Future of the NHS

Margaret Greenwood Excerpts

Thursday 23rd February 2023 Commons Chamber

[Matt Hancock]

Of course, it is critical that people do not have to use a computer to access a universal service. Many people will never use a computer in their lives, but the fact of the matter is that well over 95% of us use technology every single day. We can get enormous gains through the use of technology, which allow us to give better provision to the tiny minority of people who do not use technology. The point that the hon. Lady makes is absolutely valid, but it is no argument for not using data and digital services effectively. On the contrary, we can make it easier for the very small minority of people who cannot, will not or cannot afford to use digital technology by using data more effectively for the rest of us.

One example that shows this can be done is the vaccination programme, which was built on a high-quality data architecture. People could book their appointment, choosing where and when to get vaccinated—where else in the NHS could they do that? They should be able to do it everywhere in the NHS. Hardly anybody waited more than 10 minutes for their appointment; it was one of the most effective and largest roll-outs of a programme in the history of civilian government in this country, and we started with the data architecture. We brought in the brilliant Doug Gurr, who previously ran Amazon UK, to audit it and make sure that it was being put together in a modern, dynamic, forward-looking way. It was brilliant, so anybody who says that data cannot be used more effectively is fighting against history.

Of course, a tiny minority of people did not use the IT system to get vaccinated. That was absolutely fine, because that high-quality data system meant that everybody else could, leaving resources free for people who either needed to be phoned or needed a home visit in order to get the vaccine.

[Margaret Greenwood (Wirral West) (Lab)]

The right hon. Member is being very generous with his time. We all believe that technology is useful, and we all embrace it—of course we do—but data is a different issue, because in situations where both the NHS and the private sector are providing services, people get understandably nervous about their data being shared.

The issue I wanted to raise with the right hon. Member, which follows on from the point made by my hon. Friend the Member for Vauxhall (Florence Eshalomi), is the percentage of people who do not want to access things through the internet. I had a retired nurse come to see me, saying that she found eConsult—the system for booking a doctor’s appointment—incredibly difficult to use. She was not speaking just for herself; she was worried that many of her friends were no longer going to the doctor because they could not use eConsult. I also remind the right hon. Member that 7 million adults in this country are functionally illiterate, so having a system that is overly reliant on such methods is not going to serve the whole population.

[Matt Hancock]

Of course, if somebody cannot use eConsult, they should be able to phone up or turn up in person, but that does not take away from the fact that there will be more resources to help those people if the existing resources are used effectively, because the vast majority of people use modern technology for so much of their lives. The arguments that we have just heard are arguments for ensuring that there is also provision for the small minority who do not use data and technology, as demonstrated by the vaccine programme, where a tiny minority of people did not use technology but the vast majority did.

We require high-quality privacy for data in many different parts of our lives—for example, financial information. Whether in the public or private sector, privacy is vital, and the General Data Protection Regulation is in place to set out the framework around that. That is an argument not against the use of data, but in favour of the high-quality use of data. Health data, financial data and employment data are all sensitive and personal pieces of information. The argument that we should not use data because of privacy concerns is completely out of date and should go the same way as the fax machine.

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[Matt Hancock]

I hear such stories all the time. We should separate out free at the point of use from not abusing the service. Of course, people miss appointments for good reasons, but too often they do not have a reason. We should be thoughtful about how we address that.

On the point of the right hon. Member for Islington North about the use of the private sector, the NHS has bought things from the private sector throughout its entire life. Who built those fax machines? It was not the NHS. The NHS buys stuff—everything from basic equipment to external services. GP contracts are not employment contracts but contracts with a private organisation. Most of those private organisations are not for profit; nevertheless, they are private organisations and always have been.

The previous Labour Government expanded the use of the private sector, of course, to deliver a free-at-the-point-of-use service. Patients, in large part, do not care whether they get their service from the local Nuffield or the local NHS—it does not matter. What matters is that they get a high-quality service at the right time and as quickly as possible.

I was delighted that the shadow Secretary of State for Health and Social Care, the hon. Member for Ilford North (Wes Streeting), recently set out that Labour’s policy would return from what I regard as a totally impossible, mad, hard-left agenda of saying that we should not have the private sector in the NHS—even though it has always been there and always will be—to the position that Labour held when it was last in office and used the private sector for the delivery of services where that was in the best interest of taxpayers’ money and patient outcomes. That has been done over and over again, and that contracting is important.

To be in favour of the NHS being free at the point of use, and to be against NHS privatisation, does not rule out the NHS delivering services as effectively as possible whether through employing people or using contracts. The nature of the delivery is secondary to the importance of it being free for us all to use, for the reasons that I have set out.

[Margaret Greenwood]

Will the right hon. Member give way?

[Matt Hancock]

I will give way for the final time.

[Margaret Greenwood]

The right hon. Member is being generous. I completely disagree with him about charging people for missing appointments. I remind him that 7 million adults in this country are functionally illiterate and huge numbers of people have dementia, so if a letter comes through the door, they may not understand it. Does he not agree that it would be much better to put resources into understanding why people do not come to appointments?

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. The right hon. Gentleman has been generous in taking interventions, but I am conscious that there are quite a lot of speakers, and if everybody takes nearly half an hour, we will not get everybody in.

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[Margaret Greenwood (Wirral West) (Lab)]

I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this important debate.

The NHS is in crisis. Vacancies last September were at over 133,000, and waiting lists for routine treatments had reached over 7 million. The Government will say that this is because of covid, but that is not the case. Vacancies and waiting lists were already unacceptably high before covid; covid has made what was a terrible situation even worse. These problems, together with the fact that nurses and other dedicated NHS staff are severely overstretched without enough colleagues to work alongside them, are the result of consistent failures by Conservative Governments to plan and provide for safe staffing levels. None of this has happened by accident. It has happened by design, because the Conservatives are intent on undermining the NHS as a comprehensive and universal public service. That has been the case for decades, and it is their drive to put business rather than patients at the heart of the NHS that has led us to where we are now.

The book “NHS for Sale” by Jacky Davis, John Lister and David Wrigley sets out some of the background on what key figures in the Conservative party have thought about the NHS over the years. The book highlights how, in 1998, Oliver Letwin—at the time a future Government Minister—wrote a book called “Privatising the World: A Study of International Privatisation in Theory and Practice”, which talked of increased joint ventures between the NHS and the private sector, ultimately aiming to create a

“national health insurance system separate from the tax system.”

“NHS for Sale” also highlights how, in 2008, the current Chancellor of the Exchequer co-authored a book called “Direct Democracy: An Agenda for a New Model Party”, in which he said:

“Our ambition should be to break down the barriers between private and public provision, in effect denationalising the provision of healthcare in Britain”.

A few years later, in 2011, the then Prime Minister, David Cameron, made a speech in which he said:

“From the Health Secretary, I don’t just want to know about waiting times. I want to know how we drive the NHS to be a fantastic business for Britain.”

It should therefore come as no surprise that Conservative Governments have long been squeezing the supply of NHS provision and driving demand for private healthcare. There is perhaps no better evidence of this than the Health and Social Care Act 2012, which in effect allowed NHS foundation trusts to earn 49% of their income from treating private patients. Before the Bill was amended in the other place during its passage through Parliament, it set no limit on private income, demonstrating that the Conservative and Liberal Democrat coalition Government had initially planned to enable NHS foundation trusts to earn all their income from treating private patients, if they so chose. That is astonishing.

Had the Conservatives and Liberal Democrats been able to go through with their initial plan, the impact on NHS patients could have been catastrophic. In 2011, the majority of NHS foundation trusts had private income caps of between 0.1% and 2%, so for Government legislation to allow 49% really does show a determination and a desire to put business rather than patients at the heart of things in the national health service. It also demonstrates the sheer ruthlessness of the Conservative party’s ambition when it comes to privatising the NHS and undermining it as a comprehensive and universal service.

There have been recent reports that some NHS trusts are promoting expensive private healthcare at their hospitals, offering patients the chance to jump NHS waiting lists. That is a matter of extreme concern and will lead to a two-tier system where people who have the means to pay can get treated more quickly, while NHS patients face longer waits, often in pain and discomfort. That fundamentally undermines the NHS as a compressive and universal service, and is not in the spirit in which the NHS was created. I have called on the Government to put an end to NHS facilities being used to provide services to private patients, and I do so again. I thank colleagues who signed my early-day motion 805 on that.

In recent months, members of the Royal College of Nursing have taken strike action for the very first time in their 106-year history, as they fight for fair pay and improved patient safety. I have been proud to stand with nurses on picket lines. They have told me how stressed and burnt out they are because of staffing shortages. I know that they do not take strike action lightly. Their dedication to their patients is immense. Some have spoken about the stress they feel at shift handover times when there are not enough staff to take over, and how they end up working additional hours without pay to ensure that patients receive care.

That it is only this week, after months of dispute, that the Government agreed to get round the table with the RCN speaks volumes about how little they value the NHS workforce. Earlier this week, Professor Philip Banfield, chair of the British Medical Association council, said that the Prime Minister and Health Secretary were

“standing on the precipice of an historic mistake”

by failing to stop national NHS strikes. I hope that the Government are listening, because this is in their hands. Professor Jeremy Farrar, the director of Wellcome and soon-to-be chief scientist at the World Health Organisation, warned that healthcare workers are “absolutely shattered”, and that

“morale and resilience is very thin.”

The Government need to put things right and come forward with a solution to the disputes that are fair for hard-working nurses, ambulance staff and other dedicated NHS workers. The Conservatives have left the NHS underfunded and under-resourced. They have pushed staff to the brink and left them thinking that their only option to get their message across is to go on strike.

I believe that the NHS is one of this country’s greatest achievements. We know that if we become ill or have an accident, it is therefore us, free at the point of need. We must do all we can to oppose privatisation and fight for the NHS as a comprehensive, universal, publicly owned and publicly run service, free for each and every one of us whenever we need it.