Future of the NHS

Margaret Greenwood Excerpts

Tuesday 24th October 2023 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered the future of the NHS.

It is a pleasure to serve with you in the Chair, Mr Pritchard. I am grateful for having been granted this debate, and I thank Members for attending.

The highly respected professor of epidemiology and public health Sir Michael Marmot said earlier this year:

“If you had the hypothesis that the Government was seeking to destroy the national health service—if that were your hypothesis—all the data that we’re seeing are consistent with that hypothesis.”

When asked if we are stumbling or sleepwalking towards a privatised healthcare system, he added:

“I have no special insight into what motivates Ministers, but they are not behaving as if they want to preserve our NHS”.

A few months ago, Professor Philip Banfield, the British Medical Association’s chair of council, said:

“This government has to demonstrate that it is not setting out to destroy the NHS, which it is failing to do at this point in time…It is a very common comment that I hear, from both doctors and patients, that this government is consciously running the NHS down.”

Professor Banfield also commented that the NHS is in a state of “managed decline” because recent Governments have made “a conscious political decision” to deny it adequate resources and not to tackle staff shortages. I think that he is absolutely right.

Legislative change brought in by the Conservative-Liberal Democrat coalition Government in 2012, and by the Conservatives in 2022, fragmented the NHS and increased opportunities for privatisation. The Health and Social Care Act 2012 allowed NHS foundation trusts to, in effect, earn 49% of their income from treating private patients, and the Health and Care Act 2022 allows representatives of private companies to sit on integrated care partnerships and so play a part in preparing the integrated care strategy for an area, influencing where huge sums of public money will be spent.

It is underfunding, however, that is proving to be the Conservatives’ greatest tactic when it comes to undermining the NHS. The report “The Rational Policy-Maker’s Guide to the NHS”, published in July by The 99% Organisation, presents statistics based on research by Appleby and Gainsbury on the average annual change in per capita health spending by UK Governments since 1979, adjusted for population and demographic factors. The stark differences in commitment to the NHS along party lines are clear to see.

Under Labour between 1997 and 2010, there was an average annual increase in per capita health spending of 5.67%. Between 2010 and 2015, the Conservative-Liberal Democrat coalition Government oversaw an average annual reduction of 0.07%. Between 2015 and 2021, under the Conservatives, there was an average annual reduction of 0.03%. This Conservative Government’s committed spend up to 2024 represents an average annual increase of just 2.05%.

Put simply, Labour in government has increased per capita health spending on average significantly more than Conservative Governments. Public satisfaction levels have reflected the success of that approach. Public satisfaction in the NHS was at its highest, at 70%, in 2010, the year Labour left office. In 2022, after over a decade of Conservative government, it fell to a record low of 29%. It is no coincidence that satisfaction plummeted following more than a decade of the Conservatives’ being in power and failing to give the NHS the funding it needs.

“The Rational Policy-Maker’s Guide to the NHS” uses respected international data produced by the Commonwealth Fund in 2014 to show that, among the countries studied, the UK’s has often been the best-ranked healthcare system for effectiveness, equity and efficiency. The report also demonstrates how the UK’s spending on healthcare, which by 2009 had caught up with that of many of our peers, has drifted back far below the average for a developed-world country. For example, we spend less as a percentage of GDP than Canada, Sweden, Belgium and the Netherlands.

Our spending has not kept pace with the combination of inflation, population growth and population ageing. If we continue to underspend, performance will continue to be poor. Nigel Edwards, the chief executive of the Nuffield Trust, points out in the foreword to the report that

“the inability of too many of those in policy-making circles to recognise that underfunding the NHS—quite apart from any moral arguments against it—is not an economically sustainable strategy. Since 2010, the focus has been containing expenditure; the results of this are now very evident”.

The report asserts that

“the fundamental business model of the UK NHS is better than that of any other in a high-income country,”

and it puts forward the view that

“the rational strategy is to recommit to the fundamental model of the NHS, fund it properly and introduce operational improvements over time”.

That makes a great deal of sense.

[Daniel Kawczynski (Shrewsbury and Atcham) (Con)]

The hon. Lady is saying that more money needs to be put into the NHS. It is receiving record investment this year—more than it has in its history. Where does she anticipate that extra money coming from? Does she want to move money from other Departments into the NHS, or to increase taxation, or to increase borrowing?

[Margaret Greenwood]

First, in challenging the hon. Gentleman’s opening remark, I refer him to the point earlier in my speech when I spoke about the Government’s current spending commitment. I also ask him to listen to the rest of my speech, as I will come on to the economy.

It is not the fundamental model of the NHS that is broken; it is the fact that it has been underfunded that has led to us to where we are now. As is clear for all to see, we are at a point of crisis. Waiting lists for routine treatments recently hit a record high of 7.75 million, with more than 9,000 people waiting for more than 18 months. It is truly devastating that last year, more than 120,000 people in England died while on NHS waiting lists for hospital treatment. That is double the number who died in 2017-18. There are over 125,000 staffing vacancies, including more than 43,000 vacancies in nursing and more than 10,000 medical staff vacancies. Many of the staff who are in post are burned out, with not enough colleagues to work alongside them.

The “Fit for the Future” report published by the Royal College of General Practitioners last autumn revealed that the situation in primary care is dire. It found that 42% of GPs in England are either likely or very likely to leave the profession over the next five years. As of August 2023, there were 27,246 fully qualified full-time equivalent GPs in England, 3.1% less than in 2019 and 7.4% less than in 2015. That downward trend simply cannot go on.

Last week, the Care Quality Commission rated almost two thirds of maternity services in England either “inadequate” or “requires improvement” for the safety of care and said:

“The overarching picture is one of a service and staff under huge pressure.”

Cancer Research UK has pointed out that cancer waiting time targets continue to be missed in England, and recent months have seen some of the worst performances on record.

[Ian Lavery (Wansbeck) (Lab)]

With regard to cancer waiting lists, the Rutherford Cancer Centre, a specialist proton beam centre in my constituency, has been lying idle for almost two years, since Rutherford centres across the country went into liquidation. Does my hon. Friend agree that the NHS should take control of the Rutherford centres, and that that in itself would help to reduce waiting lists for cancer treatment?

[Margaret Greenwood]

I am not familiar with the centre that my hon. Friend speaks of, but I do believe that the NHS should control the assets and make sure that the service is there for people when they need it. I would like to hear more about the centre from him at another time.

By deliberately underfunding the NHS, the Conservatives have undermined it as a comprehensive, universal public service. Their desire to privatise the NHS has been evident for a very long time. It is a shocking agenda to essentially destroy our most cherished institution.

This determination to dismantle the NHS, which has been proven to be a world leader in terms of effectiveness, equity and efficiency, is not only immensely damaging to patients and the staff who work in the service, but damaging to the economy. Last year, an estimated 185.6 million working days were lost because of sickness or injury—a record high. Similarly, the Office for Budget Responsibility reported in July that the 15 to 64-year-old economic inactivity rate

“has increased in the UK by 0.5 percentage points”

since the covid pandemic.

[Daniel Kawczynski]

The hon. Lady is being very disparaging about the private sector. Has she ever worked in the private sector?

[Margaret Greenwood]

I have not worked in the health service in the private sector—

[Daniel Kawczynski]

Has she worked in the private sector?

--- Later in debate ---

[Margaret Greenwood]

I did write a book once, and the publisher was a private organisation. I am not disparaging the private sector. The point I am making is that the national health service is a public service.

[Daniel Kawczynski]

She has never worked in the private sector—

[Daniel Kawczynski]

The question is simple: has she ever worked in the private sector?

[Margaret Greenwood]

The answer, clearly, is yes, I have. What I am talking about is the national health service, which was set up as a public service—publicly run and publicly owned. That is what we are talking about here today. I am going to make more progress. [Interruption.] If the Minister wants to intervene, he can.

[Mark Pritchard (in the Chair)]

Order. Let me say something for the orderliness of the debate. Understandably, emotions run high around NHS issues, but there is a convention and there are protocols. If people want to make contributions they can make interventions or speeches, but Members may intervene only if the hon. Lady wants to take their intervention. I just caution everybody that I will not have any unruliness in this debate. The debate has been tabled and the hon. Lady’s constituents have a right to be heard.

[Margaret Greenwood]

Thank you, Mr Pritchard.

I was talking about ill health being a big factor behind inactivity in the labour market, and I will repeat a point. The Office for Budget Responsibility reported in July that the economic inactivity rate for 15 to 64-year-olds has increased in the UK by 0.5 percentage points since the covid pandemic, and ill health has consistently been a bigger factor behind inactivity in the UK than in most other advanced economies. The Government must understand that a Government that fails the NHS fails the wider economy.

As well as focusing on the importance of investing in the NHS for the good of the economy, the Government must focus on tackling poverty and inequality, not only as a matter of social justice but because we know that poverty is a key cause of ill health. As the King’s Fund has noted, poverty

“drives inequality in health outcomes and increases use of health services.”

In its recent research on the state of child poverty, the charity Buttle UK said that it had received some of the most distressing accounts of children in need that it had ever seen. Buttle was keen to stress that it was

“talking not just about significant hardship but life-changing and life-limiting deep poverty.”

Today we read that the Joseph Rowntree Foundation has found that more than 1 million children in the UK experienced destitution last year, meaning that their families could not afford to feed, clothe or clean them adequately, or keep them warm. This extreme hardship will have a profound impact on the individuals concerned and it will lead to greater demands on the NHS. The King’s Fund points out that

“poverty is...expensive, in direct costs to the state and in lost opportunity and productivity.”

We need to see a virtuous cycle of improvement when it comes to addressing poverty, funding the NHS and supporting economic growth. Sadly, under this Government we are seeing the reverse. Will the Minister take up this issue of the inter-relationship between poverty, NHS provision and the economy with his colleagues in the Department for Work and Pensions and with the Chancellor, and impress on them the importance of significantly increasing funding for the NHS and tackling the deep poverty faced by many people in our constituencies? The Chancellor will have the opportunity with his autumn statement to increase spending in the NHS, and to tackle poverty and inequality, and I ask the Minister to urge him to do that.

The impact of the Government’s squeeze on funding is being felt throughout the NHS. In May, it was reported that integrated care systems will have to make average efficiency savings of almost 6% to meet their financial requirements. According to the Health Service Journal, one integrated care board said of its financial plan for 2023-24:

“We do not have confidence that we can deliver it in full but are committed to trying.”

Sir Julian Hartley, the chief executive of NHS Providers, has described

“the efficiency challenge for 2023-24”

as being

“significantly harder than 2022-23”,

while one ICS director described their system as running out of the non-recurrent savings that made balancing the books last year “vaguely possible”. It is clear that the Government are simply not giving the NHS the necessary funding to meet the needs of patients.

Before I conclude, I want to pay tribute to those who work in the national health service. As I have touched on, many of them are exhausted because of the staffing shortages and many work beyond the end of their shifts because there are not enough staff to take over from them at handover times. They do so because they care deeply about the welfare of their patients.

I will specifically mention clinical support workers in my constituency in Wirral, who are currently on strike over back pay to recognise the years that they have been working above their pay band. I have joined them on the picket line in solidarity and listened to their concerns. They are immensely hard-working people who care deeply about their patients, and they deserve fair back pay that reflects the additional duties that they have been carrying out. I urge their employer, Wirral University Teaching Hospital NHS Foundation Trust, to continue engaging with the union, Unison, and to provide an offer that is acceptable to it and to staff.

What is the future of the NHS? I believe that the NHS faces an existential threat from the Government’s privatisation agenda and underfunding of the service. Patients and staff continue to suffer. There are further potential implications for staff as a result of the 2022 Act, not least the provision to remove professions from statutory regulation. The new NHS payment scheme contains rules for payment mechanisms, one of which is “local payment arrangements”, whereby

“providers and commissioners locally agree an appropriate payment approach.”

There are real concerns that that will impact national pay bargaining and the scope of “Agenda for Change”. Can the Minister give a commitment that the NHS payment scheme has not had and will not have any negative impact on the pay rates of “Agenda for Change”, pensions and other terms and conditions of all eligible NHS staff? Can he also commit to protecting national collective bargaining across the NHS? I appreciate that there is a lot of detail here; I would really like it if the Minister wrote to me on this point.

Without such a commitment, I fear that we could see a race to the bottom in the pay, terms and conditions of NHS staff, and so too an erosion of the quality of healthcare that we as patients receive over time. We need a Labour Government that will, among other things, improve GP access, boost mental health support, train thousands of extra staff every year, provide mental health support in every school and hubs in every community, and reform social care with a national care service. The next Government must also significantly increase health spending each year. History tells us that this works. It works in terms of the equity, efficiency and effectiveness of the NHS, and it works in terms of public satisfaction.

The NHS is arguably our country’s greatest achievement. We know that it is there for us, free at the point of use, if we become ill or have an accident—or at least it should be. Under the Conservatives, the service is being decimated, but there is still time for them to change tack, turn the situation around and give the NHS the funding it needs. Will the Minister impress upon the Secretary of State for Health and Social Care the importance of boosting investment in the NHS so that the needs of patients can be met and the economy can draw on a healthy workforce? Will he also call on the Secretary of State to be ambitious in his dealings with the Chancellor ahead of the autumn statement?

Finally, I want to thank health campaigners across the country who are fighting to save our NHS from privatisation and obliteration. I thank them for all that they do to fight for an NHS that is a comprehensive, universal, publicly owned and publicly run service that is there for all of us when we need it. People believe in the NHS, and I believe it is vital that we save it.

[Several hon. Members rose—]

--- Later in debate ---

[Will Quince]

I hear my hon. Friend’s concern. I have met with him and other Shropshire MPs on this issue and committed to meet with him to discuss it again. We are very keen to resolve the situation.

Before I move on from privatisation, let me gently say to Opposition Members—some of whom raised it and some of whom did not—that patient choice and the ability to use the private sector has been part of the NHS since its formation. It is a fundamental part of the NHS constitution. Let us be clear what those who call for private sector involvement to be entirely removed from the NHS are calling for: they are calling for charities, independent sector providers, GPs, dentists and community pharmacies to be removed. So let us be very careful, and very clear about exactly what we are calling for, because the independent sector plays an important role.

[Margaret Greenwood]

While the Minister is on the subject of privatisation, I would like him to respond to two points. First, the Health and Social Care Act 2012 allowed NHS foundation trusts to earn 49% of their money from private patients. Can he explain how that benefits ordinary patients? Clearly, if half a hospital is given over to private patients, the waiting time doubles. Secondly, representatives of private companies sit on integrated care partnerships, which are responsible for preparing the integrated care strategy for an area. How can it be right that a private company can influence how a huge amount of public money is spent?

[Will Quince]

I thank the hon. Lady for her question. I have already committed to write to her on some of the points relating to the 2012 Act, because she raised a number of questions. On the broader point about whether the independent sector should be part of integrated care boards and partnerships, I think it is helpful if it is, because individual systems need to know the full capacity available to them, and that includes the independent sector, which plays an important role because it is part of the health ecosystem in an area.

[Margaret Greenwood]

rose—

[Will Quince]

I will come back to the hon. Lady, but I am conscious of time.

The second area widely covered today was workforce. I echo the hon. Lady’s thanks to our NHS staff. I want to put on record my personal thanks to all those working in our health and care system: doctors, nurses, allied health professionals, managers, carers—all those who work in our NHS—for their hard work and dedication. We remain deeply grateful to them for all their work during the pandemic, in facing the new challenges of tackling the backlog, and of course the routinely excellent care they provide day in, day out. Our long-term workforce plan embodies the Government’s commitment to NHS sustainability: we are funding more doctors, more nurses and healthcare workers employed on NHS terms and conditions by NHS providers. That is backed by an additional £2.4 billion over the next five years, and at the heart of it is a significant increase in training places.

The third theme I want to focus on is transformation and innovation, which has also been touched on. We are committed to making our NHS more integrated, more strategic and better able to tackle the challenges it faces. The hon. Lady referenced the Health and Care Act 2022 numerous times—I hear her questions and points, and I will write to her on them. We put those issues on a statutory footing. We know that an increasing number of people are living with chronic medical conditions and complex care needs, which is where more integrated services can and will make an enormous difference. We want partners focusing on improving services rather than competing with each other when it is not in the interest of patients. I believe—we believe—that is the right approach because local areas know best, and certainly know far better than Ministers in Whitehall how best to organise themselves and design and deliver the best possible care for patients.

--- Later in debate ---

[Margaret Greenwood]

I thank all Members who have spoken in what has been a worthwhile debate this afternoon. We have heard from speakers across the Benches, and it is clear that the NHS is in crisis. With waiting lists for routine treatment of more than 7 million and more than 125,000 staffing vacancies, it is clear that patients’ needs are not being met. Patients are suffering as a result and existing staff members are being put under incredible pressure.

The fundamental model of the NHS is not broken; we need to see the Government recommit to the service through a significant increase in funding. We must see an end to the privatisation agenda and rebuild the service as comprehensive, universal, publicly owned and publicly run, there for anyone of us should we need it. I want to end by reiterating my thanks to NHS staff for their work and for their commitment to the NHS as a public service.

Question put and agreed to.

Resolved,

That this House has considered the future of the NHS.