Future of the NHS

Debate between Margaret Greenwood and Matt Hancock

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.

--- Later in debate ---

[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?

Health and Care Bill

Debate between Margaret Greenwood and Matt Hancock

Report stage
Monday 22nd November 2021 Commons Chamber

[Margaret Greenwood]

I thank my right hon. Friend for putting the case so clearly. She hits the nail absolutely on the head: as a result of the Bill, contracts could be handed out to the private sector without the stringent arrangements that one would expect in the awarding of public money. That is a recipe for the kind of cronyism that has become all too familiar, as she says.

I turn to the cap on care costs. I was proud to stand on a manifesto in 2019 that pledged to

“build a comprehensive National Care Service for England”,

to include

“free personal care, beginning with investments to ensure that older people have their personal care needs met, with the ambition to extend this provision to all working-age adults.”

The Conservative manifesto in 2019 did not go that far, but it at least made the guarantee that

“nobody needing care should be forced to sell their home to pay for it.”

We now know that that was a sham—another broken promise by this Government.

Last week, Ministers sneaked out changes to social care plans that would mean that poorer pensioners will not after all be able to count means-tested payments by the state for their care towards a total cap of £86,000 for any individual. The Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt), described it as “deeply disappointing” that the new plans were “not as progressive” as those put forward by Andrew Dilnot, the economist who drew up the original plans for a cap on individual contributions. Mr Dilnot has said that the Government’s plan is

“a big change that…finds savings exclusively from the less well-off group.”

A former Conservative Cabinet Minister has urged the Government

“to adopt a different approach”,

while another Conservative MP, a former Under-Secretary of State for Health, has said that

“it will be poorer pensioners who have relatively modest assets that will be most affected by these changes.”

I hope that Members on the Government Benches are listening to those points from Government as well as Opposition Members and will do the right thing. Elderly people deserve better. All Members, including Government Members, have a responsibility to vote these measures down.

When the Prime Minister was discharged from hospital in April 2020, having spent seven nights there, of which three were in intensive care, he said that

“the NHS has saved my life, no question.”

Now he and his Government should save the NHS by withdrawing the Bill. The national health service is this country’s greatest social achievement. It is devastating that this Conservative Government are intent on taking it off us.

[Matt Hancock (West Suffolk) (Con)]

I support new clause 49 because I support the action that is needed to make reforms to social care that are long overdue. I have listened carefully to the debate, and it is vital that we understand that the new clause would deliver one part, but not the whole, of the package that was set out by the Government in September. There is no doubt whatever that that package, as a whole, improves the provision of social care, makes the way it is paid for fairer, and removes some injustices that have existed in the system for far too long.

First, the proposal that has been put forward—and I think it is the right proposal—is for a cap on the costs that individuals face in paying for their care. The contributions from the state, even if they are from another part of the state such as local government, are not individuals’ care costs, and it is therefore wrong that they should be contributions towards the cap. The cap has the stated goal of being a cap on the cost of care to an individual, not a cap on the cost that accrues to both the individual and a local authority.

Let us look at what would happen if the new clause were not passed. The provision of care by local authorities is different in different areas, largely according to how well off those local authorities are. A richer council that pays more costs than the statutory minimum as set out in the Care Act 2014 would help local residents to meet the cap sooner than a poorer council that pays only the statutory minimum of care costs, and therefore people who live in poorer areas would take longer to reach the cap, so we would end up, in effect, with a postcode lottery cap meaning that people from poorer areas would tend to have to contribute more. That is wrong, and I am very glad that it is put right by the proposals that are before us today.

Secondly, for those with lower asset values, the rise in the floor in the means test is more important. It is the rise in that floor that makes this system fair. When the shadow Minister, the hon. Member for Ellesmere Port and Neston (Justin Madders), read out a long list of places with low asset values on average—places where house prices tend to be lower—he listed exactly the areas that will benefit most from the rise in the floor. [Interruption.] We can see what Labour Members are doing. [Interruption.] They are taking a narrow area, and they are taking a specific detail, and they are ignoring all the parts of the package that benefit the people who will benefit from this package as a whole. [Interruption.]

Covid-19 Update

Debate between Margaret Greenwood and Matt Hancock

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.

Future of Health and Care

Debate between Margaret Greenwood and Matt Hancock

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.

Coronavirus Vaccine

Debate between Margaret Greenwood and Matt Hancock

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.

Coronavirus Update

Debate between Margaret Greenwood and Matt Hancock

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.