NHS Shared Business Services

Jonathan Ashworth Excerpts

Monday 27th February 2017 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab)]

(Urgent Question): To ask the Secretary of State for Health to make a statement on the loss of confidential NHS correspondence by NHS Shared Business Services.

[The Secretary of State for Health (Mr Jeremy Hunt)]

On 24 March 2016, I was informed of a serious incident involving a large backlog of unprocessed NHS patient correspondence by the company contracted to deliver it to general practitioners’ surgeries, NHS Shared Business Services—SBS. The backlog arose from the primary care services GP mail redirection service that SBS was contracted to run between 2011 and 2016. However, in three areas of England—the east midlands, north-east London and the south-west of England—this did not happen, affecting 708,000 items of correspondence. None of the documents was lost and all were kept in secure storage, but my immediate concern was that patient safety might have been compromised by the delay in forwarding correspondence, so a rapid process was started to identify whether anyone had been put at risk. The Department of Health and NHS England immediately established an incident team led by Jill Matthews, who heads the NHS England primary care support services team.

All the documentation has now been sent on to the relevant GP surgery, where it is possible to do so, following an initial clinical assessment of where any patient risk might lie. Some 200,000 pieces were temporary residence forms, and a further 500,000 pieces were assessed as low risk. A first triage identified a further 2,500 items that had potential risk of harm and needed further investigation, but follow-up by local GPs has already identified nearly 2,000 of those as having “no patient harm”. The remainder are still being assessed, but so far no patient harm has been identified.

As well as patient safety, transparency for both the public and this House has been my priority. I was advised by officials not to make the issue public last March until an assessment of the risks to patient safety had been completed and all relevant GP surgeries informed. I accepted that advice, for the very simple reason that publicising the issue could have meant GP surgeries being inundated with inquiries from worried patients, which would have prevented them from doing the most important work—namely, investigating the named patients who were potentially at risk.

For the same reasons, and in good faith, a proactive statement about what had happened was again not recommended by my Department in July. However, on balance I decided it was important for the House to know what had happened before we broke for recess, so I did not follow that advice and placed a written statement before the House on 21 July. Since then, the Public Accounts Committee has been kept regularly informed, most recently being updated by my permanent secretary only last Friday. The Information Commissioner was updated in August, and the National Audit Office is currently reviewing the response. I committed in July 2016 to keeping the House updated once the investigations were complete and more was known, and will continue to do so.

[Jonathan Ashworth]

Let us be under no illusions: this is a catastrophic breach of data protection. More than half a million pieces of patient data—including blood test results, cancer screening results, biopsy results, and even correspondence relating to cases of child protection—were all undelivered, languishing in a warehouse, on the Secretary of State’s watch. It is an absolute scandal.

Time and again this Health Secretary promises us transparency; today, he stands accused of a cover-up. The Department of Health knew about this in March 2016, so why did it take this self-proclaimed champion of transparency until the last day before the House rose last summer to issue a 138-word statement to Parliament? That statement said that just “some correspondence” had not reached the intended recipients. When the Secretary of State made that statement, was he aware that it amounted to more than 700,000 letters? If so, why did he not inform Parliament? If he did not know, does that not call into question his competence?

What guarantees can the Secretary of State give us that no more warehouses of letters are yet to be discovered? Was the private contractor involved paid for the delivery of the letters? If so, what steps are being taken to recover the money? How many patients were harmed because their GP did not receive information about their ongoing treatment? Do patients remain at risk? The Secretary of State talks about NHS England’s ongoing investigation into 2,500 items; when are we likely to know the outcome?

We understand that Capita now has the contract to deliver these services. What scrutiny is the Secretary of State putting Capita under so that it does not happen again? Is it not better that, rather than this relentless pursuit of privatisation, we bring services back in-house?

Two months into 2017 and the Health Secretary lurches from one crisis to another: hospitals overcrowded and waiting lists out of control. He cannot deliver the investment that our NHS needs; he cannot deliver a social care solution; he cannot deliver patient safety; and now he cannot even deliver the post. He has overseen a shambles that puts patient safety at risk. Patients deserve answers and they deserve an apology.

[Mr Hunt]

The hon. Gentleman is reasonable and sensible, but sadly those commendable sides to his character have not been on display this afternoon, not least because I answered a number of his questions before he read out his pre-prepared script. He said that there had been a catastrophic breach of data protection. Let me remind him that no patient data were lost and all patient data were kept in secure settings. I know that it is a great temptation to go on about the privatisation agenda, but may I gently tell him that, since SBS lost this account, this particular work has been taken in-house? It is being done not by Capita, but by the NHS—so much for the Government’s “relentless pursuit” of the private sector.

More seriously, the hon. Gentleman is quoted in this morning’s edition of The Guardian as saying:

“Patient safety will have been put seriously at risk.”

As he knows, patient safety is always our primary concern, but if he had listened to my response he would have heard that, as things stand, there is no evidence so far that patients’ safety has been put at risk. [Interruption.] Well, we have been through more than 700,000 documents, and so far, we can find no such evidence. We are now doing a second check, with GPs, on 2,500 documents—so a second clinical opinion is being sought—nearly 2,000 of which we believe will not show any evidence, and we are now going through the remaining ones.

Let me say that it was indeed totally incompetent of SBS to allow this incident to happen, and we take full responsibility as a Government, because we were responsible at the time. None the less, the measure of the competence of a Government is not when suppliers make mistakes—I gently remind the hon. Gentleman that that did happen a few times when Labour was running the NHS—but what we do to sort out the problem. We immediately set up a national incident team. Every single piece of correspondence has been assessed, and around 80% of the higher risk cases have been assessed by a second clinician.

The hon. Gentleman then went on to suggest that the Government have been trying to hide the matter. If he had listened to what I said, he would have heard that I did not follow the advice that I got from my officials, which was not to publicise the matter. I actually decided that the House needed to know about it. It was only a week after I was reappointed to this job last summer that I not only laid a written ministerial statement, but referred to the matter in my Department’s annual report and accounts. He said this morning that I played down the severity of what happened, but what did that annual report say? It said that a “serious incident was identified”, and it talked about

“a large backlog of unprocessed correspondence relating to patients.”

It could not have been clearer.

This Government have always cared about patient safety. We have listened to the advice of people—as the hon. Gentleman would have done had he been in office—who said that if we had gone public right away, GP surgeries could have been prevented from doing what we needed them to do, which is making detailed assessments of a small number of at-risk cases. That was why we paused, but as soon as we judged that it was possible to do so, we informed this House and the public and we stayed absolutely true to our commitment both to patient safety and to transparency.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. Actually, the policy is that all A&Es, where space is available, should do that. The hospitals that do it have by far the most successful results—not least Luton and Dunstable, which has pioneered that model.

[Jonathan Ashworth (Leicester South) (Lab)]

With respect to A&Es, diverts have been at twice the level of last year, 4,000 people have had urgent operations cancelled, 18,000 people a week in January were waiting on trolleys in corridors, and nine out of 10 hospitals have been overcrowded and are at unsafe levels. I have even read in the Secretary of State’s local paper that his local hospital had to put patients in the gym overnight. Does the Secretary of State agree with the Prime Minister that the crisis facing our NHS amounts to a “small number of incidents”?

[Mr Hunt]

The NHS is under a lot of pressure, but what we never get from the hon. Gentleman is any solutions. Our solution is 600 more A&E consultants since 2010, 1,500 more A&E doctors, 2,000 more paramedics, and 2,500 more people being seen within four hours every day. His solution at the last election was to cut the NHS budget by £1.3 billion.

[Jonathan Ashworth]

The Secretary of State’s solution has been to blame everybody else but never take responsibility himself.

What is the Secretary of State going to do about the crisis that we are now facing in staffing? Last week, we learned that half of junior doctors are abandoning specialist training. We have already heard that applications for nursing degrees are down by a quarter following the axing of the student bursary and we heard today that there is a shortage of midwives. I know that the right hon. Gentleman has been in the US and that he will try to give us his alternative facts, but when will he give us an alternative plan and deal with the staffing crisis—an issue that the Minister of State, the hon. Member for Ludlow (Mr Dunne), could not respond to a few moments ago?

[Mr Hunt]

Let us look at the reality, instead of the hon. Gentleman’s rhetoric. In his own local trust in Leicester, there are 246 more nurses than in 2010 and 313 more doctors. Some 185 more patients are being seen in A&E every day and next year a new £43 million emergency floor will open at the Leicester Royal Infirmary. That is because we are backing the NHS instead of wanting to cut its budget.

Alcohol Harm

Jonathan Ashworth Excerpts

Thursday 2nd February 2017 Westminster Hall

[Jonathan Ashworth (Leicester South) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Buck. I congratulate everyone who has contributed to a well-informed and powerful debate. I pay particular tribute to the hon. Member for Congleton (Fiona Bruce), who opened the debate with a comprehensive overview of the issues related to alcohol harm. I cannot do her speech justice—she was superb—but a couple of points struck me. Her point about attacks on emergency services workers was well made. I do not know whether she is aware, but there is currently a campaign to make such attacks a specific criminal offence, which I would support. I believe that other nations in the UK currently have, or are looking at, such measures. Perhaps the Minister would reflect on that. It was a superb speech, and I congratulate the hon. Lady on the way she made her remarks.

Other right hon. and hon. Members also gave impressive speeches. I pay particular tribute to my hon. Friend the Member for Sefton Central (Bill Esterson) for his personal speech about working with children with foetal alcohol spectrum disorder, including his own story about his adopted children. The detail he went into shows how deeply he has thought about it. He will campaign on alcohol harm for the weeks, months and years ahead.

I hope that through the work of my hon. Friend the Member for Sefton Central and of other hon. Members, such as my hon. Friends the Members for Luton North (Kelvin Hopkins) and for St Helens South and Whiston (Marie Rimmer), who raised similar issues, we can see a change of public policy on such matters. I hope that the Minister will respond to some of what has been said today. If she cannot give us reassurance today, perhaps she will take the subject away, put it through the various policy-making machines behind the scenes in Government and get back to us with some proposals, because the points that have been made today, in particular by my hon. Friend the Member for Sefton Central, were very powerful.

The hon. Member for North Ayrshire and Arran (Patricia Gibson) brought us the Scottish perspective. I sensed that she might be suggesting or hinting that my colleagues in the Scottish Labour party are not entirely supportive of some of the policies that the Scottish Government are pursuing. Her argument, however, was well considered. As Labour’s shadow Health Secretary in Westminster, I will look into what she was talking about. I enjoy political argument as much as anyone else, but we must learn from best practice, even if it comes from our political rivals.

My right hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne) delivered an incredible, powerful and staggering speech, for which I pay full tribute to him. The way in which he put his personal experiences on the record was incredibly courageous. For most of my speech I will focus on the children of alcoholics, but at the outset I want to say that his bravery and his work for the APPG inspired me to tell my story as well, which I did over Christmas. I will go into that in more detail. My right hon. Friend made a fantastic contribution—I think your father would be proud today. [Hon. Members: “Hear, hear!”]

I will now run through some of the figures—they have been rehearsed already, so I will not go into great detail. We know that the effects of alcohol have a huge impact on society and a huge financial cost, whatever the figure—some have suggested £21 billion, while others say it could be as high as £50 billion. The cost to our society is not only to our health, to the emergency services and through crime and antisocial behaviour; there is also the drag on our economy and economic growth, because of the drag on workplace productivity.

Alcohol abuse and harm is the third biggest health problem after smoking and obesity. Ultimately, it can have devastating consequences. About 307,000 admissions are attributed to alcohol and 65% of those are male. It is estimated that about 35% of all A&E attendances at peak times at weekends are alcohol-related. The number of hospital admissions with a primary diagnosis for alcohol-related diseases has increased about 100% in the past 13 years. Alcoholic liver disease is the most common cause of death, according to recent statistics. The number of deaths related to alcohol has fallen since a peak in 2008, but it remains considerably higher than it was in the mid-1990s. I therefore join the call that others have made for the Government to come forward with a renewed alcohol strategy. I hope that the Minister will tell us whether that is in the offing.

In recent weeks in my own Leicester constituency I have had the privilege of seeing specialist GP services supporting people with alcohol and other dependency issues, and to visit and learn about the Anchor Centre, which is dedicated to supporting people with alcohol problems. However, they tell me that they are worried about the future commissioning of those services, because decisions are made locally and they might not be able to be made in future because of tight budgets. Will the Minister therefore assure us that adequate resources will be put in place to ensure that such specialised alcohol treatment services are at least maintained, or even built on in future? We also heard about the Scottish experience of minimum unit pricing, so will the Minister update us on the Government’s position on that at the moment?

My right hon. Friend the Member for Birmingham, Hodge Hill made a powerful point about football team posters in people’s bedrooms—people obviously want a poster of the Leicester City side, although perhaps not this season, but they might have done last season. His argument was about marketing, and we ought to reflect on that. The previous Prime Minister was prepared to take radical action on the marketing and advertising of sugary foods. If we are to believe the rumours in the newspapers—I do not always believe them—this Prime Minister has crossed all of that out of the obesity strategy. I am interested to know what the Government’s position is on the advertising and marketing of alcohol, particularly as it affects an audience of children. I would be grateful if the Minister could tell us a little about that.

I said that I wanted to focus on the children of alcoholics. As the shadow Secretary of State, I have chosen to speak in today’s debate, although the usual practice is for another member of the team to speak, because I, too, am the child of an alcoholic. My parents divorced when I was about seven or eight years old. To be frank and candid, they divorced because of the strain that my father’s alcoholism placed on the marriage. I am an only child and I lived during the week with my mum and at weekends with my dad. My dad would spend the whole weekend drunk. In fact, from the age of eight I was in effect the carer at the weekend. It was typical for my dad to pick me up from school, but literally to fall over because he was so drunk. This was before the days of mobile phones, and I recall going to a phone box to call a taxi to take us home. The walk was not far, to be fair, but he could not walk up the street and I was a child.

On a Friday I would go back to my dad’s and open the fridge, as people do when they get home from school and want some yoghurt, chocolate biscuits or whatever, only to find it completely empty apart from the huge bottles of white wine—four or five 1.5-litre bottles lined up; the supplies for the weekend. My job as a 10, 11, 12 and 13-year-old was to go down to the shops to get the food in for the weekend and to sort things out. There were loads of such occasions and similar stories. My dad was not bothered about Christmas or with having a Christmas tree, so I would have to go to the shop to get some decorations to make the house look a bit Christmassy, as my friends’ houses were.

On another occasion, my dad played in goal at a works football match—I do not know why, because he was quite short, like me, so not a natural goalkeeper. I was about eight or nine and quite excited to be watching a football game, thinking I was going to a stadium, which it was not—it was an astroturf in Salford. It was the first time I had been to a football game and I was quite excited to watch my dad. I remember vividly his mates in the crowd shouting, “Jon Ash is in goal. All you have to do is throw a can of Stella in that direction, and he will go for that rather than the ball.” That was a joke, just workplace laughing, but I remember thinking, “That’s my dad.”

Dealing with my dad’s alcoholism coloured my upbringing and my life. As I was sitting here listening to my right hon. Friend the Member for Birmingham, Hodge Hill, I remember all those feelings that he was talking about: the shame, the embarrassment, particularly as a teenager, and the anger. But I always loved my dad, and he always loved me. We were lucky; he was never violent or abusive. Millions of children—or perhaps hundreds of thousands—are not in that lucky situation.

To be frank, it was only when my right hon. Friend and other Members started speaking out about this matter that I began to realise that I was not unusual, that I was not alone and that other children were going through this. When he started publishing his reports and doing his newspaper articles, I began to look into the subject, too. That was when I learned that 2.6 million children—perhaps more, according to some estimates—are in these circumstances.

I attended this debate because I wanted to speak out, as my right hon. Friend has, and ask the Government to consider putting in place a strategy for children of alcoholics as well as an alcohol strategy. Like him, when I spoke out in the media over Christmas—entirely by accident, by the way; I was asked a question and sort of blurted it out—I was inundated by people getting in touch with similar stories and saying that they remembered leaving their parent in the morning to go to school, never knowing whether they would be the same person when they got home that night. People have also told me that they spent their childhood ensuring that they did not say something off-hand and just wanting to disappear into the background, because their parent had not only an alcohol problem but a problem with violence, and anything that they said or did might cause their parent to turn because of alcohol.

When we read all those stories and study the research, it is clear that something has to be done. My right hon. Friend used a brilliant phrase. He said that children of alcoholics sit at a junction, where it is not obvious which public service should step in to support them, and too often they fall between the cracks. Is it the school’s responsibility? Is it the local GP’s responsibility? Is it the responsibility of children’s social services? That is why I agree that we need a national strategy, and I ask the Minister to consider including in that strategy a statutory duty on local authorities to put in place local strategies, both to deal with alcoholism and to support children of alcoholics.

The arguments that have been made about collecting data are so important. We have heard that an estimated 2.5 million children are affected, but we are not entirely sure—some suggest it is 3.5 million—so please will the Government look at putting in place a way of collecting statistics so that we know the scale of the problem across the country?

I do not want to be partisan—this is not the place for that—but in a lot of communities across the country school nurses are being cut back. It strikes me that if we want to put in place an effective strategy to help children of alcoholics, school nurses would be a good place to start. I appreciate that such services are now commissioned locally, but will the Minister consider whether the Government can offer any more support to our school nurse and community health visitor networks? I also entirely endorse the comments that were made about labelling and support for mothers in pregnancy.

I am perhaps going off my portfolio as the shadow Health Secretary, but when the hon. Member for North Ayrshire and Arran mentioned the high density of shops and so on in more deprived areas, I wondered whether a community’s health needs should be taken into account in local authorities’ licensing decisions. Perhaps the Minister could reflect on that, although I appreciate that she is not a local government Minister.

My biggest regret in life is that my dad moved away to Thailand when he was about 59. He literally said to me one day, at Christmas, “I’m going to Thailand.” I said, “What?” He said, “I’m going.” I did not believe him, but he went, and that was that. He just went. Six months later, I got married. He promised me that he would come to the wedding. The day before, he phoned me and said he was not coming. I was so angry I could hardly speak to him. I wanted him to meet my new wife. To be fair, he had met her once, very briefly, but I wanted him to meet the new family. I was so angry that I could not talk to him, as you would expect. A few months later, he was dead. I had to go to Thailand to get the body and deal with the funeral. The friends he had made over there told me he was drinking a bottle of whisky a day. They told me he could not come to the wedding because he did not want to embarrass me. We were from a working-class family in Salford. I had gone to university and become a politician, and posh people would be at the wedding, and he felt that he would embarrass me by being there. I will always regret that.

I am the shadow Health Secretary, so I will do a lot of criticising the Tories, because that is my job, but I say to the Minister that I will work with the Government on a cross-party basis to put in place a proper strategy for supporting children of alcoholics because, quite simply, 2 million children are suffering. Let us send them a message that they should no longer suffer in silence.

NHS and Social Care Funding

Jonathan Ashworth Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab)]

I beg to move,

That this House supports NHS England’s four-hour standard, which sets out that a minimum of 95 per cent of all patients to A&E will be treated within four hours; notes the widespread public and medical professional support for this standard; further notes that £4.6 billion has been cut from the social care budget since 2010 and that NHS funding will fall per head of population in 2018-19 and 2019-20; and calls on the Government to bring forward extra funding now for social care to help hospitals cope this winter, and to pledge a new improved funding settlement for the NHS and social care in the March 2017 Budget.

I begin by paying tribute to the staff working in the NHS. To nurses, midwives, GPs, consultants, junior doctors, paramedics—all staff—we say thank you for your hard work, goodwill, commitment and dedication though this winter crisis. I had the pleasure of meeting some of those hard-working staff with my hon. Friend the Member for Tooting (Dr Allin-Khan) at St George’s hospital on Monday, and they told me of the pressures they face. Last night, I convened a summit of representatives of various royal colleges and trade unions working in the health service to meet staff and hear directly from the frontline of the pressures we now see in hospitals every day. Many royal colleges have spoken out today, warning of underfunding and understaffing. Over the past few days, I have received messages from doctors and clinicians from across the country who tell of the immense pressure, strain and, yes, crisis that we face this winter.

Let me share with the House some of the stories that I have been told, and I deliberately exclude the names of hospitals and trusts so as not to cause undue stress and alarm. This is a flavour of what I have heard. One doctor told me:

“There was a point when A&E was completely full and we had no space for a major trauma call that was coming in. The trauma case was going to have to be put into a corridor because the resuscitation area was full.”

Another story:

“In my A&E ‘Corridor Care’ isn’t unusual, it’s now the norm. Patient buzzers have actually been installed on the walls in said corridor.”

How about this:

“We’re…trying our best to keep patients safe but there aren’t enough of us and we’re on our knees. Doctor and nurses in tears”?

Another story:

“Over the weekend my bosses repeatedly asked for ambulances to be diverted away from our hospital because we had no beds, but we had multiple requests denied.”

Finally, another one:

“The A&E is perpetually rammed with the corridor full of ambulance trolleys and paramedics.”

I have many more examples, but I am sure the House understands the broader point that I am trying to make.

[Ms Angela Eagle (Wallasey) (Lab)]

There is unprecedented pressure in Wirral, too. As recently as last week A&E attendances and GP referrals were massively up. Unprecedentedly, 84 additional beds are being laid on, and they are now full. Last week, all elective in-patient appointments were cancelled and ambulance turnarounds reached up to five hours. At Prime Minister’s questions, the Prime Minister did not seem to think that there is a crisis in the NHS. If this is not a crisis, can my hon. Friend tell us what is?

[Jonathan Ashworth]

My hon. Friend makes her point eloquently and represents her constituents powerfully, as she always does in this place. I hope the Secretary of State will respond to some of those points.

[Robert Flello (Stoke-on-Trent South) (Lab)]

The Royal Stoke in my city is under intense pressure. No doubt, we will hear shortly from the Secretary of State that that is winter pressure. Winter has not really started. We have not really had a winter, yet we have been under this pressure not for a few weeks but for months. The whole NHS system is broken. That is the problem that we really face.

[Jonathan Ashworth]

My hon. Friend makes an eloquent point about the particular situation that has been facing Stoke for some time, of which many of us are aware. I hope the Secretary of State will touch on the situation in Stoke, because sadly it is one that we have had to raise previously.

[Several hon. Members rose—]

[Jonathan Ashworth]

If I may, I will make a little progress. I promise to try to give way to as many hon. Members as possible.

I assure the Secretary of State that I will pass on the names of the trusts and hospitals that I highlighted, so perhaps he can look into them. Let us be absolutely clear that these desperate stories are not the words of politicians trying to score political points but are the honest, heartfelt, considered testimonies of doctors and clinicians on the frontline in our hospitals. They simply want to do the very best for their patients. Indeed, many clinicians want to speak out but feel that they cannot, which is why the remarks were made anonymously.

According to reports on the BBC’s “You and Yours”, the Prime Minister has sent instructions to hospital trust chief executives telling them not to speak out. I would be grateful if the Secretary of State verified those reports.

[Maria Caulfield (Lewes) (Con)]

I worked in the NHS over the Christmas period. Although it has been a very tough winter so far, this is nothing new. I have worked in the NHS for more than 20 years, and under previous Governments we had ambulances queuing around the block to get into A&E. Major incidents were declared in A&Es because they were too full. Will the hon. Gentleman accept that this is not a new problem?

[Jonathan Ashworth]

I entirely respect the hon. Lady’s work as a nurse before she came into this place—[Hon. Members: “She still is.”] I beg her pardon. She is still a nurse, and I genuinely respect her, but if we are not raising these matters on behalf of our constituents, we are failing in our responsibility as Members of Parliament. We must never forget that this is not just about the staff in our NHS; it is about patients and their safety, which must always be our absolute priority.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I am grateful to my hon. Friend for kindly giving way and for his important remarks. I echo his point that this is about patients across the country. My constituent’s mother, Angela, has been waiting for an acute mental health bed for more than a week. She was taken in an ambulance to A&E, but she could not be treated locally in Liverpool because the department was full. She was treated for the physical effects of her mental health condition in an ambulance and sent home. Her family are devastated and are concerned about her condition. Her story is one of countless stories across the country, and we need to recollect and focus on those stories today.

[Jonathan Ashworth]

My hon. Friend speaks passionately, as she always does, on behalf of her constituents and, more broadly, on mental health provision. Again, I hope the Secretary of State will respond to her on the specifics of that case.

My hon. Friend talks about patient care, and she is absolutely right. All of us, or at least many of us, in this House will have been getting stories from constituents telling us of their recent experiences in hospitals. I have been given a few, and I will share some heart-breaking examples with the House. Again, I will not reveal the names of trusts and hospitals, but I will pass them on to the Secretary of State after the debate.

Example No. 1 is of a mum of four children under 10 years old who has a secondary tumour in her liver. She was due to go into hospital this Thursday to have the tumour removed. Her surgery has been delayed for at least two weeks, so that the hospital could cope with the winter crisis and because no beds are available. She has not yet been given a new date.

Someone else got in touch with me this morning. Their wife has been on the waiting list for a knee replacement since April last year. An appointment for early December was cancelled owing to the hospital being on black alert. A few weeks later, the hospital phoned with an appointment for today, which was cancelled yesterday.

Again, these patients are not trying to score political points or to politicise matters. They are decent, hard-working people who are simply desperate for something to be done.

[Helen Whately (Faversham and Mid Kent) (Con)]

Conservative Members care deeply about patients. I personally follow up on the individual stories and challenges experienced by my constituents, but the hon. Gentleman has surely seen the guidance this week from NHS Providers, which is not always a friend of the Government, that said that we need to be careful when extrapolating from individual incidents in hospitals that are under particular pressure and implying that they constitute a wider trend. Yes, times are tough in the NHS, and there are winter pressures, but he should not make inappropriate use of individual stories.

--- Later in debate ---

[Jonathan Ashworth]

The hon. Lady should be careful. I will be charitable, but she would not want to give the impression that she is dismissing the stories and examples that I am highlighting. NHS Providers has continually warned of the chronic underfunding of the NHS under this Government, and it has continually warned that, head for head, spending in this country will fall next year. If she wants to quote NHS Providers, she should quote all the facts from NHS Providers.

[Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)]

My hon. Friend is telling some shocking stories. Was he as shocked as I was to hear Government Members shouting at and heckling the Leader of the Opposition during Prime Minister’s questions? They shouted, “What about Wales?” Does my hon. Friend agree that there is actually a stark contrast in Wales? Welsh Labour is delivering 6% more funding than in England for the NHS and social care. We have brand new hospitals, including in my constituency, and an £80 million new treatment fund was announced yesterday to allow better access to treatments.

[Jonathan Ashworth]

My hon. Friend makes a powerful point about Wales. As a Member for Cardiff, he understands what is happening in the Welsh health service. I wish Conservative Members understood that better.

[Mr Kenneth Clarke (Rushcliffe) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I will give way to the right hon. and learned Gentleman, but I will then make some progress.

[Mr Clarke]

Does the hon. Gentleman accept that every winter, for as long as I can recall, we have had a winter crisis in the NHS? It usually happens after Christmas. In winter the demands on the service become unpredictable, infections spread and the NHS starts losing staff. There are bound to be parts of the system that come under very real strain, and no one is trying to minimise the fact that they do. Apart from just producing this year’s crop of stories of very unfortunate incidents in various places, does he have any policy proposal at all, apart from simply spending more money wherever the reports are coming from?

[Jonathan Ashworth]

I am very grateful to the right hon. and learned Gentleman, who is a very experienced parliamentarian, for his intervention, but he will know that this is one of the worst winters for probably 20 years. He casually suggests that this happens every year, but I remember the years of a Labour Government when it did not happen. I remember the years of a Labour Government when we went further than the financial settlements he delivered as Chancellor of the Exchequer and were more than doubling the money going into the NHS—and tripling it in cash terms.

[Several hon. Members rose—]

[Jonathan Ashworth]

If I may, I would like to make a bit of progress. I promise my hon. Friends, and indeed Conservative Members, that I will try to give way as much as possible, but I am very aware that many Members have put in to speak.

We are all becoming familiar—far too familiar perhaps—with the grim statistics: in December, 50 of the 152 English hospital trusts called for urgent action to cope with demand; the number of patients being turned away from A&E and sent to other hospitals is at a record high; A&E departments have turned patients away more than 140 times; and 15 hospitals ran out of beds in one day in December. Last night, the BBC revealed that leaked documents from NHS Improvement showed that there were more than 18,000 trolley waits of four hours or more; that almost a quarter of patients waited longer than four hours in A&E last week, with just one hospital—just one—hitting its target; and that since the start of December, hospitals have seen only 82.3% of patients who attended A&E within the four-hour target. We will return to the four-hour target in a few moments.

Ministers can try to deny what is going on, but they cannot deny these facts about what is happening this winter in the NHS on their watch. We know that what happens in the NHS in the winter is a signifier of a wider crisis, because across the piece bed occupancy levels now routinely exceed the recommended maximum level of 85%—often to levels higher than 95%. As I have said, the NHS is going through the largest financial squeeze in its history. Indeed, the former Secretary of State, Lord Lansley, said that five years of NHS austerity had been planned for, but having 10 years of it was never expected. We have seen £4.6 billion cut from social care budgets—

[Tom Pursglove (Corby) (Con)]

rose—

[Jonathan Ashworth]

I will give way in a moment. As the King’s Fund said, the reason there is a problem is quite simply because there is a

“mismatch between funding and activity”

affecting our hospitals. The response of Ministers, from the Prime Minister downwards, has been one of utter complacency. The Secretary of State told “Sky News” on Monday that things had only been

“falling over in a couple of places”.

When he came to the House on Monday to make his statement, he did not commit to extra emergency funding for social care and he did not promise that the financial settlements would be reassessed in the March Budget. It is worse than that, because while he was making his statement, his spin doctors were telling the Health Service Journal—this on the day when the winter crisis is leading the news and he is making a statement in the House—and letting it be known that there is “no prospect” of

“additional funding to support emergency care any time before the next election.”

So there is nothing for social care, nothing for emergency care, nothing to tackle understaffing and nothing to tackle underfunding—well thank you very much. What did we get as a response? We got a downgrade of the four-hour A&E target.

[The Secretary of State for Health (Mr Jeremy Hunt)]

indicated dissent.

[Jonathan Ashworth]

The Secretary of State shakes his head and says, “Nonsense”, but let me remind him of what he said in the House on Monday:

“we need to have an honest discussion with the public about the purpose of A&E departments.”

He began by saying he wanted to provoke a discussion. He has certainly provoked a backlash, not least by blaming the public, it seems, for turning up at A&E departments. He went on to say that the four-hour target

“is a promise to sort out all urgent health problems within four hours”,

but he added a little clarification, continuing:

“but not all health problems, however minor.”—[Official Report, 9 January 2017; Vol. 619, c. 38.]

That is what he said in the House, and now we have seen the letter from NHS Improvement to trusts a few weeks ago, which talks of

“broadening our oversight of A&E”.

On the four-hour standard, it said that it believed

“there is merit in broadening our oversight approach, beyond a single metric”.

So in the interests of that discussion the Secretary of State wants to engage in, perhaps he can answer our questions, although I know he avoided the questions on Sky yesterday. Does he recall that in 2015, when he asked Sir Bruce Keogh to review these matters on waiting times, Sir Bruce said:

“The A&E standard has been an important means of ensuring people who need it get rapid access to urgent and emergency care and we must not lose this focus”?

[Henry Smith (Crawley) (Con)]

rose—

[Jonathan Ashworth]

I will give way in a few moments. Sir Bruce continued:

“I do not consider that there is a case for changing the 4 hour standard at this time.”

Does the Secretary of State still agree with Bruce Keogh? If he does, why did he make his remarks on Monday about needing to have a discussion about the future of the A&E standard?

[Seema Kennedy (South Ribble) (Con)]

rose—

[Jonathan Ashworth]

I will give way in a few moments. If the Secretary of State wants to lead a discussion about the future of the four-hour A&E standard, will he tell us what discussions he has had with the Royal College of Emergency Medicine? It argues that the four-hour standard is a vital measure of performance and safety, and believes the standard should apply to at least 95% of all patients attending emergency departments. If he says he is still committed to that four-hour standard, is he still committed to maintaining it at 95%?

[Robert Flello]

Will my hon. Friend give way?

[Jonathan Ashworth]

My hon. Friend has had one bite of the cherry, so if he does not mind I shall make a little progress and then I will do my best to get as many people in as possible.

Does the Secretary of State agree—

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

rose—

[Jonathan Ashworth]

I will give way in a few moments.

Does the Secretary of State agree that the four-hour standard is a reasonable proxy for patient safety? Does he agree that every breach of the four-hour standard can be regarded as a potentially elevated risk?

[Seema Kennedy]

rose—

[Jonathan Ashworth]

I will give way to the hon. Lady, as she has been very persistent.

[Seema Kennedy]

If the hon. Gentleman were to read the Government amendment, he would see that the Secretary of State says he “supports and endorses” the 95% target for A&E waiting times.

[Jonathan Ashworth]

I pay tribute to the hon. Lady for the work she is doing on tackling loneliness. I know that all Labour Members very much appreciate the work she is doing on that, along with my hon. Friend the Member for Leeds West (Rachel Reeves). The Government amendment is conspicuous in not referring to all patients.

The Secretary of State did distinguish between “urgent” and “minor”—[Interruption.] The hon. Member for Beverley and Holderness (Graham Stuart) says I should get a haircut. Did he say that? No? I beg his pardon, but he heckles so much it is sometimes difficult to hear what he is saying. Can the Secretary of State tell us how he would define the difference between urgent and minor care for instances relating to this four-hour standard? Can he tell us what will be the minimum severity of physical injury or other medical problem which will be needed for a patient to qualify for access to an A&E? How will we determine these new access standards? How quickly will they be available? Will patients with visible injuries be exempt from a new triage system? If so, which injuries will qualify? If the Secretary of State is not moving away from this four-hour standard, he needs to clarify matters urgently, because the impression has been given that he is doing so. [Interruption.] Not by me, but by his own remarks in the House on Monday. If he is not moving away from that standard, will he guarantee that he will not shift away at all from it throughout this Parliament and that it will remain at its current rate?

[Mr Harper]

rose—

[Jonathan Ashworth]

I will give way to the former Government Chief Whip.

[Mr Harper]

I, too, was in the Chamber on Monday and I listened carefully to the Secretary of State then. He was challenged by the right hon. Member for Exeter (Mr Bradshaw) on the target and was asked whether he was watering it down. He said explicitly that “far from watering down” he was recommitting the Government to it. He was generous to the Labour party in saying that it was one of the best things the NHS did. I think that was very clear.

[Jonathan Ashworth]

Let me say to the former Chief Whip that the Secretary of State said that

“we need to be clear that it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.”—[Official Report, 9 January 2017; Vol. 619, c. 38.]

The Secretary of State did not need to come to the House to make those remarks and set these various hares running, so the right hon. Member for Forest of Dean (Mr Harper) should make his objections not to me, but to the Secretary of State—

[Several hon. Members rose—]

[Jonathan Ashworth]

I am going to move on a little.

If the Secretary of State is not abandoning the four-hour standard, as he insists he is not, we look forward to hearing him make that absolutely clear. He also said and has implied that we need to educate the public better, so that they do not turn up at A&E departments. That was the implication of his remarks on Monday. Will he tell us how he is going to do that? What will be the cost implications of explaining to the public that they must not turn up at A&E departments? Are we expecting to see a large advertising campaign? Will the cost fall on local authorities’ public health budgets, which have already been cut? Will local authorities be given more resources for this new public education campaign?

[Derek Twigg (Halton) (Lab)]

My hon. Friend is making an important point. The key similarity is that back in 1997, when Labour took over, the health service was in crisis, and it is again today. Is not part of the problem that people are having to go to A&E because they cannot get in to see their GP?

[Jonathan Ashworth]

Absolutely. It is so difficult to get to a GP, which is why there are all these pressures on our A&Es. Of course, it is only going to get worse, because this year we are going to see cuts to community pharmacies—3,000 will be lost from our towns and streets because of the cuts that are being pursued. Let us not forget that the figure of 3,000 community pharmacies being lost was what the previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), told MPs.

[Mrs Anne Main (St Albans) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I will give way one last time, but then I really must make some progress.

[Mrs Main]

I led a debate in Westminster Hall this morning on pharmacies and integrated services in the NHS, and not one Back-Bench Labour MP could be bothered to take part—not one!

[Jonathan Ashworth]

Labour MPs have been raising these matters in this House for weeks, including at urgent questions and in Opposition day debates.

[Bill Esterson (Sefton Central) (Lab)]

I presume what the hon. Member for St Albans (Mrs Main) meant to say was that two Back-Bench Labour Members took part in the debate—I was one of them. Does my hon. Friend agree that the point about community pharmacies, GPs and investment in social care is that they save the Government money? That is why they should invest in them now to take pressure off A&Es.

--- Later in debate ---

[Jonathan Ashworth]

I thank my hon. Friend for correcting the record about that debate in Westminster Hall.

The Secretary of State denies that he is going to water down the A&E target; we welcome that, but we will watch carefully to ensure that he does not sneakily water it down throughout the remaining years of the Parliament. Will he tell us what he expects to happen next as we go through the winter? Weather warnings have been issued, and we could be heading for a cold snap. Will he update us on what urgent preparations he is putting in place to ensure that the NHS can cope? Is the NHS prepared for a flu outbreak, and what is his assessment of whether overstretched hospitals will be able to cope if there is one? It appears that, so far, Ministers have been burying their heads in the sand, but that will no longer do.

[Lucy Frazer (South East Cambridgeshire) (Con)]

My right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) and my hon. Friend the Member for Lewes (Maria Caulfield) both made the point that the issues in the NHS are historical. On Radio 4 this morning the right hon. Member for Leigh (Andy Burnham) said he accepted that the previous Labour Government had not spent the right amount of money on social care. Will the hon. Gentleman accept that these issues are historical—they are not new—and that Labour does not have all the answers?

[Jonathan Ashworth]

The hon. Lady refers to history; under this Government the NHS is going through the largest financial squeeze in its history. When we had a Labour Government, we more than doubled investment into the NHS.

[Tom Pursglove]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

Because he is a Member from the east midlands, I shall give way to the hon. Gentleman from Corby.

[Tom Pursglove]

I agree with the shadow Secretary of State that we need to have an honest debate, so does he accept that he stood on a general election manifesto that would have seen Labour spend billions less on our national health service? Will he set out for the House exactly what NHS services he would be spending less on now?

[Jonathan Ashworth]

We stood on a manifesto that would have delivered more doctors and nurses for our NHS; the hon. Gentleman stood on a manifesto that said the Conservatives would cut the deficit and not the NHS. They are cutting the NHS and failing on the deficit.

I have a few direct questions for the Secretary of State about Royal Worcestershire hospital. I was grateful for his remarks on Monday, but I want to press him a little further. It has been reported that NHS England was warned of a bed crisis as early as 22 December. Will he update the House on what urgent meetings he is having on Royal Worcestershire? When will we be closer to knowing the outcome of an inquiry? In that context, there is a proposal in the sustainability and transformation plan for the Worcestershire area for a significant reduction in the number of acute beds. The Secretary of State will say that these are local plans and so on, but in the context of the issues in Worcestershire, will he comment on whether he thinks that is the right proposal to follow?

On STPs more generally, the NHS is going through a winter crisis, and it is about to go through another top-down reorganisation—[Interruption.] Someone says it is bottom-up, but it is not; we know it is coming from the top. Those making the STPs are being told that they have to fill a financial gap of £21.764 billion—that is the reality that STPs throughout the country now have to face. We have seen the plans, so we know that that is going to mean a number of community hospitals being closed, a number of A&Es being downgraded, and acute beds being lost.

In places such as Devon, where the STP talks of an over-reliance on hospital beds, the implication is that beds will be lost. Closures and downgrades are being considered throughout Somerset, with their priority list of vulnerable services including maternity and paediatrics. In London, a city with the very worst health inequalities, the STPs are expected to deliver better health outcomes for the city’s growing 10 million residents with £4.3 billion less to spend. Will the Secretary of State explain to the House how he expects the NHS to perform in future winters, when we have a growing elderly population and STPs are pursuing multibillion-pound cuts to beds, A&Es and wider services?

[James Heappey (Wells) (Con)]

I was recently briefed by an excellent and well-respected local GP and a clinical psychiatrist, who were the authors of our county’s STP. Will the shadow Secretary of State explain how on earth they are responsible for a top-down reorganisation?

[Jonathan Ashworth]

Because they were being told by NHS England, which was in turn told by the Secretary of State.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

The right hon. and learned Member for Rushcliffe (Mr Clarke) mentioned infections spreading in the NHS. Does my hon. Friend share my concern about the infection that is spreading on the Government Benches? It is the infection of arrogance, complacency and being completely out of touch with the patients and their families who are suffering under the current crisis. We are witnessing inaction on an epic scale.

[Jonathan Ashworth]

My hon. Friend makes his point extremely well, although I would not want to be so mean about the Secretary of State—[Hon. Members: “Go on!”] No, I am not going to be mean about the Secretary of State.

[Toby Perkins (Chesterfield) (Lab)]

In the past few moments, we have heard the ludicrous suggestion that Labour did not deliver on either spending or performance, but in fact our track record was excellent. That is not just my opinion; the former Prime Minister, David Cameron, said in 2011:

“I refuse to go back to the days when people had to wait for hours on end to be seen in A&E, or months and months to have surgery done. So let me be absolutely clear: we won’t.”

He knew that Labour had a good record and that the NHS used to be good; why will these Tories not admit it?

[Jonathan Ashworth]

My hon. Friend makes a powerful point. Indeed, I remember, when we were in government, shadow Health Secretaries standing at this Dispatch Box opposing every penny piece of money that Labour was putting into the NHS. I remember a shadow Health Secretary, who now sits in the Cabinet as the Secretary of State for International Trade, standing at this Dispatch Box and saying that the A&E target was “indecent.” That was the Tories’ attitude when we were in government, so it is no wonder that we are sceptical about the Government’s intentions for the A&E target when we look at their history.

[Henry Smith]

The shadow Secretary of State is talking about the Labour record on the NHS. Does he recall Labour closing not only maternity at Crawley hospital, but accident and emergency in 2005?

[Jonathan Ashworth]

I do not have the details of the Sussex STP to hand, but presumably if it contains any suggested closures the hon. Gentleman will be campaigning against them and knocking on the door of the Secretary of State, if those remarks are an indication of his point of view on these matters.

[James Cartlidge (South Suffolk) (Con)]

The hon. Gentleman is saying that everything was rosy under Labour, but he should remember that it was 10 years ago when the scandal at Mid Staffs broke, in which hundreds more elderly patients died than was projected. It was a terrible scandal and he should remember that. What our shadow team was doing at the time was holding the Labour Government to account.

[Jonathan Ashworth]

I take all deaths in hospitals seriously. My commitment to patient safety is unswerving. I will continue to raise matters, whether it is at Royal Worcestershire or elsewhere, but not in a partisan way with the Secretary of State—[Interruption.] I was not being partisan when I was asking questions about the Royal Worcestershire. The Government Whip, the hon. Member for Beverley and Holderness (Graham Stuart), really needs to calm down. I will raise these matters, because that is the responsible thing to do. It is unbecoming to play politics with patients in that way.

Culpability for the state that the NHS is in today lies at the door of Downing Street. The Government promised to protect the NHS and to cut the deficit, and they have not done so. The Government give away billion-pound tax cuts to corporations—[Interruption.] Yes, this Government. The Government waste billions, pushing the NHS in the direction of fragmentation and greater outsourcing, while ignoring the ever-lengthening queues of the sick and the elderly in all our constituencies.

Yesterday, we saw the Secretary of State on Sky losing his ministerial car and being chased down the street. It was his whole approach laid bare: not a clue where he is going; nothing to say; and not facing up to the problems. Last year, he blamed the junior doctors. On Monday, he blamed the patients. Today, he blames Simon Stevens. Tomorrow, he will blame the weather. It is time that the Health Secretary started pointing the finger at himself and not at everybody else. The NHS is in crisis, and Ministers are in denial. I say to the Government, on behalf of patients, their families and NHS staff, please get a grip. I commend our motion to the House.

Mental Health and NHS Performance

Jonathan Ashworth Excerpts

Monday 9th January 2017 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab)]

I am grateful to the Secretary of State for an advance copy of his statement. I, too, begin by paying tribute to all the NHS staff who are working day in, day out to provide the best possible care to patients during this busy period. Of course we welcome measures to improve mental health services in this country, as indeed we welcomed such announcements exactly 12 months ago, when the then Prime Minister made similar promises. But does the Secretary of State not agree that if this Prime Minister wants to shine a light on mental health provision, she should aim her torch at the Government’s record: 6,600 fewer nurses working in mental health; a reduction in mental health beds; 400 fewer doctors working in mental health; and, perhaps most disgracefully of all, the raiding of children’s local mental health budgets in order to plug funding gaps in the wider NHS? Could he therefore tell us why the Prime Minister was unable to confirm this morning that money for mental health would be ring-fenced to prevent this raiding of budgets from happening in the future? We welcome measures to improve mental health support in schools. Will the Government offer more resources to local authority education psychologists? What provision will be in place to give teachers suitable training for doing this work?

On the winter crisis, this morning the Secretary of State said that things have only been “falling over in a couple of places”. Let us look at the facts: a third of hospitals declared last month that they needed urgent help to deal with the number of patients coming through the doors; A&E departments have turned patients away more than 140 times; 15 hospitals ran out of beds in one day in December; several hospitals have warned that they cannot offer comprehensive care; and elderly patients have been left languishing on hospital trolleys in corridors, sometimes for more than 24 hours. And he says that care is only falling over in a couple of places! I know that “La La Land” did well at the Golden Globes last night, but I did not realise the Secretary of State was living there—perhaps that is where he has been all weekend. Will he confirm that the NHS is facing a winter crisis, and that the blame lies at the doors of No. 10 Downing Street?

Does the Secretary of State agree that it was a monumental error to ignore the pleas for extra support for social care to be included in the autumn statement only weeks ago? Will he support calls to bring forward now the extra £700 million that is allocated for 2019, to help social care? Will he urge the Chancellor and the Prime Minister to announce a new funding settlement for the NHS and social care in the March Budget so that a crisis like this year’s never happens again?

I press the Secretary of State further on the announcement he has just made on the four-hour A&E target. Is he really telling patients that rather than trying to hit that four-hour target, the Government are now in fact rewriting and downgrading it? If so, does NHS England support that move? What guidance has he had from the Royal College of Emergency Medicine to say that that is an appropriate change to the waiting-time standard?

The Secretary of State has made patient safety an absolute priority; in that, he has our unswerving support. I am sure he will agree that one of the most upsetting reports to come out of hospitals last week was that on the death of two patients at Worcestershire Royal hospital who had been waiting on trolleys. Will he commit to personally lead an inquiry into those deaths? Does he know whether they were isolated incidents? When does the trust intend to report back on its investigation? Will he undertake to keep the House updated on those matters?

There is no doubt that the current crisis could have been averted. Hospital bosses, council leaders, patients groups and MPs from both sides of the House urged the Chancellor to give the NHS and social care extra money in the autumn statement. Those requests fell on deaf ears and we are now seeing the dismal consequences. NHS staff deserve better. Patients deserve better. The Government need to do better. I urge the Health Secretary to get a grip.

[Mr Hunt]

I am happy to respond to the hon. Gentleman’s comments and, indeed, to the comments of all Members, but I shall first say this about the tone of what he said. He speaks as if the NHS never had any problems over winters when Labour was in power. The one thing NHS staff do not want right now is for any party to start weaponising the NHS for party political purposes. I remind him that when his party runs the NHS, the number of people on waiting lists for treatments doubles, A&E performance is 10% lower and people wait twice as long to have their hips replaced. Whatever the problems are in the NHS, Labour is not the solution.

The hon. Gentleman talked about mental health, so let me tell him what is happening on that. Thanks to the efforts of this Government and the Conservative-led coalition, we now have some of the highest dementia diagnosis rates in the world. Our talking therapies programme—one of the most popular programmes for the treatment of depression and anxiety—is treating 750,000 more people every year and is being copied in Sweden. Every day, we are treating 1,400 more people with mental health conditions and we have record numbers of psychiatrists. The hon. Gentleman mentioned mental health nurses: in this Parliament we are training 8,000 more, which is a 22% increase.

All that is backed up by what we are confirming today, which has not been done before: the Government are accepting the report of the independent taskforce review—led by Paul Farmer, the chief executive of Mind—which commits us to spending £1 billion more a year on mental health by the end of the Parliament. That would not be possible with the spending commitments that Labour was prepared to make for the NHS in the previous Parliament. It is because of this Government’s funding that we are able to make such commitments on mental health.

The hon. Gentleman talked about the NHS and gave completely the wrong impression of what I said this morning. I was completely clear that all NHS hospitals are operating under greater pressure than they ever have. He should listen to independent voices, such as that of Chris Hopson—no friend of the Government when it comes to NHS policy—who is clear that in the vast majority of trusts people are actually coping slightly better than last year. However, we have some very serious problems in a few trusts, including in Worcestershire and a number of others. I can commit to him that we will follow closely the investigations into the two reported deaths at Worcestershire and keep the House updated.

The hon. Gentleman talked about social care, which is where, I think, his politicising goes wrong. Last year, spending on social care went up by around £600 million. At the last election, he stood on a platform of not a penny more to local authorities for social care, so to stand here as a defender of social care is, frankly, an insult to vulnerable people up and down the country, particularly to those living under Labour councils such as Hounslow, Merton and Ealing, which are refusing to raise the social care precept, but complaining about social care funding.

The hon. Gentleman talked more generally about NHS funding, but in the last Parliament it was not the Conservatives who wanted to cut funding for the NHS—it was his party. It was not the Conservatives who said that funding the five-year forward view was impossible—it was his party. Labour said that the cheque would bounce. Well, it has not bounced, and we are putting in that money.

In conclusion, it is tough on the NHS frontline. The hon. Gentleman was right to raise this issue in this House, but wrong to raise it in the way that he did. Under this Government, the NHS has record numbers of doctors and nurses and record funding. Despite the pressures of winter, care is safer, of higher quality and reaching more people than ever before. It is time to support those on the frontline, and not try to use them for party political points.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Speaker]

I have just been advised by a very sagacious source that in supplementary questions and answers to this question some reference to winter is desirable.

[Jonathan Ashworth (Leicester South) (Lab)]

I associate myself with the Secretary of State’s remarks about Berlin. I wish everyone in the House a merry Christmas and I extend my best wishes for a very peaceful and joyful Christmas and new year to all NHS staff, especially those working over Christmas.

Pressures on the NHS this winter are such and the underfunding is so severe that hospitals have been ordered to close operating theatres for elective surgery over Christmas. Is this what the Secretary of State means by a seven-day NHS?

[Mr Hunt]

Let me wish the shadow Health Secretary a merry Christmas and say that despite his rhetoric I see that Santa has been quite generous to him. His local trust in Leicester has 254 more nurses and 306 more doctors than in 2010. Next year, we will have a new £43 million emergency floor at the Leicester royal infirmary. We need to ensure that there is sufficient bed capacity in our hospitals over winter—that is a very important part of winter planning—but we are also doing 5,000 more elective operations every day than when Labour was in office.

[Jonathan Ashworth]

I am delighted that the Secretary of State has done his research on Leicester, but is closing operating theatres for a month this Christmas not, in reality, a short-term fix? The truth is that when the pause ends and hospitals fill up again above the 85% occupancy recommendations, patients will be left with a simple choice: get stuck on a waiting list while hospitals try to reduce occupancy rates to safe levels, or risk going into a hospital when it is at full capacity and potentially unsafe and be exposed to higher infection risks. Which option would the Secretary of State choose?

[Mr Hunt]

May I gently urge the hon. Gentleman to be careful with his rhetoric? We are not closing operating theatres for a month over Christmas. We need to be very careful what we say in this place, because people outside are listening. The answer is to ensure that we increase capacity in the NHS, and that is why we have 11,000 more doctors and 11,000 more hospital nurses than we had six years ago. We are training 15,000 more doctors every year from 2018-19 to ensure that we can avoid these problems in the future.

CQC: NHS Deaths Review

Jonathan Ashworth Excerpts

Tuesday 13th December 2016 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab)]

I thank the Secretary of State for advance sight of his statement, and I thank the CQC for its report.

Any death is a tragedy for families, but when that death could have been prevented, or was the fault of a system that is meant to care for our loved ones, the trauma is all the more difficult to cope with. The circumstances of Connor Sparrowhawk’s death were shocking, and I, like the Secretary of State, pay tribute to his family, who have fought so hard for justice and to ensure other families do not have to go through what they went through. Connor Sparrowhawk’s step-father, Richard, told Radio 5 live:

“When a loved one dies in care, knowing how and why they died is the very least a family should be able to expect”.

We agree.

The findings of the CQC are a wake-up call: relatives shut out of investigations; reasonable questions going unanswered; and grieving families made to feel like a “pain in the neck” or feeling they would be better dealt with at a “supermarket checkout”. This is totally unacceptable—it is shameful and it has to change. We therefore strongly welcome the recommendation of a national framework and the specific measures the Secretary of State has outlined today. I assure him we will work with him and the Care Quality Commission to support the establishment of such a framework in a timely fashion.

Families and patients should not be forgotten in this process. Will the Secretary of State pledge that families and carers will be equal partners in developing the Government’s plans for implementing the CQC’s recommendations? Does he agree that those who work in the NHS show extraordinary compassion, good will and professionalism? Does he accept that when something, sadly and tragically, goes wrong, it can often be the result of a number of interplaying systemic failures and that therefore a national framework will provide welcome standards and guidance across the service?

Does the Secretary of State recall that the National Patient Safety Agency was responsible for monitoring patient safety incidents in the NHS, including medication and prescribing errors, before it was scrapped under the Health and Social Care Act 2012? Will he perhaps acknowledge in retrospect that scrapping that agency was a mistake?

For such a national framework and the Secretary of State’s proposed measures to succeed, investment will be necessary. Will hospitals and trusts receive extra funding to carry out the additional requirements that the CQC has recommended? More generally, hospitals across England are suffering chronic staff shortages, which is leaving doctors and nurses overstretched and struggling to do basic tasks. We all recall that Sir Robert Francis called for safe nurse staffing levels to be published by the National Institute for Health and Care Excellence, but this guidance has been blocked. Will the Secretary of State now consider committing to NICE publishing safe nurse staffing levels, as recommended by the Francis report?

The Secretary of State is aware of the wider pressures on the service. Will he acknowledge that cuts to social care and the failure to provide it with extra investment in the autumn statement two weeks ago are leaving hospitals dangerously overstretched, with patients at risk of harm?

The Secretary of State will also be aware of the pressures on mental health provision. Over the weekend, we saw reports that bed shortages in England are now such that seriously ill patients with eating disorders are having to travel hundreds of miles for treatment. What does he make of this practice, and does he consider it safe and sustainable?

May I ask the Secretary of State about the heart-breaking case of the death of baby Elizabeth Dixon? I know that he has spoken of this in the past. He rightly ordered an investigation, but I understand from the family that 16 months down the line the investigation has not started. Will he provide the House with an update?

The CQC has called for the issues addressed in its report to be a national priority, and for all those involved in delivering safe care to review the findings and publish a full report. We absolutely agree. Action is needed. We welcome the recommendations and stand ready to work with the Government to ensure that these issues are no longer ignored.

[Mr Hunt]

I thank the shadow Health Secretary for the constructive nature of his comments. He is absolutely right in that, because this issue can unite people in all parts of the House. In fairness, these tragedies happen when those on either side of the House are responsible for the NHS, and we all have a responsibility to work to do better than we are doing at the moment.

I particularly agree with the hon. Gentleman that front-line doctors and nurses work incredibly hard, and we need to get away from a blame culture when these tragedies happen. That blame culture is the root cause of why we are not learning as we should from the problems that arise, because people are worried about what will happen to them personally if they speak out. We have seen this with a number of tragedies. Through the national framework, we are trying to move away from a blame culture. Of course people have to be held accountable. If there is gross negligence and people do totally irresponsible things, then there must be no hiding place and proper accountability: that is what families rightly insist on. For the vast majority of the time, however, people are just trying to do their jobs as best they can. As he rightly says, it is often a systemic problem that can be solved with systemic changes. We are now trying to implement the culture of investigation that has worked so successfully in the airline industry and other industries.

I absolutely assure the hon. Gentleman that families and carers will be equal partners as we develop the new national guidance. This area was one of the most shocking things about the CQC report. I am sure that it was a great surprise to many people in the NHS how excluded many families felt. We clearly have to do better in that respect.

The hon. Gentleman talked about the National Patient Safety Agency, and I pay credit to Sir Liam Donaldson, who was chief medical officer under the previous Labour Government and a great champion of patient safety, but we now have different structures in place. The new CQC inspection regime and the healthcare safety investigation branch are giving equal, if not greater, priority to patient safety.

We discuss on many occasions the funding issues that the hon. Gentleman raised, as I think he is acknowledging with his facial expressions. The point I would make, because we have had a good exchange and I do not want to get into the specific politics of NHS funding, is that this is a win-win, because avoidable harm and death is incredibly expensive for the NHS. The time it takes to carry out investigations when things go wrong is utterly exhausting for the doctors, nurses and managers involved, who would much rather be doing front-line care. Preventing these things from happening in future is the best possible way of freeing up time for people on the frontline.

I will take away what the hon. Gentleman said about the Elizabeth Dixon case and find out what is happening with that review.

The real lesson of today is that every family, every doctor and every nurse has a simple aim when a tragedy happens. It is not about money; it is about making sure that lessons are learned openly and transparently so that history does not repeat itself. That is really what this is about, and that is why we will continue our mission to make NHS care the safest and highest quality in the world.

National Health Service Funding

Jonathan Ashworth Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab)]

I beg to move,

That this House notes with concern that the deficit in the budgets of NHS trusts and foundation trusts in England at the end of the 2015-16 financial year was £2.45 billion; further notes that members of the Health Committee wrote to the Chancellor of the Exchequer about their concerns that Government assertions on NHS funding were incorrect and risked giving a false impression; and calls on the Government to use the Autumn Statement to address the underfunding of the NHS and guarantee sustainable financing of the NHS.

I begin by reminding the House that, six years ago, the then Conservative leader promised to

“cut the deficit and not the NHS.”

The previous Chancellor, the right hon. Member for Tatton (Mr Osborne), told us that he would “properly fund public services” and that

“investment in public services would come before tax cuts.”—[Official Report, 27 November 2006; Vol. 453, c. 837.]

[Robert Flello (Stoke-on-Trent South) (Lab)]

Will my hon. Friend give way on that point?

[Jonathan Ashworth]

Oh, go on then.

[Robert Flello]

My hon. Friend is most generous. He might have missed something. Did the Chancellor not say that he would wipe out the deficit by 2015?

[Jonathan Ashworth]

My hon. Friend is eagle-eyed, and I congratulate him on reminding us that the Government should have balanced the books by 2015, and that they completely failed on that pledge.

Then the new Prime Minister made this promise:

“We will be looking to ensure that we provide the health service that is right for everyone in this country.”—[Official Report, 7 September 2016; Vol. 614, c. 333.]

Fine words, but it is by their deeds that they shall be known. What did we actually get? An NHS that is going through the largest financial squeeze in its history. Far from protecting the NHS through the years of this Tory Government, NHS spending will represent an average annual increase of just 0.9%—a decade of barely any increase in spending despite an ageing population with increasingly complex needs.

[David T. C. Davies (Monmouth) (Con)]

rose—

[Jonathan Ashworth]

I will give way in a few moments.

By 2017, NHS spending per head will level out, and, head for head, by 2018 NHS spending will be falling under this Conservative Government. Trusts ended last year in deficit for the second year running—they were £2.45 billion in deficit and they are reported to be heading for a deficit of around £670 million at the end of this financial year.

[Helen Goodman (Bishop Auckland) (Lab)]

Is this the explanation for the secret plan in County Durham to cut the number of beds for frail elderly people by 20%?

[Jonathan Ashworth]

My hon. Friend makes a very important point. I will be coming on to those secret plans as I develop my speech.

We will be spending less on the NHS as a proportion of GDP than our European neighbours such as Germany, France and the Netherlands. The NHS maintenance budgets have been repeatedly raided, with billions that had been allocated to capital routinely being switched to revenue to plug gaps.

[David T. C. Davies]

rose—

[Jonathan Ashworth]

I will give way in a moment.

The maintenance situation has got so bad that the NHS faces a backlog of £5 billion in repairs.

[Michael Gove (Surrey Heath) (Con)]

Will the hon. Gentleman give way.

[Jonathan Ashworth]

I will give way in a moment. The former Education Secretary needs to calm down, Madam Deputy Speaker.

Public health budgets, which fund projects to tackle teenage pregnancy, excessive alcohol consumption, sexually transmitted infections and substance misuse and to provide anti-smoking interventions, will have been cut by 9.7% by the end of this Parliament. That is a completely false economy leading to greater demands on the acute sector. As my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) so brilliantly outlined last week, the adult social care budget has been slashed.

[Sir Simon Burns (Chelmsford) (Con)]

rose—

[Jonathan Ashworth]

I will give way to the right hon. Gentleman.

[Sir Simon Burns]

I am so grateful to the hon. Gentleman. The House would take him somewhat more seriously if he pointed out that, by 2019-20, the real-terms increase in spending on the health service will be £10 billion. During the last election, his party promised to increase spending in this Parliament by only a quarter of that— £2.5 billion.

[Jonathan Ashworth]

The right hon. Gentleman was the Minister who took the Health and Social Care Act 2012 through this Parliament, and who wasted £3 billion on an unnecessary top-down reorganisation. He should be apologising to the House, not making those comments.

[Several hon. Members rose—]

[Jonathan Ashworth]

No, I want to make a bit of progress.

We are seeing unprecedented cuts to social care, which means that the number of people aged over 65 accessing publicly funded social care will fall by 26%. UK public spending on social care is set to fall to less than 1% of GDP by the end of this Parliament.

Just yesterday, Baroness Altmann, the former Conservative pensions Minister who was appointed last year to great fanfare by David Cameron, said that we are “sleepwalking into a crisis” and that the NHS will not be able to pick up the pieces of a “broken system”.

[Sir Simon Burns]

rose—

[Jonathan Ashworth]

I have given way to the right hon. Gentleman. [Interruption.] He can check Hansard tomorrow.

[Gloria De Piero (Ashfield) (Lab)]

Does my hon. Friend agree that when funding is cut, our hospitals seek to raise cash in other ways, such as the unacceptable level of car parking charges at our hospitals—charges which the Government promised before the last election to clamp down on?

[Jonathan Ashworth]

My hon. Friend is running a brilliant campaign on that. I hope that when the Minister responds, he will reply to that point.

[Mr Stewart Jackson (Peterborough) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I shall make a little progress because many other Members want to speak and I want to give them a chance.

The scale of the financial pressures engulfing the NHS are such that the chief executive of NHS Providers, Chris Hopson, said recently:

“The gap between what the NHS is being asked to deliver and the funding it has available is too big and is growing rapidly.”

The King’s Fund said, with respect to the NHS deficit, that

“it signifies a health system buckling under the strain of huge financial and operational pressures.”

In the most damning assessment of the Government’s handling of the NHS, the National Audit Office concluded today that financial problems in the NHS

“are endemic and this is not sustainable.”

Even the former Health Secretary, Andrew Lansley, said that

“in 2010 we knew we had to implement a tight budget squeeze for five years, but we never thought it would last for ten.”

[David T. C. Davies]

Surely the hon. Gentleman has seen the report from the Nuffield Trust on the four health systems of the United Kingdom, which shows very clearly that there is only one part of the United Kingdom that has seen a real-terms cut in NHS expenditure, and that is Wales under a Labour Government.

[Jonathan Ashworth]

There will be a cash injection in Wales in 2017, whereas spending per head in the English NHS will be levelling out and then falling in 2018.

[Joan Ryan (Enfield North) (Lab)]

In Enfield we are short of 84 GPs going forward and we have just had a hospital crisis at the North Middlesex hospital, where there were not enough doctors for our A&E to be safe for patients, yet the only thing we hear about is the sustainability and transformation plan locally which, as far as we can see, is not only secret but about taking £22 billion out of the NHS.

[Jonathan Ashworth]

My right hon. Friend is right and she is a brilliant campaigner for the health service in Enfield. The points that she makes about the staffing crisis in the NHS are well made. I hope that the Secretary of State will respond to her.

Things are so bad for the Health Secretary that even the NHS chief executive told the Health Committee that

“2018-19 will be the most pressurised year for us…will have negative per-person NHS funding growth.”

Those were the chief executive’s words. Will the Health Secretary sit up and listen, and respond to the chief executive, or will we get what we saw in the Sunday newspapers—briefing against him? We heard that the Government are “gunning for” Mr Stevens and are going to “fix” him. I hope the Secretary of State will repudiate that briefing when he responds to the debate and distance himself from it.

The only people who do not appear to accept the need for more money for the NHS are the Prime Minister and the Secretary of State. We anticipate what the Secretary of State will tell us from the Dispatch Box. The right hon. Member for Chelmsford (Sir Simon Burns) alluded to it and I will now answer his question. The Secretary of State will not only tell us that we have a generous, munificent Conservative Government who have given the NHS the money it asked for, but persist with the fiction that the NHS is receiving an extra £10 billion. However, we all know—and I suspect that the Secretary of State knows, because he now distances himself from the figure when he does interviews—thanks to the Health Committee and others that this £10 billion claim is bogus. It is a claim universally derided and discredited, apart from in the drawing room of 10 Downing Street.

[Michael Gove]

rose—

[Jonathan Ashworth]

It will be a pleasure to give way to the former Education Secretary.

[Michael Gove]

The chief executive of the NHS, whom the hon. Gentleman has just mentioned, welcomed that additional £10 billion and said that it gives the NHS the extra headroom we need. Will the hon. Gentleman repudiate his criticism now and make it clear that he associates himself with the chief executive of the NHS in welcoming that £10 billion of extra funding?

[Jonathan Ashworth]

The chief executive’s comments to the Select Committee speak for themselves. Talking of repudiation, when are we going to get £350 million a week, or were the Tories typically saying one thing before the people voted and something completely different after they had had their say? That is what the ex-Education Secretary should be telling us.

Let me remind the House what the Health Committee said. I see the hon. Member for Totnes (Dr Wollaston) in her place, and she said:

“The continued use of the figure of £10 billion for the additional health spending up to 2020-21 is not only incorrect but risks giving a false impression that the NHS is awash with cash.”

She is sitting only a little further down from the right hon. Member for Surrey Heath (Michael Gove). Perhaps he can have a word with her if he disagrees.

The Secretary of State hopes we do not notice that he is stretching the timeframe over which he presents this funding allocation. He hopes we do not notice that NHS spending has been redefined by the most recent spending review. He hopes we do not spot that he is cutting billions from public health budgets and other Department of Health funding streams—a £3 billion cut. But we have noticed.

[Mr Jackson]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

In a few moments.

We have spotted the Secretary of State’s conjuring act because we have seen this Tory trick before—robbing Peter to pay Paul. The result of this trick is cuts and underfunding, more pressures flowing through to the frontline, and, as the NAO said,

“Financial stress…harming patient care”.

In all our constituencies we see ever-lengthening queues of the elderly and the sick waiting for treatment. Across the board, we see the worst performance data since records began.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Nonsense.

[Jonathan Ashworth]

What world is the Secretary of State living in? Half a million patients have waited for four hours or more in A&E in the past three months—the worst performance for this time of year for more than a decade—and he says it is nonsense. Some 350,000 of our constituents are waiting longer than the promised time for elective treatment—some have been waiting more than a year—and he says it is nonsense. Delayed discharges from hospitals are at record levels, and he says it is nonsense. The number of people waiting for 12 hours or more on trolleys has increased by over 700% since 2011-12.

[Anna Soubry (Broxtowe) (Con)]

Will the hon. Gentleman tell the House why it is that, after 12 minutes, he has yet to praise all our hard-working doctors, nurses and other health professionals? Why is he constantly talking down our great NHS, including the hospitals in Leicester?

[Jonathan Ashworth]

I praise the hard-working staff in the NHS every day of the week, but I rather suspect that staff in the NHS will have more sympathy with the position I am outlining than with the right hon. Lady’s position, not least when, according to surveys, 88% of NHS staff think that the NHS is under the most pressure they can remember, and 77% think that there is less access to resources, putting the quality of patient care and clinical standards at risk. That, I say to her, is what NHS staff are saying.

[Mr Jackson]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

Oh, okay.

[Mr Jackson]

Perhaps I can just allow the hon. Gentleman to break off from reading his press release. I think we are moving towards a consensus on this issue, in that we do need to integrate acute clinical care and adult social care, and I understand that. In that vein, why was it that, in 13 years, when there was significant demographic change, the Labour Government failed to bring forward a better care fund or a precept for social care?

[Jonathan Ashworth]

It beggars belief! We tripled investment in the NHS, and the hon. Gentleman and his hon. Friends voted against every penny piece. When we left office, we had the best waiting times and the highest satisfaction levels on record. That is the difference between a Labour Government and a Conservative Government on the NHS.

[Henry Smith (Crawley) (Con)]

Can the hon. Gentleman explain, then, why the Labour Government closed the maternity and accident and emergency departments at Crawley hospital?

[Jonathan Ashworth]

Well, reconfigurations are always going ahead. [Interruption.] If Conservative Members are so concerned, I look forward to the hon. Gentleman campaigning against the STPs for his area, when they are published in a few weeks.

[Several hon. Members rose—]

[Jonathan Ashworth]

I am going to make a bit of progress, because I am aware that Members want to speak.

We have seen what the reality of six years of Tory underfunding and cuts in our NHS are all about, and there are more stealth cuts to come, which will add further pressures. For example—these are small things, but they all add up—cuts to the Care Quality Commission mean that it will increase its fees for NHS hospitals, other trusts and other providers. Some trusts will have to pay over £100,000 as a result of these cuts. Reductions in education and training tariffs will put more pressures on trusts and on the frontline. In the House the other week, we debated how cuts to community pharmacies will lead to increased demands on the NHS.

Only last week, news slipped out about the privatisation of NHS Professionals. A body that makes a profit for the NHS and ploughs that back into the NHS is going to be privatised, and that profit will presumably go to private companies.

The combination of all these cuts and privatisations, the utter failure to deal with the crisis in adult social care, and the lack of planning for an ageing population with complex needs will directly lead to greater demands on the NHS, bigger cuts, and deficits across the board. It is in this context that the NHS is also expected to find £22 billion of so-called efficiencies and to redesign services across England completely as part of the sustainability and transformation process.

Where sustainability and transformation plans are about transforming services in the interests of patient care, reversing fragmentation and ensuring more collaboration in geographical areas, we will consider them carefully. We will want to look at every single STP to see whether those plans are genuinely jointly owned, and whether they tackle the crisis in social care, guarantee better access to care for the long term, and are transparent and financially viable. What we know so far, though, is far from reassuring, because we can see from the 19 or so STPs that have been published that the ground has shifted. It has become obvious that what began as a project to transform services for patients and build up community services is now more about closing the financial gap:

“Of course, the driving force behind STPs is the emergence in the last two financial years of substantial deficits.”

Those are not my words, but those of Andrew Lansley just a few weeks ago. The STP areas that we have seen so far have been racking up shortfalls of about £10 billion that can be filled only by cuts to hundreds of beds, closing hospitals, downgrading A&Es, downgrading maternity wings and withdrawing treatments.

[Helen Jones (Warrington North) (Lab)]

Does my hon. Friend agree that proposals to downgrade A&E in an area such as Warrington, which is surrounded by motorways as well as containing many people who suffer from health deprivation, is a recipe for disaster? If people have to travel further for emergency care, that will not improve their care in any way.

[Jonathan Ashworth]

My hon. Friend is extremely knowledgeable about the health service and has been campaigning vigorously on the STPs. She is completely right. We will see hospitals merged in the Merseyside area and in London, hospitals lost in Durham, and efficiencies found by changing staffing levels. In fact, the STP for Cheshire and Merseyside, the area that she represents, talks enticingly of

“Exploration of a Factory Model”.

Doesn’t that sound nice?

With cuts to services and rock-bottom staff morale, we have the Sports Direct approach to the NHS, with the Secretary of State playing the part of Mike Ashley. The public deserve better than this bargain basement approach. Scaling back the acute sector while not investing in the community sector simply does not work. The Prime Minister might have ruled out extra funding—

[Michael Gove]

I have listened with great interest to the hon. Gentleman. He has spoken eloquently of his concerns about the NHS, but has not, in the course of 18 minutes, put forward a single positive policy or explained where a single penny of additional funding would come from. He has secured the time for this debate, so would he at least put forward a positive policy for the NHS, or a suggestion as to where the money should come from?

[Jonathan Ashworth]

The right hon. Gentleman really does have a brass neck. We still do not know when we are going to get the £350 million from him, but next time he intervenes perhaps he will tell us.

[Michael Gove]

Answer the question.

[Rosie Cooper (West Lancashire) (Lab)]

rose—

[Jonathan Ashworth]

I give way to my hon. Friend. [Interruption.]

[Madam Deputy Speaker (Natascha Engel)]

Order. That is enough shouting.

--- Later in debate ---

[Rosie Cooper]

Perhaps the right hon. Member for Surrey Heath (Michael Gove) would like to tell me how cutting the A&E at Southport and Ormskirk hospital and giving local community and acute services to Virgin Care can be a positive story for the NHS.

[Jonathan Ashworth]

This is exactly the sort of point that we are making; my hon. Friend is absolutely correct. That is why we need to look carefully at all these STPs. Of course, we do not know much about them at the moment, because all we see is glossy brochures that tell us that everything is going to be all right and not to worry. We want transparency. The Secretary of State should insist that every single STP is published and that we have the details of the cuts that will be made in our communities.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

rose—

[Jonathan Ashworth]

I give way to my right hon. Friend the former Chief Whip.

[Dame Rosie Winterton]

Is not one of the problems with local planning the recruitment of GPs and the lack of GPs locally? Would it not help if we were to amend the Health and Social Care Act 2012 so that clinical commissioning groups and NHS England could provide directly salaried GPs instead of being prevented from doing so, as is the case at the moment? That is a practical example of something that would save money and increase the local provision of GP services.

[Jonathan Ashworth]

My right hon. Friend is absolutely right. Morale among GPs is at an all-time low. She identifies another problem that has emerged because of the 2012 Act. I hope that the Minister will respond to her important point.

[Helen Jones]

rose—

[Jonathan Ashworth]

I will give way to my hon. Friend, but then I will not take any more interventions.

[Helen Jones]

Is my hon. Friend aware that the Cheshire and Merseyside group has not only refused to publish details about the STP, but refused my Freedom of Information Act request for information about the meetings that were held on the STP and who was present at them? Does that not simply give rise to suspicion that this whole process is being driven by cuts rather than the need to improve care?

[Jonathan Ashworth]

My hon. Friend is absolutely right. I will now make a bit of progress because I know that other Members are anxious to speak.

The Chancellor should respond tomorrow to the growing body of evidence that the NHS has not been given the money that it needs. Tomorrow, we need an end to the scandal of crumbling hospitals. Tomorrow, the Chancellor must put right the Government’s greatest betrayal on adult social care. Tomorrow, the Government must deliver the long-overdue investment that our NHS needs.

[Michael Gove]

Where is the money coming from?

--- Later in debate ---

[Jonathan Ashworth]

What sense does it make to carry on cutting inheritance tax, capital gains tax and corporation tax, at a cost of billions to the Exchequer, while at the same time failing to fund our national health service or to give social care the money it demands? The Prime Minister lets the CBI know that she is prepared to give away billions extra in corporation tax, but she tells us that there is no more money for the NHS. The Chancellor will be prevented from acting tomorrow not by financial constraints, but by the ideological constraints that the Government have placed on themselves. It is time to give the NHS the funding that it needs. I commend the motion to the House.

Oral Answers to Questions

Jonathan Ashworth Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Hunt]

As ever, my hon. Friend speaks wisely. Thanks to this Government, health spending in England is up by 10.1% in cash terms—4.6% in real terms—since 2010. That is double the cash increase in Scotland and three times the cash increase in Wales. Other parties talk about funding the NHS, but Conservatives say that actions speak louder than words.

[Jonathan Ashworth (Leicester South) (Lab)]

But we have seen public health budgets cut and social care budgets cut, and I can now tell the House that the maintenance budgets have been cut. In fact, the backlog of high-risk maintenance facing the NHS has soared by 69% in the past year. In London alone, the high-risk backlog has grown by £338 million; across the country the figure is nearly £5 billion. NHS finances are so stretched that even the most urgent repairs are being left undone. Is this what the Secretary of State meant when he said that he is giving the NHS the money it asked for?

[Mr Hunt]

I know that the hon. Gentleman has only been shadow Health Secretary for a while, but may I ask him to cast his mind back to 2010, when the party that wanted to cut the NHS budget was not the Conservative party but Labour? In 2015, his party turned its back on the five year forward view and said it would increase funding not by £8 billion but by just £2.5 billion. It is not enough to found the NHS—you have got to fund it.

[Mr Speaker]

Order. These exchanges, not untypically, are taking far too long, and part of the reason for that is that the Secretary of State keeps dilating on the policies of the Labour party. If he does so again, I will sit him down straight away. [Interruption.] Order. There are a lot of colleagues who want to ask questions. We want to hear about Government policy, not that of the Opposition. I have said it, it is clear— please heed it.

[Jonathan Ashworth]

Thank you, Mr Speaker.

If everything is so rosy with the NHS’s finances, why did Simon Stevens say just a couple of weeks ago that

“2018-19 will be the most pressurised year for us, where we will actually have negative per-person NHS funding growth in England”—

in other words, that NHS spending per head will be falling? The number of patients waiting longer than four hours in A&Es has increased. The number of days lost to delayed discharge has increased. The number of people waiting more than 62 days to start cancer treatment following referral has increased. Should not the Secretary of State do his job and make sure that next week’s autumn statement delivers the money that the NHS urgently needs?

[Mr Hunt]

Unlike other parties in this House, we have been increasing funding for the NHS. Thanks to that, we are now funding the NHS in England at a 10% higher proportion of GDP than the OECD average, and we are in line with the western European average because of our commitment. These are difficult financial times and there is financial pressure, but this Government have been saying that despite that financial pressure we must make sure that the NHS continues to offer safe, high-quality care—and that is our focus.

Community Pharmacies

Jonathan Ashworth Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab)]

I beg to move,

That this House notes that community pharmacies are valued assets that offer face-to-face healthcare advice which relieves pressure on other NHS services; calls on the Government to rethink its changes to community pharmacy funding; and further calls on the Government to ensure that community pharmacies are protected from service reduction and closure and that local provision of community pharmacy services is protected.

This is an issue that affects many of our constituents, and it has aroused considerable opposition from so many of them that 2.2 million people have signed a petition. Community pharmacists, I am sure, have lobbied Members of all parties about these cuts and have explained why they should be opposed. Indeed, Members of all parties have raised their concerns and their opposition to these cuts.

I pay particular tribute to my hon. Friend the Member for Barnsley East (Michael Dugher), who has campaigned tirelessly on this issue, and to my right hon. Friend the Member for Rother Valley (Kevin Barron). Government Members have also raised their opposition in Westminster Hall debates, Adjournment debates and parliamentary questions. Their opposition to the cuts is entirely understandable.

When the Government announced, in December last year, that they were going to pursue the cuts, they talked of cutting the budget for community pharmacy services by £170 million, with further cuts to follow. Opposition to the cuts was clear, and indeed was heightened when the previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), who I see in his place and for whom I have tremendous respect, suggested that the cuts could lead to the closure of up to 3,000 community pharmacies.

[Andy Slaughter (Hammersmith) (Lab)]

We have had a lot of correspondence from local pharmacists and their customers worried about essential parts of the local community such as businesses, but is it not also the case that, with massive cuts in acute services and with primary care under pressure, those pharmacies provide an essential and cost-effective part of the local health service, which we simply cannot do without?

[Jonathan Ashworth]

My hon. Friend has anticipated my argument—I could probably sit down now that he has put it so eloquently, but I shall plough on while I have the indulgence of the House.

I was saying that the right hon. Member for North East Bedfordshire had said that the cuts might lead to some 3,000 community pharmacies closing. Then, of course, the right hon. Gentleman left his post in the Department of Health, which we are all very sad about. Now we have a new Minister, and we are delighted to welcome the hon. Member for Warrington South (David Mowat) to his place—not least because in one of his first interventions when he was allowed out, he visited the Royal Pharmaceutical Society’s annual conference in September and said he was delaying the cuts. He said:

“I think it is right that we spend the time, particularly me as an incoming minister, to make sure that we are making the correct decision”.

He continued by saying that

“what we do is going to be right for you, is going to be right for the NHS and right for the public more generally.”

Well, if the Minister had left it there—with that U-turn—he would have won the praise of Labour Members.

Unfortunately, we then had a U-turn on the U-turn from the Minister. When the Minister came before the House last month we found out that, far from having listened, taken account of various consultations and decided to do what was best for the NHS, he intended to impose a 12% cut on current levels to pharmacy budgets for the remainder of this financial year—giving pharmacists just six weeks’ notice—and a 7% cut the year after that.

[Kate Green (Stretford and Urmston) (Lab)]

rose—

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

rose—

[Jonathan Ashworth]

Because she represents my mother’s home town, I will give way first to my hon. Friend the Member for Stretford and Urmston.

[Kate Green]

It is a privilege to represent my hon. Friend’s mother, and he, of course, knows my constituency well. The constituency has high levels of deprivation, and our primary care services face incredible pressure owing to unsuitable practice premises and the difficulty of recruiting GPs. Does my hon. Friend agree that with only seven weeks’ notice, it is impossible for GPs, other primary care providers and pharmacists to accommodate and make provision for these cuts in a way that will allow them to continue to support deprived communities in my constituency and, indeed, the constituencies of all Members?

[Jonathan Ashworth]

My hon. Friend is absolutely right. That is why the cuts have aroused so much opposition from not just Labour but Conservative Members.

[Catherine McKinnell]

My hon. Friend is making an excellent speech. Over the past few years, a significant amount of work has been put into the Think Pharmacy First campaign, whose aim is to take pressure off GPs, ambulances and A & E services, but is “Think Pharmacy First for cuts and closures” really what the Government have in mind?

[Jonathan Ashworth]

My hon. Friend has made a powerful point, which completely blows apart many of the arguments that the Government have advanced in recent years.

[Jeremy Quin (Horsham) (Con)]

Given the clustering of pharmacies, does the hon. Gentleman believe that no better way of funding the service can be envisaged?

--- Later in debate ---

[Jonathan Ashworth]

The cuts are not aimed at clusters. They are completely arbitrary, and they will result in the closure of many pharmacies in some of the most deprived parts of the country.

[Several hon. Members rose—]

[Jonathan Ashworth]

I want to make a bit of progress, because I know that many other Members wish to speak.

The cuts will mean that patients, many of them elderly and unable to travel long distances, will be forced to go elsewhere for essential medical advice and support. What we need from the Minister now are the details of how many pharmacies will close. The previous Minister, the right hon. Member for North East Bedfordshire, told us that up to 3,000 community pharmacies—a quarter of all pharmacies—could close.

[Alistair Burt (North East Bedfordshire) (Con)]

It may be helpful if I make a brief intervention at this stage. I gave an estimate which was based on what we thought was a possible worst-case scenario. The Department never had any plans to close pharmacies. It was the best estimate that I had at the time, but it was not a definitive figure.

[Jonathan Ashworth]

The right hon. Gentleman is an extremely experienced former Health Minister, possibly the most extreme—[Laughter.] He is definitely not an extremist, but he is possibly the most experienced Conservative former Health Minister apart from, perhaps, the right hon. and learned Member for Rushcliffe (Mr Clarke). It is very noble of him to try to get the Minister off the hook, but the fact remains that he was the one who said that 3,000 pharmacies would close, and we will continue to remind Ministers of that.

[Dame Rosie Winterton (Doncaster Central) (Lab)]

rose—

[Jonathan Ashworth]

I will give way to the former Chief Whip, but then I will make some progress.

[Dame Rosie Winterton]

Doncaster pharmacists have told me that at least 20 pharmacies in the town will close as a result of the cuts. That is their estimate, on the ground. They have also told me that the Government should sit down with pharmacists and engage in meaningful discussions about pharmacy delivery. For example, setting up a minor ailments service and cutting the drugs budget could possibly save the NHS £5 million in Doncaster and £650 million overall.

[Jonathan Ashworth]

My right hon. Friend is absolutely correct. She was not only an exceptional Chief Whip but an exceptional pharmacies Minister in the last Labour Government, and she knows how foolhardy it would be to make cuts in the pharmacy sector.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

I should like to make a bit of progress, if I may. As I said earlier, I am extremely conscious that other Members wish to speak.

As we have heard, the former Health Minister said that 3,000 community pharmacies could close. When pressed about the figures last month, the current Minister said

“no community will be left without a pharmacy.”—[Official Report, 17 October 2016; Vol. 615.]

I hope he will confirm that he still stands by that statement. He also claimed:

“Nobody is talking about thousands of pharmacies closing”. —[Official Report, 17 October 2016; Vol. 615, c. 602-3.]

He obviously did not receive the memo from the right hon. Member for North East Bedfordshire. But what did he say when he was pressed by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) about the number of closures? What soothing, reassuring words did he offer to all our constituents? He said, “I do not know.”

I am sorry that the Minister has not got a clue, but I hope that when he winds up the debate he will be able to tell us how many pharmacies will close as a result of these cuts. If he is not prepared to tell us that, will he tell us how many services will be cut?

[Oliver Colvile (Plymouth, Sutton and Devonport) (Con)]

rose—

[Jonathan Ashworth]

I will give way to the vice-chair of the all-party parliamentary group on pharmacy, but then I must make progress.

[Oliver Colvile]

Is the hon. Gentleman aware that the number of pharmacies has increased by 18% over the past 10 years?

[Jonathan Ashworth]

I know that the hon. Gentleman works tirelessly as a champion for pharmacies, but he knows that these proposals will mean cuts in many services.

[Maria Eagle (Garston and Halewood) (Lab)]

Many pharmacies in Halewood deliver medication, up to 8.30 pm, to elderly and vulnerable people who cannot get out of the house, and to care homes. What does my hon. Friend think will happen if those pharmacies have to close?

[Jonathan Ashworth]

I do not need to say what I think; I need to say what the sector thinks, and the sector has made it clear today that it will have to cut services such as the delivery of medicines to some of the most elderly and vulnerable members of society.

[Dr Murrison]

rose—

[Mr Ben Bradshaw (Exeter) (Lab)]

rose—

[Jonathan Ashworth]

I will give way to my right hon. Friend the Member for Exeter, but then I really must make some progress.

[Mr Bradshaw]

Although the Government say that they want to devote a greater proportion of overall health spending to primary care, our Health Committee’s report on primary care, published in the summer, showed that a smaller proportion was being devoted to the primary care sector, which, of course, includes pharmacies. Is that not the ultimate false economy? If we do not invest more in primary care, all the pressure goes into the acute sector.

[Jonathan Ashworth]

My right hon. Friend is another experienced former Health Minister, and he is right. As we learned this week, the Health Committee has completely blown apart the Government’s figures on the financing of the NHS.

[Dr Murrison]

Will the hon. Gentleman give way?

[Jonathan Ashworth]

If I may, I shall make some progress. I promise to give way to the hon. Gentleman in a few moments, but I know that others wish to speak.

The Government will say that they are mitigating the cuts by introducing a pharmacy access scheme, but the scheme takes no account of the needs of the most deprived communities. The four constituencies that top the health deprivation and disability indices are Liverpool Walton, Blackpool South, Manchester Central and Blackley and Broughton. Not one pharmacy in those constituencies is eligible for the pharmacy access scheme. The least deprived constituencies are Chesham and Amersham and Wokingham. In Chesham and Amersham, 28% of pharmacies are eligible for this mitigating scheme, while in Wokingham 35% are eligible. [Interruption.] The Minister says that it is a disgrace, but those are the figures. Only this Department, which spins figures all the time and which has been discredited for the way in which it uses them, can call a pharmacy cuts package an “access scheme”.

Today, in an article in The Times, the Minister himself focuses on cities such as Leicester and Birmingham. He claims that if you walk

“along roads in Leicester you will see 12 pharmacies within ten minutes of each other”.

As the Member of Parliament for Leicester South, I walk along roads in Leicester every day. I do not know whether the Minister has actually walked along any of those roads; he has never told me that he has. Let me therefore extend an invitation to him to come to Leicester, where he will see numerous community pharmacists in areas with a high proportion of black and ethnic minority communities providing specialist services for families who have relied on them for 20 or 30 years, often dealing with elderly people and speaking to them in Gujarati, Urdu and Punjabi. Many of those people will have to go to GPs’ surgeries and A & E departments if the pharmacies are closed. The Government’s assessment takes no account of the disproportionate effect that the cuts will have on black and ethnic minority communities in cities such as Leicester and Birmingham.

[Dr Murrison]

rose—

[Robert Jenrick (Newark) (Con)]

rose—

[Jonathan Ashworth]

I will give way to the hon. Member for Newark.

[Robert Jenrick]

Will the hon. Gentleman at least acknowledge that we all support community pharmacies? The town I live in has 3,500 residents and there are four pharmacies within a quarter of a mile. Will he at least acknowledge that a model that gives a block grant of £25,000 to each of those pharmacies purely for establishing themselves regardless of demand obviously needs review?

--- Later in debate ---

[Jonathan Ashworth]

If the hon. Gentleman wants to tell his constituents he is in favour of closing pharmacies, good luck to him.

Of course it is not just pharmacy closures that we will see. The National Pharmacy Association has reported today that that 81% of community pharmacies will have to restrict services that help elderly people and 86% will have to restrict free services such as delivering medicine to housebound patients. Does that not confirm that the elderly and the most vulnerable will be hit the hardest by the cuts to community pharmacies, and the Government are entirely to blame?

[Dr Murrison]

rose—

[Jonathan Ashworth]

I give way to the hon. Gentleman, who has been very patient.

[Dr Murrison]

Surely the hon. Gentleman accepts that we have to get the most efficiencies we possibly can from the system? His party colleague the right hon. Member for Doncaster Central (Dame Rosie Winterton) made a serious point about engaging with pharmacies to see how we can do it better. Does he agree—I would be interested to know why this is not in his motion—that category M clawbacks, which are levied exclusively on small independent pharmacies, might be extended to vertically integrated wholesalers as a way of making sure the system is more efficient than at present?

[Jonathan Ashworth]

The hon. Gentleman talks of efficiencies; he will presumably have seen the research that says if people cannot get to a pharmacy one in four will go to a GP. We will see greater demand on GP surgeries and A&E departments. That is not efficient. It is a false economy, which is why the Pharmaceutical Services Negotiating Committee has said the proposals are

“founded on ignorance of the value of pharmacies to local communities, to the NHS, and to social care, and will do great damage to all three. We cannot accept them.”

It is why the chief executive of Pharmacy Voice described the decision as

“incoherent, self-defeating and wholly unacceptable”,

and it is why charities such as Age UK have said the plans are

“out of step with messages encouraging people to make more use of their community pharmacists, to relieve pressure on overstretched A&E departments and GP surgeries.”

Age UK has hit the nail on the head: these cuts to community pharmacies completely contradict everything we have been told by Ministers over recent years and will lead to increased pressures and increased demands on GP surgeries and A&E departments.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

My hon. Friend has made some crucial points about how the funding has been allocated across our country. There are 129 community pharmacies across the whole of Liverpool, yet just two of them will be eligible for this payment. Does my hon. Friend agree that that is absolutely outrageous and will impact on the entire population of Liverpool?

[Jonathan Ashworth]

My hon. Friend is right, and even after this scheme is in place pharmacists who are eligible for the mitigating funds are still saying that they will have to close despite them.

We believe in the importance of community pharmacies, because

“pharmacies have a big role to play in this, as one in 11 or 12 A and E appointments could be dealt with at a pharmacy”—[Official Report, 25 February 2014; Vol. 576, c. 162.]—

and:

“Pharmacies have an important role to play, because they could save a significant number of A and E and GP visits.”—[Official Report, 23 October 2014; Vol. 586, c. 1049.]

Those are not my words: they are the words of the Health Secretary, said from that Dispatch Box over the last two years.

If the message the Health Secretary has been giving at that Dispatch Box is that community pharmacies are a way of relieving pressure on A&Es and GP surgeries, why is he now coming to the House to support cutting community pharmacies? It is a complete false economy. I will give way if he wants to explain that. He does not, probably because he knows it is a completely false economy.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

Arundhati Patel runs the Jamaica Road pharmacy in my constituency and an alcohol cessation service is one of the services it provides to the local community. He pointed out there were 1,400 hospital stays in Southwark due to alcohol harm. On the point about efficiencies and avoiding visits to hospital that Members have talked about, is this not another example of what my right hon. Friend the Member for Exeter (Mr Bradshaw) called a false economy?

[Jonathan Ashworth]

My hon. Friend is right, and Government Ministers, including the Health Secretary even on Monday, justify these as part of a package of efficiencies. Indeed when I raised this a few months ago with the previous Minister, the right hon. Member for North East Bedfordshire, he told me in correspondence that these cuts were necessary as part of delivering the £22 billion-worth of efficiency savings. So this is more proof that when they talk of efficiency savings, they are actually talking of cuts to frontline services.

[Huw Merriman (Bexhill and Battle) (Con)]

rose—

[Jonathan Ashworth]

I am sorry, but I need to make progress.

The NHS is going through the worst financial crisis in its 68-year history. Even the previous Health Secretary, who is now in the other place, said he did not expect another five years of such tight budgets for the NHS.

The black hole in hospital finances last year was £2.45 billion. Under Labour, we spent the European average on health as a proportion of GDP; we are now spending less than Greece. We are seeing a huge financial squeeze on the NHS and the cuts are part of that squeeze agenda.

We want the Government to think again on the cuts, because they will lead to more pressures on GP surgeries and A&E departments. There is a consensus not just among the Labour party, but among our constituents, the sector, clinicians and indeed Conservative Members against the cuts. It is Ministers who stand outside that consensus. The hon. Member for Stevenage (Stephen McPartland) has said:

“It does not make sense that we are encouraging pharmacies to take on a bigger role in the NHS, while potentially reducing the number of them.”

The right hon. Member for Broxtowe (Anna Soubry) has said:

“I do not think this 4% cut is a wise move.”—[Official Report, 20 October 2016; Vol. 615, c. 974.]

The hon. Member for Colne Valley (Jason McCartney) said

“when our A&Es are under so much pressure, we need community pharmacies”.—[Official Report, 17 October 2016; Vol. 615, c. 598.]

I agree and our message to Conservative Members who want to stand up for their constituents and who have been lobbied by pharmacists is, “Join us in the Division Lobbies and get Ministers to think again on these damaging cuts.” I commend the motion to the House.

--- Later in debate ---

[David Mowat]

The access scheme is the device that will ensure that pharmacies are not closed in a random way. I want to address the point about closures head on. It is my belief that there will be a minimal number of closures. The impact analysis talks about 100 and it models 100. The average pharmacy has a margin of 15%, and the amount of efficiency savings that we are asking pharmacies to make over two years is 7%. In addition, the average pharmacy is trading for £750,000 when it closes or merges, even after we announced these efficiency savings a year ago. That value is being retained.

[Jonathan Ashworth]

The previous Minister put a figure on this. Will the hon. Gentleman tell us what he means by a “minimal” number of closures? What is the number?

[David Mowat]

These are private businesses, each with a different business model and a different amount of income from the NHS, from other retail activities and from services. Each is financed in a different way. Indeed, 30% of them are owned by two public companies, and 70% of them are multiples.

--- Later in debate ---

[David Mowat]

I need to make some progress. I will give way in a moment.

At present, the average pharmacy receives NHS income of £220,000 a year, which is based on throughput of £1 million from the NHS. That translates into a value of the order of £750,000 for each pharmacy. When pharmacies merge or are sold, that is what they are traded for and the changes will not make a significant difference.

Returning to an earlier point, 40% of all pharmacies are located within a 10-minute walk of at least two others. Instances exist of a dozen or more pharmacies located within half a mile of each other. As I noted earlier, each one will most likely be receiving £25,000 a year just for being there.

[Jonathan Ashworth]

Has the Minister been to Leicester?

[David Mowat]

I was brought up on the outskirts of Leicester, so I am delighted to tell the hon. Gentleman that I have indeed been there. Giving all these clusters £25,000 of national health service money is not the best way to spend precious resources.

In addition, the extra services that pharmacies will choose to provide, such as winter flu jabs and public health services, are commissioned separately and will be unaffected by the reset. For example, 600,000 flu jabs have been given in community pharmacies this year—more than all of last winter.