NHS: Long-term Strategy

Karin Smyth Excerpts

Wednesday 11th January 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

I beg to move an amendment, to leave out from “House” to end and add:

“pays tribute to the work done by the National Health Service and recognises that there are pressures on health systems around the world; recognises that all parts of the UK are facing pressures; welcomes that the Government has committed to reduce waiting times in England as part of its strategy to strengthen the NHS and care system with up to £14.1 billion additional funding being made available by government over the next two years to improve urgent and emergency care and tackle the backlog—the highest spend on health and care in any government’s history; and regrets that the Scottish and Welsh governments have refused to make similar such commitments.”

I am grateful for the opportunity to update the House further to my statement on Monday, in which I recognised the very real pressures faced by the NHS, particularly in emergency departments and with ambulance handovers, and the fact that the experience had not been acceptable for some patients and staff in recent weeks. I set out a range of actions that we are taking in response to those pressures—pressures that are being experienced by healthcare systems throughout the United Kingdom, and in Europe and beyond.

Before I turn to the honourable Opposition’s flawed motion, I want to reflect on a few points that the hon. Member for Ilford North (Wes Streeting) did not cover. For a start, he hardly mentioned social care, although that was an issue raised on his own Benches. We have made £2.8 billion and £4.7 billion available for social care in each of the next two years, recognising that what happens in one part of the system impacts the other. He also failed to mention any of our life sciences success stories, such as our 10-year partnership with Moderna, our deal with BioNTech to give 10,000 people early access to cancer therapies, and how we were the first country in the world to have the bivalent vaccines. That kind of work will shift the dial on prevention.

[Karin Smyth (Bristol South) (Lab)]

Will the Secretary of State give way?

[Steve Barclay]

I will, and perhaps the hon. Lady will explain why none of her Welsh colleagues is here for the debate.

[Karin Smyth]

I speak for the people of Bristol South. Let me talk about social care: can the Secretary of State explain why he will not publish information about the trailblazers on social care? The Government made a huge commitment to people in this country that they would fix social care, but they have reneged on that promise. They spent £2.9 million on trailblazers. I have asked written parliamentary questions of the Secretary of State and have been told that they are not publishing information. We do not know what has happened to that money. We do not know the outcome of that trailblazers report. If we are to learn from the disaster of the last year in which the Government marched us up the hill and back down again, we need to understand the outcomes. Will he commit to publish the evidence that we have had thus far?

[Steve Barclay]

I support transparency, so I will take away the issue of trailblazers that she raises. [Interruption.] The hon. Member for Wallasey (Dame Angela Eagle) chunters from a sedentary position, but I am agreeing to look at the point that the hon. Member for Bristol South (Karin Smyth) raises. She and I have debated in the past, not least when I was a Minister of State and she raised the issue of NHS property. She knows that I was a supporter then of transparency. She raises an interesting point that has not been raised with me previously.

I am very happy to take that away and look at how we get some transparency on that, because it is important that the House is able to see the evaluation of innovation and where pilots are done. Secondly, one of the challenges that the NHS faces is that it does not adopt that innovation at scale. The substance of the hon. Lady’s point is fair and I will happily take it away. On why I mentioned Welsh MPs, given Bristol’s proximity I thought she may be able to shine a light on the strange absence of any Welsh MPs, unlike the Secretary of State for Wales who is taking a keen interest in this debate.

I turn to the motion moved by the shadow Secretary of State, which seems, incidentally, to have been written before my statement on Monday. I might have thought that he would change it. We set out a further £250 million to support emergency departments and to get those patients out of hospital who are medically fit to be discharged. Across the House, people recognise that the pandemic has had a significant impact on that. It effects flow in hospitals and it is an area of common ground between the shadow Secretary of State and me: the issue of delayed discharge is a big factor in the compression in emergency departments.

--- Later in debate ---

[Steve Brine]

I said in the House on Monday that covid has put the health service on its knees—it has done so to health services in the UK and around the world. To repeat what I have just said, it is disingenuous to suggest that the problems faced by our health service right now are not caused by our covid experience. The number of people presenting with suspected cancers is through the roof. That is good—many of those cases will turn out not to be cancer, which is even better—but so many people are coming forward because we suppressed demand during that time, and it is adding to the demand outstripping the supply in the health service right now.

[Karin Smyth]

The hon. Gentleman chairs the Select Committee, so it is really important that he is clear about this. The Government ran the health service at 96% capacity well through the 2010s, well before the pandemic. They were consistently warned that 96% capacity is too much; we should be running at about 85% capacity for staffing and so on. Capacity in the system has been our problem for a long time. Demand is outstripping capacity—supply is about capacity—and he, as Chair of the Health and Social Care Committee, needs to be clear about that point.

[Steve Brine]

I will choose my words and the hon. Lady can choose hers. I will come to capacity in the conclusion of my remarks—I promise her that.

I will touch on patient flow. Any acute sector that I speak to or visit at the moment is saying clearly that patient flow is hampering everything happening at the front door and the back door. One of the reasons why those in the ambulance service are striking is that they are so heartbroken about not being able to deliver the service that they want to deliver and cannot get out on the road because they are waiting to dispatch their patients.

I said it on Monday and I will say it again now: I welcome the £250 million that the Government have put forward to buy beds. I repeat that two thirds of social care is domiciliary care—care in people’s homes—and we must not forget that, because it is important to getting people through the acute system. The modular work that the Secretary of State talked about—modular units in and around emergency departments—to add extra capacity and meet some of the extra demand coming through the front door, is also very welcome.

I said that we have to separate the now from the long term, so let me address the long term. The elective recovery taskforce is important; the 15 new elective hubs are important. At Prime Minister’s questions today, the Prime Minister talked about eliminating the two-year wait, and that is good—it is not, of course, the extent of his ambition, and to say so is facile. We do not yet have an elective hub in Winchester. The Secretary of State knows that I am on his case about it, but may I just land that point with him again? The Prime Minister’s primary emergency care plan, which we eagerly expect later this month, will be important. It is also part of a long-term strategy and plan, and I think many people in the ambulance service will be pleased with what they see there. I hope that it will be as ambitious as what we hear in some of the rumours.

Some of the things the Select Committee is looking at feed into what the Secretary of State and the Government are doing. Integrated care systems are a creation of this Government. They are about flattening services across the NHS and breaking down those barriers between health and social care. We are in the middle of a big inquiry into integrated care systems, and we are liaising with the Hewitt review, which is a good thing. We were talking to the Care Quality Commission this week, and the Government have not yet laid the regulations on how the CQC will look at ICSs. Will the Minister please look at that?

This morning we talked about the digital transformation of the NHS. There are huge dividends in digital for the NHS, including simple things, such as the amount of money that the NHS spends on sending letters to patients—not least given that they never get there due to Royal Mail strikes. There are clinical dangers to that. Let us pursue our digital transformation, and I know that the Secretary of State is up for that. In terms of the stuff we will be doing this year, we eagerly await the workforce plan.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

The root cause of this problem is capacity. In my area of Bristol, north Somerset and south Gloucestershire, we are short of roughly 300 beds. Commitments made in the 2004 plan, when we rightly closed one hospital and consolidated services in another, have not delivered community-based beds—mainly in south Gloucestershire, which is largely represented by Conservative MPs who do not want to admit that problem. Added to the low base of funding, in a growing city we have a real capacity problem, and the solution now is 30 temporary hotel beds. That will not cut it. It is short term and, frankly, a very poor use of money.

In the short time I have, I want to highlight some issues with the social care promise. We were promised so much, and people were led up the garden path. A lot of money has been allocated and, frankly, it has just disappeared. Some £3.6 billion was allocated for the social care charging system between 2022 and 2025. That has now been postponed. There was over £70 million for local authorities to look at market-shaping and commissioning capabilities—gone. As I said earlier, there was £2.9 million on trailblazers, but what have we learned from them, and how is that being used?

I have asked a lot of questions about where our money has been allocated, where has it gone and what we have got for it. In written answers, I have been told that we might get something on trailblazers soon—that was in October 2022—but in December, the Minister who is in her place said there were “no current plans” to publish an independent assessment of the fair funding trials by selected local authorities. It is our taxpayers’ money, but it has now been wasted and we need to know what has happened to it.

In conclusion, matching capacity to demand in all ICB areas, so that we understand in our own patches what is really happening, is the way forward. To help the system, we need to start paying carers a decent wage, with a career structure and decent employment rights, to reduce the 165,000 vacancies. That would give people the care they need where they need it, it would help women in communities increase their economic power, and it would rebuild primary and community-based services from the cradle to the grave.