NHS 70th Anniversary

Neil Gray Excerpts

Wednesday 16th May 2018 Westminster Hall

[Nick Smith]

My hon. Friend makes an important point. As always, she is ahead of the game—I will come on to that point shortly.

Obesity is the second biggest preventable cause of cancer. Diabetes leads to significant complications, including, in extreme cases, amputation. The consequences for our society are massive. NHS England has said that around £16 billion a year is spent on the direct medical costs of diabetes and conditions related to being overweight or obese. That is more than the cost of delivering all our countries’ police and fire services combined. The Government cannot shirk their responsibility to tackle the issue head on. When the next chapter of their childhood obesity plan comes into effect, it needs an effective UK-wide public health drive. It needs to do more to deal with that priority. The 2015 Conservative manifesto pledge to clamp down on advertising unhealthy brands vanished into thin air by the time of the first childhood obesity plan.

It now looks like junk food ads may be banned from programmes where three quarters of the viewers are children. That is to be applauded. It is a good thing, but it fails to tackle the big primetime shows that families gather around the sofa for: shows such as “The X Factors” and the aptly named “Saturday Night Takeaway”. That is without mentioning, with the World cup on the horizon, the premium advertising space around sport. There is a real contradiction when fantastic displays of athletic prowess are bookended by burgers and packaged with pizzas.

Alongside others, Cancer Research UK is pushing for a 9 o’clock watershed for junk food adverts, and the Government must consider that proposal seriously. It is not only me who thinks that; the head of the NHS, Simon Stevens, thinks it would be a good way to tackle this scourge. He believes that even the likes of Facebook must be roped into any plans that limit junk food advertising. The Jamie Oliver Food Foundation suggests having mandatory training for GPs and health professionals to talk about weight in a helpful way and to refer patients to nutritional experts. Whatever the Government decide, they will need to be bold in the face of pressure from the industry heavyweights and their lobbying teams. When plans emerge from this Government, every organisation should be doing their bit.

I was pleased to see the Mayor of London, Sadiq Khan, take real steps to address junk food advertising last week with his announcement that such adverts are to be banned from the tube and bus networks. Almost 40% of London’s 10 and 11-year-olds are obese or overweight. The Mayor is taking a positive step to tackle what he has rightly called “a ticking time bomb”, and that must be supported. However, it is up to all public bodies, including devolved Administrations, councils and housing associations, to weigh in. Primary schools should promote walking every day to their pupils. It is about using soft power and nudge, as well as improved regulation to make legislative and cultural change.

[Neil Gray (Airdrie and Shotts) (SNP)]

The hon. Gentleman is talking about action to tackle childhood obesity and junk food adverts, and also about Jamie Oliver. He will perhaps be aware that Jamie Oliver met the First Minister of Scotland on Monday and welcomed and supported the Scottish Government’s plan to halve childhood obesity by 2030. Would he care to welcome that, as Jamie Oliver did?

[Nick Smith]

I am pleased to welcome that support for a UK issue that we all need to work on.

With further support, we could achieve the healthy lifestyles that so many people want by using influence and our voices. I want to round this speech off with one initiative that I think deserves real backing. It will help our society get on track to healthier lifestyles. To return to Bevan, the initiative is about harnessing community support to deliver improved health for all. Dame Kelly Holmes teamed up with the NHS and parkrun last weekend to encourage people to “take care of yourself” in the build-up to a special parkrun for the NHS on 9 June. My local parkrun group is the Parc Bryn Bach running club, and I can report what a difference such initiatives can make. After a year of running every week, my blood pressure is down and I have tightened my belt a few notches.

I am grateful for the esprit de corps of my local running club. Parc Bryn Bach has Saturday parkruns, special Sunday sessions for parkrun juniors and is a backer of the brilliant NHS Couch to 5k scheme. Just a few Mondays ago, it had 150 people running through a wet, windy April evening to get their fitness up. Over three months, many of those local people will gain confidence and a level of fitness to help them change their lifestyle. The camaraderie and support on offer is fantastic, and that is what makes these schemes fun to join and easy to keep up. Unsurprisingly, the club membership has doubled in recent years, and the coaches and volunteers include many health professionals. They are a great team. I am pleased that the Welsh Labour Government have seen the value of that. Welsh Athletics is supporting clubs with regional Couch to 5k programmes.

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[Neil Gray (Airdrie and Shotts) (SNP)]

It is a sincere and genuine pleasure to serve under your chairmanship, Mr Hosie. I pay tribute to the hon. Member for Blaenau Gwent (Nick Smith) for securing this debate and for his thorough and measured speech. He talked about the challenges we face in the NHS, about austerity—obviously, across these isles, we all face the challenge of dealing with austerity constraints—and about obesity. I mentioned earlier that on Monday, Jamie Oliver met the First Minister of Scotland, Nicola Sturgeon, here in London. He backed the Scottish Government’s target to halve childhood obesity rates by 2030 with a new healthy weight and diet plan, which is due to be published this summer. It will include action to restrict promotions that advertise junk food, including multi-buy deals on unhealthy products.

The hon. Gentleman mentioned the fantastic parkrun, which is one of the best lifestyle movements—if you will pardon the pun, Mr Hosie—that we have. It is free, run by volunteers and accessible. It is 5 km—anyone of any ability can manage that. This morning, I managed to get some miles in the bank before this debate, alongside my Scottish National party running club colleagues. The hon. Gentleman is more than welcome to join us any time he wishes. The invitation is open to all: we are ecumenical.

The hon. Member for Ayr, Carrick and Cumnock (Bill Grant) gave us a very good history lesson about how far the NHS has come. He was very comradely in his cross-party acknowledgment that Labour founded the NHS, and rightly so. In his comradeliness, he neglected to mention any of the NHS measures in Scotland, which are no doubt helped in no small part by the intervention and support of his daughters. It is right that we pay tribute to NHS workers. The NHS in Scotland is the best performing in the UK.

My constituency neighbour, the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney), perhaps missed the tone a wee bit, but I understand his anxiety. He talked about Monklands Hospital, which is in my constituency. Of course, the SNP Scottish Government have committed funding to build a new Monklands Hospital. We are all aware of the challenges previous Scottish Governments faced with the accident and emergency service at Monklands Hospital. There was potential for a downgrade, but the hospital’s future is secure and we are going to get a new service. The hon. Gentleman talked about funding, and of course the NHS in Scotland is supported by record funding levels. However, the hon. Gentleman is right that, like all NHS services, we are not without our challenges in Scotland. In that regard, I hope that he pursues the case that he mentioned, involving his mother. It is right that where there are problems they are called out and we learn from them.

The hon. Member for Henley (John Howell) talked about the need for a long-term plan for the NHS. We all agree with that. He also talked about care not being properly integrated, but in Scotland we have legislated to integrate health and social care, so we are further down the road to seeing it realised. He was right to mention that public health must be central—we must all remember that, and remind ourselves of it.

The hon. Member for York Central (Rachael Maskell) was right to pay tribute to Dame Tessa Jowell, who personified dignity, passion and eruditeness in her final months of campaigning on health issues. We all pay tribute to her work and pass on our sincere condolences to her family.

The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) gave a very measured speech based on experience and personal testimony. He is right that the NHS is fundamentally about fairness, and he was right to pay tribute to our NHS staff, as we should all do—it should be something to unify us all. He talked about rurality and distance, and I benefit from experience in that regard because I am originally from Orkney, so I well appreciate the challenges of local service delivery, which are not too dissimilar from the ones that he faces in his constituency. I know, however, that the Scottish Government are aware of that and that the door is open to him should he seek to make representations or come up with ideas.

The hon. Gentleman also spoke about the potential for UK conversations, but as I have said, the Scottish health service is performing well according to any number of measures. The issues and conversations that we are having are about funding, and about breaking the austerity stranglehold that affects all our local public services. Perhaps he will join us in continuing to challenge UK Ministers to end austerity.

The hon. Member for Bristol South (Karin Smyth), too, gave a very good speech based on experience. She spoke about the new challenges that we face and how they have changed over time. She mentioned obesity, as I have, and alcohol abuse. The Scottish Government have intervened to legislate for and bring in, after much challenge, a minimum unit price for alcohol in Scotland. UK Ministers are following developments to see how progress is made. When discussing NHS staff, it is right to mention frontline staff—our nurses and doctors—but we should also mention the decision makers, leaders and management level. I have a good working relationship with my local decision makers and managers, and the hon. Lady was right to mention them.

I want to touch a wee bit on my personal experience of the NHS. In many ways, it has shaped where I am, and I am personally indebted to it. First, when I was a young boy, not that much older than my son is now, I pulled a kettle of boiling water down on myself. The scars are still there on my arm and chest, a physical reminder of what happened. Had it not been for swift and expert intervention at the time I would not have the full use of my right arm, so I am personally indebted to the staff in Kirkwall and Aberdeen for what they did for me.

Those who know me and my slightly accident-prone nature will be surprised to learn that my next major intervention from the NHS was not for 20 years, when I dislocated my knee running on a running track, ending what little there was of my athletics career. However, it could have been far worse. Had it not been for the swift intervention of the surgeon at Ninewells Hospital, John Dearing, who operated within the week, because of the nerve damage I sustained when I dislocated my knee I would not have the full range of mobility in my legs that I have now. As I have said, I can still run, and play football and rugby equally badly, but I would not have been able to had it not been for his swift and timely intervention, so I am very grateful.

I am sure that many of us in the House are indebted to the NHS in one area that we have not really talked about, other than the hon. Member for Caithness, Sutherland and Easter Ross. I am certainly grateful to the NHS for the wonderful experience of the birth of my two children. Sometimes we take such services for granted, in particular when we hear about the experience of friends in America, for example. Anecdotally, if we make an analogy with the recent delivery of the royal baby in the Lindo wing, American patients could travel first-class the whole way to the Lindo wing for the same price that it would cost to have their baby delivered in America. We should all remind ourselves of how fortunate we are in many regards in this country.

I know that we do not all have positive experiences when we interact with the NHS. I deal with complaints about the NHS, just as any MP, any Member of the Scottish Parliament up the road, or any colleagues of the hon. Member for Blaenau Gwent in Wales do. However, as I mull over developments in my area, such as the new Monklands Hospital, and the medical advances that have been made over the past 70 years, we should be incredibly proud of our NHS and protect its integrity with every political and moral fibre available to us. I thank all those who work in our NHS, past and present, in Scotland and across these isles, and I wish the institution that we are so proud of a very happy 70th birthday.

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[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

What an interesting debate. I echo the view of the shadow Minister, the hon. Member for Washington and Sunderland West (Mrs Hodgson), that it is a privilege to be in this position at this time in the NHS’s history. I feel like I know her Aunty Ella personally—what a lovely family anecdote that was. That real example was a good reminder of what the NHS has brought to families.

I congratulate the hon. Member for Blaenau Gwent (Nick Smith) on securing the debate. Those who know me know that I certainly share his passion for this topic. Winchester cannot claim ownership of Mr Bevan, but Florence Nightingale established a hospital in my city on the hill—the Royal Hampshire County Hospital, which is much loved and is still there doing great things. It has very committed and caring staff. The hon. Member for Bristol South (Karin Smyth) said that the NHS was a great achievement but that there were also a number of compromises. If I may say so, she was very astute to put it that way. As many Members have said, we live with that achievement but there are many compromises.

The NHS is of course 70 years old this year. Much has changed in our society and our health since 1948. Our health needs are very different, and we have better drugs and diagnostic tools. When the NHS was born, life expectancy was 66 for men and 71 for women; today it is 79 and 83 respectively. That is incredible. In 1948 there were more than 34 deaths for every 1,000 live births; today there are just five, although that is still too many.

I will start where every Health Minister should, by thanking our NHS staff for all they do, day in, day out, to make our NHS something that we are incredibly proud of. There was a great awards event this week in London, at which the Duke of Cambridge spoke, which showcased so many wonderful examples. Indeed, Mr Bevan would be amazed at the work that goes on today across the NHS.

We want to use the NHS70 moment to reflect on the last 70 years of patient care, to celebrate the innovations in the NHS, to raise awareness of the many ways we can support the system and, probably most importantly, to promote the public’s role in the future of the NHS and the importance of taking care of our own health and using the NHS wisely—and, yes, accountability, which the hon. Member for Bristol South wisely raised. I am giving her a lot of credit. [Interruption.] “Keep going,” she says.

So much of this debate is about our changing society, but the NHS has consistently been a universal service that is free at the point of need. That will continue. However, as several Members said, we are facing many different challenges from those we faced back in the ’40s, such as the prevalence of type 2 diabetes, which my hon. Friend the Member for Henley (John Howell) mentioned. He sits on the all-party parliamentary group on diabetes. I was bitterly disappointed that he did not give us any of his medical updates, but I know that those will come another time. In fact, we heard a couple of medical examples from the SNP spokesman, the hon. Member for Airdrie and Shotts (Neil Gray). The rising prevalence of type 2 diabetes is a great challenge for us, as is cancer. Both can be reduced if we tackle obesity and encourage more people to lead healthier lifestyles, so that is where I will focus.

The Government take the public health challenge we face incredibly seriously. We have responded by putting prevention at the heart of public policy making. We have taken quite stringent steps. As the shadow Minister said, we are a global leader on tobacco control. We were the first country in Europe to introduce legislation to bring in plain packaging for cigarettes, off the back of the smoking ban in public places. She rightly mentioned Fresh North East, which is a very good example—it is in many ways the apple of my eye in this policy area. I hope at some point, if the arithmetic in this place ever allows, to go and see it for myself. I will let her know if I do—perhaps we can do that together. In April we introduced the soft drinks industry levy, which is a big public health measure. In recent years we have vaccinated more than 1 million infants against meningitis and an additional 2 million children against flu.

We have run award-winning public health campaigns, including Be Clear on Cancer, which I am very invested in, and Act FAST, the public health stroke campaign. They all sit with the inheritance of the landmark Don’t Die of Ignorance campaign about the AIDS challenge we faced in the late 1980s—I am surprised that was not mentioned. That campaign still makes the hair on the back of the neck stand up, does it not? It was an incredibly impactful and powerful piece of work that came out of the public health movement.

I want to cover a lot of things, but let me return to diabetes, which is a major challenge. Preventing diabetes is a huge priority for the Government. According to Diabetes UK, which I saw just last week, about 5 million people in our country are currently at high risk of developing type 2 diabetes. If the current trend persists, one in three people will be obese by 2034 and one in 10 will develop type 2 diabetes. Some of the risk factors for type 2 diabetes, such as poor diet and a sedentary lifestyle, which can lead to obesity, can be changed. We know that 61.4% of adults are either overweight or obese; and 26% of adults and 20% of children aged 10 to 11 are obese. The obesity crisis has been decades in the making, and tackling it is a real challenge. It will not be turned around overnight, and no one pretends that it can be. That is why tackling obesity is absolutely a Government priority. I will come back to that point in a moment.

I mentioned the NHS diabetes prevention programme, which is aimed at providing people aged 40 to 60 who are at risk of diabetes with personalised help with healthy eating and lifestyle, and bespoke physical activity. So far, as I said at Health questions last week, more than 170,000 people have been referred to that programme. Those who are referred get tailored, personalised help, and that is really making an impact.

[Neil Gray]

It was remiss of me when talking about childhood obesity and lifestyle changes not to commend those who started and spread the daily mile challenge in our schools. Perhaps the Minister will touch on that, and on its roots in Scotland.

[Steve Brine]

I thank the hon. Gentleman for that point. I touched on child obesity, which is one of the top public health challenges, if not the top challenge, for this generation. Overweight and obesity-related ill health is estimated to cost the NHS in England about £5.1 billion each year. The estimated total cost to society is between £27 billion and £46 billion per year. Our child obesity plan, which was published back in 2016, is informed by the latest evidence and research in the area. At its heart is a desire to change the nature of the food that children eat and make it easier for families to make healthier choices. Since we published the plan, real progress has been made on sugar production. Since the introduction of the soft drinks industry levy, which I mentioned, sugar has been drastically reduced in around half of all soft drinks products that fall under the levy. I recognise the daily mile, which was rightly raised by the hon. Gentleman, which he said started in Scotland. It is in England as well, though not as much as I would like to see it—we have an ambition for it to do much better.

Many Members mentioned child obesity, and we have always been clear that the child obesity strategy is the start of a conversation and not the final word—we call it chapter 1 for a reason. We continue to monitor the progress we have made since the publication of the strategy a couple of years ago, and if further measures are needed we will take them.

Let me touch on physical activity, which the hon. Member for Blaenau Gwent rightly spoke about. People know that being active is good for their health and they want to do more, but the truth is that many of us are simply not active enough to benefit our health. Only 66% of men and 58% of women in England meet the chief medical officer’s recommendation to be active for at least 150 minutes a week. Children are no better, with only 23% of boys and 20% of girls being active for at least 60 minutes a day. As we get older, we become less active. It is recommended that we do muscle strengthening and balance exercises on at least two days a week, but the most recent health survey shows that only 1% of the adult population in England meet that guideline.

Why is that important? We are facing an ageing population and there is good evidence that being active reduces the chance of falls, depression and dementia by up to 30%. That will help people stay healthy and independent for longer, and we need that to happen if the NHS is to be sustainable for its next 70 years. People need to understand why being active is important and have a clear understanding of how much activity they should do and the impact that can have on their health. I was pleased to hear parkruns mentioned by a number of Members, including the hon. Member for Blaenau Gwent, because they are incredibly important. I have them in my constituency at the River Park leisure centre.

It is vital that we acknowledge the importance of good mental health, which was mentioned a couple of times in the debate. Everybody’s mental health is on a point on the spectrum and, as my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) said, mental health is just the other side of the coin of physical health. Good mental health is so important to leading positive and productive lives and to the NHS. This is Mental Health Awareness Week, but really every day should be a mental health awareness day. Mental health is a key priority for the Secretary of State and the Prime Minister, which is why last December we published the Green Paper on children and young people’s mental health, backed by more than £300 million of funding to improve access to services and, crucially, mental health support in schools.

Just yesterday I was at the Maudsley Hospital in London, looking at the incredible work it has done in bringing us to a smoke-free NHS. We identified mental health in-patients as a key target in the tobacco control plan. I saw the important work being done, which I would recommend to any Members who think they could inspire their local areas to follow that lead.

My hon. Friend the Member for Ayr, Carrick and Cumnock was dead right to mention delayed transfers of care—delayed discharges—which are a key component and in many ways the magic key to the NHS. It is also always nice to hear Robert Burns quoted in the Chamber, but I am sorry that he did not sing it—maybe next time.

I understand why the hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) made the speech he did. He certainly put down a marker for the Scottish Government, who govern his constituents.

I thank my hon. Friend the Member for Henley for mentioning the long-term economic plan—I have not said that for a while—and the multi-year funding plan that the Prime Minister talked about at the Liaison Committee. He is dead right. That is exactly what we should be doing, and it is exactly what we will do.

As always, the hon. Member for York Central (Rachael Maskell) spoke from the heart about health matters. She mentioned the integrated public health plan for her city, which sounds great. Local application of what is good for local areas is right, and I look forward to hearing more about her local area when we meet.

The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) raised questions about the devolution settlement. Of course, we talk across England and the devolved nations, but the settled will of this Parliament and of the people in this country is that we have a devolution settlement. Devolution can bring difference, and that can be good or bad. Yes, we do talk and share best practice, and I know that NHS England and Public Health England talk to their counterparts in the devolved nations all the time.

On good and bad difference—this is not political knockabout; it is just some facts—it would be remiss of me, as a Conservative Health Minister, not to put on the record that since 2010 we have increased NHS spending each and every year, even as we have had to take some very difficult financial decisions, given the state of the public finances we inherited. The NHS now has £14 billion more to spend on caring for people than it did in 2010. To give that some context, over the past five years funding for the NHS increased in Wales by 7.2%, in Scotland by 11.5%, and in England by 17.3%. I say that not to make a political point; it is a simple fact that should be put on the record.

Let me take this opportunity once again to congratulate the hon. Member for Blaenau Gwent on introducing this timely and important debate. As we have seen, the challenges that the NHS faces are radically different from those it faced in 1948. The debate has shown us why we, the Government, the NHS and the people we all represent, wherever they live in this United Kingdom, are all part of the solution to the deep and significant public health challenges we face as a nation. They are also all part of the inheritance of that health service that we are all so proud of.

In the short time available I have tried to show how seriously the Government and the NHS take those challenges. We must use all the opportunities we have at our disposal and that long-term health economic plan—I like saying that—to address the big public health challenges facing our nation. Only through the combined efforts of the Government, the NHS and the people in our country who are taking responsibility for their own healthcare, as technology increasingly allows them to do, which was another good point made in the debate, can we truly tackle the public health challenges we face and make sure that the NHS does not just survive for another 70 years—we are not interested in that—but thrives and goes from strength to strength, being a preventive health service as much as a treatment health service. That will truly honour Nye Bevan and everyone else involved in its establishment back in the ’40s.