National Health Service

Liz Kendall Excerpts

Wednesday 21st January 2015 Commons Chamber

[Chloe Smith]

My hon. Friend makes a wise point.

Tomorrow, I am visiting a walk-in centre and the hospital that serves my constituents. When I am there, I shall be explaining, as I have several times in the House recently, my support for the NHS in Norwich and across Britain, my thanks for what the staff are doing and my understanding of what the patients, my constituents, need from the NHS.

I want to make three points in the debate. My first point is that, as many hon. Members have said this afternoon, the NHS is under unprecedented demand. It does it no disservice to acknowledge that and bring it into the debate. I for one welcome the decisions that allow for increased numbers of doctors and nurses in urgent care—that is true in the Norfolk and Norwich University Hospitals Trust; for an increased number of operations to be carried out each year—that is true everywhere in the country; and for increased hours at GP surgeries. I recently learned to my pleasure that Norwich doctors will apply for the next round of the access fund. They have not done that before and it is very welcome. The Government have made the fund available and it could be of great benefit to patients in my area.

I am also grateful to the Government for the decisions made early—earlier than ever before—that have allowed for winter pressures to be dealt with. Again, that directly benefits the area of Norfolk that contains the Norfolk and Norwich hospital. I am particularly pleased that the use of that funding will be planned jointly with local authorities through the system resilience group. That is incredibly important. I will turn to that kind of joined-up working in my final remarks.

Let me make a point about the motion. We have heard wise contributions from Back Benchers on both sides of the Chamber. For example, my hon. Friend the Member for Stafford (Jeremy Lefroy) rightly asked us not to use the name of his area as a shorthand. He is right that we ought to look much deeper. As a further example, the hon. Member for Wirral South (Alison McGovern) rightly spoke eloquently about mental health. Unfortunately she is not in the Chamber, but I am sure she will be back before the winding-up speeches. I intervened on her to ask why the motion does not refer in its own right to mental health; it is a great shame that it does not. The motion is 10 lines of overblown and fly-blown rhetoric. It asks for an NHS that is “fit for the future”, but makes no mention of mental health being equal to physical health, which I believe strongly. Mental health and physical health should be equal in word and deed, and in budgets. Indeed, I have been discussing that with the Minister recently through parliamentary questions.

The truth is that the motion is rather sad and inadequate. It betrays even the usual standards of political football that are played on Opposition days. The right hon. Member for Leigh (Andy Burnham) said in his opening speech that it is time for honesty. To that end, we would like to know whether his party leader believes in “weaponising” the NHS. To that end, we would like an end to the shabby leaflets on the NHS that go around the country.

I would have liked mental health, which is an important topic, to replace the waste of words in the motion. The motion is a pathetic reuse of the tired and crumbling money-making policy—the mansion tax—that not even all Opposition Members agree with.

[Liz Kendall (Leicester West) (Lab)]

Will the hon. Lady give way?

[Chloe Smith]

Perhaps the hon. Lady will explain whether the mansion tax will be spent once or 20 times over, like Labour’s bonus tax.

[Liz Kendall]

Why is the NHS as a whole not one of the hon. Lady’s Government’s five priorities?

[Chloe Smith]

The hon. Lady will have heard the Secretary of State speak eloquently on the topic of the Government’s priorities. The point I was about to make is that economic competence allows us to run an NHS securely and strongly for the future. It is the Conservative party and this Government who are demonstrating such economic competence, thus allowing the NHS to be a priority for the future.

My final point is much more important than this political to-ing and fro-ing. My hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) made a sensible point about the good that can come from local commissioning and joined-up working. I would add a third point, to make a kind of trinity. The third important thing we all want to see in our local health services is the making of decisions in good time. For example, the walk-in centre in Norwich has recently had to move. As I mentioned, I will be there tomorrow discussing this further with staff and patients. There was no need for the decision to relocate to be made at the last minute. It is a source of great frustration to patients locally that the decision was not confronted earlier on. It was there in black and white in the centre’s rental lease contract, so it was not too hard to spot.

Patients look to health officials—both locally and, where it applies, nationally—to make sensible decisions on time, and for those decisions to be made locally, wherever possible, and in a joined-up way, as my hon. Friend the Member for Blackpool North and Cleveleys rightly said. I would like the walk-in centre to look to its future by assessing its relationship with accident and emergency, GPs, physical health, mental health and all types of provider, including the voluntary sector, which has not been mentioned in the debate so far. I would particularly like decisions about the walk-in centre to be made in good time. There can be no forgiving decisions taken right up to the wire, which fail to deal with the real world as it stands in terms of rental contracts and, most importantly, fail to serve patients best.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a privilege to speak in this debate, which has seen some passionate and thoughtful contributions about the NHS. Many hon. Members spoke about the pressures on their local ambulance services and A and E departments, including the hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Barrow and Furness (John Woodcock), for Penistone and Stocksbridge (Angela Smith), for Heywood and Middleton (Liz McInnes), for Hammersmith (Mr Slaughter) and for Bolton South East (Yasmin Qureshi). The hon. Member for Stafford (Jeremy Lefroy) and my hon. Friends the Members for Jarrow (Mr Hepburn) and for Wirral South (Alison McGovern) spoke about the closure of walk-in centres, and difficulties in getting a GP appointment, which are piling pressure on their local hospitals.

My right hon. Friends the Members for Holborn and St Pancras (Frank Dobson) and for Rother Valley (Kevin Barron) described the terrible impact that this Government’s cuts to social care are having on elderly and disabled people, piling further pressure on the NHS, as Age UK’s excellent report showed yet again today. My hon. Friends the Members for York Central (Sir Hugh Bayley) and for Kingston upon Hull West and Hessle (Alan Johnson) spoke about the problems with child and adolescent mental health services, which have seen their constituents, like mine, sent thousands of miles away from family and friends to get treatment, which is terrible for them, terrible for their families and costs the taxpayer far more.

We have heard time and again during the debate how many of the long, hard fought-for gains achieved under the previous Government are being squandered before our eyes. When we left office, 98% of patients were seen within four hours in hospital A and E departments. Now that is down to 84%, with 180,000 patients having waited for more than four hours in the last month alone. In 2010, 80% of people could get a GP appointment within 48 hours; now one in four waits a week or more or cannot get an appointment at all.

The maximum 18-week wait for treatment has been missed for the last six months. Cancelled operations and delayed discharges from hospital have reached record highs in recent months. The vital cancer waiting target has been missed for the last nine months, meaning that 15,000 people have had to wait more than 62 days to start their cancer treatment. Anyone who has had a family member or friend wait for that treatment to start knows just how frightening that can be.

Ministers repeatedly claim that these problems are nothing to do with them and are simply the result of people living longer. But when our population is ageing, when more people are living with long-term chronic conditions and when the NHS faces the tightest financial settlement of its life, we should not cut the very services that help keep people out of hospital and living at home, which is better for them and better for the taxpayer. We should not remove the very incentives that improved GP access and close a quarter of walk-in centres, so that more people end up in A and E.

We should not slash social care budgets by £3.5 billion, so that half a million fewer of the most vulnerable older and disabled people cannot get help to get up, washed, dressed and fed. Forty per cent. fewer people get home adaptations such as grab rails, which prevent falls, and 220,000 fewer people get meals on wheels. We should not cut 2,000 district and community nurses, who are essential to helping elderly people get back home from hospital, and prevent people with long-term conditions ending up in hospital in the first place. We should not cut training places, so that hospitals are now spending £2.5 billion on more expensive agency staff and hospitals such as mine in Leicester have had to recruit 260 nurses from Spain and Portugal.

Moreover, as my hon. Friend the Member for Dudley North (Ian Austin) and my right hon. Friend the Member for Tottenham (Mr Lammy) so powerfully explained, we should not force through the biggest back-room reorganisation in the history of the NHS, wasting £3 billion, distracting the entire system, making thousands of people redundant only to re-employ them elsewhere in the system, and creating even more layers of bureaucracy, so that no one knows who is responsible or accountable for leading the changes that patients need on the ground.

In case the House needs reminding, I should say that the Government have created not only NHS England, alongside Monitor, the Care Quality Commission and the Trust Development Authority, but regional NHS England teams, local area teams and commissioning support units, as well as clinical commissioning groups and health and wellbeing boards. No wonder there is so little leadership in the system.

Labour Members make no apology for holding this Government to account for their record. After all, their Prime Minister promised people that his top priority in government could be summed up in three letters: NHS. I would hate to see what happened in a service he is not so bothered about.

Labour Members know that people want hope—the hope that there is a proper plan to get the NHS back on track. That is exactly what Labour will deliver. We have set out our plans for immediate action to ease the strain on A and Es by making sure that there are enough GPs in emergency departments and enough clinicians on NHS 111; stopping walk-in centres from closing; getting nurses to return to practice; and making sure that councils, the NHS and voluntary organisations identify the older people who are most at risk of going into hospital so that they get the right support to stay at home.

We have also set out a long-term plan for investment and reform so that our care services are fit for the future. We will provide an extra £2.5 billion on top of this Government’s plans to get the GPs, nurses and home care workers we need to transform services in the community and at home.

[Mr Stewart Jackson (Peterborough) (Con)]

Despite the £40 million structural deficit and a dodgy PFI deal that the right hon. Member for Leigh (Andy Burnham) shackled my local hospital to, in the past four years we have increased the number of nurses by 14% and the number of doctors by 9%. On the subject of apologies, would the hon. Lady like to apologise for her party’s dodgy £63 billion encumbrance of PFI off-balance-sheet deals that have been forced on my constituents and others?

[Mr Speaker]

There is no breach of order; that is a matter of taste and judgment for individual Members.

[Liz Kendall]

I make no apology for my party’s record on the NHS. When we came into government, people were dying on waiting lists for operations. People could not get to see their GPs, and mental health services had suffered. I would have thought that the hon. Gentleman would be pro reforms that help to keep his elderly constituents at home and oppose the cuts to social care that make that so much more difficult.

We have set out our plans to bring together physical, mental and social care across primary and secondary services in a single service to deliver truly personalised care and support, shift the focus to prevention, and get the best value for taxpayers’ money. We are going to help family carers get the health checks and breaks they need to stop them from reaching crisis point, and give them one point of contact with care services so that they do not have to battle all the different services.

We have a radical programme to improve public health, which is the biggest long-term challenge we face, by helping people to do more to help themselves: setting limits on sugar, salt and fat in food marketed to children; improving food labelling to tackle the impending obesity crisis; and taking tough action on tobacco, which this Government have abjectly failed to do. We have a bold national ambition to transform physical activity in our schools, communities and workplaces. That is what we need to put the NHS on a sustainable track in future by making sure that the health of our population improves.

People want a serious Government who face up to the problems in the NHS, not deny they exist or try to sweep them under the carpet. They want a Government who will deliver the real investment and real reforms we need to make sure that our care services are fit for the future. They want competence, not chaos, and a long-term plan that puts the NHS on the real road to a strong recovery. That is what Labour will deliver. I commend this motion to the House.

--- Later in debate ---

[Norman Lamb]

No. I need to make progress, and I have very little time.

In a Guardian debate yesterday, in which I took part, Peter Carter, the respected chief executive of the Royal College of Nursing, spoke of the need for political consensus

“so that we stop this ridiculous points-scoring”,

which

“frankly is destructive and does nothing to enhance the quality of the debate.”

Let us take his plea on board. I have argued for a non-partisan review of NHS and care budgets this year —whoever is in power—which would engage the public. We should all commit to that.

Labour claims that it will increase funding, but its proposed way of doing so appears to be unravelling before our eyes. Lord Mandelson has described the mansion tax as “sort of crude” and “sort of short-termist”. In the debate, the hon. Member for Hackney North and Stoke Newington (Ms Abbott) cast doubt on how much the policy would raise.

Before I address the main issues, I want to pick up the remarks made by the right hon. Member for Kingston upon Hull West and Hessle, who raised important issues about mental health. He talked about the case of his constituent, Beth. It is intolerable that she has been shunted around the country. I have met the right hon. Gentleman, and I am happy to engage with him again. It is unacceptable for this to continue to happen. That is why there is an urgent need for children’s mental health services to be reformed, and our taskforce will soon report on the essential changes that are necessary.

[Liz Kendall]

Will the Minister give way?

[Norman Lamb]

I do not have time.

I am pleased that the right hon. Member for Kingston upon Hull West and Hessle endorsed the case for access and waiting times standards in mental health, which I think will have the same transformative effect as they had in cancer care when his party was in government. As my hon. Friend the Member for Norwich North (Chloe Smith) said, why is mental health not in the motion? It certainly ought to be.

[Liz Kendall]

Will the Minister give way?

[Norman Lamb]

Let me make this point.

I acknowledge that several Members, including the hon. Members for Penistone and Stocksbridge (Angela Smith) and for Barrow and Furness (John Woodcock), raised distressing cases. I offer my personal sympathies to everyone who has been let down by the system. Such cases should motivate us all to strive to do everything that we can to improve how our NHS operates and to address the areas where it falls short.

The Opposition claim that the move from NHS Direct to NHS 111 has increased the demand faced by accident and emergency departments. There is no evidence to support that claim. Only 8% of calls result in a recommendation to go to A and E, and 30% of callers say that they would have gone to A and E if NHS 111 had not been available.

An accusation has been made about the impact of local authority cuts on social care. I remind the Labour party that the Government were faced with a £160 billion black hole in the public finances and had to act to sort that out. There is still no proposal from the Labour party to increase the funding for social care. The claims that it makes are hollow, without the money to go with them.

Let us look at one of the key indicators: delayed discharges from hospital. From August 2010 to November 2014, delayed days attributable solely to social care decreased from 38,324 to 37,000. The position is not as simple as some people suggest. Social care is performing incredibly well under difficult circumstances. In Cambridgeshire, there is the brilliant development of a service for older people to address their needs in innovative ways.

It has been claimed that the closure of walk-in centres has led to the current pressures on A and E. Again, we need to look at the evidence. A report by Monitor found that the reasons why local commissioners decided to close walk-in centres included that they were replacing them with urgent care centres co-located with A and E departments or other models of integrating primary care staff in A and E departments. The situation is not as simple as is suggested by the claim that walk-in centres have been closed and A and E has been left to pick up the burden.

The Opposition have said that the ambulance service is failing. In fact, ambulance services nationally are delivering nearly 2,000 more emergency journeys every day than in 2010. Ambulances respond to the majority of life-threatening cases in less than eight minutes. The Government have provided an additional £50 million to support ambulance services through this winter. It is right to take clinical advice to ensure that target response times are clinically based to avoid the unintended consequences of ambulance crews being driven crazy in the pursuit of targets, when it is patient safety that should be prioritised.

I come to the solution. In the short term, the Government have made an additional £700 million available to the NHS to cope with the pressures this winter. The right hon. Member for Tottenham (Mr Lammy) did at least acknowledge that. In the longer term, we need to focus on stopping the crises from occurring in the first place. We need a much greater focus on prevention, better integration of health and social care, and the implementation of Simon Stevens’s forward view.

I thank NHS staff for the amazing work that they do, often under great pressure, and the tremendous commitment that they make. We owe it to them and to the public to ensure that our NHS is protected and enhanced. Most people who use urgent and emergency care services receive effective, timely treatment. That is as it should be. Patients and their families should get the right advice and should get a response when they need it. We set the toughest standards in the world, and rightly so. We all know that those standards are under pressure across the UK, so let us be open and honest about that.