Health
Debate between Jonathan Ashworth and Jim Cunningham(5 years, 7 months ago)
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Jonathan Ashworth
My hon. Friend is absolutely right and, typically, anticipates the argument I am going to make.
Advances in life expectancy look as though they are going backwards for some of the poorest in our communities, particularly women. Let me take as an example our infant mortality rates, which reflect the survival rates for the very sickest of small babies. Those mortality rates have risen again, for the second year in a row.
Mr Jim Cunningham (Coventry South) (Lab)
Two or three weeks ago I visited a food bank, one of the biggest in the west midlands, and what amazed me was that it had to provide clothing for babies, which struck me as very profound. In other words, at least 20,000 people in Coventry are using food banks, and that tells us the consequences on people’s health. When they have to go to these centres for clothing and cots, does that not say something about austerity under this Government?
Jonathan Ashworth
It most certainly does. We are seeing a huge rise in the number of children living in poverty and an explosion not just in food bank use but in so-called baby banks, where parents arrive to pick up toys, nappies, and so on—even milk. It really is quite shameful.
We are also seeing an increase in the prevalence of mental health conditions among the poorest. Children and adults in the poorest areas are three times more likely to suffer mental health problems. We are also now seeing an increase in so-called “deaths of despair” for those in middle age, that is, deaths from suicide, drug and alcohol overdose, and alcohol liver disease. They are rising—[Interruption.] The Secretary of State says that that is not true, but it is in the report from the Institute for Fiscal Studies today.
Rates of premature mortality, including deaths linked to heart disease, lung cancers, and chronic obstructive pulmonary disease, are two times higher in the most deprived areas of England compared with the most affluent. Growing up and living in poverty means people get sick quicker and die sooner. It is shameful.
Integrated Care Regulations
Debate between Jonathan Ashworth and Jim Cunningham(5 years, 9 months ago)
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Jonathan Ashworth
The changes in the regulations have aroused considerable concern in the country, and proper parliamentary time should have been made available for a proper debate on them; they should not have been made through secondary legislation.
The Opposition oppose the regulations and will seek to test the House’s opinion on them. We oppose the changes not because we are against integration. We have long called for greater integration of services to offer seamless care to patients, because the demands on the NHS are of a different nature from those of 71 years ago, when a Labour Government created the NHS with a tripartite structure. In those days, life expectancy was so much shorter, and infectious disease was the overwhelming medical challenge. In 2019, we are worlds away from the days when 30,000 hospital beds were set aside for the treatment of tuberculosis, or when wards were filled with row after row of iron lungs to treat those suffering from polio. Today, we are all living longer, with a variety of complex conditions, from diabetes to cardiovascular disease and chronic obstructive pulmonary disease—conditions that increase the risk of a poorer quality of life and mean a greater risk of premature death. Indeed, around 14.2 million people in England—nearly a quarter of all adults—have two or more conditions. More than half of hospital admissions and out-patient visits, and three quarters of primary care prescriptions, are for people living with two or more conditions.
The issue is not just ageing and frailty; poverty takes its toll. People in the most deprived areas of England can expect to have two or more health conditions at 61 years—10 years earlier than people in the least deprived areas. Health inequalities are widening, while advances in life expectancy are stalling. An ageing population, the increase in long-term conditions, and the increasing number of people with multiple health conditions means that we need to integrate services. Sometimes in these debates, when we talk of long-term conditions, we suggest that we are talking about a homo- geneous group, but it is quite the opposite. We could be talking of a 61-year-old man with renal failure and high blood pressure, or a 101-year-old woman with profound deafness and blindness. The way that such conditions affect quality of life, and the extent to which they are amenable to medical intervention, is likely to vary.
If health services are not better co-ordinated and not integrated, there is a greater risk to patient care through the poor co-ordination of medical care and increased time spent managing illness. The need to manage multiple medications may lead to poorer medication adherence, adverse drug events, and the aggravation of one condition by the symptoms or treatment of another. It can also mean damaging self-management regimes in which there are competing priorities, and a bewildering landscape for patients, who are often of an advanced age, with cognitive impairment and limited health literacy, so we support integration.
I have seen integration working on the ground. Just last week, I was in Bolton, where I visited the Winifred Kettle centre to see the model of integrated multi-agency work bring together mental health professionals, pharmacy, physio, occupational therapy and social workers. In Bury, I heard about how the local council’s chief executive doubles up as the chief executive of the clinical commissioning group. In Luton and Dunstable I saw with my own eyes that the hospital trust has various social care workers in its discharge unit, helping to avoid the indignity of huge numbers of elderly patients being trapped in hospital, ready for discharge but delayed for days on end, as happens too often. In Wolverhampton, a fascinating example is being developed: the hospital trust is taking on and employing GPs directly. In Wolverhampton, they call it vertical integration, although some might wish to go as far as to suggest that it is the nationalisation of general practice, something that not even Nye Bevan was able to achieve.
A Labour Government would move away from a competitive landscape of autonomous providers to one of area-based care delivered through integration, collaboration, partnership and planning. We will restore a universal, publicly provided and administered national health service. Locally, we envisage something akin to health and care boards, with a duty to provide health not only for those on a CCG list but for all residents. Nationally, the Secretary of State’s duty to provide care will be reinstated. We are consulting on these matters with patients, staff and wider stakeholders.
Mr Jim Cunningham (Coventry South) (Lab)
Very quickly, does my hon. Friend not agree that the big problem with integration, if we support it, is the lack of funding, and the lack of proper training in the various disciplines? Only a couple of years ago, there was a cut in the funding for pharmaceuticals.
Jonathan Ashworth
My hon. Friend makes a very important point. Integration is not about saving money. For integration to work properly, it needs to be fully funded, and, of course, the NHS has been through the biggest financial squeeze in its history. We do not oppose integration. Indeed, that is why the previous Labour Government introduced a section 75 partnership arrangement, and why we were so vociferous in our opposition to the Andrew Lansley Health and Social Care Act 2012, which went completely counter to international evidence and exacerbated local fragmentation of health structures. It is a delicious irony that Ministers, all of whom were dragooned through the Lobby to support the Lansley Act, despite expert after expert warning them what a mistake it would be to press ahead with it, are now trying to propose regulatory changes, so that we can essentially work around that Act. The reason why we cannot support the regulations today is that the most damaging part of that Act is still on the statute book.
NHS Outsourcing and Privatisation
Debate between Jonathan Ashworth and Jim Cunningham(6 years, 7 months ago)
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Jonathan Ashworth
I shall take your guidance, Mr Deputy Speaker. It is always a pleasure to indulge the right hon. Lady, but I have to point out to her that Councillor Cutts of Nottinghamshire County Council is cutting care homes across Nottinghamshire. The record will show that.
Jonathan Ashworth
Given that Mr Deputy Speaker has just castigated me, let me make a little progress. Hopefully, I will be able to take more interventions towards the end of my remarks.
Underfunding and lack of capacity have driven more and more—
Jonathan Ashworth
I say to the right hon. Gentleman, of whom I am tremendously fond, as he knows, that I agree broadly with the point that he is making. If my memory serves me correctly, he sits for a Sussex constituency and, of course, in Sussex, we had the shambles of a patient transport contract that went to a firm, Coperforma, which did not even own any ambulances and which was leaving patients stranded on their doorstep waiting for transport to dialysis appointments and to chemotherapy appointments. It often could not then pick up the patients from the hospital and take them home. That contract had to come back in-house. It is these types of privatisation that we believe are doing great damage to the health service.
Mr Cunningham
My hon. Friend has been generous in giving way. Does he agree that private companies are also increasing car parking charges, which is a tax on patients, and that, more importantly, because of the lack of social workers we have bed-blocking in the national health service, too?
Several hon. Members rose—
NHS Pay
Debate between Jonathan Ashworth and Jim Cunningham(7 years, 3 months ago)
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Jonathan Ashworth
Perhaps we really should, but I think the hon. Gentleman, who is an enthusiastic supporter of his Front-Bench team, is quoting selectively from the report, which I will move on to in a few moments.
Today’s motion is not just about doing what is right for NHS staff; it is about doing what is right for patients, too. I remind the House that we are significantly short of GPs and that we are short of 3,500 midwives. According to the Royal College of Nursing, we are also short of 40,000 nurses, with one in 10 nursing posts remaining vacant. Nearly 40% of the full-time vacancies advertised on NHS Jobs earlier this year were in nursing, and the Opposition know that Brexit is having an impact through nurses leaving the UK. The Nursing and Midwifery Council shows an increase in the numbers of nurses and midwives leaving its register. The average midwife has seen the value of their pay drop by over £6,000 since 2010, and we are significantly short of numbers, with 80% of midwives intending to leave the profession in the next two years as a result of the pay cap.
Jonathan Ashworth
May I make a little progress?
The hon. Member for Croydon South said that pay does not affect retention and recruitment, but the Opposition say that the pay cap is at the heart of the retention and recruitment crisis. Earlier this year, NHS Providers, which represents hospital trusts, warned that low pay is causing staff to leave the NHS to stack shelves in supermarkets. Chris Hopson said:
“Years of pay restraint and stressful working conditions are taking their toll. Pay is becoming uncompetitive. Significant numbers of trusts say lower paid staff are leaving to stack shelves in supermarkets rather than carry on working in the NHS.”
Jonathan Ashworth
My hon. Friend is right. A popular, successful walk-in centre in her constituency has had to close to shift the staff to fill vacancies at the local A&E at Arrowe Park hospital, because the pay cap and other Government decisions have led to a staffing crisis in the wider NHS.
Jonathan Ashworth
I did promise my hon. Friend that I would give way, but I will take no more interventions afterwards.
Mr Cunningham
Has my hon. Friend noticed that the Government do not necessarily have to abide by the pay reviews? In other words, they could give an increase that goes further than what the pay review body recommends. The Tories are wrecking the national health service. They should put their money where their mouth is. If they really appreciate NHS and its staff, they should vote with us tonight.
Jonathan Ashworth
My hon. Friend is absolutely right. The Tories have been running the NHS for seven years now. It is going through the biggest financial squeeze in its history and we have some of the worst waiting times on record.
The hon. Member for Croydon South should note that the NHS Pay Review Body’s March report said that
“public sector pay policy is coming under stress. There are significant supply shortages in a number of staff groups and geographical areas. There are widespread concerns about recruitment, retention and motivation that are shared by employers and staff side alike.”
Again, NHS Providers said that
“seven years of NHS pay restraint is now preventing them from recruiting and retaining the staff they need to provide safe, high-quality patient care. The NHS can’t carry on failing to reflect the contribution of our staff through fair and competitive pay for five more years.”
We agree. Addressing NHS pay and lifting the pay cap are crucial to addressing the retention and recruitment crisis now facing the NHS.
Britain in the World
Debate between Jonathan Ashworth and Jim Cunningham(9 years, 6 months ago)
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