A Plan for the NHS and Social Care

Matt Hancock Excerpts

Wednesday 19th May 2021 Commons Chamber

[The Secretary of State for Health and Social Care (Matt Hancock)]

I start by thanking the right hon. Member for Leicester South (Jonathan Ashworth) for his comradely advice, and I just correct the record because, thanks to his steadfast support for the Government’s action through the pandemic and the very grown-up approach he takes to these exchanges, Her Majesty the Queen was pleased to invite him to join the Privy Council, which we on the Government Benches welcome.

I am grateful to the right hon. Gentleman for describing the bond that has grown between us. It is true that, even while challenging each other from time to time in times of pandemic, sometimes relationships are strengthened in the heat of responding to something so serious. That is absolutely true. I think he is a wonderful man. I know that occasionally he has to criticise, because he has to please his Back Benchers, but I know he does not really mean it.

Throughout these great challenges and these difficult months, we have protected the NHS and protected and supported the amazing people who work in it, and we are determined to give the NHS all it needs as we emerge from this pandemic. The Queen’s Speech underlines that commitment, first, with a total focus on beating covid through our unprecedented vaccination programme, and then through an ambitious programme of support for our whole health and care system to tackle the backlogs caused by the pandemic, which the right hon. Gentleman rightly described, and a health and care Bill to set the NHS fair for the future—a Bill whose ideas and central propositions come from the NHS itself—alongside social care reforms to tackle injustices that have remained for far too long, public health reforms to learn the lessons of the pandemic and to promote the health of the nation, mental health reforms to bring that legislation into the 21st century and digital health reforms to harness all the opportunities that modern technology provides. That is our mission, a mission to ensure that, in support of all this, we also turn our nation into a life sciences superpower.

The last year has proved beyond measure the value of the NHS across Britain, the importance of social care and the strength of feeling that people rightly have for these cherished institutions. Our task in this Parliament is to help them further strengthen and build back better, and that is what this Queen’s Speech will allow us to do.

I turn first to the immediate task of tackling covid. With more than 70% of adults now having had a first dose and almost two fifths already double vaccinated, we have much to celebrate. Vaccination underpins our road map, which means we can now have pints in pubs and hugs in homes. Yet, as I updated the House on Monday, the race between the virus and the vaccine has got a whole lot closer. I can tell the House that 2,967 cases of covid-19 with the B1617.2 variant have now been identified. We are protecting the progress we have made and the progress that everybody has worked so hard to achieve, with the biggest surge in local resources of this pandemic so far. That means surging vaccines and testing. In the last week across Bolton and Blackburn with Darwen, we have given 26,094 jabs, as well as delivering 75,000 extra tests.

But this challenge is not restricted to Bolton and Blackburn. We have used the extensive biosecurity surveillance system that we have built and new techniques to identify the areas we are most concerned about, where we will now surge testing and vaccinations further. We, of course, look at the data on cases, variants and hospitalisations, all of which we publish, but we are now able to use further tools. Mobility data shows how often people travel from one area to another, and we look at that in deciding where the virus is likely to spread. We now analyse waste water in 70% of the country, and we can spot the virus and the variants in the water to identify communities where there is spread.

As a result of all that analysis, I can tell the House that we will now surge testing and vaccinations in Bedford, Burnley, Hounslow, Kirklees, Leicester and North Tyneside, and we are supporting the Scottish Government, who are taking similar action in Glasgow and Moray. In practice, this means that we are putting in place more testing and more testing sites, and we are making more vaccinations available to everyone who is eligible. We are not yet opening up vaccinations to those who are 35 and younger, because across the whole country, the message is crystal clear. This episode shows just how important it is that every single person who is vulnerable to covid-19 gets not just one but two doses, because the vaccine offers the best possible protection against this disease.

Turning to our programme for the future, we must learn from the success of this vaccine roll-out, which shows how we can deliver huge projects with huge flexibility at huge pace. We must apply these lessons to how we tackle the backlog, and I want to set out clearly to the House the sheer scale of the challenge left by the pandemic. I agree very much with the analysis that the right hon. Member for Leicester South set out in respect of the scale of the challenge.

We now have 4.7 million people in England waiting for care and more in Scotland, Wales and Northern Ireland. Before the pandemic, we had succeeded in getting the 12-month waiting list down from 18,700 in 2010 to just 1,600 in the months leading up to the pandemic. Now, 380,000 have waited more than a year for care, but these figures do not yet include the returning demand of those people who have a problem but have not yet come forward during the pandemic, often because they have been trying to reduce the burden on the NHS, but are now rightly regaining the confidence to approach the NHS. So the real waiting list is far larger than those figures, and as people re-present with problems that they might not have wanted to bother the NHS with in the past year, we will see the waiting lists go up.

We know that, during the pandemic, 6.9 million fewer patients were added to the waiting list for diagnosis and treatment. The scale of the pent-up demand that will come forward is unknowable, but to give the House a sense of the scale of the challenge, since the start of the pandemic, the NHS performed 70% fewer electives than in a normal year. Some of those will have been resolved without the need for hospital treatment, and that is fine, but some will return. We do not yet know how many will present themselves and add to the waiting lists, but we do know that the NHS needs to operate at a scale never seen before across the whole United Kingdom to clear the backlog, so we are working hard to support the NHS to accelerate the recovery of services.

[Chris Bryant]

The Secretary of State will know that people with traumatic brain injury might well have been treated because they have been in a car crash or something like that over the last year, but then the ongoing neurorehabilitation simply will not have been made available to them. On top of that, we have a new set of people who have neurocognitive problems because of covid. May I urge him to think of putting a single person in charge of the whole sphere of neurorehabilitation and brain injury, to try to get this back on course?

--- Later in debate ---

[Matt Hancock]

I will absolutely consider that. The hon. Gentleman raises one example of the sort of backlog that has not yet presented itself in many cases to the NHS, and I know that he met the Minister for Health recently to discuss how we can tackle this further.

[James Cartlidge]

The Secretary of State heard the intervention I made on the right hon. Member for Leicester South (Jonathan Ashworth). Is he aware that, in January, Ipswich Hospital was able to more than double the number of intensive care unit beds it had available, from 11 to 25, precisely because it moved cancer patients to the Nuffield hospital in the independent sector? Does that not show the danger of ideologically ruling out the use of the independent sector, which immediately reduces the capacity of the NHS?

[Matt Hancock]

Yes, my hon. Friend is absolutely right. I thought that his exchanges with the right hon. Member for Leicester South were disappointing, because we know that the Opposition spokesman supports the use of the private sector in the NHS, because he was the guy behind the private finance initiative projects of the last Labour Government. Mr PFI there is a huge fan of the use of the private sector in the NHS, but he cannot admit it, because of the people sitting behind him, and the right hon. Member for Ashton-under-Lyne (Angela Rayner) sitting next to him, keeping watch over him from the hard left of the party.

[Jonathan Ashworth]

For goodness’ sake, I was not responsible for a single PFI contract. Actually, I remember that it was for the previous Chancellor of the Exchequer, George Osborne, that the right hon. Member was the chief lickspittle and bag carrier in signing off PFI contracts when he was first appointed to the Treasury. He can go through all the Treasury documents and he can FOI it until the cows come home, and he will find that I was not involved in any PFI contracts when I worked in the Labour Government, but I was responsible for helping invest in the NHS, which brought waiting lists down to their lowest level ever.

[Matt Hancock]

Well, it did not actually, because after 2010 we then had to bring waiting lists down, and we brought them down. The 52-week waits came down to just 1,600 before the pandemic, and it is our task and our mission to make sure that we get them down once again. However, this will take time and it will take all the resources that are possible—yes, extra staff, and that is happening; yes, extra capital investment, and that is happening; and yes, extra diagnostics, and that is happening. We have to use all the capacity of everything that we can—north and south, revenue and capital, public and private. What people care about and what our constituents care about is whether they can get the problem fixed, and last year has demonstrated that without doubt. So on the Government side we will use everything in our power to support the NHS. It is only those on the other side of the House who have the ideological divisions, and that just demonstrates once again that we are the party of the NHS.

In March, we committed £7 billion for further funding for healthcare services, including £1 billion to address backlogs from the pandemic, and that has taken our additional funding for covid-19 to £92 billion. We are also helping the NHS to recover medical training, and today I can confirm to the House an additional £30 million for postgraduate medical training. The formula for beating this backlog is looking closely at the demand as we emerge from the pandemic, putting in the right resources to meet this demand and putting in place an ambitious programme of improvement in the NHS.

That brings me to the third thing I want to talk about, which is how we are going to build back better. The Queen’s Speech outlines improvement in almost every area of healthcare, applying vital lessons that we have learned from the pandemic, including from the successful vaccination programme, when the whole health and care system has worked as one in the face of challenge and adversity. The vaccination programme brought a jigsaw of academics, the private sector, volunteers, the NHS, civil servants and many more, and put this together, revealing a bold picture of what is possible in this country when we pull together. That is the spirit and the energy that will underpin our reforms, and all of them have a common thread, which is to improve the health of the nation, based on the principle that prevention is better than cure.

Turning to our health and care Bill, as outlined in Her Majesty’s most Gracious Speech, one of the lessons of the crisis is the importance of integrated working. We knew this before, but it has come right to the front of mind. For years, people in the NHS at all levels have called for stronger integration within the NHS, and between the NHS and others they work so closely with, such as local authorities. The Bill will allow for a more preventive, population health-based approach to how we spend NHS money, helping people to stay healthy in the first place, and that is at the core of our Bill.

The right hon. Member for Leicester South asked about the new integrated care systems. They will bring together decision making at a local level between the NHS and local authorities to ensure that decisions about local health can be taken as locally as possible. The Bill will tackle much of the bureaucracy that makes it harder to do the right thing and free up the system to innovate and embrace technology as a better platform to support staff and patient care.

Her Majesty also set out our commitment to reform adult social care, and we will bring forward proposals this year to give everyone who needs care the dignity and security they deserve. Throughout the pandemic, we have sought to protect the elderly and the most vulnerable, and this will remain our priority as we look to end the care lottery and ensure that people receive high-quality, joined-up care.

This country understands the importance of the NHS and social care, but I also think that there has never been a greater appreciation of the importance of public health. Never have the public been more engaged, and never have we learned quite so much in such a short space of time. We must capture the lessons of the pandemic on how we do public health in this country and put that together with the innovations of the last decade—in data, genomics, population health, science and research.

One of the lessons that we have had to learn quickly is that health security and health promotion each need a single-minded focus. The people who get up in the morning and think about how we increase healthy life expectancy must be different from the people focused on fighting novel pandemic threats. Each is important and each needs dedicated focus. We have split these functions into two purpose-built organisations so that we are better at both.

The new UK Health Security Agency will have a dedicated focus on responding to the current threats, planning for the next pandemic and scanning the horizon for new threats in good times as well as bad. Of course, pandemics do not respect administrative boundaries. The UKHSA’s role is specifically to promote and protect the security of the United Kingdom as a whole.

Next, the job of our new Office for Health Promotion will be to lead national efforts to improve and level up our health—addressing the causes of ill health, not just the symptoms, such as through our plans to tackle obesity and make healthier choices easier and more accessible, and through supporting our colleagues in primary and community care. General practice, after all, is at the forefront of all population health measures and GPs are the bedrock of the NHS. General practice will be central to our levelling up the health of the nation because we know, and they know, that prevention is better than cure. A greater proportion of our efforts will now be directed at preventing people from becoming patients in the first place.

All of that brings me to mental health reforms. To truly level up health and reduce health inequalities, we must level up every part of our health, including mental health. I am determined to see mental ill health treated on a par with physical ill health, and to ensure that support is in place for those struggling with their mental wellbeing. We have provided record levels of funding for mental health services, especially to meet the additional burdens of the pandemic, but we need a better legislative basis—a mental health Act fit for the 21st century.

We are modernising the Mental Health Act to improve services for the most serious mental illnesses and support people so that they can manage their own mental health. The new Act will tackle the disparities and iniquities of our system and improve how people with learning difficulties and autism are supported. Ultimately, it is going to be there for every single one of us if we need it.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I know that my right hon. Friend shares my passion for legislative reform of the Mental Health Act. We go through this process every 20 years or so. I was wondering whether he could unpack how this will go forward, bearing in mind the need to get the law right while delivering it very quickly so that patients get the benefits.

[Matt Hancock]

My hon. Friend has enormous expertise and wisdom in this area. He is right to make the argument that we need to support everybody’s mental wellbeing, but that we also need a specific focus on very serious mental ill health, much of which has been, in many cases, exacerbated by the privations that have been necessary during the pandemic. He says that this is a process that happens once every 20 years, but it is almost 40 years since we had a new mental health Act. We want to do this with stakeholders on a consensual basis—I am very glad to hear the reiteration of cross-party support just now from the right hon. Member for Leicester South. Our goal is to bring forward a draft Bill in this Session and a Bill potentially in the next Session, so that we ensure it is legislated for during this Parliament. That is a timetable on which we have worked with the many experts who have informed the process, led by Sir Simon Wessley, of course, whose report sparked off this work. I look forward to working on that with him and the Minister with responsibility for mental health, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries).

[Chris Bryant]

I think the Secretary of State just said that we have not had a mental health Act for 40 years, but I remember sitting on the Public Bill Committee for the Mental Health Act 2007. I know that everybody is against lobbying, but my experience as a member of that Committee was that the lobbyists from the mental health charities, the British Medical Association and the pharmaceutical companies were absolutely invaluable in ensuring that we got the legislation right. Will he make sure that is available again this time?

[Matt Hancock]

Yes, I am absolutely happy to stress that point. This is a consensual process taking into account all the expertise from those who rightly want to influence. The hon. Gentleman almost made a joke about lobbying. The truth is that listening to people who have an expertise and an interest is absolutely critical to getting such a sensitive piece of legislation right. The legislation that this will replace was introduced in the early ’80s, so it is essentially 40 years old. There have been some updates, but there are still some extraordinarily antiquated things in our current mental health legislation. For instance, if someone does not declare then it is automatically assumed, if they are unmarried, that their father should take decisions on their behalf, rather than them choosing who might take those decisions—not their mother and not just one of their parents, but their father. That is just one example of the antiquated practices in this area that we need to address.

Finally, turning to our digital reforms, the pandemic has shown that one of the greatest allies we have in our battle for the nation’s health is data and technology. Digital health has truly come of age over the past year. There is no doubt about it: data saves lives. As we reshape health and social care, we will do it underpinned by a modern data platform, so we can get the most out of this powerful new technology. I am glad, again, that this is an area of cross-party consensus. Telemedicine has taken off. The NHS covid-19 app has been downloaded almost 24 million times and the wider NHS app, on which we can now demonstrate our vaccine status, was downloaded more times on Monday this week than on any previous day. If Members have not downloaded it yet, I recommend that they do. They can see their medical records and show somebody when you had the jab. NHSX committed to delivering the app by the ambitious schedule of 17 May, and it delivered. I am grateful to everybody who worked on this incredibly important project. The lesson of our data-driven vaccine roll-out must be applied everywhere. As citizens, we value the ability to see our data—after all, it is about us and it effectively belongs to us—and we want to see it used to drive better decisions, better research, better treatment and better support for colleagues on the frontline.

My view is that for years the health system has shied away from the modern use of data, and struggled on with paper forms, fax machines and clunky systems that do not talk to each other—but no longer. The pandemic has proved without doubt the incredible value to patients and clinicians alike of the modern use of data. Because of the gift of a universal NHS, we have the opportunity to have the best data-driven healthcare in the world, and I am determined that we seize it. Our health and care Bill and our new data strategy will drive a whole new approach to unleash that potential.

In addition to all those changes, we must, throughout, support all those who improve our health, including those in our life sciences and those who work in the NHS. Last week, I attended with colleagues a service to commemorate the life of Florence Nightingale. In his bidding, the Dean of Westminster reminded us that in Florence Nightingale, compassion and care had the power to deliver not just healing, but change. That must be our mission too: not just to heal, but to change. I am proud to be a member of a Government who deliver on our commitments. We delivered on our commitment to Brexit. We delivered on our commitment to protect the NHS. We are delivering on our commitment to vaccinate all. This Queen’s Speech is a commitment for healing and for change, for a United Kingdom that is stronger, healthier and more prosperous together, and I commend it to the House.

[Madam Deputy Speaker (Dame Eleanor Laing)]

It might be helpful for the House to know that the initial time limit on Back-Bench speeches will be five minutes, and in that cohort of five-minute speeches we have two maiden speeches this afternoon. I can see the hon. Member for Twickenham (Munira Wilson) looking at her notes, and I am sorry to have to say that when we come to her and those after her on the list, the time limit will reduce to three minutes. [Interruption.] She is taking it very well. [Laughter.] Now we go by video link to Dr Philippa Whitford.