A Plan for the NHS and Social Care

Nigel Evans Excerpts

Wednesday 19th May 2021 Commons Chamber

[Damian Green (Ashford) (Con)]

It is always a pleasure to follow the hon. Member for Rhondda (Chris Bryant).

Like other Members across the House, I welcome the performance and incredible dedication of NHS and social care staff throughout the pandemic. In the specific context of the Queen’s Speech, I also welcome the Government’s commitment to greater integration. The NHS is a great institution full of massively dedicated people, but my observation over the years has been that it is also a series of individual institutions, all of which are tenacious in the defence of their own interests. GPs are wary of hospital trusts, community services have a separate set of interests, and so do ambulance trusts and others such as pharmacies, which play a vital role but too often do not feel engaged enough.

The integration that the promised health and care Bill seeks to bring about is exactly the right solution, in a number of fields. Technology is clearly key—not just technology at the cutting edge of diagnostics or life sciences, but straightforward stuff so that systems talk to one another and patients do not have to repeat the same set of symptoms to doctor after doctor in different settings because their records have not been passed on. That kind of frustration has no place in the 21st century and should disappear.

The biggest prize of all is proper integration between the health and social care systems. My right hon. Friend the Secretary of State is absolutely right to focus on that in one of his White Papers, and I welcome that as well, but with two caveats. This must not be a takeover by the NHS of social care. The White Paper suggests integrated care systems, which are fine, but I slightly raise my eyebrows at the proposed dual system where the NHS effectively gets its integrated decision in first and then shares it with the social care system. It is vital that social care has a voice at the table where the decisions are taken.

My second caveat is that the social care voice must be properly representative. Too often when people say, “We have consulted social care”, what they mean is, “We have consulted the local authorities.” Clearly, local authorities have a key role to play in this, but they are not the whole social care sector. There are third sector providers and private sector providers, and their voices need to be heard as well. There are 1.6 million workers in the sector—it is larger than the NHS—and their voices need to be heard.

Of course, all this will mean something only if we have a stable and sustainable solution to the social care conundrum that has defined Governments since the 1990s. On that, I want to make four quick points. The first is on funding, which lies at the root of many of the frustrations. It must come out of national, not local, taxation, and it must certainly involve extra state spending, possibly through a hypothecated national insurance increase for some people. It should also involve extra personal savings from those who can afford it, perhaps based on a small percentage of total assets rather than a flat figure for the whole country.

We need to solve the question of funding to solve this, but as well as that, we need a proper workforce plan, not just with better pay, though that is needed, but with a career structure, so that a social care career can be seen as the equivalent of a career in the NHS. The great value of social care workers should be reflected not just inside the system but in wider Government policy, including, for example, in the immigration system.

We also need changes to our attitude to housing and planning. We need to build homes so that people can live in their own homes for longer than they too often can now. Everyone prefers to live in their own home. And, fourthly, to assist that, we must do much better with technology. We need to use the technologies that are now available—it is not cutting-edge technology—to allow people to spend much more of their life in their own home, living a life in comfort before they may have to go into residential care. That is not only better for people, it is much cheaper for the taxpayer and for the families.

All these reforms are necessary if we are going to have a long-term, stable system. Along with my right hon. Friend the Member for South West Surrey (Jeremy Hunt), I have called for a 10-year plan for social care to go along with the long-term NHS plan. That is absolutely essential. It is also essential that this is the year in which we start down this path. We have talked for too long about social care: we need to act.

[Mr Deputy Speaker (Mr Nigel Evans)]

We are in for a treat now: one of two maiden speeches today. I remind everybody that, by convention, there will be no interventions. We are not putting the clock on the maiden speeches, but both Members have been told about the time constraints, so good luck! To make her maiden speech, I call Anum Qaisar-Javed.

[Anum Qaisar-Javed (Airdrie and Shotts) (SNP)]

Thank you, Mr Deputy Speaker. It gives me immense pleasure to be making my maiden speech during an incredibly important debate on the NHS, and it is a pleasure to follow the right hon. Member for Ashford (Damian Green). I thank my constituents for voting SNP—[Hon. Members: “Hear, hear!”]—and for bestowing upon me the greatest honour of my life by electing me as the Member of Parliament for Airdrie and Shotts. I want to take this opportunity to send a strong message to my constituents: I am here for you. I pledge to stand strong and work tirelessly for you, your families and our communities across the constituency.

I would also like to use my maiden speech to pay tribute to my predecessor, Neil Gray, and to congratulate him on his election to the Scottish Parliament. In this place, Neil showed himself to be a fierce advocate for his constituents and for social justice. I very much look forward to working with him in the constituency we now share and delivering for our community from Westminster and Holyrood.

I must confess, Mr Deputy Speaker, I am not altogether unfamiliar with this place, having had the privilege of working for my hon. Friend the Member for Glasgow North West (Carol Monaghan) some years ago. I subsequently followed my other passion and retrained as a teacher. Teaching modern studies and politics has been a delight. In fact, it was only recently that I showed my high school democracy pupils video clips of this very Chamber. It was suggested to me by a colleague that I would miss my school pupils, because no matter how rowdy they were, the House of Commons was much worse. I am pleased to say, however, that my experience so far has not confirmed that.

Some say Scotland is cold, but in Airdrie and Shotts, you will feel a warmth you will remember. The people are friendly, welcoming, honest and thoroughly decent. At the beating heart of the constituency are hard-working activists—people like Sharon Craig, who has continually championed her local community in Craigneuk, and Sarah Quinn, whose dedication knows no bounds and is making young voices heard via the Fortissat Youth Forum.

Upon entering this place, I did in fact ask for an internal map—there are lots of corridors. I was told that the best way to navigate myself through the building was to simply get lost. I must take this opportunity to thank all the House staff, who have been very kind and welcoming, even though they were telling me to get lost—in particular Kate Emms, who has been a source of guidance, and Doorkeeper Sarah Binstead-Chapman, who found me wandering while I was wishing there was a parliamentary sat-nav app.

It is fitting to make my maiden speech while we discuss the NHS. It was in fact a campaign by my SNP predecessor that kept the Monklands hospital in Airdrie. I have witnessed at first hand the sacrifice and dedication of our NHS staff, not least by my husband, Dr Usman Javed, who is sitting in the Gallery today. I take this opportunity to thank all the healthcare workers in my constituency and beyond for the sacrifices they have made this last year.

I wish to make one more plea that goes slightly beyond the NHS. The NHS would have collapsed without overseas staffing and immigrants who have made valuable contributions to this country. This may not be popular in some circles, but the points-based immigration system championed by the Government is deeply flawed. Were it in use when my father planned to come to this island, he would have been blocked and this country would have been deprived of one Member of Parliament, one doctor and one medical student—myself and my siblings. That is one of the reasons why Scotland needs independence, so that policies best suited for our people’s needs are developed and delivered by those in Scotland.

So I end my maiden speech with a plea: please let Scotland be free. In the short term, devolve immigration so that we can set policies that are reflective of the needs of Scotland.

[Mr Deputy Speaker (Mr Nigel Evans)]

Congratulations. My maiden speech was shocking. [Interruption.] A bit like my other speeches, I know. But yours was accomplished, so many congratulations.

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[Mr Virendra Sharma (Ealing, Southall) (Lab) [V]]

Thank you, Mr Deputy Speaker, for giving me the opportunity to speak in this vital debate on the NHS and social care.

I want to speak about social care, which is in the midst of a severe crisis. Tragically, 40,000 older people have died in care homes since the beginning of the pandemic. In response to this tragedy, only one sentence of the Queen’s Speech last week was afforded to fixing the care system. In the memory of those people, the Government must put in place a proper social care system that will prevent such an injustice from ever taking place again. Instead, another year goes by where the Prime Minister has nothing to say to the hundreds of thousands of older people neglected by a broken system that still denies them the care that they so desperately need. This Government have been in power for 11 years and have done nothing to act on the matter.

Over the past 20 years, there have been at least 12 Government reviews, royal commissions, consultations, and Green and White Papers, yet still we have no change. During this time, Germany, Austria, France and Japan have all solved the issue. Even the Scottish Government, under a Labour Administration, were able to institute free personal care. This Government have dodged the issue for 11 years to the detriment of the 400,000 older people who go without the care they need. This is a failure of leadership, but it is also a collective failure of our political class to solve one of the defining issues of our time by ensuring that the older generation, after a long life of hard work and contribution to our society, are afforded the dignity that they deserve in older age.

It cannot be right that more than 10% of older people spend virtually all of their life savings on care. When the Prime Minister came to office, he committed to

“fix the crisis in social care once and for all.”

Now, nearly two years on, he needs to do something to fix this problem once and for all.

When it comes to who needs access to care, it is often smokers, so we need to commit to support reduced-risk products as the best way to help people move off cigarettes. We cannot let those in deprived areas continue to suffer from further smoking-led health inequalities. We must establish two distinct categories of regulation to differentiate between the most harmful tobacco products, and the reduced risk products such as vapes and “heat not burn” cigarettes. I am deeply concerned that public health advice is not getting to my constituents. Black, Asian and minority ethnic communities must have access to the right information and advice to quit cigarettes or to move to less harmful alternatives—that could prove to be a distinct success.

As a result of these pressures, we see more and more care homes close every year, with fewer people able to find the beds they need. I urge the Secretary of State on behalf of the thousands who need help today to take two parallel courses of action. First, I urge the Government to immediately commence cross-party discussions in good faith to create consensus, not over the problems, but to find solutions. Over the past half century, at every turn, politicisation has disturbed what window of opportunity we have had available, and the adversarial nature of our politics has not solved this vital problem.

Secondly, the Government must have faith in local government, and give councils the tools and resources to build and then run a cohesive system of social care. Local authorities have performed admirably during covid-19, and have shown that they are truly capable of running such a system. We should take the lessons learned over the past 14 months and put them into action. Local government knows how to run programmes; the Government should give them the resources to do it. Acting now is not a political white flag. It is not compromise; it is showing decisive leadership. It is weak to leave this issue unaddressed. Strength is acting to save lives, and the dignity of everyone forced into the arms of social care. The Prime Minister is—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. I am sorry, Virendra; you have just run out of time. I do apologise. No offence is intended.

I call Robin Millar to make his maiden speech.

[Robin Millar (Aberconwy) (Con)]

It is a privilege to rise and speak in this debate, and indeed a pleasure to follow the hon. Member for Ealing, Southall (Mr Sharma). I must say it has been a particular pleasure, too, to listen to speeches in this Chamber for the past 17 months, and I am humbled by the eloquence, the learning, the quick humour and concerns that hon. Members across the House bring to debates such as these.

My predecessor, Guto Bebb, was a man who followed his principles. As a Back Bencher, his campaign on interest rate swaps led to 11 bully banks paying out more than £1.5 billion in settlements to more than 15,000 businesses. He went on to become a Parliamentary Under-Secretary of State for Wales and then Minister for Defence Procurement. In short, he was a three-time winner of general election campaigns, a two-time Minister of State and an effective advocate for the exploited. He earned the respect of colleagues and opponents and secured the affections of his office team. Those are considerable accomplishments, and they have guided me since entering the House, so it is a pleasure to recognise them with these few words today.

I was born and raised in north-west Wales. That is where I learned the importance of family, where I found my Christian faith, and where lifelong values were formed. It is also where I had my first political experience, as a six-year-old in 1974, campaigning for the late Wyn Roberts MP, more recently Lord Roberts of Conwy. Even now I remember his campaign cry of “Win with Wyn”, and I still proudly wear the campaign rosette he gave me to thank me for my decisive contribution to his successful re-election campaign that year.

In Wales we have a word, cynefin, which loosely translates as habitat; but it means much more than that, and carries a sense of belonging and being in the right place. So, although I left family and home for education, a career and for love, it was perhaps inevitable that I should return to Wales and end up in politics. To be sent to Westminster by the people of Aberconwy is a very special personal honour and a great privilege, and I will do all I can to repay the trust and the confidence they have placed in me.

For centuries the beauty of Aberconwy, its heritage and culture have drawn visitors from around the world, including many hon. Members from this House. Many who have come have stayed, and the houses they have built tell a fascinating story of ambition and influence, dispute and resolution. The Victorians enjoyed our seaside towns and villages so much that their houses line the promenades from Llanfairfechan to Llandudno. The Groes Inn on the shoulder of the Conwy valley is the oldest licensed pub in Wales, and has been a place of rest and refreshment for weary travellers since 1573.

Each of the castles of Aberconwy, along the Conwy valley—Deganwy, Conwy itself, Gwydir and Dolwyddelan —offer different perspectives on our rich history of English kings and Welsh princes in their mountain passes. Further up the valley and deep into Snowdonia—or Eryri, as we call it—is Tŷ Mawr, the house of Bishop William Morgan. His translation of the Bible into Welsh not only saved the Welsh language but changed the history of Wales, and it serves as a testament to the relevance of timeless truths to us today in this place.

These are rich seams, and points that I will return to another day, but the subject of today’s debate is the Health and Care Bill and Her Majesty’s Gracious Speech. The UK has a growing and ageing population. Around 18% are over 65 years old, but in Aberconwy that figure is closer to 27%. While there is no cure for old age yet, the challenge that we face is to reduce the burden of care and help ensure longer, better lives. So I support the Prime Minister’s aim to give every older person the dignity and security they deserve. On this one point I will make a simple observation.

This UK Government ensured that residents in all parts of the UK could benefit from the furlough scheme and receive financial relief at a time of crisis; this UK Government ensured that residents in all parts of the UK would benefit from a world-leading and lifesaving vaccination programme; and this UK Government can use the Health and Care Bill to ensure that residents in all parts of the UK will have access to consistent minimum standards of healthcare.

While residents of Aberconwy in north Wales are served by the gifted and hard-working professionals of Betsi Cadwaladr University Health Board, it was in special measures for six years until just a few months ago. Workers there have coped superbly with the pandemic response and are delivering hundreds of thousands of vaccines, yet some 6% of residents in north Wales have been on a waiting list for treatment for over a year. These are UK residents, they need the support of their UK Government, and this Bill, surely, is an opportunity for us to enable that support.

That is just one of the challenges we face in Aberconwy. We must build back a balanced economy, improve our road, rail and telecommunications links, develop green energy schemes, tackle flooding, and more. But whether on climate change, public service finance, social care, national security, our economy or international trade, these challenges are best faced together. I believe that our United Kingdom is the best response to the global challenges we face today. I do not underestimate the difficulty of building solutions across political parties and Parliaments, but we must strengthen the ties that bind us to best serve those we are here to represent.

[Mr Deputy Speaker (Mr Nigel Evans)]

Congratulations, Robin, and thank you for the Welsh lesson on “cynefin”. I used to see it outside houses in Swansea and always wondered what it meant, so now I know.

We are now going to a three-minute limit on speeches. I call Munira Wilson.

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[Dr James Davies (Vale of Clwyd) (Con)]

It is a pleasure to rise in support of the Queen’s Speech today. The past year has highlighted the challenges facing our health and social care systems, and I welcome the Government’s legislative agenda, which will tackle some of the most pressing issues. In the short time available, I will focus on three issues: plans to tackle obesity, the potential benefits of UK-wide comparable healthcare data, and the need for better access to, and choice of, secondary and tertiary healthcare for the residents of north Wales.

In the UK, 63% of adults are overweight or living with obesity. This places an enormous strain on the NHS, reduces quality of life and stifles economic productivity. The Government have a clear agenda to tackle obesity, and I welcome, among other measures, the confirmation of a total online ban and a 9 pm TV watershed for the advertising of high-fat, salt and sugar products. The commitment to legislate for calorie labelling in cafés, restaurants and takeaways is also welcome. Although I acknowledge certain concerns on behalf of those with eating disorders, I believe this policy will have a clear net benefit for our national health.

Can progress also be made on introducing calorie labelling for alcohol products? I am in no way anti-alcohol, Mr Deputy Speaker, as you know—in fact, I am a proud member of the beer, and wine and spirits all-party parliamentary groups—but I believe that there is currently poor awareness that alcohol consumption is a significant contributor towards our national obesity crisis. An alcohol calorie labelling programme would be a useful tool to enhance the plans already outlined in the Queen’s Speech.

The availability of comparable data on covid infection rates and vaccination roll-out throughout the country has been a key driver in our response to the pandemic, yet looking at healthcare more broadly, comparisons between England, Scotland, Wales and Northern Ireland can be difficult to draw. My personal experience as a GP, anecdotal evidence and basic comparisons indicate that, despite the hard work and commitment of health staff, patients in Wales often receive inferior levels of service when compared with their friends in England.

By introducing UK-wide health data, politicians at all levels will be held to account, practitioners and policy makers can better share best practice, and, ultimately, equal health outcomes will be promoted. Such an approach would be complemented by the establishment of independent UK-wide healthcare inspection, safety and audit mechanisms. In short, we have opportunities that I believe we must seize to level up healthcare. I ask the Minister to consider what the UK Government can do, beyond the legislative programme already announced, to protect and promote the health of all British citizens.

I am looking forward to seeing the progress of the health and care Bill. I hope that, as part of the legislative process, the Government will consider the challenges that Welsh patients currently experience, whereby access to specialist healthcare treatment in England is typically dependent on restrictive contracts or individual funding requests. Improving access to specialist care—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Sorry, James.

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[Dehenna Davison (Bishop Auckland) (Con) [V]]

I would like to begin by congratulating my hon. Friend the Member for Aberconwy (Robin Millar) and the hon. Member for Airdrie and Shotts (Anum Qaisar-Javed) on their excellent maiden speeches. I remember all too well how daunting that is, having made my own maiden speech in the Queen’s Speech NHS debate in January last year.

Since then, our NHS has had the most turbulent of times. I pay tribute to the dedicated healthcare staff in my constituency, working day and night to keep us safe from coronavirus. I pay special tribute to Dr Poornima Nair, a dedicated and well respected GP at the Station View medical centre who died with coronavirus last year. In the House, I have talked about the light at the end of the covid tunnel. Thanks to the success of the UK’s vaccine roll-out, we are now beginning to see that light.

It was a UK grandmother who became the first person in the world to be given the Pfizer covid jab and, from then on, it has been onwards and upwards. The Government’s early focus on securing an extensive vaccine portfolio means that over 57 million doses have been given in the UK. The pandemic has really highlighted the importance of local healthcare and, as I mentioned in my maiden speech, it is one issue that unites every corner of my constituency. That has never been more true. From Bishop Auckland Hospital caring for covid patients to local GP surgeries and pharmacies vaccinating us to get us out of this pandemic, all parts of my constituency have pulled together.

Local healthcare provision matters, and that is why I will never stop banging the drum in this place for improved health services at Bishop Auckland Hospital. I am campaigning to restore the A&E that was lost under Labour, and I am grateful to both the Health Secretary and the Minister of State for Health for meeting me to discuss the campaign.  So far, the Government have invested £450 million to upgrade accident and emergency facilities in more than 120 trusts, so I know they understand how vital A&Es are to local healthcare provision, and I hope my ministerial friends will hear me clearly when I say I will continue to fight for the restoration of our A&E in Bishop Auckland.

The Queen’s Speech has healthcare at its heart, and I want to focus on one aspect that is close to my heart and to my politics: mental health. I have talked in the past about my own struggles around mental health. The importance of talking about it cannot be overstated. Every speech, every conversation, every time we talk about our own challenges that we have faced, we chip away at the stigma, but it is clear that talking about mental health alone is not enough. I am glad, therefore, that the Government are pushing ahead with their reform of the Mental Health Act 1983. Work is already under way on improving access to community-based mental health support, with £2.3 billion a year as part of the NHS long-term plan, but I am looking forward to seeing what further changes are proposed. The stigma around mental health needs to end, and every time we talk about it we help chip away at that stigma. Let us press ahead with improving the situation on the ground, improving mental health support and helping to ensure that no more lives are lost through poor mental health.

[Mr Deputy Speaker (Mr Nigel Evans)]

Thanks, Dehenna. Sadly, we had to cut the video—we had a still of you—and the audio was not brilliant. Perhaps you could have a chat with the technicians to try to establish what the problem was.