A Plan for the NHS and Social Care

Margaret Greenwood Excerpts

Wednesday 19th May 2021 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab) [V]]

A recovery plan for the NHS and social care is urgently needed. Almost 5 million people in England are waiting for NHS treatment, and a quarter of people with mental health problems are having to wait months to get help. NHS staff are exhausted from battling coronavirus, and there are nearly 90,000 vacancies across the NHS in England. Social care is in crisis following over a decade of savage cuts by the Conservatives, and 1.5 million older people are not receiving the social care support that they need. Care workers, many of them paid below the real living wage, have been working in extremely difficult circumstances.

However, instead of addressing these issues, the Government have come forward with a damaging White Paper that says very little on care but proposes a major reorganisation of the national health service. To do so at a time when staff are exhausted and millions are waiting for treatment is reckless and irresponsible. It is not acceptable that the Government have not carried out a consultation on their White Paper, and Ministers have failed to communicate the impact that the changes would have on patients and staff.

It beggars belief that the Secretary of State said on Monday that his proposed reforms would help to deal with the backlog. Nothing could be further from the truth. Sir David Nicholson, former chief executive of NHS England, has warned that the Government’s impending shake-up of the NHS could prompt a lot of staff already exhausted by covid to quit.

The Government’s damaging plans to put 42 integrated care systems across England on a statutory footing, with each ICS setting its own plan for health and social care, would embed a postcode lottery, with the health and social care services that people could access varying depending on where they live. The plans would open up the opportunity for private companies to have a say in what health and social care services are provided in an area, and the very same private companies could potentially then provide those services, representing an opportunity for huge conflicts of interest. The plans would also give the Government the power to remove a profession from regulation, with potentially serious implications for patient safety and for the employment status and terms and conditions of workers.

Professor Kailash Chand, honorary vice-president of the British Medical Association, said:

“The core thrust of the new reforms is to deprofessionalise and downskill the practice of medicine in this country, so as to make staff more interchangeable, easier to fire, more biddable, and, above all, cheaper.”

The plans would also allow the discharge of vulnerable patients from hospital before they have been assessed for continuing healthcare, leaving patients at risk and families to pick up the pieces. The Government’s plans would create immense uncertainty for NHS staff and open the door to widespread cronyism and increased privatisation.

On Monday, the Secretary of State told me that my party’s Front Benchers welcome the reforms. He is wrong. Labour’s Front Benchers have not welcomed these reforms. He really should get his facts straight. I call on the Government to pause the whole process of their reorganisation of the national health service until after all covid restrictions have been lifted and they have carried out a full public consultation, so that patients, NHS staff, care workers and unpaid carers can have their say on the proposals.

Covid-19 Update

Margaret Greenwood Excerpts

Monday 17th May 2021 Commons Chamber

[Matt Hancock]

We are working on a plan for that with my right hon. Friend the Secretary of State for Digital, Culture, Media and Sport, and of course on the social distancing review that the Prime Minister is leading on. We are committed to making sure that we publish that well in advance of the decision on 14 June as to what the data show about step 4, which is currently planned for 21 June. Of course, we have set out four parameters for taking that step on 21 June, and the first three are currently in good shape. The challenge is the new variant, but it is far too early to be able to say anything about that specifically. We will look at the data up to 14 June and make an announcement on that date.

[Margaret Greenwood (Wirral West) (Lab) [V]]

Covid restrictions are easing, but almost 5 million people are waiting to start NHS treatment, so now is not the time for a major reorganisation of the national health service. However, the Government’s plans for the future of the NHS and social care would embed a postcode lottery, allow for the deregulation of NHS professions and allow the discharge of vulnerable patients from hospital before they have been assessed for continuing healthcare. Public consultation on this has been woefully inadequate, so will the Secretary of State pause the entire process until after all covid restrictions have been lifted, and then carry out a full public consultation so that patients, NHS staff, care workers and unpaid carers can have their say?

[Matt Hancock]

On the contrary, the proposed reforms set out in the White Paper, which have come from the NHS itself, will help to deal with the backlog. They will help to make sure that the NHS is ready for the rest of the 21st century. They have been welcomed by the Health and Social Care Committee, and I am grateful to that Committee for its report last week, which welcomed those reforms while asking for further detail on a couple of other areas, which we will work with the Committee on.

I urge the hon. Lady to speak to her colleagues in the local NHS, and ask them whether they think that collaboration is the way forward; whether we should have greater interoperability; and whether we should have greater integration on the ground, and get rid of a load of the bureaucracy that is currently there in law. If she is not persuaded by her local NHS, by me or by the Select Committee, perhaps she should speak to her own Front Benchers, who also welcomed the reforms.

Social Care Reform

Margaret Greenwood Excerpts

Thursday 18th March 2021 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab) [V]]

It is a pleasure to serve under your chairmanship, Dr Huq.

Social care is in a state of crisis as a result of severe underfunding by Conservative Governments. There is very little detail about social care in the White Paper. The Government say they will bring forward separate proposals later in the year, but under the plans they have put forward, integrated care systems will be given a single budget for the health and social of their area, and an ICS will have the power to increase resources in some places and reduce them in others.

Understandably, people are concerned that they might see a reduction in the NHS or social care offer in their area and that a stark postcode lottery will emerge. What is the sense in creating a system where local NHS and social care providers will be competing with each other for funding at local level? For all the talk of joint working, that is what will happen if this is put on a statutory footing: the system will be robbing Peter to pay Paul, and levels of services and jobs within the NHS and social care will be impacted.

The White Paper states:

“There will be a duty placed on the ICS NHS Body to meet the system financial objectives which require financial balance to be delivered.”

A senior health manager explained to me that the point of having a single budget for a local health and social care system, and the requirement for the system to manage that budget, was to drive efficiencies in the system. He also told me that there needs to be a drive to reduce the number of people in hospital, and the White Paper supports such a drive. The proposals make it easier for hospitals to discharge patients by removing the legal requirement to assess patients for NHS continued healthcare and NHS-funded nursing care before they are discharged from hospital.

What about patient safety? Anyone who has experienced seeing a friend or relative discharged from hospital too early, only to have to be readmitted, knows just how serious this is. What will this arrangement mean for the millions of unpaid carers who will be asked to take over once their family member has been discharged from hospital?

The question of the social care workforce is crucial. Retention is an issue, because carers generally earn a lot less than nurses and other NHS staff. Given the duty of the ICS NHS body to find financial balance within the system, there is a concern that responsible social care employers who look after their staff and pay well will be less likely to be awarded contracts, and that there will be a race to the bottom when it comes to the pay and conditions of care workers. There is concern, too, about the influence that private companies will have on the ICS health and care partnership boards and that providers are being given the power to help to design the very services they want to deliver—representing the opportunity for direct conflicts of interest.

The Government produced their White Paper in the middle of a pandemic, when NHS and care workers are exhausted. They should call a halt to the proposals and carry out a full public consultation once, and only once, covid restrictions are lifted.

[Dr Rupa Huq (in the Chair)]

Now we go to the last man standing: Kevin Hollinrake.

Covid-19

Margaret Greenwood Excerpts

Monday 22nd February 2021 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab) [V]]

Coronavirus has had a profound impact on all our lives. The UK has had the worst death toll in Europe, and there have been more than 120,000 covid-19 related deaths. In Wirral, more than 850 people have lost their lives, leaving thousands of people grieving.

Today, the Prime Minister announced his plan for the easing of lockdown measures in England, and of course we all want life to return to normal as soon as it is safe, but the number of those with covid is still high, and so are infection rates. There is much the Government must learn from their failings. They were too slow to lock down at the start of the pandemic. They failed and continue to fail to make sure that people on low incomes get the financial support they need to isolate, and they also failed to quickly put in place an effective test and trace system.

In a debate last March, the Opposition spelled out the fact that almost 2 million workers on low incomes and 5 million self-employed workers did not qualify for statutory sick pay and that the level of payment was too low. We called on Ministers to address that as a matter of urgency. Now, as then, those who need to isolate must be able to do so without fear of how they will pay the bills. The Government ignored our call, and it took them until September to introduce the £500 Test and Trace support payment, yet the Resolution Foundation has said that seven in eight workers will not qualify for it. Ministers have had nearly a year to get this right. Why are they still getting it wrong?

The Government have failed, too, on test and trace. I wrote to the Minister on numerous occasions calling for local authority public health departments to be given the data they needed. The Government dragged their heels all the way and prioritised giving money to private companies to implement a centralised system. Ministers have been obsessed with outsourcing and spent almost £2 billion of public money on giving crony contracts to their Conservative friends and donors.

The dedication and commitment of NHS and care workers throughout the pandemic have been heroic, yet the Government have chosen this time of immense stress for all of them to publish a White Paper on proposals for major changes in the way health and social care are delivered in England. NHS England ran a consultation over Christmas and new year when health and care workers were either working round the clock or taking a few days’ break. It is wholly unacceptable for the Secretary of State to go ahead with such huge changes while we are in the middle of the biggest public health crisis our NHS has ever faced and while staff are exhausted. So I call on him to pause the whole process until all covid restrictions have been lifted and to carry out a full consultation with the public, setting out clearly what those proposals mean for patients and staff. To do anything less would be an insult to NHS workers, care staff and every single person who believes in and relies on our national health service.

Future of Health and Care

Margaret Greenwood Excerpts

Thursday 11th February 2021 Commons Chamber

[Matt Hancock]

Yes, absolutely. It is important that, while the NHS continues to evolve and must evolve, it is there to serve our constituents. For a reform to take place, it needs to make the argument for why that is better for our constituents. Ultimately, when such a large amount of taxpayers’ money is spent on a public service, it is right that there is accountability to Ministers, and through Ministers to the House, for the services that are provided—that is the essence of a democracy—while preserving clinical independence, for instance, for individual decisions, and for the National Institute for Health and Care Excellence and decisions about appropriate advice on drugs. That is the settlement that the White Paper proposes and that I hope garners widespread support.

[Margaret Greenwood (Wirral West) (Lab) [V]]

Integrated care systems have their roots in accountable care organisations, such as those used in America, in which individuals take out private health insurance. It is therefore hardly surprising that there is a great deal of concern about the introduction of integrated care systems here. Will the Secretary of State give a cast-iron guarantee that he will legislate to ensure that NHS patient data cannot be used to promote or sell private health insurance or services to patients?

[Matt Hancock]

I do not understand the logic of the hon. Lady’s question. I have not seen the sorts of concerns that she raises about integrated care systems, which, in the UK, have provided the joined-up care that people have been looking for for so long. I am happy to look at the details she raises on the provision of data, but the White Paper is about NHS provision, not the provision of healthcare through insurance, other than the national insurance that we come together as a society to pay in order to provide healthcare free at the point of use. That is a belief that I hold dear and is shared by the vast majority in the House and the country. I am happy to reaffirm that and reassure the hon. Lady.

Public Health

Margaret Greenwood Excerpts

Wednesday 6th January 2021 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab) [V]]

The recent sharp rise in covid-19 cases across the UK makes it imperative that we have a national lockdown. One in 50 people in England has the virus. In Wirral, there were 606 cases per 100,000 in the week to 1 January—well above the rate in the average area in England, which had 481. Sadly, nearly 600 coronavirus-related deaths have been registered in Wirral since the start of the pandemic. My thoughts are with the families and friends of those people at this very sad time.

We all have to do everything we can to halt the spread of the virus, to save lives and to protect the NHS. As people right across the country play their part by staying at home, the Government must do their job and deliver the vaccine. As part of that, they must make it easier for retired NHS staff to help with the vaccination programme. One retired clinician has written to me to say that he is trying to register as a vaccinator but found the NHS Professionals website unusable. The Government must take immediate action to address that and to make it easier for those with valuable medical expertise to volunteer at this time of national crisis. He also asked whether vaccinators will receive priority for the vaccine as frontline NHS staff. That is something that the Government must do to protect these people and to encourage others to come forward.

With these national restrictions in force, the Government must step up and provide real support to the businesses and workers who will be affected up and down the country. Will the Minister impress on the Chancellor the importance of extending statutory sick pay to all workers, including the self-employed, and raising its level?

In December, Sir Michael Marmot reported:

“England entered the pandemic with its public services in a depleted state and its tax and benefit system regeared to the disadvantage of lower income groups… The levels of social, environmental and economic inequality in society are damaging health and wellbeing.”

Will the Minister take action on the social inequalities that are driving health inequalities, and join me and others on both sides of the House in calling on the Chancellor to stop the £20 a week cut to universal credit?

Last month, the Secretary of State for Health and Social Care stood at the Dispatch Box and assured me that his Government are increasing the public health grant next year, but a junior Minister subsequently told me that local authority spending on the public health grant will merely be maintained, so will the Secretary of State clear up the confusion in his Department, commit clearly to increasing the public health grant and set out how much that increase will be?

We all have a part to play in tackling this virus, and the Government must ensure they deliver on the vaccine, provide businesses and workers with the support they need, invest in public health departments and protect the NHS as a public service.

Coronavirus Vaccine

Margaret Greenwood Excerpts

Wednesday 2nd December 2020 Commons Chamber

[Matt Hancock]

As the Prime Minister said yesterday, we do look at the human geography and how the epidemiology shows the spread of the virus is occurring across the country, especially, but not limited to, the big rural counties. We have to be slightly careful in North Yorkshire. One of the challenged areas is Scarborough, where the case rates are elevated. I appreciate that that is a long way from my hon. Friend’s patch. We do look at it at that granular level and make decisions on that basis, but the decision to put the whole of North Yorkshire into tier 2 was taken looking at each part of North Yorkshire on its merits.

[Margaret Greenwood (Wirral West) (Lab) [V]]

Dr de Gruchy, the president of the Association of Directors of Public Health, has said:

“it is completely incomprehensible that the Government is not increasing the public health grant”

to local authorities next year. She spoke of the importance of

“learning the lessons of how existing health inequalities have driven and exacerbated the impact of COVID-19”,

as well as addressing

“the socio-economic determinants of health”

and giving public health teams the resources they need both to continue the fight against covid-19 and for the longer term. Will the Secretary of State pay heed to that message, and will he call on the Chancellor to give local public health teams the funding they need?

[Matt Hancock]

We are increasing the public health grant next year. Also, the public health grant is but one part of the massive overall investment in public health that we have made this year and will, of course, have to continue to make next year as we get the virus under control.

Local Contact Tracing

Margaret Greenwood Excerpts

Wednesday 14th October 2020 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

A comprehensive and effective track and trace system is essential if we are to tackle this virus. Sadly, the Government have failed to deliver on that. Wirral headteachers have written to me about the damaging delays in receiving test results, which have meant teachers in local schools being absent as they wait to find out whether they have covid-19. One NHS doctor wrote to describe how she, her husband, who is also a doctor, and other family members had multiple phone calls from different people giving them different advice on quarantine periods. Another individual told me how he received a letter dated 3 October that told him he had to self-isolate until 8 September.

In the latest weekly statistics, more than 51,000 people tested positive for covid-19 nationally, but only two thirds of those were transferred to the contact tracing system. Council officers in Wirral tell me that the national system is only reaching 63% of close contacts in Wirral, meaning that 37% are not being provided with timely advice. I have written to the Secretary of State three times since May calling on the Government to share the vital data that Wirral Council public health department needs to aid it in its test and trace measures and outbreak plans.

Instead of putting contact tracing in the hands of councils or local public health teams who know their communities well, the Government have decided to award huge contracts with eye-watering sums of money to private companies to run test and trace. The Government have allowed their obsession with privatising the national health service to overshadow the need to provide a comprehensive and effective system. The public are quite rightly angry about that.

Serco was initially given a contract for £108 million for 14 weeks with the option to extend for a longer period, with a value of up to £410 million in total. However, we need to know how Serco’s performance is being measured and whether it has been subject to deductions for failing to meet standards of delivery. That transparency is denied to us under this Government.

Along with the additional restrictions that have come in for the Liverpool city region this week, the Government have at last confirmed £14 million for the region for a range of activities, which include enhanced contact tracing, but we need clarity from the Government. Will the Minister clarify how that money will be spent, and will she commit to an expansion of our local authority public health teams?

It is time that the Government took a sober look at the landscape in which we find ourselves. They must once and for all hand over control of contact tracing to councils and local public health teams across the country, and that must be backed up with the necessary resources, so that we can defeat the virus and save lives.

Public Health

Margaret Greenwood Excerpts

Wednesday 7th October 2020 Commons Chamber

[Margaret Greenwood (Wirral West) (Lab)]

We all owe a huge debt of gratitude to all those people have been working so hard during the pandemic to keep us safe. We are all very aware of the many sacrifices that people have had to make, not being able to visit loved ones or be with family members.

Last week’s announcement of additional measures for Wirral and the rest of the Liverpool city region was in response to the sharp increase in infection we have seen in Wirral in recent weeks. It is a matter of very real concern, so we all have an important part to play in tackling it. It is also important, though, that the Government recognise that the regulations will have a profound impact on local jobs and the economy. In Wirral West, 500 people work in pubs and bars, 400 work in licensed restaurants and many thousands more across the region work in the sector.

The Government must recognise that the regulations have serious implications for local authorities and city region combined authorities. Last week, the Secretary of State announced £7 million of funding to local authorities in the areas under new measures, which he said was

“to support them with their vital work.”—[Official Report, 1 October 2020; Vol. 681, c. 499.]

However, it appears that that money is to be shared across nine local authorities—something he did not make clear at the time. That money is to be used only for outbreak management; it is not to support any businesses that might be affected.

Public health regulations are important, and I am pleased to say that there is a high level of compliance in Wirral—people really do want to do the right thing—but the Government must match that by playing their part: they must provide financial support for the local economy and keep people in their jobs. The Government must also make sure that we have a test and trace system that is up to the job. If the regulations are to be successful locally, that is essential. Shockingly, we have been waiting for such a system for more than six months now. I have written to the Secretary of State three times in recent months—most recently in September—asking him to fully utilise the expertise and knowledge of local authorities’ public health departments as a means of fixing track and trace. We need a track and trace system that uses the expertise based in our local health teams in local authorities and one that is sensitive to the needs of communities. Instead, what we see from this Government is sheer incompetence.

The report this weekend that 16,000 positive covid-19 tests went missing because the Excel spreadsheet that was being used was 13 years out of date is evidence of yet further catastrophic mismanagement by this Government in what is a massive crisis. IT consultants across the country will have looked on in dismay and disbelief as it emerged that the data was being kept on an Excel spreadsheet at all, let alone one that was 13 years old. How do the Government expect infection rates to come down if vital data is lost and local public health teams are not provided with the information that they need to advise people to isolate? How do the Government expect to be able to assess the effectiveness of these regulations without a high-quality, reliable test and trace system? These are matters of great urgency and I ask the Minister to respond to that urgency today and set out what she will do to ensure that Wirral and the Liverpool city region get the support that they need.

Coronavirus Update

Margaret Greenwood Excerpts

Tuesday 14th July 2020 Commons Chamber

[Matt Hancock]

The need to restrict the spread of the virus while allowing the ancient liberty of a gentleman to go shopping is a difficult balance to strike. We have made the judgment that the best way to strike it is to allow a gentleman to go shopping but require him to wear face mask. Of course, enforcement for the police, but I think enforcement will largely be undertaken by the British people, who have been remarkable in their fortitude, sticking with the rules even while they may be a frustrating imposition.

[Margaret Greenwood (Wirral West) (Lab) [V]]

Wirral Council has led the way in recognising the importance of the work that care workers do by making funding available for providers to pay them the real living wage for this financial year. However, the scheme is not mandatory and not all care homes currently pay it. The Government have taken £7.7 billion out of adult social care budgets since 2010, and the care sector faces real challenges. When will the Government step up and fund social care properly to ensure that all care workers earn at least the real living wage?

[Matt Hancock]

I am incredibly proud to have supported the introduction of the living wage. We brought that in, and it has had a bigger impact on care workers’ salaries than on pay in almost any other sector. The introduction of the living wage is a real testament to the fact that the Government support the lowest paid workers to get the support they need. That is true in social care across the board. The hon. Member says it is not mandatory. It absolutely is mandatory, it is in force, and we are putting the living wage up.