Budget Resolutions

Jonathan Ashworth Excerpts

Tuesday 30th October 2018 Commons Chamber

[Matt Hancock]

I pay tribute again to my right hon. Friend, who has worked tirelessly in support of that project. The Defence and National Rehabilitation Centre in Loughborough will link world-class military medical facilities with our NHS. That means lessons learned in the medical field from treating our brave troops who come back from the frontline can be brought into the NHS—for instance, surgical techniques that were learned in battle can be adapted to help civilians here. I pay tribute to her and others for the work they have done.

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

Here is a representation from a Jonathan from Leicester. Further to the question from the Chair of the Select Committee on Health and Social Care, the hon. Member for Totnes (Dr Wollaston), can the Secretary of State confirm that, in next year’s spending review, the cuts to capital budgets and the £700 million-worth of cuts to public health budgets will be reversed, and that there will be real-terms increases in funding for capital, training and public health? Can he guarantee that?

[Matt Hancock]

The spending review is next year. What I can guarantee is a £20.5 billion increase in NHS spending. That is the biggest increase in any spending commitment for any public service in the history of this country. [Interruption.] It is a pity that the Leader of the Opposition is not interested and does not want to hear about it. If he stayed, he could also hear about the reforms we are going to make. He should hear this more than anyone. We are acutely aware on the Conservative Benches that this is not Government money or NHS money but the hard-earned money of taxpayers, and we need to ensure that it is spent wisely. When he sprays his commitments around, Opposition Front Benchers would do well to remember that this is money from taxpayers.

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[Dr Sarah Wollaston (Totnes) (Con)]

May I start by apologising for being absent for much of this debate because I was chairing the Health and Social Care Committee? I also declare a personal interest, as three members of my immediate family are employed as NHS doctors.

We need to take a whole-system approach to health— to think of it not just as the NHS, but as a system including social care, public health, the prevention arm and training budgets. I return to a point that I made in an intervention: I wholly welcome the uplift in the NHS budget, but the increase in the NHS England budget that will take place between 2018-19 and 2019-20 is £7.2 billion, whereas the uplift in the wider health budget in the Red Book is only £6.3 billion. It concerns me that this might indicate that some of the uplift in the NHS England budget will come by way of being taken out of other aspects of the health budget, particularly the Public Health England budget, as we have seen in previous years. I hope that the Minister will touch on that in his response.

[Jonathan Ashworth]

I think that the hon. Lady may have left the debate to attend her Committee when I re-emphasised her point directly to the Secretary of State, who told us that we would have to wait for the spending review. Would she share my disappointment if the Government tried to pull the same trick that they pulled three years ago, and actually misled us or gave us bogus figures for NHS spending that did not include public health expenditure, capital and training?

[Dr Wollaston]

We need absolute transparency around health spending, and to take not only a whole-system approach but a long-term view.

Public health is the prevention arm of the system, and taking money out of public health has a serious impact on future spending and our ability to tackle health inequalities. It would be very troubling indeed if much of this uplift came directly from a public health cut. We need to be specific about that, and it is not sufficient to wait for the spending review to clarify that point; I hope that the Minister will be able to tell us further about what it means. People need to plan for the future, so if £900 million is going to be taken out of public health grants, we need to know that now.

When we ask the public which parts of the system they prioritise, public health tends to be at the bottom of the list. It is up to the Government to look at the evidence, and they must be clear that the evidence shows that we must focus unrelentingly on the prevention arm of healthcare. That is the right thing to do, and it is where we have the greatest chance of tackling the burning injustices of health inequality, so it is an important point to address.

The other aspect I want to touch on is social care. The Health and Social Care Committee has just had a sitting with the Care Quality Commission on its excellent “State of Care” report. The report comments on “fragility,” and the report of a couple of years ago talked about “a tipping point.” The CQC told us that that tipping point has been passed for many people in social care. The interaction between social care and the health service is so close that, if we do not focus on social care, we are simply tipping more costs on to the health service.

Of course it is welcome that there will be an in-year increase for adult social care of £240 million this year and £650 million next year, but it is widely recognised that, because of the extraordinary increase in demand and pressure—driven not just by the welcome fact that we are living longer but by the great increase in the number of people with multiple long-term conditions living to an older age and by younger, working-age adults living with multiple complex needs—social care needs more than £1 billion a year just to stand still, so we need to go further.

I recognise that much of this will come alongside next year’s social care Green Paper, which we are all looking forward to, but the system is under considerable challenge. I hope the Minister will recognise in his closing remarks that we are not there yet on social care. He needs to say what we are going to do in the long term to address our social care needs. As I have said before, we will require an approach that involves the Labour Front Benchers, too. We need to see political consensus, otherwise the politically difficult decisions on funding will not get through the House.

If there are to be cuts to public health, the Government will have an even greater responsibility to provide other levers in their public health policy to reduce demand in the system. The Chancellor specifically referred to wanting to reduce the tragedy of lives lost to suicide. Unfortunately, at the same time, the delay in the reduction of the maximum stake for fixed odds betting terminals means that we have passed up on an important opportunity to address the misery of gambling addiction. That is a hugely wasted opportunity. Likewise, there is a missed opportunity to look at what has happened in Scotland on minimum unit pricing to make sure we are addressing some of the key drivers of public health problems. The Government cannot duck that if we are to see cuts to the public health grant.

Finally, there is the impact of Brexit. The Chancellor has said that there will be £4.2 billion for preparations for a no-deal Brexit. I am afraid that the costs will be far higher. The Health and Social Care Committee recently heard from the pharmaceutical industry that it is having to plough hundreds of millions of pounds into preparing for no deal. That is phenomenal and inexcusable waste; it is money down the drain. I hope the Government will rethink their policy, because no version of Brexit will provide more money for the NHS. There is a Brexit penalty, not a Brexit dividend, and I hope both Front-Bench teams will come together and agree that, ultimately, we need the informed consent of the British people for whatever version of Brexit we come up with, with the option to remain and properly use the money instead for tackling austerity and improving the lives and the health of our nation.

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

With your indulgence, Mr Speaker, may I preface my remarks by briefly mentioning the awful tragedy that took place at Leicester City football club in my Leicester constituency this weekend? My city—the city I represent—is grieving. We have lost a much loved friend who enjoyed the respect, affection and admiration of not just Leicester City football fans but everyone across our city. Our condolences go out to the loved ones of all who lost their lives in that terrible helicopter crash, and again I pay my tribute to our extraordinary emergency services—the police, the fire and rescue services, the NHS and all other staff—for their quick response, their dedication and their professionalism.

This was supposed to be the Budget that ended austerity, but instead, as my right hon. Friend the shadow Chancellor outlined, we have more of the same. Cuts to public services will continue. Poverty will increase. The very poorest households in society will lose out. Austerity has not ended; we know austerity has not ended because that is the headline in George Osborne’s Evening Standard this evening.

Members have spoken in this debate with great passion, and I am sure the House will forgive me if I cannot mention each and every one of them, but some did catch my attention. My hon. Friend the Member for Huddersfield (Mr Sheerman) began the debate with a tour de force and reminded the House that PFI was a Tory policy begun by—[Interruption.] Conservative Members are chuntering. Perhaps they should have a word with the International Trade Secretary who from this Dispatch Box used to urge us to pursue PFI because it was

“exclusively to fund private capital projects”—[Official Report, 8 January 2003; Vol. 397, c. 181.]

Perhaps they should have a word with the Chancellor of the Duchy of Lancaster who used to give a “warm welcome” to PFI. Perhaps they should have a word with the former Brexit Secretary; I know he is on the Back Benches now, but he used to say in this House:

“The PFI has many virtues—after all, it was a Conservative policy in the first instance.”—[Official Report, 10 March 1999; Vol. 327, c. 429.]

Perhaps they should have a word with the Business Secretary, who said:

“PFI was initiated by the previous Conservative Government.”—[Official Report, 12 February 2013; Vol. 558, c. 787.]

Perhaps they should also have a word with the Scottish Secretary, who said that PFI was a “successful basis for funding”, or with the Welsh Secretary, who said:

“I am a fan of PFI in general.”—[Official Report, 4 November 2010; Vol. 517, c. 1124.]

We will take no lessons on PFI from the Tories.

We have heard other welcome contributions to the debate today. My hon. Friend the Member for Easington (Grahame Morris), who is no longer in his place, spoke eloquently about the need for investment in radiotherapy and cancer treatments. It was a very constructive speech and I saw the Health Minister on the Front Bench nodding at the time; he has obviously had to leave the debate now. The hon. Member for Redditch (Rachel Maclean)—I do not know whether she is still here—mentioned the importance of more investment in and recognition of the menopause. I entirely agree with her on that.

My hon. Friend the Member for Sheffield Central (Paul Blomfield) talked about the terrible and devastating consequences of gambling addiction. As someone who has spoken out about how addiction has taken a devastating toll on my own family, I completely endorse what my hon. Friend said today. The Government really need to push ahead with changes to fixed-odds betting terminals. My hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) and others talked about health inequalities and how the advances in life expectancy were beginning to stall for the first time in 100 years, and were indeed going backwards in some of the poorest parts of our country. This should shame us as a society, and I endorse the calls for an inquiry. If we had a Labour Government, we would have a specific target for narrowing health inequalities.

The hon. Member for Glasgow Central (Alison Thewliss) spoke eloquently about the effects of the Budget on children. I commend all her work as chair of the all-party parliamentary group on infant feeding. It is shameful in our society that, as we saw on Channel 4’s “Dispatches” last night, one in 100 families are now turning to baby banks in our constituencies for access to baby clothing, food and toys. That is absolutely disgraceful. The hon. Member for Mid Dorset and North Poole (Michael Tomlinson) complained about chuntering from our side as he spoke about the importance of marriage. I agree that marriage is an immensely important institution, but I say to him that children should take priority in social policy and that the Government should be investing in children regardless of the marital status of their parents.

I hope that Members will forgive me if I do not mention everyone, but I did enjoy the passionate speech from my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) on the value of public services. At one point, she said, “This is my truth.” I do not know whether she was referring to the Manic Street Preachers or to Aneurin Bevan, who also said:

“This is my truth, tell me yours.”

My hon. Friend’s speech was a superb successor contribution to some of the speeches that Bevan would have made from the Dispatch Box when he created the NHS and the Conservatives voted against its creation.

The Health Secretary does not seem to be in this place to hear the wind-ups, but I am sure that he is on his way. I am told that he is a fan of horse-racing, but I am afraid that his speech fell at the first hurdle day. You see, Mr Speaker, it is not just the Chancellor who can do rubbish jokes in the Chamber. The Health Secretary forgot to tell us what eight years of austerity had delivered for the national health service and what eight years of the deepest and longest financial squeeze in the NHS’s history had delivered. We now have 4.3 million people on the waiting list and 2.8 million people waiting for more than four hours in A&E, of whom more than 600,000 are designated as trolley waits. Over 25,000 people are waiting beyond two months for cancer treatment, which is twice the number in 2010.

Winters are now so bad in the NHS than they were branded a “humanitarian crisis” by the Red Cross. Last winter, 186,000 patients were trapped in the back of cold ambulances and not even able to be admitted to an overcrowded hospital. Hip replacements, knee replacements, cataract treatments and rounds of IVF are being rationed and restricted. There were 84,000 cancelled operations in the past year, including nearly 19,000 cancellations of children’s operations for broken bones, for the removal of rotten teeth, for eye surgery and even for cancer.

Nowhere is the disgraceful neglect of children in our health service more prevalent than in mental health services. Three in four children with a diagnosable mental health condition do not get access to the support they need. The numbers of young people attending A&E with a recorded diagnosis of a psychiatric condition have trebled in the past eight years. A fifth of children and young people referred for an eating disorder wait more than four weeks for treatment, while more than 1,000 children are sent far from home—sometimes more than 100 miles away—for in-patient care. That is what happens after eight years of cuts, closures, service privatisation and failure to invest in staffing. That is what austerity has done, and it will continue.

One really must examine the small print of the spending readjustments for the NHS. The Health Secretary talked about £20 billion extra for the NHS over five years, but there is no new money for the winter ahead, which hospital bosses are already warning will be even tougher than last year’s. According to Ministers, the NHS budget is set to grow by 3.6% next year. If the shadow Chancellor were Chancellor, it would grow by 5% next year.

Let us look at what is not included in the health budget, which the hon. Member for Totnes (Dr Wollaston), who chairs the Health Committee, and others alluded to. First, even though the Health Secretary tells us staffing is his priority, we have 107,000 vacancies across the NHS. We are short of 40,000 nurses and midwives and of 10,000 doctors. The number of GPs is down by 1,000, the number of district nurses by 43% and the number of mental health nurses by more than 5,000. And what has happened to training budgets? They were excluded from that 3.6% allocation and, as my hon. Friend the Member for Lincoln (Karen Lee) pointed out, the Chancellor failed to reinstate the nursing bursary. There is no plan in the Budget to increase NHS staffing.

Secondly, the Health Secretary promised us a “technological revolution”. Our NHS faces a £6 billion repair backlog, relies on 12,000 fax machines and uses at least 1,700 pieces of outdated and often faulty equipment, yet capital budgets are excluded from the 3.6% allocation. In fact, according to the Red Book, capital will be cut by £500 million. The Chancellor boasted that he was ending PFI—I do not why he thought that would embarrass the shadow Chancellor or the Leader of the Opposition; he has obviously not followed the history of the Labour party in recent years—but the Government’s response to the Naylor report on infrastructure needs for primary care signalled that £3 billion would be raised from private finance investment. If PFI is abolished, where will that £3 billion for primary care transformation come from? Or is the reality that the Chancellor has not abolished private financing of public capital projects, but has simply abolished an acronym?

Thirdly, despite the Health Secretary’s hollow commitment to prevention, public health services are still being cut. We have seen £700 million of cuts so far, with another £96 million to come. For example, substance misuse services in our constituencies will be cut by £34 million next year at a time when we have some of the highest drug deaths and alcohol-related hospital admissions on record. Sexually transmitted infections are on the increase, yet sexual health services are set to be cut by £17.6 million next year. We are falling behind internationally on children’s health outcomes, from obesity to immunisations and support for new mums with breastfeeding, and the numbers of health visitors and school nurses are falling, yet early years health services will be cut next year because of cuts to the public health grant. Those cuts should have been reversed in the Budget, not endorsed.

Taken together, there will be £1 billion of cuts to public health, training and capital, which means this health settlement represents an increase next year not of 3.6% but of 2.7%. That is not enough to deliver the level of service that patients expect.

Let us look at what the £20 billion will fund. We have been told there is £2 billion extra for mental health, but growing mental health spending in line with the increase in overall health spending costs an extra £2 billion. That is more spin and smoke and mirrors. The Institute for Public Policy Research says we need £4 billion extra. NHS England advises us that NHS activity increases by 3.1% a year. Demand is rising, the burden of chronic disease is rising and the number of patients with multiple chronic conditions using the NHS is increasing. Those demographic changes and the rising burden of disease will take up £16 billion of that £20 billion. The pay increase, which the Government have been forced into because of campaigning of staff, the trade unions and the Labour party, will take up another £3.5 billion. That is £19.5 billion of the £20 billion already taken up—and still no plan to reduce waiting lists, tackle the A&E crisis, invest in general practice, or deal with the £4.3 billion of underlying deficits of hospitals and loans owed by NHS trusts.

The Chancellor’s answer in the Red Book is to say that we should have 1% efficiencies a year in the NHS. What does that mean? It means more cuts and greater rationing of treatments. In the Red Book, the Chancellor also says that we can create savings through prevention—even though he is cutting prevention budgets—and integration of care. How can we integrate care with the health sector when billions of pounds have been cut from social care? Some £7 billion has been cut from social care, so 400,000 people now go without care support and over 50,000 over-65s with dementia are admitted to hospital because of a lack of social care.

The Chancellor said yesterday that he is giving more to social care, but he is cutting local authority budgets by £1.3 billion with one hand and is offering councils £650 million to be shared between adult and children’s social care with the other. He is literally asking councils to choose between supporting vulnerable children with social care and supporting vulnerable adults with social care. That is not a serious choice; it is callous, cruel, nasty politics. We need a comprehensive settlement for social care, not the ongoing short-term drips from this Government.

We need a plan for the NHS. Yesterday was an opportunity to turn around our greatest institution, but it is not enough to deal with waiting lists or the crisis in recruiting the staff we need. There is no plan to bring waiting lists down and end rationing of treatment, no plan to recruit the doctors and nurses needed for the future, no plan to reverse the cuts to children’s health services and end privatisation, no plan to rebuild social care and improve care for those living with dementia, no plan to expand community health services and general practice, and no plan to transform services for the future. The record will show, yet again, that you simply cannot trust the Tories with the NHS.