater transparency, as the Minister has said. One way of doing that is by extending freedom of information to include all companies engaged in publicly funded contracts. I am concerned about the data contract with the US data company Palantir, which is notorious for its links with Trump and the white supremacist far right. Will the Minister confirm whether that contract has been the subject of a data protection impact assessment, including a public consultation, and whether Palantir will be able to sell on NHS data at a later stage, even, for example, to the Conservative party for electoral purposes?

[Edward Argar]

I will not stray near the wilder accusations made by the right hon. Gentleman. What I will say to him is that the data of NHS service users is always protected by this Government.