NHS Spending

Karin Smyth Excerpts

Wednesday 6th July 2016 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

Does my right hon. Friend accept that as well as the £350 million promise, the issue of access to GP primary care appointments caused a lot of anxiety in many communities? That is the fault not only of the funding situation but of the way in which primary care has been run down in the past six years.

[Joan Ryan]

The lack of primary care—particularly in London but also elsewhere—is a key factor behind the huge pressures on our accident and emergency departments and urgent care. No wonder people go there when they cannot get an appointment.

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[Kirsty Blackman (Aberdeen North) (SNP)]

Throughout this referendum campaign, there were numerous times when the campaigns were deceitful. There were numerous times when things that could not be promised were promised. Today, the Vote Leave official Twitter page still has a headline that says:

“We send the EU £350 million a week. Let’s fund our NHS instead.”

That is still on the Vote Leave Twitter page. In fact, they have not posted since the 23rd; I think they have screwed things up and run away.

I was a bit surprised that the Labour party’s motion did not mention the right hon. Member for Birmingham, Edgbaston (Ms Stuart), because when I looked up the £350 million claim, the first quote that came up was:

“Every week we send £350 million to Brussels. I’d rather that we control how to spend that money, and if I had that control I would spend it on the NHS.”

That was said by the right hon. Lady, and it was patently untrue.

BBC Radio 4’s “More or Less” looked at the statistics. For anyone who does not listen to the programme, I should say that it is rather excellent and tends to debunk what politicians say on a regular basis. It does not usually say something is actually false, however; it will say “It’s not quite right.” But with this claim, it said that it was false.

[Karin Smyth (Bristol South) (Lab)]

I hear what the hon. Lady says about my right hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), but she is not in the Government so does not have the power to transfer that money to the NHS budget, unlike those on the Conservative Benches. Does the hon. Lady agree?

[Kirsty Blackman]

I agree that the right hon. Member for Birmingham, Edgbaston is not in the Government, but she was in the Vote Leave campaign and made those promises.

Going back to “More or Less”, Tim Harford said:

“If we left the EU we wouldn’t have an extra £350 million to spend on the NHS.”

He also talked about the amount of money that we pay to the EU in comparison with the amount that comes back and said that the

“rebate is about £85 million a week. Unless you think we’d continue to get the EU rebate after we left the EU, it’s impossible to make the claim that there would be £350 million a week to spend on the NHS.”

He went on to say:

“We reckon that in the year 2014 the UK paid £280 million a week to the EU and received back £90 million a week in contributions to farmers and poorer regions and another £50 million in spending on British companies.”

Therefore, the most that could possibly have been available is £140 million, and there was no way that anybody in the leave campaign was ever going to spend all that money on the NHS.

It is not unusual, however, for people to be disingenuous. The people of Scotland are actually quite used to people telling untruths during referendums. The article below the now-famous headline, “The Vow”, stated:

“People want to see change.”

Well, they certainly delivered that. The article also said:

“We will honour those principles and values not only before the referendum but after.”

Ruth Davidson, leader of the Conservative party in Scotland, said on 2 September 2014:

“No means we stay in”

the EU. The Conservatives have completely failed to deliver on the promise they made to the people of Scotland. They are trying to drag Scotland out of the EU against our will.

This Conservative Government have a terrible record of making disastrous pledges, mostly because I think they did not expect to have a majority. They thought that they could write anything they wanted into their manifesto and then backslide on it because they were not going to have a majority. They had the fiscal charter, which was disastrous and condemned us to austerity. They had the removal of the subsidy for onshore wind, which was also disastrous. They had the pledge to have an EU referendum and they thought that they could avoid that one because they would not get a majority, but now look at what has happened.

There was also the disastrous, awful, horrendous migration cap. I am faced with constituents most weeks who sit in my office and explain to me what they do for their community and the work that they do in local government or the NHS. They talk about their volunteering and say to me, “Why does this Government want to send me back to another country?” The only answer that I can possibly give them is that this Government signed up to a migration cap and are therefore trying to reduce the number of people here based not on how hard they work, how much they give to their community or how much they put into NHS services, for example, but on trying to reduce the headcount. The Government’s behaviour is absolutely ridiculous.

What does that mean for the future of political campaigning? People across the UK are looking at the pledges, such as the one that is still on the Vote Leave Twitter page saying that £350 million should be spent on the NHS, and their trust in politics and politicians is being eroded further than ever before. If we want to try to bring things back, we are going to have to work incredibly hard and be incredibly truthful. Our campaigning is going to have to be incredibly positive. The fear factor inspires nobody, and we are losing the trust of so much of the population. They do not believe what we say because we constantly present them with fear, which is not good.

The Health Secretary spoke earlier about having to be careful in what he said in case he further damaged the British economy. He did not want to talk down the economy, which I understand, but I hope that that does not mean that the Conservative Government will refuse to be positive about the benefits of migration. The people who come to this country to work in our NHS and in other services provide a huge economic benefit to the UK as a whole and Scotland in particular. It is important to our country’s economy that people are willing to come here. If the Government are scared about damaging the economy and their ability to use people as bargaining chips and are unwilling to talk about the benefits to the British economy of migration, that is a major issue. Things are bad enough already; we do not want to make them any worse.

I want to mention a few other things that people have said. The hon. Member for Uxbridge and South Ruislip (Boris Johnson) said that people would value NHS services more if they had to pay for them. He then said that the £350 million should go to the NHS. Those two things are mutually incompatible. It is a shame that such points were not highlighted a bit more during the campaign.

So many Westminster Governments over so many years, and indeed decades, have been unwilling to do anything other than take part in short-term politics, focusing on what will be of benefit in the next five years in order to try to win elections. The NHS is a prime example, because some of the health measures put in place by the Conservative Government avoid touching on some of the thorniest issues. For example, breast feeding counselling and support, access to which is being reduced, costs money now but will result in a financial benefit—a return to the Treasury—many years later. It would be good if the Government were willing to take such decisions, which may mean they have a smaller budget now, in order to give people health benefits in 20 years’ time.

Earlier this week we had the main debate on the estimates. NHS and health budgets regularly go against HM Treasury guidance by transferring capital to revenue spend, which other Departments are not allowed to do. What I want to know is why that money is not being spent on capital projects. What capital projects on which the money should be spent are being avoided? Why are the Government not funding the NHS revenue spend to the levels they should be? Why does the NHS have to make these transfers between capital and revenue, rather than being adequately funded?

Madam Deputy Speaker, thank you for your indulgence in allowing me to speak in this debate. I really appreciate it.

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[Karin Smyth (Bristol South) (Lab)]

The Public Accounts Committee, of which I am a member, has published seven reports since January on the workings of the Department of Health, including on diabetes, the cancer drugs fund, services for people with neurological conditions, access to GP services, acute hospital trusts, NHS clinical staff and personal budgets in social care. We have had two further hearings, for reports yet to be published, on discharging older people from hospital and specialised services.

I recommend those reports to those on the Government Front Bench—I have a few copies with me, just in case they do not wish to watch the football tonight. Taken together, they paint a bleak picture of a system under immense pressure, with commitments undelivered, a massive increase in complexity as a result of the Health and Social Care Act 2012 and, above all for the Public Accounts Committee, continuing poor data upon which to make decisions and manage performance, as well as a complete lack of clarity about accountability for delivery on the areas we have investigated.

The concerns outlined in our reports include: on staffing, that trusts have been set unrealistic efficiency targets, and that the shortage of nurses is expected to continue for the next three years; on funding, that the financial performance of trusts has deteriorated sharply, and that this trend is not sustainable; and that the data used to estimate trusts’ potential cost savings targets are seriously flawed.

[Melanie Onn (Great Grimsby) (Lab)]

Northern Lincolnshire and Goole NHS Foundation Trust has only just been taken out of special measures, but last week’s Care Quality Commission report highlights a concerning dip in standards at Diana, Princess of Wales hospital. The bosses have said that that is because they struggled to recruit quality staff. Does my hon. Friend agree that removing the NHS nursing bursary is long-term pain for short-term gain?

[Karin Smyth]

I agree with my hon. Friend. In fact, one of the reports I have with me is the one we published in December about the work of the Care Quality Commission and some of the concerns that have already been issued about the work it does to uncover issues such as the ones she has highlighted in her constituency.

[Catherine West (Hornsey and Wood Green) (Lab)]

Does my hon. Friend agree that a worrying number of trusts are now in deficit, whereas 10 years ago they were simply bubbling along well—in fact, they were getting more money for their budgets? Even for North Middlesex hospital, which we have heard about extensively tonight, the situation is increasingly worrying, as it is now in deficit for the first time in 10 years.

[Karin Smyth]

I agree and I will talk about some of the issues with trusts.

Hon. Members have provided examples that highlight our concerns about how the Department is managing to do what Parliament intended with the funds voted to it. They highlight the importance of giving the Public Accounts Committee and Parliament the opportunity to review the departmental accounts properly.

The Department of Health annual accounts cover more than 20 arm’s-length bodies and delivery partners, not only NHS England, but the Care Quality Commission, NHS Improvement, the National Institute for Health and Care Excellence, the Human Tissue Authority, Health Education England, the NHS Litigation Authority and—one of my and, I am sure, many hon. Members’ favourite organisations—NHS Property Services Ltd.

Within NHS England, NHS trusts reported a record deficit of £2.45 billion in 2015-16—almost £500 million worse than planned, and triple the size of the 2014-15 deficit. As my hon. Friend the Member for Hornsey and Wood Green (Catherine West) said, a record 121 out of 138 acute trusts ended 2015-16 in deficit. Analysis by the King’s Fund and the Health Foundation has challenged the Secretary of State’s claim that, in the 2016-17 Budget, the NHS will receive the sixth biggest funding increase in its history. The chief economist at the King’s Fund concluded that this year’s total real spend increase of 1.6% is the 28th largest increase since 1975-76.

The Health Foundation noted:

“The health budget has been protected from cuts but spending growth is substantially below the growing pressures on the service…In exchange for this protection, the NHS has been asked to absorb these pressures through improved efficiency. There are opportunities to improve the efficiency and effectiveness of the NHS but realising these savings is proving to be a huge challenge—particularly against a backdrop of staffing shortage.”

Given the size of the trust deficit and the implications for the budget of NHS England, which takes up by far the greatest part of the Department’s budget, there are widespread concerns about how the Department might stay within its departmental expenditure limit. Failure to do so would be an exceptional breach of control. As my friend, the hon. Member for Aberdeen North (Kirsty Blackman) said, there are issues about the way in which capital has been transferred to revenue and so on.

The Public Accounts Committee understands that the accounts will be available before the recess—perhaps next week, which would be very welcome. We need to look at not only NHS England’s spend, but that of the other 20 or so bodies that make up the Department of Health. I know that you, Madam Deputy Speaker, and Parliament will take a dim view if the Department’s accounts are not subject to proper scrutiny when the Committee, which had some additional training this year to review the accounts, is ready to undertake such scrutiny.

In addition to my concerns about last year’s accounts and this year’s departmental budget, I believe that Brexit now poses huge risks. My major concerns are about staffing, procurement and medicines, but there are many others. In my NHS career as a non-executive director on a trust board and as a manager, I read and indeed compiled many a risk register. It is truly a joyful task. The Department requires all its bodies to identify, assess and mitigate risks. As anyone in any business knows, risk registers are an essential part of the planning process. Few if any risks to business could be greater than Brexit. I would expect the Department to have a robust Department-wide risk assessment process, and I would expect it to include Brexit.

Yesterday at Health questions, I asked what was being done across the Department, including the NHS, to assess and mitigate the risks to its current year budget of Brexit’s huge impact on staffing, procurement and medicines. I received a far from satisfactory reply—although he tried to be helpful—from the Under-Secretary of State for Life Sciences. I therefore pose three key questions to Ministers: what are the risks of Brexit that the Department must surely have already identified through its risk register or by other means? How are they to be mitigated? When will they be debated and discussed in Parliament?