Health and Social Care

Jonathan Ashworth Excerpts

Thursday 16th January 2020 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 regrets that the Gracious Speech fails to ensure that the National Health Service and social care will be properly funded; and calls for the Government to bring forward a plan and additional funding to end the crisis in social care and provide for at least a 4 per cent per year real terms increase in health spending.”.

Before I move on to the substance of my remarks, may I congratulate you, Mr Deputy Speaker? It is a pleasure to see you back in your place overseeing these proceedings. I will endeavour to be as brief as I can in my remarks, because I am aware that many Members hope to catch your eye to offer their maiden contributions. I am sure that every one of them will do their constituencies proud.

At the outset, I also wish to thank our hard-working NHS and social care staff who every day go beyond the call of duty and go the extra mile, especially over the Christmas period. We are forever in their debt. Our amendment, which we will put to the vote today, is essentially about backing up those hard-working NHS and social care staff, and sending a message to the Government that they should be given the resources that they need.

This is a motion about the 4.5 million people on waiting lists. This is a motion about the pregnant woman who waited so long for her glaucoma operation at a hospital in Southampton that she nearly lost her sight and has never seen the face of her child. This is a motion about the 34,000 people who wait more than two months for cancer treatment. This is a motion about those constituents, such as mine in Leicester, who had their bladder cancer operations cancelled twice. This is a motion about the 79,000 cancelled operations last year, and the 18,000 children’s cancelled operations. This is a motion about the 110,000 children denied mental health care, even though they are in the most desperate of circumstances. This is a motion about the 98,000 patients who waited on trolleys last month—a 65% increase on the previous year—many of them elderly, many of them in their 80s and 90s, languishing for hours and hours on trolleys in hospital corridors.

This is a motion about those hospitals that have been pushed to rack and ruin after years of cuts to capital budgets, including Hillingdon hospital in the Prime Minister’s own backyard, where children’s wards had to be closed because of subsidence. This is a motion about the Royal Cornwall hospital that is discharging patients early because it is so overwhelmed. This is a motion about the 1.5 million people, many of them with dementia, denied the social care support they need after years and years of swingeing cuts.

[Sir Desmond Swayne (New Forest West) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

Let me make a little bit of progress. I think Members on both sides would agree that I am usually generous in taking interventions, but I am aware that many colleagues want to make their maiden speeches today. I will take some interventions, but let me make a little bit of progress. I hope the right hon. Gentleman will give me a bit of leeway.

This motion is about giving the NHS the funding it needs. It is a motion that will test every newly elected Conservative Member of Parliament on their commitment to the NHS.

The Government are correct to signal in the Queen’s Speech, as they did indeed in the pre-election Queen’s Speech, that health and social care should be the priority. On that, at least, they have my agreement. Yesterday the Prime Minister promised to

“get those waiting lists down.”—[Official Report, 15 January 2020; Vol. 669, c. 1015.]

So the test that must be applied to the NHS and social care announcements in the Gracious Address is whether they add up to a strategy to drive waiting lists down and A&E performance up. The answer on that front is surely no. We have promises of 40 new hospitals, 50,000 new extra nurses, and 50 million more GP appointments, with 6,000 extra GPs. On each and every one of these commitments, we will keep track of progress and test Ministers on whether they deliver.

But we will also test Ministers on social—

[Sir Desmond Swayne]

rose—

[Mr Mark Harper (Forest of Dean) (Con)]

rose—

[Jonathan Ashworth]

I give way first to the right hon. Member for New Forest West (Sir Desmond Swayne) and then I will make some progress because I know that many Members want to speak.

[Sir Desmond Swayne]

The hon. Gentleman will recall that the Government accepted the Dilnot proposals and even put in place certain legislative provisions for them to be implemented in the next financial year. I never understood why, during the 2017 election campaign, they departed from that position—but what is the Opposition’s position on Dilnot?

[Jonathan Ashworth]

We have long argued for a cap on care costs, but of course the Government, as the right hon. Gentleman says, dropped their support for this policy.

On the issue of social care, the Prime Minister said at the Dispatch Box yesterday that he wanted cross-party talks, although in his BBC interview the day before he said that he had a plan that he would bring forward in the next 12 months. The Government want a consensus. I say to the Government that the Labour party has proposed free personal care. We have a version of free personal care in Scotland. There is a similar version of it in Northern Ireland. There is a version of it in Wales. The House of Lords Economic Affairs Committee, which includes Thatcherites such as Michael Forsyth and Norman Lamont, alongside the former Labour Chancellor, Alistair Darling, has proposed free personal social care. There already is a political consensus. It is the Secretary of State and the Prime Minister who stand outside that consensus. If the Secretary of State wants to engage with us on that basis, then my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) is happy to do so. I will now take the intervention from the former Chief Whip.

[Mr Harper]

Given that the hon. Gentleman’s party is undergoing a leadership election and that will clearly mean—[Interruption.] No, I am trying to say this helpfully. If the Secretary of State has made a commitment to start the process of cross-party talks within the next 100 days, that will obviously be before that leadership election is concluded. So my serious point is that if we wish to engage on a cross-party basis on whether to implement the Dilnot proposals, as my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) mentioned, or on the basis that the hon. Gentleman just said, is he in a position to start that engagement with the support of his current party leader so that we can make progress urgently? The social care problems in the country are not going to wait, frankly, for another Leader of the Opposition to be elected. That is meant as a really serious and cross-party point.

[Jonathan Ashworth]

It is a serious point, and I am grateful for the way in which the right hon. Gentleman has put it. Of course, we are very happy to engage. My hon. Friend the Member for Worsley and Eccles South, who sits in the shadow Cabinet and leads on social care, is happy to sit down with Ministers at any point.

I am suggesting to the Secretary of State, rather gently, that there is a degree of political consensus on free adult personal social care. The House of Lords Committee, which includes Michael Forsyth and Norman Lamont, not socialists red in tooth and claw by any means, alongside Alistair Darling, has proposed it. We, as a Front-Bench team, have proposed it. There are forms of it in some of the devolved nations. It is the Secretary of State who is standing outside that consensus. If he wants to engage with us on those terms, and on the point about a cap as proposed by Dilnot, then of course we are prepared to have those levels of engagement.

There is also a degree of consensus around the need for better integration between health and social care, and better co-ordination of health and social care. That is why we are intrigued by the Secretary of State’s proposal to consult on the NHS Funding Bill.

[James Cartlidge (South Suffolk) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

For the last time, because a lot of Members want to speak.

[James Cartlidge]

This is directly relevant. The hon. Gentleman made a point about the House of Lords Committee, but he will be aware that the House of Commons Committee recommended a social insurance system—perhaps along the lines of Germany’s, for example. Is he, in principle, supportive of that solution?

[Jonathan Ashworth]

No, because we do not think it would work—it is not feasible. It is not just the Committee in the Lords that says that—plenty of think-tanks have said it is not feasible as well.

There is broad consensus about the principle of better integration between health and social care. We have long argued for it, and now the Government have come round to arguing for it as well. The Government are proposing an NHS Bill along the lines of what Simon Stevens of NHS England has proposed. We long warned that the Health and Social Care Act 2012, which was introduced by Andrew Lansley and supported by sitting many of the Ministers on the Front Bench, would not lead to the levels of integration and co-ordination of care that was needed but to a fragmented mess.

We also long warned that the compulsory competitive tendering provisions of the Act would lead to more contracts being handed to the private sector. About £9 billion-worth of contracts were handed to the private sector, despite the Secretary of State telling us that there would be no privatisation on his watch. If his Bill gets rid of those compulsory competitive tendering provisions—the so-called section 75 regulations—we would welcome that, but we want competitive tendering to be abolished completely. We do not want clinical services privatised. We do not want clinical services outsourced, such as pathology labs in London, as is happening on the Secretary of State’s watch. We do not want tinkering in the Bill: we want the Health and Social Care Act binned so that we can restore a universal public national health service. [Interruption.] The Secretary of State says that it is universal. He is clearly not aware of the rationing that is going on across the country because of austerity and the privatisation of the NHS that is his policy.

As I indicated in the debate on the Gracious Address before the election, we will work constructively with Ministers to ensure the speedy passage of the health service safety investigations Bill. We will look to strengthen the independence of medical examiners. We call on the Government to do more to roll out medical examiners across NHS trusts. It is disappointing that so far only about 50% of trusts have medical examiners. These are absolutely vital to improving patient safety, because we know that things do go wrong in the delivery of care. We have all been shocked by the revelations at Shrewsbury and Telford Hospital NHS Trust. This is the worst ever maternity scandal, with clinical malpractice apparently allowed to continue unchecked since the ’70s. It is absolutely horrific and astonishing. I cannot imagine the grief that the families affected must have had to endure. Will the Secretary of State update the House on what is happening at Shrewsbury and Telford? I appreciate that there was an Adjournment debate on that matter last night, but I think the House would appreciate his offering us some reflections on what is happening at Shrewsbury and Telford. Will he also commit to reinstating the maternity training fund to help to improve maternity safety in our hospitals?

I am sure that the Secretary of State will agree, more broadly, that the delivery of safe care depends on adequate staffing levels as well, so would he support enshrining safe staffing levels in legislation? We are short of 44,000 nurses in England. Community nurses have been cut by 6,000 since 2010. Learning disability nurses are being cut. Mental health nurses have been cut by 10%. Health visitor numbers are down. School nurses have been cut. We have been warning for years about the detrimental impact on safe care of these staffing shortages. That is why, for example, we fought the Government on the abolition of the training bursary. We welcome the fact that Ministers are now bringing back a partial version of the bursary in the form of a maintenance grant, but why not bring back the whole bursary? Without bringing back the whole bursary, many are sceptical that the Secretary of State will deliver on his commitment for 50,000 new nurses, because as quickly as—[Interruption.] Well, he is rather stretching the definition of the word “new”. He gave the impression in the general election campaign that there were going to be 50,000 new nurses, but that soon unravelled, because when he went on the media it turned out that he was including in his figures 19,000 nurses who already work in the national health service. I of course have some sympathy—

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I am afraid that on this occasion I will not, because many Members want to make maiden speeches. There is nothing worse for a Member waiting to make a maiden speech than seeing the time ticking down because Front Benchers are taking lots of interventions.

[The Secretary of State for Health and Social Care (Matt Hancock)]

You know you’re talking rubbish.

[Jonathan Ashworth]

I will tell you who was talking rubbish, Mr Deputy Speaker: the Secretary of State when he said at the general election that he was delivering 50,000 extra nurses. That is why he avoided Piers Morgan during the election campaign. I do not know why the Secretary of State avoided Piers Morgan—he is a pussycat. I went on Piers Morgan’s show every week; why did the Secretary of State not go on?

I will give way once more, and then if Members will indulge me, I will not give way again, because a lot of Members want to make their maiden speeches in the debate.

[Dr Caroline Johnson]

I am grateful to the hon. Gentleman for giving way. He is using a lot of statistics and figures, and he talked about the definition of “more” and “new”. I want to ask him about the 44,000 vacancies that he talked about. Is it not right that when the Health Committee looked at that, it found that 38,000 of those places were actually occupied by nurses who work on the bank because they choose that working model?

[Jonathan Ashworth]

As the hon. Lady knows from her work on the frontline in the NHS, the problem is that bank and agency staffing have contributed to many of the deficits that our trusts are dealing with. That is one of the problems with the way in which the workforce have been managed by the Government.

The Secretary of State says that his figures include 19,000 existing nurses. I have some sympathy for him, because we have been raising the issue of retention in the NHS for some time. That is why we were so vigorous in opposing the public sector pay cap, of which he was a great champion for many years as a Tory Minister, and it is why we were pleased that the Government got rid of it, following pressure from those on the Labour Front Bench. It is a laudable aim to improve retention in the NHS, but it is not the same as recruiting new nurses.

The Secretary of State expects to recruit 12,500 nurses internationally, while at the same time imposing a tax on those nurses through the immigration health surcharge, increasing it to more than £600 per family member per year of a nurse’s working visa. Does he really expect to recruit 12,500 nurses internationally while imposing this nurses’ tax on them?

The Secretary of State will also know that we are desperately short of nurses in the field of mental health services. We welcome the commitment to reform the Mental Health Act 1983, and we will work constructively with him on that, but we have had enough warm words and rhetoric on mental health services. It is now time to deliver the parity of esteem that patients deserve. We have a shortage of mental health beds, which means that too many people are sent hundreds of miles across the country to receive care, away from their family and friends, often in poor-quality private providers.

The Secretary of State likes to boast of hospital upgrades, but anyone who has been in a mental health trust, works in one or has visited one, as I have, knows that the mental health estate is, frankly, some of the worst estate in the NHS. It is unsafe. Mental health patients deserve so much better, yet there is still no credible plan in anything he has said to modernise and replace the 1,000 beds in old-style dormitory wards in mental health trusts across the country. Children are being particularly let down, with increasing rationing of mental health services and more than 130,000 referrals to specialist services turned down despite children showing signs of eating disorders, self-harm and abuse. Matters have become so desperate that there are even reports of GPs advising children to exaggerate problems, because otherwise they will not get any help. This is the chaos of the underfunded system, and it leads to an increasing number of children and young people presenting at A&E in mental health crisis. A&E is no place for someone in mental health crisis. This is a disgrace, and our mental health services now need investment.

That brings me to A&E more generally. The Secretary of State will say that there is increased demand on our A&E, and that is true. There is increased demand on our A&E because mental health services have been pushed to the brink; because years of cuts to social care are pushing more and more people to A&E; because public health prevention budgets have been hammered by years of cuts under this Conservative Government; because GP numbers in our communities have been cut and people cannot get appointments; because walk-in centres have closed under the Tories; and because pharmacies were cut back. More broadly, it is because decisions by this Government—whether it is their decisions on housing and universal credit or their cuts to children’s services, with Sure Start centres closing—and rising levels of poverty mean that health inequalities are widening. It all adds up to more people presenting at A&E because of 10 years of Tory austerity.

What is the Tories’ answer to the worst A&E performance figures on record? It is to scrap the four-hour A&E target. Abolishing the target will not magic away the problems in A&E. It will not suddenly fix a system that saw 100,000 people waiting on trolleys last December. That is why the president of the Royal College of Emergency Medicine said yesterday:

“Rather than focus on ways around the target, we need to get back to the business of delivering on it”.

But Ministers cannot get back to the business of delivering the target, because they will soon ask the House to approve legislation that will legally bake in the underfunding of our NHS. The NHS underfunding Bill effectively caps NHS spending way below the level that experts say our NHS will need. The last Labour Government did not need legislation to signal their support of and commitment to the NHS. The last Labour Government got on and delivered record investment in our NHS. They delivered a 6% increase in investment into the NHS, and they delivered the lowest waiting lists and the highest satisfaction ratings on record—and we did not need the gimmick of a Bill to do it. We got on and delivered it.

The Secretary of State is proposing a Bill that fails to reverse the £850 million of cuts to public health prevention services. This is at a time of rising drug deaths, rising presentations at A&E for alcohol abuse, rising STI infections and rising obesity among children. He is asking us to approve a Bill that does not reverse the raids on capital budgets or deal with the £6.5 billion backlog of repairs facing our hospitals, which has left hospitals with sewage pipes bursting, ceilings falling in and lifts not working. He is proposing a Bill that does not give the NHS the 4% uplift annually that many experts say it needs. That is why Labour has tabled an amendment today to give the NHS a 4% uplift, and every Tory MP who believes in the NHS should support it. The Secretary of State is enshrining in law four more years of underfunding of our national health service and four more years of capped expenditure in our national health service, but it does not have to be that way.

I congratulate the Government on securing election. I congratulate the Secretary of State and all the Ministers who have been reappointed to the Front Bench, and I pay tribute to my former shadow Ministers who lost their seat, Paula Sherriff and Julie Cooper. We will hold the Secretary of State to account. We will test him on whether he delivers 40 new hospitals, 50,000 new nurses and 6,000 new GPs. We will test him on whether he drives waiting lists down, as the Prime Minister promised yesterday. Where the Secretary of State is right, we will work constructively with him. Where he is wrong, we will argue our case forcefully.

The Secretary of State was elected on a promise to fix the NHS. With 4.5 million people on the waiting lists, 2.5 million people waiting beyond four hours in A&E and 34,000 people waiting beyond two months for cancer treatment, our constituents now expect him to fix the NHS. He could start by giving the NHS the level of investment it needs, which is a 4% uplift. He could start by voting for our amendment in the Division Lobby tonight.

--- Later in debate ---

[Matt Hancock]

My hon. Friend is dead right. Pharmacies should be doing more to keep the pressure off GPs, because they are in the community and more accessible, and within a GP surgery not everything needs to be done by the GP. We are expanding the number of GPs by 6,000 over this Parliament, and increasing by 26,000 the number of other clinicians who work in primary care, supporting GPs. When someone goes to their primary care practice, they might see the GP, a practice nurse, a pharmacist, a physio or a geriatrician. The boundary that has existed since Lloyd George between primary and secondary care, where someone either sees a GP or goes to hospital, needs to become more porous so that we can have that care where it is right for patients.

My next point is that prevention is better than cure. Expanding primary care, allowing pharmacies to do more, growing our community teams—that is about driving prevention. My third priority is technology. That is not just because we stand at the cusp of a health tech revolution that has the potential to transform healthcare for the better, but because the first task is to drag the NHS out of the 20th century and into the 21st.

The next priority is infrastructure, much of which we have already started to discuss. Buildings have to be expanded and improved, and while we do that expansion, with upgrades to the 40 new hospitals, we will also repair the damage done by those terrible private finance initiative deals that have hamstrung hospitals—deals struck by the hon. Member for Leicester South and his friends: Mr PFI himself. When we hear from him about the challenges that the NHS faces, everyone should remember with every word he says that he was at the heart of the Treasury that was driving PFI, which has caused so many problems across our national health service. Our plan is for a more integrated NHS, with a culture that gives patients more control over their healthcare, and colleagues more control over their work.

[Jonathan Ashworth]

The Secretary of State is so pleased with himself and that attack line, he really is.

[Eddie Hughes (Walsall North) (Con)]

He’s got good reason to be!

[Jonathan Ashworth]

The hon. Gentleman says that he has good reason to be. I was at the Treasury as a young man in my twenties, signing off paper, when the Secretary of State was at the Bank of England, so by his logic, he would have been putting up interest rates for hardworking families. I was at the Treasury, but I was not responsible for any PFI contract. If he is going to say that I was responsible for every decision made by the Treasury when I was there in my mid-twenties, I will take responsibility for giving the NHS the biggest cash boost in its history, which meant the shortest waiting lists. That is a record I am proud of; that is a record he has not been able to match.

[Matt Hancock]

The cash boost that we are giving now is bigger. I think today is the anniversary of Prime Minister Tony Blair sitting on the couch of a TV show, talking about increasing funding for the NHS, which was opposed by Gordon Brown, who was Chancellor of the Exchequer at the time. We will not take any lectures.

I am thrilled that the public comprehensively rejected the Labour party’s baseless scaremongering, which was repeated through the election campaign and worried some of the most vulnerable people who rely on our NHS. I lost count of the number of times I had to debunk some politicised nonsense put about by the Opposition across the country because they had nothing positive to say. The hon. Member for Leicester South was at it again yesterday and in his speech. He said that the settlement in the NHS Funding Bill is a cap, although clause 1 states that it is a minimum. Clause 1(1) states:

“In making an allotment to the health service in England for each financial year…the Secretary of State must allot an amount that is at least the amount specified”.

Did the hon. Gentleman even read the Bill? Did he get to clause 1? I am not sure he bothered reading it.

Let us look specifically at the amendment. It calls for reform of social care and for the Government to bring forward a plan, and that is precisely what the Queen’s Speech provides for. It also calls for additional funding for the NHS, which is what we are legislating for. The long-term plan is fully funded by the largest cash injection in the history of the NHS, and I urge Members across the House to support it fully. We can only fund the NHS with a strong economy, and that is exactly what we will do.