Future of the NHS

Kate Osborne Excerpts

Thursday 23rd February 2023 Commons Chamber

[Kate Osborne (Jarrow) (Lab)]

I beg to move,

That this House has considered the future of the NHS, its staffing and funding.

The national health service is a beloved national institution. Everyone in the country and in this House will have interacted with the NHS and have their own personal connections and stories that they can reflect on, from the birth of their children to the death of a loved one or seeing a general practitioner about a health condition. It is undeniable to most of us that the NHS is in crisis. It is being pushed into an avoidable and unprecedented collapse after 13 years of Conservative mismanagement.

All our constituents will have been impacted in some way by the crisis, a crisis so bad that nurses have taken strike action for the first time in NHS history. Ambulance workers and other NHS staff have also taken action, and this week British Medical Association junior doctors voted with a 98% majority to do the same. I thank all my constituents who work in the NHS, particularly those who got in touch about this debate, including paramedics from the North East Ambulance Service who tell me that on a daily basis they are unable to hand over patients because of delays in A&E and lack of beds, and how frustrating it is that many of the calls are for people who need social care or cannot get a GP appointment, rather than the acute calls that they are best placed to deal with.

That highlights the impact the crisis in social care is having on the NHS. Half of all people arriving in A&E by ambulance are over 65 and one third are over 75. The lack of adequate social care for basic daily needs is storing up problems and leaving older people less able to care for themselves, or arriving in hospital with preventable health problems, adding to the pressures in A&E and bed provision. People who work in the NHS have had enough of being failed by this Government’s mismanagement. The country deserves better.

NHS dentistry is on its knees, with patients facing a growing crisis of access and resorting to DIY dentistry. The NHS was in crisis pre-pandemic and the Government’s failures and mismanagement have made the situation far worse. For Ministers to dismiss the crisis as winter pressures, or even to flat-out deny that there is a crisis, is frankly absurd.

[John McDonnell (Hayes and Harlington) (Lab)]

The crisis in dental and mental health is affecting our children at the moment. In some of our constituencies, it is a direct result of the lack of local provision. We are feeding a generation of problems as a result of that failure.

[Kate Osborne]

I absolutely agree with my right hon. Friend. The problems for our children further down the line are worrying, but of course, they are preventable if the right action is taken.

The Conservatives blame everything else—the weather, the pandemic and even NHS staff—but their 13 years of failure have left the health service in crisis. At Prime Minister’s questions yesterday, the Prime Minister boasted about

“record sums into the NHS…and…a clear path to getting people the treatment they need in the time they need it.”—[Official Report, 22 February 2023; Vol. 728, c. 222.]

He is not living in the real world. Every briefing and communication that we have received has cited delays in treatment and the devastating impact that they have, as well as the decade of underfunding. It is hard not to agree with the British Medical Association, which called the Prime Minister “delusional”.

The last Labour Governments allocated, on average, a 6% rise in the NHS budget every year. Successive Conservative and coalition Governments have since allocated a rise of only 1% a year. The Prime Minister can talk about “record sums” all he wants, but he is fooling no one. In reality, the settlement is not enough, and it is nowhere near what previous Labour Governments invested. This crisis can be laid firmly at the Government’s door.

There are so many awful headlines and statistics, and I will delve into some of them, but let me say from the outset that we must all remember, when we talk about the 7 million people on waiting lists, or the 500 avoidable deaths every week, that we are talking about people. There are faces behind those statistics: the faces of women who cannot get urgent gynaecological treatment, the faces of children who cannot access mental health support, the faces of families whose loved ones have died—lives that could, should and would have been saved if this Government cared about communities and invested in our NHS.

When we talk about 133,000 NHS vacancies, we are talking about people who have left their work in the NHS because they cannot cope financially or emotionally, we are talking about the rest of the workforce working harder to pick up the slack, we are talking about the NHS being unable to recruit because of poor wages and conditions, and we are talking about the impact that that has on patients.

The only way to solve the NHS staffing crisis is by sorting out pay. The Government agreed yesterday to negotiate with the Royal College of Nursing, and nursing strikes have been paused for those negotiations to happen. The Government could have agreed to negotiations months ago, but they chose not to. Negotiations with the RCN alone will not solve the staffing crisis. Junior doctors have voted by 98% to strike, but the Health Secretary has not even offered a meeting. Negotiations with one section of the NHS workforce are not sufficient; all unions representing NHS staff need to be negotiated with. The Government must make a pay offer that is not linked to efficiency savings and productivity, because NHS staff are already working unacceptably long shifts.

An offer—such as the one we saw on Tuesday—of 3.5%, when inflation is at least triple that and NHS workers’ pay is worth less than it was a decade ago, is, as Sharon Graham of Unite the Union said, a “sick joke”. Christina McAnea of Unison announced further strike days next month. The Government are failing to resolve this dispute; instead, they are attempting to blame workers for putting patients in danger. Patients will never forgive the Conservatives for refusing to negotiate and using patients as bargaining chips.

The staffing crisis must be urgently addressed. The impact of waiting times on individuals can be severe and the consequences irreversible. Two hundred people in my Jarrow constituency have Parkinson’s disease. Parkinson’s UK is concerned about people waiting longer than two years for a diagnosis. Similarly, the MS Society has said that more than 13,000 people have been waiting more than a year for a neurology appointment. Those delayed diagnoses and treatments have a hugely detrimental impact on the individuals concerned.

Delays in cancer diagnosis and treatment are life-threatening. For years, the Government have missed cancer targets because of a lack of concerted action on matched funding. In South Tyneside and Sunderland NHS Foundation Trust, only 73% of people were treated within the target of two months following a cancer referral, and only 61% of people are treated within that target nationally. The UK is being left behind, and people are dying avoidable and preventable deaths. That is why we need a workforce strategy—yes, to pay people properly, but also to enable the NHS to save people’s lives.

Labour has a workforce strategy, while the Government have not even committed to fully funding their promised workforce plan. The Chancellor praised Labour’s plan, so why does he not put his money where his mouth is by implementing it? Labour will deliver a new 10-year plan for the NHS, including one of the biggest ever expansions of its workforce.

[Alex Cunningham (Stockton North) (Lab)]

I congratulate my hon. Friend on securing the debate. This will come as a surprise to her, but I have visited a private health provider in my constituency in the last fortnight. People there told me that they are recruiting staff directly from university, so people are trained at the state’s expense but are then used for private profit. That means that the health service, which cannot afford to pay the same wages, loses out. Does she have any ideas about how that might be sorted out?

[Kate Osborne]

I will address my hon. Friend’s point in my remarks. This Government’s ideological commitment to the free market has led them to force through more and more privatisation of our national health service. Some Government Back Benchers are talking openly about moving to an Americanised healthcare system in which people are priced out of healthcare, and they have even mentioned it in this Chamber. We have seen corrupt contracts for cronies, and friends of the Government making millions while people suffer. The Government have allowed the private sector to run rampant, taking hundreds of billions out of the NHS budget over the last 10 years.

It is as if the Government are on a mission to destroy the NHS as we know it. They have even performed smash-and-grab raids on hospital repair budgets, taking £4.3 billion away and leaving hospitals crumbling, leaking and falling apart at the seams. Fifty per cent. of trusts now have structural issues with leaks, collapsing floors, raw sewage and unsafe wards.

American news agency CNN said last week:

“Britain’s NHS was once idolized. Now its worst-ever crisis is fueling a boom in private health care.”

The number of people paying privately for operations is up 34% in 2022. If that trend continues, it will embed a two-tier service in our NHS and price many people out of healthcare. My constituent Christine was referred to a private health company by her GP, while another constituent, Ray, was told that he could no longer get a service from the NHS and that he would need to pay privately, at a cost of £50. Ray said to me:

“As I am 74 years old and rely on my state pension it makes it very difficult for me in the current economic climate to pay this amount. Having paid national insurance contributions for 50 years, I don’t understand. Why do I have to pay again?”

I look forward to receiving a response for Ray from the Minister.

Ray is correct, of course. As Nye Bevan said:

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

As with any crisis, companies step in to exploit the situation and make money.

[Florence Eshalomi (Vauxhall) (Lab/Co-op)]

I thank my hon. Friend for making such a powerful speech on a really important issue. A fantastic GP surgery in my constituency, the Waterloo Health Centre, is closing because the landlord is selling to a private developer. Many people who have used that GP service for decades are now worried about where they will register. A number of people across the country are waiting to register with NHS GPs, and waiting lists continue to grow. Does she agree that that is another example of the private sector coming in and making it really difficult for our NHS system?

[Kate Osborne]

Yes. We have all seen for ourselves and heard from our constituents how difficult it is to get an appointment, and the private profiteers are driving that.

[Richard Burgon (Leeds East) (Lab)]

I congratulate my hon. Friend on securing this important debate and making such a powerful case. On the subject of privatisation, does she share my concern that, as we have heard in recent speeches in the Chamber by Conservative Back-Bench MPs, this is entirely deliberate? They want to manufacture consent among the public for a move to an insurance-based, American-style system by more and more people feeling forced to take out health insurance or pay for healthcare, so that over a number of years, we see healthcare provision go down the same path as council houses, which went from mass provision to minority provision.

[Kate Osborne]

I agree that if things do not change, that is exactly the route we are going down.

[Rachael Maskell (York Central) (Lab/Co-op)]

I congratulate my hon. Friend on securing the debate. Does she acknowledge that this has already happened in dentistry, with families taking out dental plans because they cannot access an NHS dentist?

[Kate Osborne]

We are seeing this across the whole NHS, including dentistry, as my hon. Friend rightly says.

As with any crisis, we see companies step in to exploit the situation and make money. US group Cleveland Clinic plans to open its third UK facility in London later this year, adding to the 184-bed hospital and six-floor clinic that it opened in 2021 and 2022 respectively. HCA Healthcare, another American group, which has over 30 facilities in London and Manchester, will be opening a £100 million private hospital in Birmingham later this year. Some 40% of private mental health companies need safety improvement, and we are handing over billions to companies that are failing our constituents.

Too much of what is happening is hidden from Parliament and from the public. Where is the accountability for these private companies? Labour’s plan for the NHS includes working with partners to ensure patient safety and to bring down waiting lists. What it does not include is the rampant corrupt profiteering, with contracts for cronies and profit put above patients, that this Government are presiding over.

In England, we have a 20-year gap in life expectancy between the most and least affluent areas of the country. Less than a year ago, the Government promised to tackle the causes and symptoms of these underlying health inequalities and publish a White Paper on health inequalities. Last month, the Department of Health and Social Care confirmed that no White Paper would be published. I am pleased that today, Labour announced that we will build an NHS fit for the future and cut health inequalities.

The cost of living crisis has pushed over two thirds of UK households into fuel poverty, which will exacerbate health inequalities that were already widened during the pandemic. In September 2022, one in four households with children experienced food insecurity, and in my constituency of Jarrow, 39% of children are living in food poverty. Malnutrition costs the NHS an estimated £19.6 billion each year. Investment in greater support, particularly targeted at the most vulnerable, would lead to returns in reduced NHS demand. As well as a strategy for the NHS, this Government need to start prioritising much more support to get the most vulnerable through the cost of living crisis. I hope Ministers will listen closely to the contributions in the debate and take on board what is needed for a workforce strategy and funding to secure the future of our NHS.

--- Later in debate ---

[Rob Roberts]

I thank the hon. Lady for her intervention. How easy would it have been to go out into the media and say, “We’re asking for a 20% pay increase, by the way” —which is what happened—and then to blame the Government for not coming to the table? When the Government are called to the table on such ludicrous terms—from my point of view; everyone will have their own opinion—why should they engage? Timing is everything; they are now getting around the table and are now doing it. To answer the hon. Lady, she has condemned the Government for not doing it sooner, so I am sure she will now praise the Government for taking the time to do it.

The same strikes have been announced in Wales, but what happened there? Would the hon. Lady also condemn the Welsh Government for not getting around the table and not negotiating in the right way? [Interruption.] It never happens, or it is very rare. It is easy for the Opposition to play the blame game. Where has it got them?

[Kate Osborne]

I fail to see how the hon. Member does not understand that these points are political. For 13 years, a Conservative Government have underfunded the NHS, which has led to over 7 million people on waiting lists and tens of thousands of vacancies. As for the trade unions, yes, the Government are now talking to the RCN, but when are they going talk to Unite, GMB and the other trade unions that represent NHS workers?

[Rob Roberts]

I thank the hon. Lady for her intervention, but I am so exasperated by this. We hear from the Opposition all the time that the NHS was properly funded by Labour in 2010, but as the King’s Fund and many others will tell us, NHS funding has increased in real terms since 2010.

[Kate Osborne]

indicated dissent.

[Rob Roberts]

It has—although if Opposition Members want to argue with the King’s Fund, that is fine. But if NHS funding was okay under Labour and has increased in real terms since then, how is it not okay now? I agree that it is not okay now, but that is because of all the reasons I have already mentioned: we are keeping people alive longer, and sicker, there are more of them, and it is more expensive to diagnose and treat them. They are not political issues.

To draw my remarks to a conclusion, I am not familiar with the machinations of how to go about these things, but it seems perfectly reasonable to have, finally, some kind of royal commission—some kind of massive public engagement exercise—on the future of health services in the United Kingdom. We must tackle it head-on. We must not be afraid to go wherever that debate takes us in search of better outcomes for people. I just wish we would keep in mind that we are here for people. We are here to serve them and give them the best outcomes we possibly can, not to get caught up in form and process, or dogma and ideology. We are trying to make people better. We have to do whatever we can to get to the root causes of the issue, because as my former NHS and now private sector nurse partner tells me all the time—I quote—“You could fix so much if you’d just stop politics getting in the bloody way.”

--- Later in debate ---

[Neil O’Brien]

It will be right across the piece. We have already set out some of our plans for social care, and the full details will hopefully be with the hon. Lady in the not-too-distant future.

The NHS recently published a delivery plan for recovering urgent and emergency care services. It is backed by record investment, including a £1 billion dedicated fund for hospital capacity over 2023-24. We will achieve these improvements by delivering 800 new ambulances and 5,000 more sustainable, fully staffed hospital beds, as well as an ambition to scale up innovative virtual wards, which are already making huge improvements, to support 50,000 people a month in their own home.

The number of ambulance and ambulance support staff is up by 40% since 2010. As well as having those extra staff, we are putting in an extra £50 million in capital funding to upgrade and expand hospitals, including with ambulance hubs and facilities for patients who are about to be discharged. That will free up hospital beds and address handover delays, helping to get those extra ambulances swiftly back on the road.

As well as getting people to hospital, we must further prevent the need for urgent care. That is why we extended vaccinations and are rolling out fall services across the country. We also need to improve the flow through hospitals, as the hon. Member for Leicester West (Liz Kendall) said, by investing in social care. I will say more about that in a moment.

Members know only too well the pressure that the pandemic put on the NHS. The number of people waiting more than 52 weeks for elective care rose from 1,468 in August 2019 to 436,000 in March 2021. In February 2022, the NHS published a delivery plan for tackling the covid-19 backlog, which set out a series of public commitments and initiatives to reduce the backlog. We met our first target by virtually eliminating waits of two years or more by July 2022—that is from a peak of 23,800 at the start of January 2022. To support that elective recovery and to cut backlogs, one of our top five priorities is to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund made available last year. As well as having 4,800 more doctors and 10,900 more nurses than this time just last year, we have 89 new surgical hubs and 92 community diagnostic centres already up and running—the hon. Member for Stockton North (Alex Cunningham) talked about the one in his local area.

As part of this elective recovery, we continue to deliver the huge investment in mental health that was set out in the long-term plan for the NHS, with £2.3 billion extra by next year, supporting an extra 2 million people to get the treatment they need each year. Taken together, that elective funding could deliver the equivalent of about 9 million more checks and procedures, and means that the NHS in England is aiming to deliver about 30% more elective activity by 2024-25 than it was delivering before the pandemic—that is a huge increase. We are aiming to end 18-month waits by April and the NHS is making good progress towards that.

Turning to general practice and primary care, I know that GPs are under huge pressure, and I am incredibly grateful to them and their teams for their hard work. We are investing an extra £1.5 billion to create an additional 50 million general practice appointments a year by 2024. We are doing that by increasing and diversifying the workforce and we are well on our way to hitting that target. In December and indeed January, there were, on average, 1.34 million general practice appointments per working day, excluding the covid vaccinations that GPs are doing. That is about a 10% increase on pre-pandemic levels. GPs are doing more than ever before and a wider range of things than ever before, and they are really working hard.

Since 2019, we have recruited more than 2,000 more doctors into general practice and more than 25,000 additional clinical staff into general practice. So we are well on the way to hitting the 26,000 extra commitment that we made ahead of schedule. They are covering a wide range of extra roles, from pharmacists to physios, mental health specialists and more. So GPs are now effectively leading a diverse team with many different specialist skills. We also had a record-breaking number starting training as GPs last year—it is up from about 2,400 a year to 4,000 a year now. As we committed to do in our plan for patients, we have amended funding rules to bolster general practice teams with new roles. We have increased the clinical services available from community pharmacies already and we are looking at how we can go further. We have introduced new digital tools and improved IT systems, where, again, we are looking to go further.

Of course, we know we need to do more. In the autumn statement, we committed to creating a recovery plan for primary care that addresses the challenges facing general practice. That plan will aim to make it easier for the public to contact their practice and easier for practices to see their patients sooner. That is due to be published in the coming weeks.

[Kate Osborne]

Can the Minister clarify something for me? He talks about the workforce plan. Can he tell us whether it is fully funded and whether it includes social care?

[Neil O’Brien]

It will be about both what is needed over time—some of the time horizons might be longer—and what we are going to do about it.

Let me complete the thought about primary care—

[Kate Osborne]

Will the Minister give way again?

[Neil O’Brien]

I want to make a bit of progress. I am sorry, but I will perhaps come back to the hon. Lady in a bit.

Let me complete the thought on primary care. We will also be saying more about dentistry, which was an issue raised by the hon. Member for Bolton South East. She mentioned some of the reforms that we made. We are trying to make dental practice more attractive. We started reforming the contract and creating more unit of dental activity bands to better reflect the fair cost of NHS work and so incentivise it. We have introduced the minimum UDA value to help where it is particularly low. We are letting dentists deliver 110% of their contracted UDAs to encourage more activity. We have changed the law to make it easier for overseas dentists to do NHS work here, which someone mentioned earlier. Plans are advancing for centres for dental development in Ipswich and places such as Cumbria. But there is much more to do, as the hon. Lady said, and we will be saying more about that soon.

On adult social care, we are taking decisive action, with record investment, making available up to £7.5 billion over the next two years to support adult social care and discharge. That historic funding boost—that record investment in adult social care—will put the system on a much stronger financial footing and help local authorities to address pressures in the sector.

--- Later in debate ---

[Kate Osborne]

I thank everyone who has contributed today. I also thank all NHS staff who are taking industrial action to save our health services. No one takes strike action lightly, especially those who are caring for the most vulnerable in society, but this Government have left them with no choice. I thank the campaigners who are out every week, highlighting the impact that 13 years of Conservative Governments have had on our NHS. Those groups would not be necessary if this Government were funding the NHS properly, but they are necessary.

Across the country, there are groups, including the Save South Tyneside Hospital Campaign in my Jarrow constituency, campaigning to save hospital services and calling for the Government to fund the NHS properly. I also thank the organisations that got in touch ahead of the debate, including Diabetes UK, the British Dental Association, Age UK, the Royal College of General Practitioners, the British Heart Foundation, the Cystic Fibrosis Trust, the Royal College of Ophthalmologists, Keep Our NHS Public, Parkinson’s UK, the MS Society UK, Cancer Research UK, the Royal College of Paediatrics and Child Health, Your NHS Needs You and the trade unions.

Health spending in the UK is 18% below the EU14 average. The UK would have needed to spend £40 billion more a year every year for the past 10 years to keep up. That shows just how far behind we have fallen. The root cause of this crisis is that the Conservatives have failed to provide the NHS with the resources and staff it needs to treat patients on time. Labour will train a new generation of NHS staff, paid for by abolishing the non-dom tax status, so that the NHS has the workforce it desperately needs. As the shadow Minister, my hon. Friend the Member for Leicester West (Liz Kendall), said, why will the Government not commit to doing that, as the Chancellor has suggested?

I thank all who contributed to the debate, which has highlighted a number of urgent requirements of the Government to secure the future of our NHS, including increased funding, the accountability of the private sector, a fully funded workforce strategy and a strategy to deal with health inequalities. I hope that the Minister has listened—I am not sure as he has not made eye contact with many Members—because without immediate action, we will see thousands more avoidable deaths, including the death of our NHS.

Question put and agreed to.

Resolved,

That this House has considered the future of the NHS, its staffing and funding.