NHS 10-Year Plan

Jonathan Ashworth Excerpts

Tuesday 19th February 2019 Commons Chamber

[Louise Haigh (Sheffield, Heeley) (Lab)]

The long-term plan acknowledges that life expectancy continues to improve for the most affluent 10% but has either stalled or fallen for the most deprived 10%. In Sheffield, life expectancy for the most deprived women has fallen by four years over the nine years that this Government have been in power. Does the Minister have any analysis of why life expectancy has fallen for the most deprived women on his watch?

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

Very good question.

[Stephen Hammond]

I am sure that there will be a number of excellent questions and interventions, but it was a good question. The plan sets out that all local health systems will be expected to outline this year how they will reduce health inequalities by 2023-24, and the intention is that that process will consider exactly the health inequalities that the hon. Member for Sheffield, Heeley (Louise Haigh) mentions.

Additional money for the primary sector will ensure that funding for primary medical and community health services, such as GPs, nurses and physiotherapists, increases by £4.5 billion in real terms in the next five years. That will mean up to 20,000 extra health professionals working in GP practices, with more trained social prescribing link workers within primary care networks. By 2021, all patients will be offered a digital-first option when accessing primary care. The plan also considers the future of the health system, and the new proposals for integration are the deepest and most sophisticated ever proposed by the NHS.

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

I thank the Minister for his brevity. I am sure the House will appreciate the way in which he both took a number of interventions and made his remarks speedily. I will endeavour to copy him. [Hon. Members: “Hear, hear.”]

I start where the Minister almost concluded, by thanking NHS staff for the work they do day in, day out. He is a relatively new Minister to the post—so new that you gave him a different surname, Madam Deputy Speaker, but we will gloss over that. He inherits his portfolio after a time in which the NHS has suffered the most severe financial squeeze in its 70-year history. At one point under the Conservatives’ spending plans for national health services the money was set to fall on a head-for-head basis, although they have now revised the spending plans. Because of that financial squeeze over many years, he inherits a portfolio where 4.3 million people are on waiting lists and 2,237 people are waiting more than 12 months for treatment, more than 2.9 million people waited more than four hours in an accident and emergency department, and nearly 27,000 people wait two months for cancer treatment. The 18-week referral to treatment target has not been met since February 2016, the cancer target has not been met since December 2015, the diagnostic target has not been met since November 2013, and the A&E target has not been met since July 2015. Those targets are all enshrined in the NHS constitution and in statute, and they were routinely delivered under the last Labour Government. Under this Government, they have, in effect, been abandoned.

[Gloria De Piero (Ashfield) (Lab)]

People in my constituency have to wait longer than most people in the country for a GP appointment: 23% waited more than two weeks; and 15% waited more than three weeks. Does my hon. Friend agree that one of the many brilliant things the last Labour Government did was introduce the 48-hour target to see a GP?

[Jonathan Ashworth]

The last Labour Government put record investment into the NHS, which was voted against every step of the way by the Conservatives. That Labour Government delivered some of the best waiting times on record and some of the highest satisfaction ratings, and they increased access to GPs in constituencies such as Ashfield.

The A&E standard is important not only for patients waiting in an overcrowded A&E but because it tells us much about flow through a hospital. Last week we had the worst A&E performance data since records began, with just 76.1% of those attending type 1 A&E seen, discharged or admitted to a ward in four hours. Behind the statistics are stories of patients left waiting in pain and distress and of the elderly languishing on trolleys. In fact, we have had 618,000 trolley waits in the past year. Patients have been waiting without dignity, at risk of cross-infection. There is no road map at all in the long-term plan to restoring access standards. Of course, the A&E standard is being revised in the long-term plan, even though the Royal College of Emergency Medicine has said:

“In our expert opinion scrapping the four-hour target will have a near catastrophic impact on patient safety in many Emergency Departments that are already struggling to deliver safe patient care in a wider system that is failing badly.”

I hope that when the review reports we can have a full debate in the House.

[Dr Poulter]

The hon. Gentleman is right to highlight the Blair Government’s injection of cash into the NHS and the meaningful difference that that made to many patients’ lives. On the waiting-time targets, if we are serious about parity for mental health and physical health, we should reflect on the fact that historically there have not been access targets for mental health of anywhere near the same standards that there are for physical health. Will the hon. Gentleman join me in urging a rethink of that and a much greater push for access targets for mental health services as a way to raise standards and improve the time within which patients get care?

[Jonathan Ashworth]

The hon. Gentleman makes an important point. There are elements of the long-term plan that we welcome, including the access targets for mental health. We also welcome the commitment to save 400,000 lives, although there is no detail in the plan about how those lives are going to be saved. We welcome the rolling out of early cancer diagnostic and testing centres—after all, it is a policy that I announced in the 2017 general election campaign. We welcome the roll-out of alcohol care teams in hospitals—a policy that I announced at the Labour party conference last year. We welcome the commitments on perinatal mental health—again, a policy that we announced previously. We welcome the commitment for preferential funding allocated to mental health services—another policy that the Labour Opposition previously announced—but we will need to study the details carefully, as the hon. Member for Oxford West and Abingdon (Layla Moran) said.

The points about mental health from the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) were well made, because currently three in four children with a diagnosable mental health condition do not get access to the support they need. Child and adolescent mental health services are turning away more than a quarter of the children referred to them for treatment by parents, GPs, teachers and others. That is quite disgraceful, so I hope the extra investment in mental health services reaches the frontline quickly, and I hope that in summing up the debate the Minister will give us more details about when we can expect to see progress on that front.

[Darren Jones (Bristol North West) (Lab)]

Does my hon. Friend agree that for hospitals such as Southmead Hospital in my constituency, which is one of the largest hospitals in Europe, frontline delivery requires a workforce that is able to meet the demand? Does he therefore agree with the comments from the King’s Fund, which says that the Government not only failed the test on the workforce but did not even turn up for the exam?

[Jonathan Ashworth]

My hon. Friend makes a good point, and I will come on to discuss the workforce in a few moments. First, let me pick up the point made by my hon. Friend the Member for Sheffield, Heeley (Louise Haigh).

There is recognition in the plan that widening health inequalities are becoming a more important issue, which we need to confront. There is much in the document about widening health inequalities. After years of austerity, with poverty rates increasing and child poverty at 4.1 million, we now see life expectancy in this country stalling for the first time in a hundred years, and actually going backward in the poorest parts of the country. Child mortality rates for children born into the most deprived of circumstances have increased. The truth is that poorer people get sick quicker and die earlier. For me, as a socialist and a Labour politician, that is shameful. We should be creating conditions in which people live longer, healthier, happier lives, which is why we need to end austerity across the board. The focus on health inequalities is therefore welcome, and that includes the stark recognition that inequalities are costing the NHS £4.8 billion a year in admissions—a remarkable figure.

[Matt Rodda (Reading East) (Lab)]

I concur on the benefits of our Labour health policy and how the Government should do much more to fund healthcare in this country. Does my hon. Friend agree that there is a particular problem of retaining public sector workers in many high-cost areas? In areas such as Reading and Oxford—my hon. Friend the Member for Oxford East (Anneliese Dodds) is sitting in front of me—there is severe pressure on the NHS because of the relatively low pay of many skilled staff.

[Jonathan Ashworth]

Absolutely. I will come on to the workforce in a second.

Overall, there are welcome commitments in the long-term plan. We have counted up to 60 commitments to improve, expand or establish new services, but sadly there is no detail on how they will be delivered. There are commitments to expanding access to general practice, but where is the plan to recruit the workforce we need in the national health service?

When the previous Secretary of State came to the House last June, he said that there would be a full workforce plan—not an interim plan shared by Dido Harding, but a full workforce plan to coincide with this long-term plan.

[Hon. Members]

Where is it?

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[Jonathan Ashworth]

It has been delayed. There are no details about training budgets, because the Department has to wait for the spending review. We have 100,000 vacancies across the national health service, with think-tanks warning that we will have 250,000 vacancies unless we do something. We cannot wait for this workforce plan; we need action now.

Also missing from the long-term plan is any serious investment in public health services—this is picking up on another point that the hon. Member for Central Suffolk and North Ipswich made. Public health services are being cut again this financial year under this Government. When we take into account the cuts to public health services, the cuts to infrastructure, and the cuts to training, there is actually a £1 billion cut to health spending this year. The cuts to public health are equivalent to 1,600 fewer health visitors, 1,700 fewer school nurses, and 3,000 fewer drug workers. They mean that our constituents become sicker and demands on the wider NHS become greater. Drug and alcohol services will be cut by £34 million this year, even though the unmet need for treatment for alcohol problems has risen to 600,000 and admissions to hospital where alcohol is a primary factor have increased by 30%.

Also cut are smoking cessation services and obesity services. Cuts to health visitors and early years initiatives correlate with a fall in vaccination rates. Admissions to hospital for whooping cough are up by 59%. There have been deep cuts to sexual health services at a time when infections such as syphilis and gonorrhoea are increasing. These cuts to sexual health services are having an impact on women’s reproductive health, with experts expressing concerns that the use of long-acting reversible contraception is decreasing. Abortion rates among the over-30s are increasing and 8 million women live in areas where funding for contraception has decreased.

Let me read the House a quick extract from the Health Committee involving my friend—I will still call her my friend—the hon. Member for Liverpool, Wavertree (Luciana Berger). I am desperately sad that she felt that she had to leave the Labour party. I hope that the Labour party will get on top of this antisemitism issue. At the Health Committee, she asked about the health consequences of delays in accessing sexual health services. In responding, Dr Olwen Williams from the British Association for Sexual Health and HIV said:

“We are seeing neonatal syphilis for the first time in decades and neonatal deaths due to syphilis in the UK…We are seeing an increase in women presenting with infectious syphilis in pregnancy, and that has dire outcomes.”

These public health cuts were endorsed, not reversed, in the long-term plan.

[Paul Scully (Sutton and Cheam) (Con)]

rose—

[Jonathan Ashworth]

I will give way for the final time.

[Paul Scully]

I am grateful to the hon. Gentleman for giving way. He talked about a few different topics, but I think that I heard him say that there was an overall cut in the health service—I think he did so when he was welcoming some of the Government’s measures. In the 2017 manifesto, Labour committed to a 2.2% increase, whereas this Government committed to a 3.4% increase, so I hope that he welcomes that increase as well.

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[Jonathan Ashworth]

We committed more in our 2017 manifesto than the Tory party did in the manifesto on which the hon. Gentleman fought the election. The Tory party revised its spending plans because of pressure from the Labour Opposition. [Interruption.] Madam Deputy Speaker wants me to hurry up.

The final point that I want to make is this: the most intriguing part of the long-term plan is the remark that the Health and Social Care Act has created a complete mess, hindering integration; and it proposes scrapping the so-called section 75 provisions. We do not want to say, “We told you so,” but we did tell them so, and Tory MPs should apologise for voting to pass the Lansley Act. If they are going to support NHS England’s call to get rid of the section 75 arrangements, which put through a proposed privatisation, why do they not block the £128 million-worth of contracts that are currently out to tender? If they do not, it will be clear that the Tory party is still committed to privatisation in the national health service.

The truth is, the Tories have spent nearly nine years running down the NHS, refusing to give it the spending that it needs. They are privatising it still; there will be a £1 billion cut to the NHS this year. It is Labour who will rebuild the national health service.