Hospital Building Programme

Debate between Justin Madders and Virendra Sharma

Wednesday 3rd November 2021 Westminster Hall

[Justin Madders]

I will reflect on the right hon. Gentleman’s comments. That leads on to another point I wanted to raise with the Minister: we are aware that the economy is currently in something of a flux in a whole range of sectors, in terms of finding the right people and the right skills, and construction is not immune to that. Do the plans include any wiggle room to take account of the fact that the cost of labour and materials is unfortunately going up quite rapidly at the moment?

NHS Providers said that

“there are still significant questions on whether the NHS will be able to meet the government's manifesto pledge to upgrade 70 hospitals and build 40 new ones given the lack of clear, long term, funding commitments beyond 2024/25.”

It also said that it awaits

“confirmation of the money that will be available to providers to tackle the £9.2bn maintenance backlog that has built up.”

The Minister will know that that has shot up in recent years, leading to cancelled operations and a 23% increase in treatments being delayed or cancelled in the last year because of infrastructure failures, and yet we are hearing very little on what is being done about that. I think the hon. Member for Eddisbury mentioned something in the region of £400 million being identified as the maintenance backlog costs at Leighton Hospital alone. We have also heard from other Members on infrastructure issues causing difficulties in their own trusts.

These problems are not new; they are the result of a decade of underfunding on both capital and revenue, with the Health Foundation reporting that

“the UK is investing significantly less in health care capital as a share of GDP compared with most other similar European countries.”

Of course, we have also seen frequent revenue raids on capital in the last few years. If these plans are to be successful, those raids must stop. I hope the Minister will be able to guarantee that there will be no revenue raids on capital for this programme in the next decade. I would also be grateful if he could set out the Department’s plan to tackle the maintenance backlog.

A few moments ago, I mentioned the interplay between large infrastructure projects and other capital requirements at a system level, particularly around how we get capital investment into primary and community care. Taking my own patch, Ellesmere Port, which I know best, we have several GP premises in the town centre that are past their best—past their useful life, perhaps—they are not really suitable in these covid-conscious times. We are not short of more modern, available premises in the town centre, where there might even be greater potential for integration with other services

However, these projects take time and money, and some decision must be taken at a system level to prioritise them. I think that would be an important step forward for improving access in my community and dealing with some of the health inequalities we have talked about. I recognise that sometimes it is a fact of life that the bigger players—the acute trusts—will always be higher profile than individual practices for attracting funds and investment. In many ways, this is an echo of the debate that the Minister and I have had in recent weeks on the Health and Care Bill Committee. I mention it again because, particularly with capital investment, there is a danger that primary and community services will struggle to have their voices heard against some of the bigger players in an extremely large integrated care system.

I will end with a few comments from stakeholders regarding the Chancellor’s statement last week. The King’s Fund said that

“the real game changer would have been clear funding for a workforce plan. Chronic workforce shortages across the health and care system heap further pressure on overstretched staff who are exhausted from the pandemic. Yet despite pledges, promises and manifesto commitments, the government has failed to use this Spending Review to answer the question of how it will chart a path out of the staffing crisis by setting out the funding for a multi-year workforce strategy.”

The Health Foundation said that

“new money for technology and buildings, although vital, is of limited value without additional staff. A workforce plan backed by investment in training are critical and we await details of both so that the NHS’s recovery can be secured.”

The Nuffield Trust said:

“It is striking that there is a lack of strategic workforce investment alongside this boost in funding for facilities. Staffing is recognised as the number one issue for the sustainability of the health service. Recovery from the pandemic not only rests on investment but on hard-working staff as well.”

Finally, the NHS Confederation said that

“to ensure the extra money delivers for the public, a strong and supported NHS workforce is needed. This is why training and increasing the supply of doctors, nurses and other health and care professionals is so important at a time when public polling recognizes that staffing is the biggest problem facing the NHS.”

While we welcome the investment in new buildings, we hope that none end up being a white elephant, because the elephant in the room is that we could find ourselves in the remarkable position by 2030 that brand new hospitals, extensions, or refurbishments are delivered, but are not fully operational because of a failure over the preceding decade to tackle the workforce crisis. That is here and now, and it needs to be tackled in the short, medium and long term. That is the final plea I make to the Minister: these investments are welcome, but we must ensure that we have a plan so that these buildings are fully staffed when they are up and running.

[Mr Virendra Sharma (in the Chair)]

Before I ask the Minister to contribute, I will just say that I will be joining that long queue very soon to lobby for Ealing Hospital’s future, but not this morning.

Rough Sleeping

Debate between Justin Madders and Virendra Sharma

Thursday 7th February 2019 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma. There were a lot of thanks in the opening remarks from my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle), but I would like to thank him for securing the debate and for the excellent work that he does, alongside the hon. Member for Colchester (Will Quince), in chairing the APPG on ending homelessness. My hon. Friend gave a passionate and well informed introduction to the subject.

Sleeping out on the streets happens all year round, but it is at times such as this, when the temperature is very low and any night could be someone’s last, that the issue comes into focus. I commend those organisations that have taken extra steps in recent weeks, when the weather has been particularly cold, but we must recognise —as I think hon. Members do—that, welcome as those interventions are, they deal only with the issue as it presents itself. We need to look at the underlying causes of what I consider to be a national scandal.

Rough sleeping is a national crisis. As we have heard, the figure has risen by 165% since 2010. No doubt we will hear—indeed, we have heard already—that there has been a 2% fall in the number of people sleeping rough across England as a whole in the last year, but what I see with my own eyes tells me that we have a crisis right here and now. I have been a Member of this House for just under four years and I have noticed a significant increase in the number of people sleeping in doorways on the walk back to my flat. This morning, while walking in, I saw lots of sleeping bags and cardboard boxes—evidence of people sleeping rough. I notice, whenever I go out in a big city, that there are more and more people sleeping on the streets; there are more than there used to be. I have also noticed an increase in the number of people coming to my surgery who are sleeping rough or facing homelessness. Every night when I leave this place, I see the people sheltering in the subways under the Palace of Westminster and I feel ashamed—ashamed that right by the corridors of power, in one of the richest countries in the world, we have people sleeping rough. I am sure that I am not the only person who, looking at that, thinks: how can we let this happen?

As we have heard, there is a huge crisis. There were 4,677 people sleeping rough on any given night last year, compared with 1,768 in a similar survey in 2010. Nearly 5,000 people sleep rough every night. Saying the number does not really do the issue justice. Imagine filling a stand at a lower-league football ground and saying that every single person in it will be out on the streets that night. Think about exactly where those people will go, how they will feel and how that could be happening to a similar number of people not just that night, but every night throughout the year. That gives us a sense of the scale of the challenge that we face.

In the context of these surveys, those who are seen sleeping rough are, as my hon. Friend the Member for Bermondsey and Old Southwark said, only the tip of the iceberg. Rough sleeping is the most visible form of homelessness, but of course many people are in temporary accommodation; there are people relying on friends and family for a place to live; and there are people sheltering in alcoves or other places away from the worst excesses of the weather.

It has not always been like this. As we know, in 2010, after 20 years of concerted Government effort across the parties, rough sleeping appeared to be almost at an end. Because homelessness is not inevitable, it can be prevented. It is clear that the Government accept that it can be prevented, because they aim to eradicate it by 2027. That seems an awful long time away for such a national scandal. We need to act more firmly now.

We have heard about the connections between health and rough sleeping. The British Medical Association tells us that being homeless can have a devastating effect on people’s mental and physical health. That is borne out by the Office for National Statistics figures, which show that a staggering 597 people died while sleeping rough or in emergency accommodation in 2017. That means that every night, at least one homeless person died. The average age of the people dying is 44 for men and 42 for women. Those deaths are premature and entirely preventable. It is a stain on this country that we did not prevent those deaths.

The interventions and funding in the Government’s new rough sleeping strategy are welcome, but they are only a first step. If the Government are to reach their own targets of halving rough sleeping by 2022 and ending it by 2027, they must address the key drivers, which we have heard a bit about in the debate: spiralling housing costs, lack of social housing, insecurity for private renters and cuts to homelessness services. Only by addressing those issues can we have long-lasting change.

Since the Government came to power, rents have become increasingly unaffordable. Between 2011 and 2017, rents grew 60% faster than wages. In those circumstances, it is no wonder that people struggle to keep a roof over their heads. At the same time, welfare reforms have made private sector landlords increasingly reluctant to rent to tenants who rely on housing benefit. As we have heard, many landlords now refuse to accept tenants in receipt of benefit at all.

A quarter of private renters, equating to over 1 million households, rely on housing benefit or a housing element of universal credit to keep a roof over their head. Because of the decline in social housing stock, with nearly 1.2 million people trapped waiting for social housing, many of those families face greater and further instability with rising rents in the private rented sector. Housing benefit, as we have heard, is only paid up to the rate determined by the local housing allowance. The decision to freeze that in 2016 is causing real problems now. There is no requirement for landlords to let their properties at that level. It is a perfect recipe for people to fall further and further into debt.

If the Government were serious about tackling these issues and meeting the goals they have set, they would tackle the causes of homelessness. We need to make more homes available to people with a history of rough sleeping, and to continue to improve security for private renters. Three-year tenancies should be a minimum. We need to look at rent controls. We need to build thousands more homes for affordable rent.

Those are some of the causes, but I also question whether the system does enough to help those who become homeless. The new duties on local housing authorities to assess, prevent and relieve homelessness under the Homelessness Reduction Act 2017 are welcome. However, I have seen that amount to little more than handing out a list of private landlords for people to contact. Shelter tells us that the leading cause of homelessness is the loss of a private rented home, so I find it incredible that some local authorities see their duty to prevent homelessness as being fulfilled by nothing more than pointing people back in the direction of the sector that was responsible for their situation in the first place.

We know that, once evicted, many more people now struggle to find a new property due to the cost of securing a new tenancy, with deposits and other fees coming on top of the unaffordable rents that I have already referred to. I also have concerns that people who are given notice to quit by their private landlord are not really helped by the local authority. They are given no special priority until they are very close to the eviction date, which causes unnecessary stress and anxiety, and encourages—if not forces—landlords to go to court to get the eviction order they need. Who picks up the tab for those legal costs? Of course, it is the tenant. That approach does not help anyone.

Telling people who go into the council with a notice to quit that it might not be a lawful notice and they should seek legal advice is not actually helping people to get rehoused. The landlord will get them out eventually. It might take them a bit longer or cost them a bit more, but the council is not discharging its duties.

In response to the draft homelessness code of guidance, Shelter also identified a problem with the system for local connection referrals. Even when referrals are made in the proper way, people are often left in a period of limbo, during which they may not get any help with the relief of homelessness. This is even more of a problem when the referral is actually disputed. People in that situation are at risk of becoming citizens of nowhere, so it is hardly surprising that we see the consequences of that every night.

I am conscious that many hon. Members want to speak, so I will conclude. I believe that rough sleeping is a damning indictment of our society. The lack of priority and support we give to those who have fallen on hard times should shame us all. We have to do much better than we currently do.

[Mr Virendra Sharma (in the Chair)]

I will not impose a time limit on speeches at this stage, but I urge hon. Members to keep to seven or eight minutes. I would appreciate that. Otherwise, I might set a time limit later.