NHS Winter Crisis

Lilian Greenwood Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Speaker]

It is better than the alternative.

[Lilian Greenwood (Nottingham South) (Lab)]

Nottingham University Hospitals NHS Trust and the East Midlands Ambulance Service have both declared the highest level of alert in recent days. Despite the heroic efforts of NHS staff, emergency patients’ care, safety and dignity have been put at risk, and of course other patients have had their operations cancelled. Does this not confirm that the Government’s preparations and resourcing were too little and too late?

[Mr Dunne]

As I have tried to explain to the House, the preparations began earlier, have involved more alternative measures than ever before and have been accompanied by considerable resource allocations right across the country, including, I think, £3.4 million to the hon. Lady’s area.

Hormone Pregnancy Tests

Lilian Greenwood Excerpts

Thursday 14th December 2017 Commons Chamber

[Bill Grant (Ayr, Carrick and Cumnock) (Con)]

I thank my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) for securing this extremely important debate. Many constituents in Ayr, Carrick and Cumnock, and throughout the UK, will have been disappointed by the recently published outcome of the review by the Commission on Human Medicines expert working group, but I have one constituent in particular who is devastated by it. It was concluded that the scientific evidence did not support a causal association between the use of hormone pregnancy tests such as Primodos in the mid to late part of the last century—roughly from 1953 to the late 1970s—and miscarriages or horrendous birth defects ranging from brain damage and heart abnormalities to transposed internal organs.

Of particular concern to my constituent is the apparent non-availability of her general practitioner records for the relevant period, when she was prescribed—a better word might simply be “given”—Primodos as part of a pregnancy test. It appears that others find themselves in a similar position.

[Lilian Greenwood (Nottingham South) (Lab)]

My constituent, Peggy Gedling, finds herself in precisely that situation. In 1969, when she gave birth to her son Justin, she attended a medical practice in Crawley. Many of the GP notes were handwritten, and they appear to have been lost. Her previous practice in Gloucestershire tried to obtain her medical records and found that she had ceased to exist for 12 years. It is very worrying, is it not?

[Bill Grant]

I thank the hon. Lady for that intervention, which corroborates my constituent’s concerns. This may be a common thread throughout the United Kingdom. As I understand it, general practitioners’ records are normally required to be retained for the duration of a patient’s life. In the case that the hon. Lady describes, if it had been possible to recover the GP records, it might have been interesting to establish whether there was a cluster pattern for such cases.

My constituent advises me that in June 1975, only months after she was prescribed or supplied with Primodos in the January, a warning was added to the packaging, stating that the drug should not be given to pregnant women. My constituent perceives that to be a response to a realisation that a risk had been identified, at least by that point. Her child was born in August 1975 with serious birth defects, which required major surgery. That child, in adulthood, still has to contend with the associated medical complications. Credit to both mother and child, however—despite the trauma and hardship that they have endured, they contribute positively to society and champion the care of others.

One has to ask, if Primodos is not linked to birth deformities in children whose mothers took the drug, what is the common denominator for the tragic outcomes of those pregnancies? It has, as I understand it, sadly been mooted that such women should consider genetic tests to identify other potential causes. In other words, the suggestion seems to be that all who took Primodos might coincidentally also have a defective gene—I do not think so—and that that defective gene was supposedly passed to their child and formed the root cause of miscarriage or deformity. I very much doubt that, although I might not be qualified to comment.

My constituent does not consider that she has received justice for herself or—more importantly, in her eyes—justice for her child. She feels let down by the outcome and the process followed by the EWG. She had high hopes for that outcome, but it brings us nowhere nearer to the truth or to justice for those who might have fallen foul of a drug that might not have been fit for purpose when it was prescribed, or simply given, to the patients.

For the families involved, I would welcome a broad-based and—as has been said—independent inquiry to review the evidence, of which there is a great deal. The hon. Member for Bolton South East (Yasmin Qureshi) alluded to the fact that the journey has been long, and many pieces of the jigsaw are missing. Those should be secured to enable the independent inquiry to find the truth. There might have been a regulatory failure; we need to find out. Outcomes for the people who were subjected to hormone pregnancy testing between 1953 and 1975 have been devastating. The families deserve both truth and justice, and it is the role of parliamentarians relentlessly to pursue the truth about Primodos and other such drugs.

Maternity Safety Strategy

Lilian Greenwood Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for her extraordinary campaigning on this issue. Yes, we want parents to get the answer more quickly, but we also want to be able to answer the question that every parent asks: “Can you guarantee that this won’t happen again?” The investigators will have an explicit dual remit: to get to the bottom of what happened, but also to spread that message around the system so that the same mistake is not repeated. That is the objective of setting up a new team of people to do this.

[Lilian Greenwood (Nottingham South) (Lab)]

My constituents Jack and Sarah Hawkins have spoken bravely about the tragic death of their daughter Harriet due to failures of care. Members may have heard them this morning. I spoke to Jack earlier and am pleased to tell the Secretary of State that they feel listened to and heard. They and I very much welcome his statement and his support for extending the power of coroners. However, Jack and Sarah need to be able to stop fighting and to begin healing, so I ask the Secretary of State to urge his colleagues at the Ministry of Justice to support the Bill introduced by the hon. Member for East Worthing and Shoreham (Tim Loughton) to bring about that change as soon as possible.

[Mr Hunt]

Through the hon. Lady, I express my thanks to Jack and Sarah for bravely telling their story this morning in the media, which was incredibly moving and touched a lot of hearts. With respect to allowing inquests into full-term stillbirths, our objective is to move as quickly as any legislative vehicle allows. If I am able to work closely with my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) to do that, that is exactly what I want to do.

Baby Loss Awareness Week

Lilian Greenwood Excerpts

Tuesday 10th October 2017 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

I pay tribute to the hon. Members and their constituents who have shared their deeply personal stories. It must be very difficult to talk about the loss of a child. We are indebted to all those who have had the courage to talk about their experiences, both this evening and previously. I remember watching the debate last October and being struck by the speech made by my hon. Friend the Member for Lewisham, Deptford (Vicky Foxcroft), who is in the Chamber tonight. She said then that it was the most difficult speech she had ever had to write or deliver, but it mattered enormously that she did so. Her speech, as well as those of other Members, many of whom are here tonight, demonstrated that Parliament was willing to talk about this most painful issue.

It was a few weeks after that debate that I met my constituents Jack and Sarah Hawkins, whose daughter Harriet was born dead at Nottingham City Hospital on 17 April 2016. Jack and Sarah were convinced that Harriet’s death was the result of a mismanaged labour, but their concerns were not listened to by hospital staff; they were told that a post-mortem had found that Harriet’s death was caused by an infection and

“to try to move on”.

Jack and Sarah are both health professionals, so they knew that there was no evidence of an infection. They were sure that their healthy, full-term baby had died due to mistakes in Sarah’s care, and they were not prepared to be dismissed. The debate in this House helped to give them the confidence to get in touch and seek my advice and support, but it is thanks to their courage and determination that Harriet’s death is finally the subject of a proper external investigation. But the loss of their much-wanted daughter, and the circumstances surrounding it, have had an absolutely devastating effect on every aspect of their lives. Last week, they spoke to the media about Harriet’s death and the failures of care during Sarah’s labour, and many Members may have seen, heard or read their story. I will not attempt to do justice to it now, but others will be able to look it up online if they want. Jack and Sarah are calling for a change in the law to enable coroners to investigate stillbirths and hold inquests into the deaths of babies after 37 weeks’ gestation. That is the particular issue that I want to discuss today.

Under the Coroners and Justice Act 2009, a coroner has a duty to investigate certain deaths, but current legislation means that a stillborn child is not classed as a deceased person, so the coroner cannot investigate even when a healthy full-term baby has died during labour and the parents wish the coroner to do so. I welcome the Minister’s confirmation that the standardised perinatal mortality review tool is being rolled out across the country, but will he also support calls to broaden coroners’ jurisdiction so that they are able, at the request of parents, to investigate a stillbirth? Hospitals’ internal review processes should involve parents and should answer their questions about why their baby has died, but when those questions are not answered, the coroner can play a vital role not just in providing answers—important though that is—but in identifying preventable deaths, and ensuring that lessons are learned and mistakes are not repeated. Such a change to coronial law would bring England and Wales in line with Northern Ireland, where a landmark legal ruling in 2013 held that a coroner

“can carry out an inquest into the death of a stillborn child that had been capable of being born alive.”

It is clear from several contributions this evening that there is cross-party support for such a change. I particularly welcomed the contribution of the right hon. Member for Broxtowe (Anna Soubry). She is not in the Chamber now, but she assured me that the change has her support, for which I am thankful. I hope that the Minister will deal specifically and positively with this suggestion when he responds to the debate.

There is nothing that I can do to take away the pain of Harriet’s death for Jack and Sarah, as much as I wish I could, but I think that they would gain some comfort if their experience helped to prevent other parents from suffering in the same way.

Agenda for Change: NHS Pay Restraint

Lilian Greenwood Excerpts

Monday 30th January 2017 Westminster Hall

[Justin Madders]

I agree entirely. We all know—it is well documented—the financial pressures that the health service is under. It defies belief or explanation that those in senior positions can still fly in the face of that. I can only sympathise profusely with how nurses must feel when they see those headlines.

[Lilian Greenwood (Nottingham South) (Lab)]

Important as nurses are as the backbone of our health service, many other NHS staff are affected by the Agenda for Change pay freeze. Does my hon. Friend share my particular concern for the many staff who work in support services? Given the financial pressure that trusts are under, they have been forced to privatise parts of the service, and support services staff have moved off Agenda for Change terms and conditions altogether, which is what has happened at my local trust. The private sector tries to recruit new members of staff for less than Agenda for Change, because it is implementing the funding cuts that it faces.

[Justin Madders]

My hon. Friend has encapsulated the challenge we always face when a service is privatised. Most often the only way in which the savings promised by the private company can be delivered is by changes to staff terms and conditions. I also agree that the pay freeze affects not only nurses, but the whole of the Agenda for Change workforce. Today we are focusing in particular on some of the effects on nurses, because there are clear reasons why that position is unsustainable.

To return to some of the contributions we have heard today, my right hon. Friend the Member for Leigh described clearly the impact on a ward of having agency staff, and how that creates uncertainty and is not the most efficient way of working. There is also the manifest unfairness of having someone on the same ward, who is only there for that particular shift, earning significantly more than permanent members of staff. How demoralising must that be for those involved? He was right to say in conclusion that we cannot afford to lose the good will of the nursing profession further.

In common with many hon. Members who have spoken today, I pay tribute to everyone who works in the NHS and the health and social care sector, not only to doctors and nurses, but to other allied health professionals such as porters, healthcare assistants, cleaners, receptionists, care workers, paramedics and countless others. It is important to remember that behind every story about the crisis that our NHS has faced this winter are patients waiting too long for treatment, and hard-working public servants doing everything that they can to prevent a very difficult situation from getting worse.

The NHS is the biggest employer in the country—and one of the biggest in the world—and it depends on the tireless efforts of its staff to keep going and meet the challenges of rising demand and insufficient funding. Let us be clear: we cannot indefinitely keep asking them to do more for less. I would argue, as other hon. Members have, that only the good will of NHS workers has stopped the current crisis from turning into a catastrophe. I recently heard the staff who work in our NHS described as “shock absorbers”. That seemed to be a pretty good description of how they are taking and absorbing the relentless pressure and stress of being on the frontline of an underfunded health service. They can take that for only so long before something snaps, which is why it is so important that we fully explore these issues today.

The incredible determination, professionalism and compassion that we see from staff comes against the backdrop of six years of pay restraint. Salary increases for NHS staff have either been frozen or capped at a level far below the rate of inflation. According to Unison, between 2010 and 2016 that represented a cut of more than £4.3 billion from NHS staff salaries, or a loss of between 12% and 19% in actual value since 2010. The Royal College of Nursing believes that since 2011 there has been a real-terms drop in earnings of 14% for its members. With Treasury forecasts indicating that the cost of living will go up by more than 3% every year between 2018 and 2020, it is not difficult to see how the current policy on pay restraint is unsustainable.

The policy is already beginning to have a huge personal impact on some of those affected. Registration fees have gone up by more than a third in two years, and we know well that wages have not kept pace with the cost of living. As we have heard, particularly from my hon. Friend the Member for Newcastle upon Tyne North, staff surveys from the RCN and Unison found that nearly two thirds of staff feel worse off financially than they did a year ago. Forty-nine per cent. had asked for financial support from a family or friend, 13% had used a debt advice service and 11% had used a payday loan company. About a third of nurses are struggling to pay their gas and electricity bills, 53% are working extra hours just to pay their everyday bills and 11% had pawned possessions. The Cavell Nurses’ Trust also found that 20% of nurses had skipped a meal in the last year due to money worries. Those are not abstract figures; they represent real people.

There was a lobby of Parliament today, and I am sure that some hon. Members in the Chamber went to hear at first hand from nurses how they are struggling. I met a nurse from the west midlands who works three days a week because of her caring responsibilities. She told me that she is living below the poverty line. Are we not ashamed that someone caring for our most vulnerable has to live like that? Are we really comfortable with a situation in which the people we are asking to care for our loved ones are having to pawn their possessions in order to make ends meet? In one of the richest countries in the world, can any of us accept the sight of nurses going to food banks?

Nowhere is the problem more acute than in our capital city. The Nursing Times reported that 40% of nurses who currently live in London say that the cost of housing means they will be forced to leave the capital in the next five years. Of course that challenge is not unique to the health service, but vacancy rates in the London area are among the highest in the country, with at least 10,000 nursing vacancies. How long will it be before we reach a tipping point from which there will be no recovery?

The impact is not just on nurses in their daily lives outside work, but on their working environment. NHS staff surveys paint a picture that cannot be ignored. The 2015 survey for England found that 48% of those surveyed stated that a lack of staff was impinging on their ability to do their job, and only 43% felt able to manage all the conflicting demands on their time. The warning signs are there for us all to see.

Analysis of NHS England data by the Health Service Journal found that 96% of NHS hospital trusts in England had fewer nurses covering day shifts in October than they had planned, and 85% did not have the desired numbers working at night. In 2013, the regulator Monitor, now part of NHS Improvement, warned about the potential impact of continuing pay restraint, stating in a report:

“Capping wages for longer to keep costs down would be self-defeating for the sector in the long term as it would make recruiting and retaining good quality professionals increasingly difficult.”

We had that very clear warning four years ago, but we have not heeded it.

The evidence that we have heard today and on previous occasions has proved that that prophecy was correct. The Public Accounts Committee reported that the number of nurses leaving their jobs increased from 6.8% in 2010-11 to 9.2% in 2014-15. Simon Stevens gave evidence to that Committee in 2014, stating that pay restraint would not be an “indefinitely repeatable strategy”, yet that is exactly what the Government propose to do.

Pay restraint, along with a cut to the number of nurse training places in 2010, led to a situation in which the amount of money that the NHS spent on agency staff soared by £800 million in a single year to £3.3 billion in 2014-15. Although considerable steps have been taken to bear down on the figure since then, the situation only developed because of poor and short-term decisions made by the Government, and it remains the case that we still spend far too much public money on agency staff because the NHS has been unable to recruit and retain enough of its own. If we had maintained the levels set by the last Labour Government, we would have had 8,000 more nurses trained during the last Parliament.

Recent figures have revealed that the agency staff cap has been breached almost 2.7 million times in its first nine months of operation. That is a clear example of the impact of the recruitment and retention crisis on all areas of the NHS and how the current workforce balance is completely out of kilter. The use of agency staff is meant to be a temporary measure in times of particular demand and stress for the workforce, not a permanent feature. The fact that these incidences have run into the millions in less than a year should be a huge concern to the Government and a clear warning that the stability and continuity that we all want to see in our workforce is a long way from being achieved. The Government urgently need to address the situation in which hospitals seem unable to provide safe levels of care without relying permanently on agency staff.

The dependency on agency staff has made the case for a pay increase as strong as it has ever been. That is the view not only of the Royal College of Nursing, but of those that look at the impact of skills shortages on the wider economy. In March 2016 the Migration Advisory Committee found that many nurses are moving to agency work or leaving the profession altogether. The fact that the Government have had to put nurses on the skills shortages list should have been the point at which they realised that their pay restraint policy had reached the end of the road. Instead, they have ploughed on regardless, treating the symptoms rather than the cause.

In that regard, the disastrous policy of having tuition fees for student nurses will almost certainly make the position worse, not better. The Royal College of Nursing warned at the time that the policy could act as a disincentive for students from some backgrounds—particularly mature students and those on lower incomes—and early indications are that applications to study are down by at least 20%. If that turns out to be an accurate reflection of the position, the pressure on existing staff can only increase.

[Justin Madders]

I am glad to hear that my hon. Friend is out on the doorstep on a Saturday morning, but sorry that the news she was given is so concerning. It is not, however, a surprise. This is something that just about everyone interested in the matter warned the Government of and, as she says, we will find out in the next month or so what the final figures are. If they are of the order that we are hearing about, the Government will have the opportunity seriously to reconsider the policy. Today, when I attended the lobby, I heard some student nurses saying that they are finding it difficult to get staff mentors, because senior staff are exhausted. They do not blame those staff for that; they understand the intolerable pressure, because they too see it for themselves.

The change to student fees will add an extra penalty on those training from this year onwards, due to the Government’s decision to freeze the student loan repayment threshold at £21,000. That means that all future nurses will face a real-terms pay cut. According to Unison, based on current salaries, the average nurse, midwife or allied health professional will lose more than £900 per year to meeting their debt repayments. In practical terms, for a nurse on band 5, that means a salary cut approaching 5%. It is abundantly clear that that will make staff retention harder, not easier; there is a clear link between pay and retention levels.

Nobody is suggesting for a minute that anyone who goes into nursing is motivated by money, but when someone who has just finished yet another draining shift, going above and beyond the call of duty time and again, finds that they do not have enough cash in the bank to feed themselves and their family, and when each year their wages buy them less and less, they could be forgiven for thinking, “Is it all worth it?” It is morally wrong for the Government to put our nurses in that position, and it makes no sense economically either.

[Lilian Greenwood]

That is precisely the point that one of my constituents, a nurse, made when she wrote to me. She said that she graduated last year and is earning only £21,900, one of the lowest starting salaries among her graduate friends. She says that only months into her dream profession, she feels

“worn down by the strains put on the NHS. I face continued pressures every day. Most 12-hour shifts I don’t get my unpaid break, and I leave late.”

That is on top of knowing that she is not being properly rewarded for the work that she does. Is that not precisely why our nurses are feeling so demoralised?

[Justin Madders]

Yes. It is sad to hear that someone who has only just started out in the profession is being ground down so much already and is feeling so unappreciated. It is a story and a message that we hear repeatedly from our constituents who work in the health service. The Government need to listen carefully to it.

The RCN’s submission to the pay review body not long ago said:

“Having faced a long period of pay restraint, it is inevitable that a large number of staff are now undertaking agency work as a way of restoring the real value of their earnings. Further restraint will only lead to even more damaging impact to the recruitment, retention and motivation of the most valuable asset the NHS has.”

Those comments were echoed by the House of Commons Health Committee in July 2016, which said that

“a long term pay squeeze has unintended consequences for recruitment and retention, which may drive higher costs.”

The independent Nuffield Trust made a similar statement after the 2015 summer Budget. It said that

“curbing public sector pay may make it even harder for the Government to realise some of its totemic pledges, such as seven-day working and reducing reliance on temporary staff.”

All those comments have come before the implications are clear for recruitment and retention of the thousands of staff who come from the EU. If they left tomorrow, it would make the current staffing gaps seem like a golden age.

I conclude with a couple more quotes. The first states that

“as the economy returns to growth, NHS pay will need to stay broadly in line with private sector wages in order to recruit and retain frontline staff.”

That quote is from a document that I am sure is known to us all, the NHS “Five Year Forward View”. Median weekly earnings for full-time employees in the private sector rose by 3.4% in 2016. I referred earlier to the anticipated increases in the cost of living over the next three years, which are bound to put more upward pressure on private sector wages.

The second quote is from a document entitled “The Conservative Party Manifesto 2015”, which I do not generally quote. Page 38 says:

“We will implement the NHS’s own plan to improve health care even further—the Five Year Forward View.”

As the Conservative party manifesto includes a clear commitment to delivering “Five Year Forward View”, and as it is clear that pay restraint needs to end to improve recruitment and retention rates, I must ask exactly what is preventing that from happening. I would be grateful if the Minister, when he responds, could tell us whether he considers the current policy of pay restraint to be consistent with the successful delivery of “Five Year Forward View”.

Labour agree with what has been said, be it by the cross-party Health Committee, the King’s Fund, the Nuffield Trust or the Health Foundation, about the need to end pay restraint. We agree with their crystal-clear message, and that of many hon. Members who have spoken in this debate, that further pay restraint for NHS staff would be self-defeating and unsustainable. We therefore endorse the wording of the petition.

I conclude with another quote from the Migration Advisory Committee, which said:

“The restraint on nurses’ pay instituted by the government was presented to us, and in the evidence to the pay review bodies, as an immutable fact. It is not. It is a choice”.

That is the nub of it: this is a political choice that does not need to continue. The Government have persisted with a damaging policy in pursuit of an objective that they have now abandoned, yet despite all the evidence that that policy is self-defeating and will cost more in the long run, the pay cap remains in place. It is a choice that they have made. It is the wrong choice, and it is time that they accept that they have got it wrong and change course before it is too late.

Mental Health and NHS Performance

Lilian Greenwood Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

Yes, indeed, and I congratulate all the NHS and social care staff in Torbay on doing a fantastic job. I also congratulate them on the pioneering work they have done on health and social care integration, which has made a huge difference to my hon. Friend’s constituents.

[Lilian Greenwood (Nottingham South) (Lab)]

Over the new year, East Midlands Ambulance Service NHS Trust saw life-threatening calls up 42% on last year, and the chair of Nottingham University Hospitals NHS Trust described its emergency department as pushed to the limit, with, as the right hon. Member for Broxtowe (Anna Soubry) said, almost double the normal number of hospital admissions, so clearly these were necessary attendances, but surely many of them could have been prevented. The Secretary of State has already acknowledged the connection between inadequate social care and this entirely foreseeable crisis, so I ask again: will he commit his Government to fund this properly?

[Mr Hunt]

I find these questions about funding curious coming from members of the Labour party, as, had we followed its plans, we would be spending £1.3 billion less on the NHS this year than what the NHS is actually getting, and I just say to them that the reason why we are able to spend that extra money on the NHS is that we know how to run the economy.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Speaker]

It is always useful to have a bit of additional information. We are greatly indebted to the Minister.

[Lilian Greenwood (Nottingham South) (Lab)]

In the east midlands, the average ambulance arrival time for life-threatening cases has almost doubled in the last three years, and Nottingham’s A&E waiting times are the worst in a decade. Will Ministers apologise to my constituents, including hard-working NHS staff, for their failure to fund health and social care adequately?

[Mr Dunne]

I would like to add my tribute to the work of ambulance staff up and down the country, particularly over the busy Christmas period ahead. As I have already said today, we have increased funding for ambulance services. We have increased the number of paramedics, both in training and employed. Earlier this month we announced that we had increased the payments to paramedics to move them from band 5 to band 6, to help to retain and recruit more staff.

CQC: NHS Deaths Review

Lilian Greenwood Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

I am happy to do that. The best way to understand what we are trying to achieve—this relates to what the right hon. Member for North Norfolk (Norman Lamb) said earlier about the speed of investigation—is to think about the tragedy of the recent Croydon tram crash. Within one week of the accident, the rail accident investigation branch produced and published a full investigation into exactly what happened, which made it possible to transmit that learning around the whole tram industry. That is what we are looking for. We have modelled the healthcare safety investigation branch on what happens in the transport industry. It has already been set up, and we are lucky that the person heading it up is Keith Conradi, who headed up the air accident investigation branch and knows exactly how these things should happen.

[Lilian Greenwood (Nottingham South) (Lab)]

The CQC clearly identifies the need for a change in culture, and the Secretary of State acknowledged that a number of times in his remarks today. The NHS has to be less defensive, and it needs to be more honest and open with families if there is to be a genuine commitment to reflect, learn and make sure that things are different in future. What does he think are the barriers to ensuring that that culture change takes place, and what steps does he intend to take to overcome those barriers?

[Mr Hunt]

There are a number of barriers, one of which is time. Staff feel very pressured for time. I strongly argue that it is a false economy not to allow time for lessons to be learned, because tragedies, when they happen, take up a huge amount of time. From a management and leadership point of view, we have to make sure that doctors and nurses are given the time for reflective learning as part of what they do.

Another thing is the management culture. If people feel that the management of their trust are open and listening, they are more likely to be open and listening themselves. If they feel that there is a hire-and-fire culture, they are less likely to take that approach. There are a number of lessons.

Leaving the EU: NHS Funding

Lilian Greenwood Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Umunna]

I completely agree with my hon. Friend. As he said, it was significant that the Treasury Committee came to its conclusion, since it is a cross-party Committee whose members include leavers and remainers.

As my hon. Friend the Member for Walthamstow (Stella Creasy) said, we know that the NHS needs extra cash. The Minister also knows this. As members of the Health Committee pointed out last month, the deficit in NHS trusts and foundation trusts in 2015-16 was more than £3.5 billion.

[Lilian Greenwood (Nottingham South) (Lab)]

My hon. Friend makes a powerful argument for extra NHS funding, but does he share my concern that our NHS could actually be worse off as a result of the decision to leave the EU, given that the reduction in our exchange rate will make it more expensive to purchase products from abroad? Does he also share my concern that, when I asked the Secretary of State for Health how much and what proportion of the total NHS budget was spent on imports, the Department was unaware and therefore unable to give me that information?

[Mr Umunna]

It is outrageous that Ministers were unable to give my hon. Friend those figures. Ministers themselves exacerbated the knock-on impact on the economy of the depreciation of the pound. It depreciated in value by 6% before October, and then by a further 15% because of uncertainty around our trading arrangements that was triggered by comments made by the International Trade Secretary that differed from those of the Chancellor to the Treasury Committee and in other forums. The knock-on effect is not, however, just on household budgets. As the cost of things increases, of course the NHS will take a big hit. Public services in general will be affected if growth reduces and Exchequer receipts fall.

Ministers’ claimed increases in NHS funding, which the Under-Secretary of State for Health, the hon. Member for Warrington South (David Mowat), might mention, are actually being funded by reductions in other areas of health spending that fall outside NHS England’s budget. Reductions in spending on social care are having a serious impact on the NHS, and that is translating into increased accident and emergency attendances, emergency admissions and delays to people leaving hospital. I have talked about what Select Committees, Ministers and Members of Parliament are saying, but we have also heard from third parties. The King’s Fund, the Nuffield Trust and the Health Foundation are clear that current Government spending plans through to 2019-20 will not be enough to maintain standards of care, to meet rising demand from patients and to deliver the transformation in services outlined in the NHS five year forward view.

I and more than 40 Members from different parties, including all my hon. Friends in the Chamber for the debate, have written to the Chancellor asking that when he presents his first autumn statement on 23 November, he sets out how he will put the Government on a path to increasing national NHS spending by that promised £350 million extra a week once we have left the EU. To be clear, that additional funding must be over and above the amount currently planned to be spent on the NHS. The British Medical Association has made the same demand.

--- Later in debate ---

[Mr Umunna]

I shall come on to him shortly.

A further thing that is said—again, I think this has been touched on—is that not all the people who made these pledges were members of the then Conservative Government. Perhaps that could be said of the right hon. Member for Uxbridge and South Ruislip (Boris Johnson). Well, of the five current members of the Cabinet whom I mentioned, three were members of the then Government and one—the right hon. Member for Uxbridge and South Ruislip—attended the political Cabinet at the time. Yes, the Secretary of State for International Trade was sitting on the Back Benches, but countless other Ministers from outside the Cabinet at the time who are now serving more than make up for that—for instance, the hon. Members for Portsmouth North (Penny Mordaunt), for Camborne and Redruth (George Eustice) and for Stockton South (James Wharton). I could go on. Those are just a few of the people who posed by those posters and next to that big red bus, and they must be held to account.

Finally, it is said—this is the crux of the argument advanced by the right hon. Member for Broxtowe—that the commitment was given by one side in a referendum campaign, not by a Government. I am sorry but that simply will not wash. Many of those people were put up to appear in the media and to campaign on Vote Leave’s behalf precisely because they carried the authority that attaches to Government Ministers. That was why they were used. That was why they were asked to stand by that red bus, and to stand by those posters.

All those key Vote Leave campaigners, whether they were Ministers or not, were Members of this House. If our democracy is to mean anything, it must mean that Members are answerable to the electorate for their policies, and held to account in the House for the things that they say. People cannot go around the country casually promising the world and betraying people by failing to deliver, but then expect to get away with it. We will not forget; we will not let up. It was in the name of parliamentary sovereignty that those Ministers campaigned, and it is time that the House, on behalf of the people whom we are elected to represent, took back control, if we want to use that phrase, and made those Ministers answer.

[Lilian Greenwood]

I thank my hon. Friend for giving way again. He is being very generous with his time.

Is this not dangerous and damaging not only to parliamentary democracy, but to the morale of workers in our national health service? I was told by the chair and chief executive of my local NHS trust, Nottingham University Hospitals NHS Trust, that they are frequently stopped by members of staff who ask, “When are we going to get the extra money?” Those people will surely be not just incredibly disappointed but doubly disappointed, given the difficulties that they are facing because the trust has a huge deficit and is struggling to provide the services that they know that patients require.

[Mr Umunna]

My hon. Friend is absolutely right. I am very grateful for all the interventions that Members have made today.

Either those Ministers made this pledge to the people in the expectation of delivering on it, in which case they must now show us the money, or they made it in the sure knowledge that their promise would never be fulfilled, in which case they will never be forgiven for their betrayal of those who, in good faith, relied on them. Perhaps the Minister can tell us which it will be.

NHS Funding

Lilian Greenwood Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is right to point out that problem. For years, under the previous Government, there was a total resistance anywhere in the NHS to ensuring that the only people who received care free at the point of use were people paying for the NHS through the taxes that they or their families pay. That is something to which we will put a stop. There is much more work to be done. We have the second biggest aid budget in the world. That is the way that we help developing countries, but we cannot have an international health service.

[Lilian Greenwood (Nottingham South) (Lab)]

NHS trusts’ deficits are now the worst that they have ever been, with 85% of acute hospitals unable to balance their books. That situation will be made even worse as the falling value of the pound raises the cost of imported medicines and equipment. What assessment has the Secretary of State made of the extra funding needed to protect the NHS from the devaluation of sterling following the Brexit vote? What will he do to support trusts, such as Nottingham University Hospitals NHS Trust, which are already in deficit?

[Mr Hunt]

There are indeed a number of cost pressures in the NHS, but the NHS also has the advantage of being the single largest purchaser of healthcare products—equipment and medicine—in the world, and therefore we have huge scope to get better prices for those things than we currently get. We are supporting hospitals such as the one in the hon. Lady’s constituency by centralising procurement and bearing down on the cost of agency staff and locum staff. Given that pay accounts for more than 70% of the typical hospital trust, that will help.