Department of Health and Social Care

Josh Fenton-Glynn Excerpts

Wednesday 5th March 2025 Commons Chamber

[Josh Fenton-Glynn (Calder Valley) (Lab)]

I am pleased to be called to speak in this important debate, Madam Deputy Speaker. When we talk about the NHS, we can argue either about specific investments or about general principles, and like many colleagues, I have received a great amount of correspondence highlighting no end of specific areas where investment is needed. I could also speak about the need to invest in urgent treatment centres in Todmorden, or to celebrate the work of Calderdale and Huddersfield NHS foundation trust—two things that I continue to raise with my right hon. Friend the Secretary of State for Health and Social Care. However, as I have the privilege, along with others, of sitting on the Health and Social Care Committee, I want to talk in more broad terms about some of the problems facing our health and social care system, and about how the proposed shifts in the NHS need a reprioritisation of resources.

I will focus on what I argue is the most important of those shifts—the so-called left shift of care from hospitals to the community. The hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown) outlined the need for that well—even if to hear him speak one might think that it had come from on high, and not as the result of 15 years of the previous Government. One in 10 people are stuck on waiting lists in a healthcare system that is becoming increasingly hospital-centric, and those lists will only grow if we continue on the same course. There is no solution to our crisis in emergency medicine without the left shift of solving problems earlier and closer to home.

Of course we need hospitals and to invest in them, but they should be where people go with acute and complex cases, not where they go for want of working services elsewhere. Despite the need to shift to community care being obvious to just about everyone, one of the most glaring revelations of the Darzi report was how poorly successive Governments have gone about achieving that. Meanwhile, we are not training or retaining enough GPs—that is where the renegotiation of the contracts is important.

In Calder Valley, the retention crisis has meant that Bankfield and Church Lane surgeries, Northolme practice, and Rastrick health centre all have a ratio of patients to fully qualified GPs that is far higher than the local, regional and national averages—averages that simply do not meet what is needed from our health service. More than a decade after the Dilnot report, social care remains the forgotten service—the Cinderella service, as my hon. Friend the Member for Poole (Neil Duncan-Jordan) artfully called it. With 1.4 million social care staff, our care system is the same size as the NHS workforce, but it receives nothing like the support or understanding of other areas of our health system. The consequence is that our Committee, week after week, hears about delayed discharge, with 20% of beds in my local hospital taken up by people who should be treated at home or closer to home. Meanwhile, carers are missing their appointments because they are delivering care to loved ones, and they end up with worse illnesses, adding to the strain on the NHS.

In less than a year, this Government have ended the industrial action in our NHS and delivered 2 million additional appointments, and they are now setting up a new deal with GPs. However, that cannot be the extent of our actions. The 10-year plan cannot continue down the same road that the last Government took us on, of trying to fix a crisis in the NHS by putting more money into hospitals and nothing else, because that tackles the symptoms but not the causes of the problem.

Therefore, when setting out the estimates, I urge the Minister to be mindful of the shifts we need to ensure that funding not only increases, but increases with a focus on community and social care. That is what we need for a sustainable system that will protect the rest of our health service in future, because a sustainable system is the only way to deliver better healthcare and better social care for people across the country.

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[Nesil Caliskan (Barking) (Lab)]

May I take this opportunity to thank the Chair of the Public Accounts Committee, the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown), for his work, as well as other Members who I sit on the Committee with?

The financial sustainability of our national health service will have an impact on patients now and in future. Given that such a huge amount of money is spent by the Government, it is imperative that they focus on value for money for the taxpayer so that, at a time when demand is going up but resources are limited, we can deliver the very best health service that the British people deserve and that my constituents in Barking can rely on.

For too long the Department and NHS England have taken a short-term approach to budgeting, relying on reallocating capital budgets to cover revenue shortfalls. Between 2014 and 2019, more than £4 billion was raided from the Department’s capital budgets to fund day-to-day spending. As a former council leader, that approach has always been curious to me, given that, as others have mentioned, local authorities are not permitted to have the same approach. Equally, councils are legally obliged to set annual balanced budgets, and even when they overspend because of demand-led statutory services, they cannot set deficit budgets.

[Josh Fenton-Glynn]

Another issue my hon. Friend may wish to reflect on is that the council tax base differs from place to place, so councils are even more disadvantaged than the NHS on funding.

[Nesil Caliskan]

My hon. Friend makes an important point, because health inequalities are determined by a multitude of factors and the work that local authorities do on public health is crucial too.

Compare the point I made about local authorities not being able to set deficit budgets with the situation in the NHS, where every year winter pressures mean that our NHS is at crumbling point and that despite the money poured in, the NHS overspends. Last year, that overspend was £1.4 billion, more than double the previous year. Those issues have not emerged in a silo; they are a result of years of mismanagement and failed leadership by former Ministers and by a Government who decided to allow the chaos of one year budget setting, hindering health leaders from being able to effectively plan for the future.

A lack of political commitment, coupled with a refusal to invest in the future, has led to awful consequences for patients. On the NHS estate, the National Audit Office report shows that since 2019, over 5,000 appointments, surgeries and other clinical incidences have had to be cancelled because of issues in buildings. That is absolutely shocking, so I take on board the points made by Members from across the House.

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[Sarah Bool]

I concur that I have not seen anything, which is why today’s debate is so important. My GPs tell me that more attention needs to be given to GP practices: they are the praetorian guard who can ultimately protect the NHS. Access to timely appointments is crucial, as is rebuilding the key relationship and contact between a GP and their patient.

[Josh Fenton-Glynn]

Under the last Government, 20% of NHS doctors were thinking about moving overseas. Does the hon. Lady agree that solving GP contracts is a first step towards keeping GPs working in this country?

[Sarah Bool]

I want to encourage all our GPs to remain in the UK, giving back, so I am always fully supportive of anything we can do about that.

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[Dr Johnson]

One of the key things about the Government’s deal is that they have given in on money without asking for anything in return in terms of productivity. The Government needed to agree a pay deal that was sensible and affordable, not talk about the money that they are giving to the NHS while taking away with the other hand in taxes.

Let us hear what some healthcare providers have had to say about the implications of Labour’s NICs rises for their constituents’ healthcare. The Royal College of General Practitioners has warned that the NICs increase will force GP practices to choose between redundancies and closure. The hospice sector believes that the cost of national insurance rises could be £30 million a year. The Government have given that sector a capital grant worth £100 million, which is welcome and will improve facilities; however, if those facilities are empty and cannot be staffed, they will not deliver much in the way of improvement. Air ambulances are also under threat from the Chancellor’s rise in national insurance and taxes in last year’s autumn Budget, with the local service in my constituency, Lincolnshire and Nottinghamshire air ambulance—which is entirely charitably funded—needing to find another £70,000 just to pay for those national insurance rises.

The Independent Pharmacies Association estimates that the rises in employer national insurance contributions and the minimum wage will cost the average pharmacy over £12,000 a year, totalling more than £125 million for the sector as a whole. Nick Kaye, chairman of the National Pharmacy Association, has warned that

“Pharmacies face a financial cliff edge at the beginning of April, with a triple whammy of rising National Insurance, National Living Wage, and business rates all arriving at once.”

What impact will this have on our constituents’ health? The Government talk a good talk about bringing healthcare closer to the community, but actions speak louder than words, and putting extra pressure on community-delivered services is not a good way of delivering their aims.

The Nuffield Trust suggests that the national insurance rise alone will add a £900 million burden to the adult social care sector. With other new costs factored in, the care sector is believed to be facing a bill of an additional £2.8 billion, dwarfing the £600 million extra allocated to the local authorities responsible for providing social care. This will have a devastating knock-on effect: the amount of care that can be bought by local authorities will fall, the cost of private care will rise—so more people will be reliant on the state, rather than the private sector—and the waiting lists that the Government claim to prioritise will also rise. The Nuffield Trust warns that many small care providers will either have to increase prices, stop accepting council-funded patients, or go bust.

That will have a knock-on effect on the hospital sector, as people are unable to be discharged because there is not adequate social care for them. The Government talk about creating a new national care service, but they have managed to damage the existing one by hiking the costs borne by care homes through national insurance rises and other tax and wage increases.

In January, the Government announced a deal with private hospitals in an attempt to cut waiting lists. The deal, which sounded good to start with, would see private hospitals being paid for each patient that they treated, incentivising them to treat as many people as possible. However, The Times reported that NHS England has recently capped the amount that each hospital can be paid. The chief executive of the Independent Healthcare Providers Network has warned that the policy will actually lengthen waiting times. Will the Minister comment on that?

The Minister is focused on prevention, but when the Government announced that they would be cutting the overseas development aid budget by 40%, the Prime Minister said that the UK would continue to play a key humanitarian role on a range of issues, including global health and challenges such as vaccination. I would appreciate clarification from the Minister on whether the global health budget will be cut, or whether the cuts will be made from other aspects of the ODA budget.

Workforce is the key asset of the NHS, yet sickness levels are running at around 5.5%, which is a considerable cost to Government and drag on productivity. They vary considerably across trusts and professions, with consistently less than 2% of consultants off sick, but almost 8% of ambulance support staff. If those rates could be reduced, it would lead to improved productivity and patients being treated much faster. What is the Minister doing to look at that? Perhaps she will have another one of her reviews.

[Josh Fenton-Glynn]

The hon. Member has frequently been quick to criticise NHS pay rises. Will there be more or fewer sickness absences in the ambulance service if its staff are better paid?

[Dr Johnson]

Is the hon. Gentleman suggesting that whether someone becomes ill is entirely dependent on whether they get another 2% in their pay packet? I am not sure that it is.

The Government promised a great deal when they came into power last July. Since then, they have handed out inflation-busting pay rises, raised costs and abandoned election pledges. At the centre of the Government’s approach is a classic socialist trick—a sleight of hand, taking money away from NHS providers in taxes with one hand, and expecting praise when they give some of it back with the other. The public will see straight through it.