Future of the NHS

Liz Kendall Excerpts

Thursday 23rd February 2023 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this important debate. It really is a privilege to speak after so many powerful and passionate contributions.

I want to start by telling the House about my constituent Mo Peberdy and her father, who is 83 years old. He has stage 5 kidney failure, diabetes—which has already led to a serious foot infection and the loss of one toe—and early-onset dementia. He is on a raft of medications and he has carers coming in four times a day.

On the weekend of 10 and 11 December, Mo’s father started to go downhill. By the 15th, he was in crisis. He had hugely swollen testicles and terrible sores all over his groin and backside. He could not eat or drink, let alone sit down, and he had severe diarrhoea, which was green and contained blood.

Mo immediately called the GP. She was told that no one was available and that she needed to ring out of hours. She did. When they called back several hours later, she was told to call 111. Mo called 111. Again, she waited several hours for them to ring back. When someone eventually did, at 6 pm, they said her call had been transferred to 999, so Mo and her father were told they had to wait for an ambulance—and wait, and wait, and wait. It was not until 8 am the next day—14 hours later—that a paramedic finally arrived.

All that evening, night and morning, Mo tells me,

“my dad was screaming in agony, wanting, begging to die… to listen to him in such pain, I will never forget it in all my life… My dad is one case amongst many… Our NHS is broken… We have to change from the top.”

She is right.

Time and again in this debate, we have heard about the crisis in our health and care system after 13 long years of this Conservative Government. More than 7 million people are now waiting for hospital treatment, after Labour ended waiting in the NHS. In the last month alone, 42,700 people waited more than 12 hours in A&E, and people who needed category 2 ambulance responses for suspected heart attacks and strokes waited one hour and 33 minutes on average. The target is 18 minutes.

The Royal College of Emergency Medicine estimates that up to 500 more people are dying every week due to delays in emergency care. I hope that the Minister will say what the Government are doing to investigate that and put it right, because it is a national scandal. The target that patients with suspected cancer should not have to wait longer than two months from GP referral to treatment has not been met since 2015.

As many colleagues have said, the situation in social care is even worse, with 1.5 million older people who need help with the very basics of daily living—getting up, washed, dressed and fed—not getting any help at all. Even among those who are in the system, half a million are waiting to have their care needs assessed or reviewed, or for treatment to start. Some 2.5 million unpaid family carers have been forced to give up work because they cannot get the help they need to look after their loved ones. With staff shortages in so many parts of the economy, where on earth is the sense in that? That basic issue—staff shortages—is at the heart of so many of these problems. There are 133,000 vacancies in the NHS and 165,000 in social care; the combined total is the same as the population of Newcastle. What a damning indictment of this Government.

Nobody denies that the covid pandemic and its aftermath have posed huge challenges to the NHS and social care, and I pay tribute to the frontline workers who gave us their all and got us through those dark days, but the reality is that NHS waiting times were at record levels, staff shortages were soaring and social care was stretched to breaking point long before the pandemic struck—something the Government refuse to acknowledge.

This dire situation makes the Government’s refusal to deal properly with the current industrial action in the NHS even more unforgivable.

I am pleased that Ministers are finally talking to the Royal College of Nursing about pay, but why did they not do that before Christmas, when the RCN first told the Government that it would call off the strikes if Ministers just got round the table for meaningful talks on pay? Why are they not also meeting the other unions and the junior doctors? Since the RCN first made its offer, 140,000 operations or hospital appointments have been cancelled as a result of the strikes. Those cancellations could have been prevented if Ministers had done their job and got round the table.

My constituents, and people throughout the country, deserve a Government who get on with the job, and they need a proper plan to get our NHS and care system back on track. That is why I am proud that my right hon. Friend the Leader of the Opposition has announced today that building an NHS fit for the future is one of Labour’s five key missions for government.

[Rob Roberts]

If Labour Members have this plan, have they communicated it to the Welsh Health Minister? Why is this not happening in Wales? With the greatest respect, and I really do not want to score these political points—

[Rob Roberts]

It is not a political matter! These issues affect the entire United Kingdom. Does the hon. Lady agree that that is the case? Does she agree that these matters are just the same in Wales as they are here, and that we need much wider reform?

[Liz Kendall]

May I gently say to the hon. Gentleman that I know what is best for his constituents and the people of Wales, which is a Labour Government in Westminster as well as a Labour Government in Wales delivering the changes that we are seeing? If he looks at Labour’s record when we were in government in Westminster, he will see the improvements that were made. May I also gently suggest that he focus on the lack of a workforce plan and the lack of a proper social care plan from his own Government, rather than trying to make these petty points?

Our plan will reform health and care services to speed up treatment by harnessing life sciences and technology to reduce preventable illness, and by cutting health inequalities. As a first step, we will carry out the biggest expansion of the workforce in the history of the NHS, doubling the number of medical school places, creating 10,000 more nursing and midwifery training places, recruiting 5,000 more health visitors, and doubling the number of district nurses. We will pay for this by scrapping the non-dom tax status, because we believe that people who come to live in the UK should pay their fair share of tax here. We read today in The Times that the NHS itself backs Labour’s plan, so why do the Government not back it?

[Sir Geoffrey Clifton-Brown]

I listened very carefully to what the leader of the hon. Lady’s party said on the “Today” programme this morning. He said that any proposals he would include in his manifesto for the next general election would be properly costed. Has the hon. Lady properly costed the proposals that she has just outlined, and if so, how much will they cost?

[Liz Kendall]

Yes, we have properly costed these proposals, because we—unlike the hon. Gentleman’s party, which announced huge amounts of borrowing without saying anything about where the money would come from under the former Prime Minister’s plans—will only set out our commitments when we can say where we will get the money from. We will get it by cancelling that non-dom tax status, and I urge the hon. Gentleman to encourage the Chancellor to follow that example in his Budget. I hope that when the Minister responds he will put the House and, more importantly, the public out of our misery. and just adopt Labour’s plan. If he does, he will surely have the backing of the Chancellor, who said only a few months ago that he very much hoped that the Government would adopt our proposals,

“on the basis that smart governments always nick the best ideas of their opponents.”

The truth is that Labour is proposing the solutions to the problems that the country faces because the Conservatives cannot be trusted to fix the mess that they have caused. Instead of introducing the long-term reforms that the country needs, they are constantly lurching from crisis to crisis—always reacting, always behind the curve. Every year there is a winter crisis, with more elderly people ending up stuck in hospital because they cannot get the social care and other local services that they need in the community or at home. Every year, people struggle to get the proper mental health support they need, so they end up reaching crisis point, which is worse for them and more expensive for the taxpayer. Every year, people are left hanging on the phone for hours and hours trying to get a GP appointment until there is no choice but for them to end up in A&E. Every year, there is a sticking plaster and never a cure. In contrast, Labour is calling for a 10-year plan of investment and reform to deal with the root causes of the challenges that we face and to build a care system fit for the future.

We will fix the front door to the NHS in primary care, recruiting more doctors to deliver better access to GPs, ensuring that patients can see the doctor they want in the manner they want—whether that is face to face, over the phone or online. We will fix the exit door out of the NHS and into social care, including by delivering a new deal for care workers so that they get the pay, the training and the terms and conditions that they deserve, which will mean that we can deal with the problem of delayed discharges.

We will recruit 8,500 mental health workers to provide faster treatment and also the support in schools that young people need, which will stop them from getting to crisis point, too. We will enshrine the principle of home first. Ultimately, what we need is a fundamental shift in the focus of care out of hospitals, into the community and more towards prevention. The big challenge that we face is an ageing population, with more people living with one, two, three, four or more long-term conditions. We must get that shift towards prevention. We must enable and support people to take more control over their health and care. We must have one team, with one point of contact, because people do not see their needs in the health or care silos. That is what Labour will deliver. When I first became an MP, I remember seeing in my own constituency people with the telemedicine that they needed to manage long-term conditions, such as chronic obstructive pulmonary disease. I remember visiting Totnes where there was a single, joined-up health and care team. I remember the sexual health and other support services from public health teams that Labour put in place, all of which, in my constituency, have disappeared.

I know from my time working for the last Labour Government that we cannot solve all the problems that the Tories have created overnight, but I also know—and Labour’s record in Government proves this—that with vision, determination and a clear plan, which is drawn up with the staff who provide the services and, crucially, with the users and their families, the NHS and our care system can be transformed. We have done it before. We stand ready to do it again, and Members on the Labour Benches will work day and night to deliver it.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

I am grateful to the hon. Member for Jarrow (Kate Osborne) for securing this very important debate. We have had a very large number of interesting and important speeches this afternoon—there are too many to list every single one of them. We had an important contribution from the former Health and Social Care Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock), about the importance of technology and building on the lessons of the vaccination campaign, which we are certainly doing. We had a very interesting intervention from the right hon. Member for Islington North (Jeremy Corbyn) who stressed the importance of housing for health. He is absolutely right about that, which is why we are taking forward the extension of the decent homes standard to the private sector and taking through the Social Housing (Regulation) Bill to fix some of those issues. My hon. Friend the Member for The Cotswolds (Sir Geoffrey Clifton-Brown) talked fascinatingly about the digital revolution in Denmark and the standardisation of new hospital builds there, which is something that we are in fact doing through Health 2.0. We are also looking at the discharge figures in his local area that he mentioned.

The hon. Member for Bolton South East (Yasmin Qureshi) talked about the dental reforms and said that they were only a starting point. I absolutely agree and will come on to that matter in a moment. My hon. Friend the Member for Delyn (Rob Roberts) talked about the challenges facing the NHS in Wales, reminding us that this is a common challenge across the UK. I can reassure my hon. Friend the Member for Christchurch (Sir Christopher Chope) that we are very interested in driving forward apprenticeship and non-degree routes into healthcare. We are extremely enthusiastic about that and I am happy to pursue that conversation with him after this debate.

Before I begin, I wish to pay tribute to our NHS and care workforce. Our staff work tirelessly to provide excellent care for patients, and our country is rightly very proud of them. The covid pandemic tested the NHS like never before, and all the NHS staff rose to meet those tests in extraordinary new ways. As we look to the future, we can take pride in the NHS’s response to covid-19, and take inspiration from the new and innovative ways of working that were born from the most difficult of times.

The NHS has certain foundation stones that we will never change, including being free at the point of use, regardless of income, and comprehensive services provided solely on the basis of need. It will never be for sale to the private sector. Of course we cannot just preserve the NHS; we need to make it fit for the future. The challenges we face are changing, including an ageing population and the backlog created by covid, and the NHS needs to change with them.

Today I will talk about: finance and the workforce; supporting urgent care; cutting backlogs; and improving social care and primary care. Those are some of the issues raised by hon. Members this afternoon.

The spending review provided a record settlement to the Department over this Parliament, increasing core resource spending by £46.9 billion to £180.4 billion in 2024-25, to ensure long-term sustainable funding is available to support the NHS of the future. In addition, the Chancellor’s autumn statement made up to £14 billion extra available for the NHS and adult social care.

According to the King’s Fund, real-terms spending will have increased by about 42% between 2010 and the end of this Parliament. That funding, a record both in real terms and as a share of the economy, will enable us to ensure that the NHS has the long-term resources and workforce it needs, because our NHS would be nothing without our fantastic health and social care workers. That is why we are on track to recruit an extra 50,000 nurses by March 2024, and it is why we have already expanded medical training places by 1,500 a year, or 25%. We now have 35,000 more doctors and 47,000 more nurses working in the NHS than in 2010.

Alongside recruitment, training our existing workforce is hugely important. Ensuring the NHS is a workplace that provides the environment and flexibility to support long-term careers is a key priority, which is why there are now 900 more medical specialty training posts in 2023, including 500 in mental health and cancer treatment, in addition to the 700 additional specialty training posts that we funded in 2022 and the increase in GP training posts from 2,400 a year to a record 4,000 a year.

We are committed to further supporting our NHS staff to develop their skills and to deliver excellence to patients, which is why the Government have committed to publishing a long-term NHS workforce plan this year.

[Liz Kendall]

Will that long-term workforce plan include social care staff?

[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.

--- Later in debate ---

[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.

[Liz Kendall]

The Minister has repeatedly used this £7.5 billion extra for social care figure, but will he confirm that £3.15 billion of that is from the Government’s failure to implement the cap on care costs and postponing the right of self-funders to have their care funded at local authority level, and that £1.75 billion of it is from the social care precept? In other words, this is a tax on ordinary people—it is not coming from the Government as new money.

[Neil O’Brien]

Is that not a revealing comment from the Opposition? The Government do not have any money. All this spending comes from hard-working taxpayers, and the Conservative party wants to keep the burden of tax down. On the hon. Lady’s point about the other pot of spending, we chose to prioritise funding through the frontline. That is our choice and it is one we will defend because we know we urgently need to improve social care—[Interruption.] It is tax, yes. All Government spending comes from tax, that is correct, and the idea that that is in some way a revelation speaks volumes about where the Opposition are.

In December 2021, “People at the Heart of Care: adult social care reform” was published, setting out a 10-year vision for reforming adult social care. We have made good progress over the last year on some of the commitments in that White Paper. We invested £100 million to begin implementing reforms on digitisation and technology, local authority oversight and new data collections and surveys, so that people working in the NHS and adult social care have improved access to the information they need to ensure personalised, high-quality care. The Carer’s Leave Bill, currently going through Parliament, will introduce a new leave entitlement as a day 1 right, available to all employees who are providing care for a dependant with a long-term care need. We will set out our next steps on social care soon.

We are committed to supporting our NHS by putting in place the investment and reform to secure its future and we will bring forward a workforce plan later in the year. We are building back better from the pandemic.