A Plan for the NHS and Social Care

Jonathan Ashworth Excerpts

Wednesday 19th May 2021 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

I beg to move an amendment, at the end of the Question to add:

“but respectfully regret that the Government has provided insufficient information for its proposals properly to be scrutinised; and therefore beg leave that she will be graciously pleased to give directions that the following papers be laid before Parliament: the DHSC internal review of their operation during the pandemic as referenced by the Prime Minister’s official spokesman on 12 May.”

May I take this opportunity to note that although amendment (e) in the name of my hon. Friend the Member for Rhondda (Chris Bryant) has not been selected, its contents, which relate to brain injury, are important and welcome? I hope that Ministers take on board its recommendations.

[Chris Bryant]

It is all too tempting to intervene; I have never objected to temptation. On brain injury, I just want to say that I really want us to think about legislation now. The United States of America has made dramatic changes—it has introduced legislation four times now—and I think it is time we went down that route.

[Jonathan Ashworth]

I completely agree. I hope that Ministers on the Treasury Bench have listened carefully. If they are prepared to bring forward legislation, we would work constructively across the House to ensure its speedy passage. May I thank my hon. Friend for the reference in his amendment to the impact of alcohol abuse on children? He knows that it is a subject very close to my heart; on behalf of the children of alcoholics community, I am grateful that he referred to it in his amendment.

Although we have often said this in the House, I still think that the whole House will want to remember today the 127,691 people so far who have lost their lives to covid-19, this awful disease, including the 850 health and care workers. Although repeating the numbers has become almost routine in this House, that does not make the scale or gravity of the loss any less shocking. We grieve as a nation and we all pay tribute to our healthcare workers, our social care workers and our public sector workers.

I am sure that the whole House will want to dedicate itself in good faith to learning lessons for the future. Sadly, we are in an era when, according to the experts, pandemics are becoming more predictable and will become more regular because of climate change and biodiversity loss, so learning lessons is about preparing better for the future rather than settling scores.

We know that the B1617.2 variant is spreading. From the data that I have seen, it appears to have a growth rate advantage of about 13% over the B1117 variant. It could well become the dominant strain in the United Kingdom. Although vaccination should mean that many are much safer and ought to avoid hospitalisation, the Government still have a responsibility to do all they can to contain its spread, minimise sickness and ensure that the 21 June target is not disrupted, if at all possible.

That is why I said on Monday that we need more surge vaccination in hotspot areas. We know that with vaccination there are always pockets where rates are lower than necessary, and we need to drive those rates that up. We have seen that throughout history—with measles, for example. So we urge the Government again to do all they can to drive up vaccination rates in Bolton, Bedford, Blackburn and other areas where we know there is an issue. We also need the Government to do more to contain the virus through test, trace and isolate. We need more surge testing. We need more enhanced contact tracing locally, with local authorities given the resources to carry it out. We need sick pay and isolation support fixed as well.

For those who are going in to work, or for those who are now socialising in premises, those buildings and premises need proper air filtration systems. There are experts now who can easily fix filtration systems in buildings to make them much more covid secure, and we should be inspecting workplaces in all these areas to ensure that every workplace is covid secure.

We need transparency in decision making as well. For the first time in my life, I think, I find myself agreeing with Mr Dominic Cummings. I know the Secretary of State does not often agree with Mr Dominic Cummings, but I find myself agreeing with Mr Dominic Cummings, who tweeted yesterday:

“With something as critical as variants escaping vaccines, there is *no* justification for secrecy, public interest unarguably is *open scrutiny of the plans*”.

Mr Cummings, on this occasion, is correct. [Interruption.] A wry laugh from the Secretary of State. Mr Cummings may well have been saying something different when he was in government; I do not know, but at least his public statement yesterday is correct. That is why our amendment calls for the publication of a Government lessons-learned review; not so that we can try to undermine the Government or find some hole to use across the Dispatch Box, but so that we can learn the lessons in our efforts to contain variants, and ensure that we are better prepared for the future. I hope the Secretary of State looks sympathetically upon that request, and perhaps joins us in the Division Lobby this evening.

I now turn to the contents of the Gracious Speech more generally. This should have been the Queen’s Speech that unveiled a new NHS plan to bring down the elective waiting list, which now stands at 5 million. This should have been a Queen’s Speech that outlined proposals to tackle the backlog of 436,000 people waiting over 12 months for treatment—many of them waiting in pain and anxiety, many of them facing permanent disability as a consequence of those waits.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I will certainly give way to my fellow Leicester City fan.

[Jim Shannon]

The shadow Minister and I, and many others in this House, shared that wonderful victory on Saturday. After 139 years of Leicester City, we won the FA cup; it is great news.

I chair the all-party parliamentary group for respiratory health. This morning, we were given some very worrying figures. They indicated that the halting of the lung cancer screening pilots restricted access to diagnostic tests, contributing to a 75% drop in urgent lung cancer referrals. Does the shadow Minister agree with me, and share my concern, that the outcomes for patients with the fastest-progressing cancers, such as lung cancer, are indeed very worrying?

[Jonathan Ashworth]

The hon. Gentleman is spot-on. I will come on to cancer in a few moments. He is a great champion for improving cancer care, and I thank him for reminding the House that Leicester City won the FA cup on Saturday. It is a reminder that even when the odds are stacked against them, a small team can still beat a well-funded, complacent opposition.

I will now move on to elective waiting lists. Where is the plan in this Queen’s Speech to bring down the rocketing waiting lists for treatment and surgery? Where is the plan to roll out technology such as in ophthalmology, for the thousands in our constituencies awaiting cataract operations? There are already 81,762 of our constituents waiting over 12 months for orthopaedic surgery. Where is the plan to get on with the hip replacements and knee replacements that many of our constituents will be raising with us in our surgeries, and how much longer will they have to wait? Where is the plan for the 24,407 of our constituents who are now waiting over 12 months for gynaecological surgery? How much longer will they have to wait?

Everyone understands that there has been a pandemic and that that has meant a disruption in care pathways, but the NHS was forced into this unprecedented position because we went into the crisis on the back of 10 years of Tory underfunding and cutbacks. We went into this crisis on the back of a 6% reduction in bed numbers between 2010 and 2019. That is why, at the beginning of 2020 when we debated the last Gracious Speech, 4.5 million people were on the waiting list for treatment. The target of 92% of patients beginning treatment within 18 weeks of referral from their GP had not been met for five years. We need a resourced plan now because the queues are set to lengthen further, as those who may have delayed seeking treatment for fear of covid infection will begin to emerge once again. Even though the NHS is dealing with significantly fewer covid patients, it is still operating at a much-reduced capacity and is unable to treat everyone in need of care.

Infection control measures meant that the number of beds fell by 9% in the first quarter of last year. It has only partially recovered in the past three months, but the number is still 6% lower than the previous year. What that means when we look at the most recent figures is that, on average, there are almost 4,000 fewer patients in NHS general and acute beds than the equivalent pre-covid period.

The Prime Minister has delayed the review of social distancing for entirely understandable reasons, but we must have a plan to drive up this capacity in the NHS. The solution to these capacity issues in the NHS cannot be a multi-billion pound deal with the private sector. The loss of capacity in terms of beds in the NHS is actually far larger than the whole capacity offered by the private sector. In order to reopen those closed and empty general and acute beds in the NHS, we need more capital investment. This investment needs to be built up now, so that the NHS can get on with the routine surgery that it will clearly have to confront in the coming years. I am afraid that, both the Queen’s Speech and, indeed, the Budget from a few weeks ago, failed to deliver that.

[James Cartlidge (South Suffolk) (Con)]

Is the hon. Gentleman saying that under no circumstances would he use the independent sector to reduce the pressure on elective surgery waiting lists?

[Jonathan Ashworth]

If the hon. Gentleman thinks that the answer to driving up capacity is just a four-year £10 billion deal with the private sector, then we will not be in a position to reopen the beds over the coming years in the NHS. That is the issue. It undermines capacity in the NHS. We need capital investment in the NHS, so that we can drive up capacity.

[James Cartlidge]

Let me repeat the question: is the hon. Gentleman explicitly ruling out using the independent sector at all to drive down that backlog?

[Jonathan Ashworth]

The independent sector is not the answer to this. The answer is investing in capital in the NHS. In the hon. Gentleman’s local area, there are 8,485 patients waiting for diagnostic tests—that is 25% when the operational standard is supposed to be 1% or less. He should be arguing for capital investment in the NHS, but he is not, and he is not sticking up for his constituents.

[James Cartlidge]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I want to make a bit of progress. If the hon. Gentleman wanted more beds in the NHS and greater diagnostic capacity, he would have been arguing for capital investment in the NHS, which we did not get in the Budget and we did not get in the Queen’s Speech.

That brings me to diagnostic capacity—I have just given the hon. Gentleman his local diagnostic figures. [Interruption.] This is not about new hospitals; this is about diagnostic capacity. The Secretary of State knows that we still have some of the lowest numbers of computerised tomography scanners and magnetic resonance imaging scanners per capita in the OECD. We still have only average amounts of RTE radiotherapy machines. We need investment in this technology, which we are not getting in sufficient amounts. That is why, in the past year or so, we have seen 4.6 million fewer diagnostic tests for cancer. Some 46,000 fewer people are starting cancer treatment. We should not have to choose between covid care and cancer care, but, for too many, that has been the reality of the past year, and it means that 4,500 additional avoidable cancer deaths are expected in the next 12 months. It means that progress in survival rates for colorectal cancer, breast cancer and lung cancer is expected to be undone. The proportion of cancers diagnosed while still highly curable has dropped from 44% to 41%.

The long-term plan, on which the Secretary of State fought the election, promised rapid action on cardiovascular disease. Experts now predict the highest cardiovascular mortality in a decade, and they predict 12,000 additional heart attacks and strokes over the next five years. The Queen’s Speech needed to include proposals to expand access to the appropriate cardiovascular healthcare facilities, but it also needed to include real interventions to tackle smoking and alcohol rates, and to reduce salt intake. Yes, there is a commitment to a tobacco control plan, but will there be a reversal of the 17% cuts to smoking cessation services? Given that 7,400 people died last year from alcohol abuse—a record number—will the Secretary of State reverse the cuts to drug and alcohol addiction services, with budgets being cut by 15% over the past three years?

We have been promised action, again, on banning junk food advertising, but when? I have heard the Secretary of State—and, to be fair, his predecessor—make that promise at the Dispatch Box many, many times, but when will we have the ban? When will he reverse the cuts to public health weight-management services?

Narrowing health inequalities should be at the heart of every Government policy, but there can be no levelling up while life expectancy advances stall for the poorest in society. Levelling up and tackling inequalities apply to mental health outcomes as well. More people suffer from depression in the poorest areas of the country than the richest. We know that the mental health problems are prevalent among certain minority ethnic communities —black men, in particular, are more likely to be detained under the Mental Health Act 1983, more likely to be subjected to seclusion or restraint, and less likely to access psychological therapies. We therefore welcome the commitment to reform the Mental Health Act, as we welcomed it last year, and I look forward to working constructively with the Secretary of State on reforming the Act. I would like to put on record my thanks to Sir Simon Wessely for his pioneering work on this front. Simon is a committed Chelsea fan, so I dare say that he will be more responsive to my felicitations this morning than he might have been on Saturday evening.

We face a crisis in mental health now, and we need action now. Two hundred and thirty five thousand fewer people have been referred for psychological therapies; eating disorder referrals for children have doubled; and the pandemic—again, because of infection control measures —has meant a reduction of almost 11% in beds occupied, which is equivalent to 1,700 fewer patients over the past three months compared with a year earlier. When will the Government implement their promise of significant increases in staff and resources for mental health, to ensure that mental healthcare is genuinely given parity of esteem with acute services?

That brings me to staffing more generally. Given that we are short of 200,000 staff across the health and social care sector, why was there nothing new in the Queen’s Speech to recruit more doctors, nurses and social care staff? Why was there no plan to give our NHS staff the pay rise that they deserve? NHS staff, including nurses who have cared for those with covid on wards, and district nurses who, in the first wave, cared for those who were discharged from hospital earlier than planned so that they could stay at home safely, have gone above and beyond, yet they feel that the 1% pay rise, which could well turn out to be a real-terms cut because of inflation, is a kick in the teeth. Is it any wonder that nurses are leaving the profession, including the nurse who cared for the Prime Minister, blasting Ministers for treating NHS workers with a total lack of respect? It is simply not fair. Our NHS staff deserve better.

The gaping hole in the Queen’s Speech is the plan for social care. Two years ago, the Prime Minister stood on the steps of Downing Street and said he had a plan to fix social care. He said:

“we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve.”

It was not a plan to be developed, or work in progress; no, this was a plan that was already done—oven-ready, you might say, Madam Deputy Speaker. But two years on, where is it? Has the Health Secretary seen it? What do we need to do to see it—perhaps we could pay for some cushions in the Downing Street flat? The Government promised us cross-party talks. They now brief that cross-party talks have taken place, but when—did they forget to send the Zoom link?

However, there is a consensus on social care, isn’t there? Care workers should be paid the living wage and proper sick pay. There should be a cap on costs, as this House legislated for. When the Institute for Public Policy Research, social care and older people’s charities and a House of Lords Committee, which, at the time, consisted of true-blue Thatcherites such as the noble Lords Lamont and Forsyth, have all called for reform of free personal care, why is the Secretary of State not engaging in that debate with us? To be frank, though, lack of cross-party talks is not an excuse for not getting on with reform. A Prime Minister with an 80-seat majority should be able to show some leadership and get on and fix social care.

If the Health Secretary wants to talk social care reform, I am free this afternoon. He knows where I am. I am happy to sit down with him at any time and discuss it. I think we would have very constructive conversations on this one, because it is true to say, as Members have detected, that we have developed something of a bond these past 12 months. The Health Secretary has been so friendly to me across the Dispatch Box that I am half expecting to win a lucrative PPE contract by the end of the day.

Because we have this new friendship, I have, as we say on the Labour Benches, some comradely advice for the Health Secretary. I know he is bringing forward a Bill to neuter the independence of the NHS chief executive and bring powers back to the Secretary of State. I have been around a long time and I remember when Tory MPs used to complain that the NHS needed independence, but we will leave that to one side. I just suggest that he ought to be careful what he wishes for, because I have been reading the Evening Standard, where Mr Tom Newton Dunn reveals not only that Simon Stevens, whom the Secretary of State is trying to neuter, was best man at the Prime Minister’s wedding, but that the Prime Minister is said to be about to appoint Simon Stevens—I beg your pardon, Lord Simon Stevens—to, yes, you guessed it, the newly empowered post of Secretary of State for Health and Social Care. It brings a whole new meaning to the phrase, “the best man for the job”, doesn’t it? But this is a Secretary of State who set up Test and Trace, who was responsible for PPE procurement and who failed to protect care homes. Dominic Cummings said the Department under his leadership was a “smoking ruin”—and now he wants more control.

The Queen’s Speech was remarkably unspecific in its description of the contents of the coming health and social care Bill, so perhaps the Secretary of State can reassure us today. Can he commit to ensuring that neither the NHS nor the partnership force to be set up in each integrated care system will permit the inclusion of private sector participants? Will he rule that out? Can he guarantee that as statutory bodies ICSs will meet in public, publish board papers and be subject to the Freedom of Information Act 2000? What guarantees can he give this House that the establishment of integrated care systems will not lead to more private corporations taking over GP practices, as has happened recently with Centene, or services currently delivered by NHS providers? I hope he can give us those very simple reassurances today.

With nearly 5 million people on the waiting lists and rising, ever-lengthening queues in our constituencies waiting for hip replacements and cataract removals, cancer survival rates worsening, mental healthcare in crisis, social care reform kicked into the long grass, and a costly, morale-sapping reorganisation on the way, we needed a fully resourced 10-year rescue plan for our NHS. I commend our amendment to the House.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. At the beginning of this debate, I fear it was not quite clear which other amendments had been selected by Mr Speaker. I have now had an opportunity to look at my notes on my Order Paper. For the sake of clarity, let me tell the House that Mr Speaker has not selected amendment (e) in the name of Mr Bryant, as I predicted earlier. He has selected amendment (g) in the name of the hon. Member for Walthamstow (Stella Creasy), the right hon. Member for Haltemprice and Howden (Mr Davis) and others. He has also selected amendment (i) in the name of the leader of the Scottish National party.

I remind hon. Members that, although their contributions should address the terms of these amendments, it is in order for them also to refer to other matters relevant to the Gracious Speech.

--- Later in debate ---

[Matt Hancock]

Yes, my hon. Friend is absolutely right. I thought that his exchanges with the right hon. Member for Leicester South were disappointing, because we know that the Opposition spokesman supports the use of the private sector in the NHS, because he was the guy behind the private finance initiative projects of the last Labour Government. Mr PFI there is a huge fan of the use of the private sector in the NHS, but he cannot admit it, because of the people sitting behind him, and the right hon. Member for Ashton-under-Lyne (Angela Rayner) sitting next to him, keeping watch over him from the hard left of the party.

[Jonathan Ashworth]

For goodness’ sake, I was not responsible for a single PFI contract. Actually, I remember that it was for the previous Chancellor of the Exchequer, George Osborne, that the right hon. Member was the chief lickspittle and bag carrier in signing off PFI contracts when he was first appointed to the Treasury. He can go through all the Treasury documents and he can FOI it until the cows come home, and he will find that I was not involved in any PFI contracts when I worked in the Labour Government, but I was responsible for helping invest in the NHS, which brought waiting lists down to their lowest level ever.

[Matt Hancock]

Well, it did not actually, because after 2010 we then had to bring waiting lists down, and we brought them down. The 52-week waits came down to just 1,600 before the pandemic, and it is our task and our mission to make sure that we get them down once again. However, this will take time and it will take all the resources that are possible—yes, extra staff, and that is happening; yes, extra capital investment, and that is happening; and yes, extra diagnostics, and that is happening. We have to use all the capacity of everything that we can—north and south, revenue and capital, public and private. What people care about and what our constituents care about is whether they can get the problem fixed, and last year has demonstrated that without doubt. So on the Government side we will use everything in our power to support the NHS. It is only those on the other side of the House who have the ideological divisions, and that just demonstrates once again that we are the party of the NHS.

In March, we committed £7 billion for further funding for healthcare services, including £1 billion to address backlogs from the pandemic, and that has taken our additional funding for covid-19 to £92 billion. We are also helping the NHS to recover medical training, and today I can confirm to the House an additional £30 million for postgraduate medical training. The formula for beating this backlog is looking closely at the demand as we emerge from the pandemic, putting in the right resources to meet this demand and putting in place an ambitious programme of improvement in the NHS.

That brings me to the third thing I want to talk about, which is how we are going to build back better. The Queen’s Speech outlines improvement in almost every area of healthcare, applying vital lessons that we have learned from the pandemic, including from the successful vaccination programme, when the whole health and care system has worked as one in the face of challenge and adversity. The vaccination programme brought a jigsaw of academics, the private sector, volunteers, the NHS, civil servants and many more, and put this together, revealing a bold picture of what is possible in this country when we pull together. That is the spirit and the energy that will underpin our reforms, and all of them have a common thread, which is to improve the health of the nation, based on the principle that prevention is better than cure.

Turning to our health and care Bill, as outlined in Her Majesty’s most Gracious Speech, one of the lessons of the crisis is the importance of integrated working. We knew this before, but it has come right to the front of mind. For years, people in the NHS at all levels have called for stronger integration within the NHS, and between the NHS and others they work so closely with, such as local authorities. The Bill will allow for a more preventive, population health-based approach to how we spend NHS money, helping people to stay healthy in the first place, and that is at the core of our Bill.

The right hon. Member for Leicester South asked about the new integrated care systems. They will bring together decision making at a local level between the NHS and local authorities to ensure that decisions about local health can be taken as locally as possible. The Bill will tackle much of the bureaucracy that makes it harder to do the right thing and free up the system to innovate and embrace technology as a better platform to support staff and patient care.

Her Majesty also set out our commitment to reform adult social care, and we will bring forward proposals this year to give everyone who needs care the dignity and security they deserve. Throughout the pandemic, we have sought to protect the elderly and the most vulnerable, and this will remain our priority as we look to end the care lottery and ensure that people receive high-quality, joined-up care.

This country understands the importance of the NHS and social care, but I also think that there has never been a greater appreciation of the importance of public health. Never have the public been more engaged, and never have we learned quite so much in such a short space of time. We must capture the lessons of the pandemic on how we do public health in this country and put that together with the innovations of the last decade—in data, genomics, population health, science and research.

One of the lessons that we have had to learn quickly is that health security and health promotion each need a single-minded focus. The people who get up in the morning and think about how we increase healthy life expectancy must be different from the people focused on fighting novel pandemic threats. Each is important and each needs dedicated focus. We have split these functions into two purpose-built organisations so that we are better at both.

The new UK Health Security Agency will have a dedicated focus on responding to the current threats, planning for the next pandemic and scanning the horizon for new threats in good times as well as bad. Of course, pandemics do not respect administrative boundaries. The UKHSA’s role is specifically to promote and protect the security of the United Kingdom as a whole.

Next, the job of our new Office for Health Promotion will be to lead national efforts to improve and level up our health—addressing the causes of ill health, not just the symptoms, such as through our plans to tackle obesity and make healthier choices easier and more accessible, and through supporting our colleagues in primary and community care. General practice, after all, is at the forefront of all population health measures and GPs are the bedrock of the NHS. General practice will be central to our levelling up the health of the nation because we know, and they know, that prevention is better than cure. A greater proportion of our efforts will now be directed at preventing people from becoming patients in the first place.

All of that brings me to mental health reforms. To truly level up health and reduce health inequalities, we must level up every part of our health, including mental health. I am determined to see mental ill health treated on a par with physical ill health, and to ensure that support is in place for those struggling with their mental wellbeing. We have provided record levels of funding for mental health services, especially to meet the additional burdens of the pandemic, but we need a better legislative basis—a mental health Act fit for the 21st century.

We are modernising the Mental Health Act to improve services for the most serious mental illnesses and support people so that they can manage their own mental health. The new Act will tackle the disparities and iniquities of our system and improve how people with learning difficulties and autism are supported. Ultimately, it is going to be there for every single one of us if we need it.