Future of the NHS

Debate between Mark Pritchard and Margaret Greenwood

Tuesday 24th October 2023 Westminster Hall

[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—]