The National Health Service

Mike Gapes Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Dr Whitford]

That is true, and this obviously applies to the process of bidding and tendering for delivering services. An NHS orthopaedic department will not be able to compete with a major multinational with regards to its bid team, its tendering team and its ability to put in loss leaders. The problem is that all this money is being lost in a circular reorganisation that has been going on in NHS England literally for the last 25-plus years, with people being made redundant and given a big package, but then someone quite similar being re-employed or the same person being re-employed somewhere else with a different title—health authorities to primary care trusts to clinical commissioning groups. It is a huge waste of money, which is being sucked away from patient care, and that is where we want the money actually to go.

[Mike Gapes]

The right hon. Member for Hemel Hempstead (Sir Mike Penning) mentioned the Barking, Havering and Redbridge University Hospitals NHS Trust in Romford. Queen’s Hospital in Romford is part of that trust, as is King George Hospital in my constituency. There is an independent treatment centre on the site of King George Hospital, and several years ago it was proposed that the centre be brought back in-house. But the company involved went to court and the NHS had to concede that it would remain as an independent treatment centre. These things are very damaging to the finances and integrity of our NHS.

[Dr Whitford]

Well, I am afraid that it was the Labour party that set up independent treatment centres. I am a surgeon, and one of the issues was that such centres were sucking away the routine elective work that contributes to training future surgeons, and leaving the NHS to deal with the complex, chronic, expensive cases. Before the Health and Social Care Act, the NHS usually managed to find enough money down the back of the sofa that, at the end of each year, it would have about £500 million left. After the changes, it was £100 million in debt, £800 million in debt, and then £2.5 billion in debt. That is because money is sucked out in all these different ways, leaving a lack of funding that leads to rationing, which is pushing people to have to pay for more of their own care. We are hearing about that with co-payments—paying for a second cataract operation or for a second hearing aid. My Choice, which the Health and Social Care Act also brought in, raised the cap from 2% to 49% of income that an NHS hospital could earn through private patients. The highest amount at the moment is over 27%.

The idea that that does not impact on NHS patients is nonsense, because surgeons have limited capacity in terms of who they can operate on during the day, so if someone is able to jump the queue within the NHS, they are taking someone else’s place. As we saw with Warrington and Halton Hospitals NHS Foundation Trust, price lists have been pinned up in clinics suggesting to people that they might want to pay £7,000 or £8,000 for a hip or knee replacement, and there were also a lot of cosmetic and minor operations. I would gently suggest, as a surgeon, that surgery is not a sport. Either the patient needs an operation clinically, in which case it should be provided by the NHS, or they do not, in which case they should not be able to buy it from the NHS. Under the principle of My Choice, hugely high thresholds are being set. In the case of some CCGs, a person has to have had two falls before they can have a cataract operation, or they have to be in pain, even in bed, to get their hip done. That is driving families to club together to address that. That is not right. If someone needs it, the NHS is meant to provide it free at the point of need, and if they do not, every single operation is a risk and should never be done to attract income for an NHS trust.

--- Later in debate ---

[Luciana Berger]

I thank my right hon. Friend for making that really important contribution, and waiting times are a particular issue in our NHS, especially in the Cinderella of all Cinderella services, our CAMHS. Too many young people right across our country are struggling to get a referral and then, if they do get that referral, having to wait months on end. Frankly, it is unacceptable.

[Mike Gapes]

There is a further problem with teenagers when they reach the age of 18, because there is a gap between the CAMHS and adult services. Far too often, young people who have been given help when they are 16, 17 and 18 suddenly fall off the cliff and there is no support for them.

[Luciana Berger]

I thank my hon. Friend for making that important contribution. There is a cliff edge in our young people’s mental health services when they transition into adult mental health services. They have to start all over again and repeat themselves. There are a few places across the country that are creating mental health services for young people up to the age of 25, and that is welcome, but it is the exception rather than the rule. We need to do everything possible to ensure that young people have continuity of support in their mental health services at that fragile moment in their life, because not receiving that critical support can have a detrimental impact on their ability to access education, to maintain relationships with family and friends and to get into employment.

I am particularly concerned that we have seen a serious reduction in the state of our services in the past year. I refer to the Care Quality Commission’s “State of Care” report, which came out this month. It looked at acute wards for adults of working age, psychiatric intensive care units, child and adolescent mental health in-patient services and in-patient services for people with learning disabilities or autism, and it found a significant increase in the number of those services that are now rated inadequate. Those are services for some of the most vulnerable people in our country, and we should be improving them rather than seeing an increase in inadequate ratings from 2% to 8%, 9% or 10%. That is unacceptable, and I hope the Minister will address that serious point in his response. In particular, we know that this is as a result of too many of the people using mental health and learning disability services being looked after by staff who, according to the CQC,

“lack the skills, training, experience or support from clinical staff to care for people with complex needs.”

Again, I hope the Minister will respond to this important point.

This is not just about care for people with mental illness or disability. We are seeing that same story right across our NHS, with patients waiting far too long. We have heard significant figures, with millions of people across the country struggling to access services. They are also having to travel too far for the treatment they need, and too many areas still have too few staff and not enough resources. That is reflected in the 2019 British social attitudes survey, which shows overall satisfaction in our NHS falling by 3% in the last year to 53%. The main reasons given for that include long waiting times, staff shortages and a lack of funding.

Notwithstanding the announcements in the Queen’s Speech on patient safety and changes to mental health legislation, which I welcome, I want to reinforce the point I made to the Secretary of State that this is not just about changing the Mental Health Act and that we need to have the resources for the capital infrastructure to ensure that we raise the standard of mental health in-patient settings to the same standard as physical health in-patient settings, along the lines of the recommendations given by Sir Simon Wessely, who conducted that important review for the Government.

Let us be clear that the pressures on our NHS are urgent and that they demand action, before we even contemplate the existential threat to our NHS because of Brexit. I want to talk about Brexit, because we did not hear about it today from the Front Benches. We had a reference to it from the Secretary of State, but not an actual analysis of how Brexit will impact on the provision of our national health service. We know that the impact on our economy so far from Brexit has been between 1.5% and 2.5% of GDP since 2016, and by the Government’s own assessment, Brexit will impact on our GDP by up to 9.3% over the next 15 years. We are still waiting for those further economic impact assessments on the withdrawal Bill that we have seen in the past week.

We have already discussed the impact of Brexit on our NHS workforce. We know that 63,000 EU nationals work in our NHS and that 104,000 work in adult social care. We should be lining up to thank each and every one of them for the role they play and the contribution they make to our national health service, instead of making them feel like unwanted strangers. I am surely not the only MP who has received representations from people who are serving our NHS and social care service, who go above and beyond under incredible pressure to provide the best possible levels of care and who are feeling worried about what the future holds. They are particularly concerned about the Home Secretary’s proposed immigration rules and the damage that they will inflict on our ability to recruit doctors, nurses and social care workers from the EU and the rest of the world.

I could talk about the threat of access to medicines, the creation of a new medicines approval regime, which will lead to further delays, and the impact on medical research.

--- Later in debate ---

[Mike Gapes (Ilford South) (IGC)]

Let me begin by taking everybody back to the summer of 2012 and Danny Boyle’s fantastic ceremony at the start of the Olympic games. At that time, everybody was saying that the NHS was our secular religion, and in many senses that is true. It has been good to have cross-party support from everybody; no one in this House today has challenged the fundamentals of our NHS. But we all know that there is a long-term funding challenge. Social care is dealt with not by the NHS, but mainly by local government, and there is crisis in social care because local government budgets have been slashed. This Queen’s Speech goes a little way towards addressing the underfunding problems, but we have to be honest and realise that we must deal with this urgent issue of social care.

A week ago, I went to a conference organised by the East London Health and Care Partnership. One of the speakers there pointed out that there have been no fewer than nine plans or proposals for solving the social care problem, yet it is always put in the “too difficult” box, so those plans do not happen. Proposals are denounced as a death tax or a dementia tax. We need grown-up politics and we have to deal with this problem.

The same conference brought together all the NHS bodies in east London, with representatives from the boroughs of Waltham Forest, Tower Hamlets, Redbridge, Newham, Havering, City and Hackney, and Barking and Dagenham, and the provider trusts of Barking, Havering and Redbridge University Hospitals NHS Trust, Barts Health NHS Trust, Homerton University Hospital NHS Foundation Trust, East London NHS Foundation Trust and North East London NHS Foundation Trust. The clinical commissioning groups for the areas I have listed were also reflected by the local authorities there. However, there is no integration. My borough, Redbridge, has integrated care with the north-east London foundation trust, and they do good work in a joined-up way, but each borough does different things. The NHS institutions do different things.

We have had some criticism here of what people have done in the past. I want to criticise the Labour Government for their PFI; there has been a major problem in terms of the costs at the Barking, Havering and Redbridge trust due to the PFI at Queen’s Hospital. I also want to criticise the fact that we were not allowed to take the intermediate care centre at King George Hospital back into the NHS because there was a company that took the NHS to court and won the legal challenge. But I also want to criticise, and this is why I am going to vote for the Opposition’s amendment tonight, the fragmentation of the NHS brought in by the Lansley Health and Social Care Act of the Liberal Democrats—do not forget it—and the Conservatives. If we are all doing mea culpas, we need to be honest, rather than trying to score points. What we are seeing in north-east and east London is a move back towards integration, away from what Lansley proposed.

I have been here for 27 years. I have seen all this stuff before. When I came in, there was an FHSA—a family health service authority. There was then a trust model. I had an integrated trust; mental health and acute services were in the same trust. Then it was divided. Then there were further divisions and further fragmentation. Then it was reorganised back again. That is very costly and expensive and we get the rotation of individuals. The hon. Member for Ayr, Carrick and Cumnock (Bill Grant) referred to this. People are getting huge amounts in redundancy payments and then reinventing themselves and coming back in another NHS organisation.

This cannot go on. It is really ridiculous. The public do not understand the terms. People who come to us as constituency MPs about an NHS issue do not know what a CCG is. They have no idea how to make a complaint through the system. MPs are acting as gatekeepers and advocates for our constituents to try to get through this minefield. We hear that there are going to be consultations, but most of them are predetermined shams.

I have led a campaign to save the A&E in my constituency. The former Member for Ilford North, Lee Scott, and I joined with the local paper on this campaign. The current Member for Ilford North was with me over more recent years. It took from 2006 until July this year, when the then Minister, the hon. Member for Wimbledon (Stephen Hammond) confirmed in a parliamentary answer to me that the A&E at King George Hospital was saved, and that is in the draft response to the NHS plan. That is a fantastic victory for our community, but why did it have to take so long?