NHS and Social Care Funding

Norman Lamb Excerpts

Wednesday 11th January 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right, and I talked about these issues when I visited her in her constituency. The truth is that, to solve this problem, we are going to have to have a dramatic increase in the number of people working in general practice, which is why we are funding the second biggest increase in the number of GPs in the NHS’s history.

It is a great shame that the Leader of the Opposition is not here, because this is the bit that I wanted to address to him—his proposal to put extra funding into the NHS by scrapping the corporation tax cuts. That reveals, I am afraid, a fundamental misunderstanding of how we fund the NHS. Corporation taxes are being cut so that we can boost jobs, strengthen the economy and fund the NHS. The reason we have been able to protect and increase funding in the NHS in the last six years, when the Labour party was not willing to do so, is precisely that we have created 2 million jobs and given this country the fastest growing economy in the G7, and that is even more important post-Brexit. To risk that growth, which is what the Labour party’s proposal would do, would not just risk funding for the NHS, but be dangerous for the economy and mortally dangerous for the NHS.

[Norman Lamb (North Norfolk) (LD)]

I just want to understand exactly what the Secretary of State was saying on Monday about the four-hour A&E target. Is it conceivable that some of the people who are currently within the A&E target will, at some stage, fall outside the A&E target?

[Mr Hunt]

I am committed to people using A&Es falling within the four-hour target, but I also think that we need to be much more effective at diverting people who do not need to go to A&E to other places, as is happening in Wales, as is happening in Scotland and which, frankly, is the only sensible thing to do.

However, going back to the funding issue, I just want to make this point: for all the heat in this Chamber in debates on the NHS, probably the biggest difference between the two sides of the House is not on NHS policy but on the ability to deliver the strong economy that the NHS needs to give it the funding that it requires. I am afraid that the proposals in the motion today reveal that divide even more starkly.

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[Dr Sarah Wollaston (Totnes) (Con)]

I will try to be mindful of those comments, Madam Deputy Speaker, as I follow the hon. Member for Central Ayrshire (Dr Whitford), my colleague on the Health Committee. As always, she made thoughtful and thought-provoking comments, and I would like to endorse her points and expand on some of them.

First, I thank NHS and care staff. We have heard that they are facing unprecedented demand over the winter, but it is not just winter pressures that they face now—the pressures extend into the summer. As we have heard, that is not just about numbers but about the complexity of conditions and the frailty of those presenting in our accident and emergency departments. The Health Committee heard in its recent inquiry that the trusts that are most successful in getting close to the four-hour target are those that see it as an entire-system issue, and in which both health and care staff contribute to the effort, not as a tick-box exercise but because they recognise that it is fundamentally about patient safety and the quality of patients’ experiences. That is why the four-hour target matters, and the Secretary of State is right to endorse it.

The Secretary of State is also right that we sometimes need to be more nuanced about our targets and that he needs to be open to listening to what clinicians are telling him about how we can improve the way in which targets are applied. It would be a great shame if we in this House prevented those sensible discussions from taking place because of political furore. I urge him to continue to have them and to take advice and listen to clinicians about how we can improve the use of targets, but he is absolutely right in being clear that he will keep the four-hour target.

We must talk about this as a whole-system issue. Accident and emergency is a barometer of wider system pressures, as has been pointed out, and I want to focus my remarks on the integration of health and social care.

I agree with colleagues throughout the House who have called for a convention on reviewing funding as a whole-system issue. We have heard that next year is the 70th birthday of the NHS, and what could be a better present than politicians changing the debate and the way in which we talk about the funding of health and social care, so that we do so in a collaborative manner that works towards the right solution for our patients? The consequences of our not doing that would be profound for our constituents, who would not thank us for not being prepared to put aside party differences and work towards the right solution.

Ultimately, this issue is about a demographic change that we are simply not preparing for adequately. In the case of the pension age, we recognised that there had to be a different debate given the change in longevity. Over the decade to 2015, we saw a 31% increase in the number of people living to 85 and older. Of course, that is a cause for celebration, but there has not been a matching increase in disease-free life expectancy.

I welcome the Prime Minister’s focus on tackling inequality, but unfortunately we are not making sufficient progress on that, either. In her very first speech in the job, she talked about tackling the “burning injustice” of health inequality. We in this House have a role in doing that together in a consensual manner.

[Norman Lamb]

I very much agree with the hon. Lady. Does she share my welcome for the Prime Minister’s response today in which she stated that she was prepared to meet us and other Members of Parliament from across the House and my hope that it might start a more constructive approach?

[Dr Wollaston]

Absolutely. It was extraordinarily encouraging to hear the Prime Minister say that she was prepared to consider that and to meet Members from across the House. I urge colleagues who feel that this is a better way forward to sign up to it, speak to their party Whips and make it clear that it has widespread support.

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[Norman Lamb (North Norfolk) (LD)]

I join many others in commending those who work in our NHS and in our care system, including the hon. Members for Lewes (Maria Caulfield) and for Central Suffolk and North Ipswich (Dr Poulter) both of whom continue to work in the NHS, I think without payment—[Interruption.] Not any longer. It is important that we acknowledge that many people in the NHS are working under incredible strain, and we owe them a debt of real gratitude.

I make it clear that I support the Labour motion, and I recognise the importance of access standards in our health service. After arriving here in 2001, my first Westminster Hall debate was on waiting time standards in Norfolk for orthopaedic cases. People in those days were sometimes waiting three years for treatment. So the waiting time standards that were introduced dramatically changed people’s experience of healthcare, and we should celebrate that. But it is also right to say that sometimes the standards distort behaviour, and those distortions need to be addressed, as the hon. Member for Lewes made clear. Another example to cite is that of the ambulance standards, where I am concerned about a very serious distortion of behaviour, which often causes enormous frustration for paramedics, who are also working under ludicrous amounts of pressure.

The other point I wish to make on access standards is that although I totally applaud the Labour Government for introducing them, they did not introduce them for mental health. That is why we now have to complete the picture. This Government have confirmed that they accept in full the Paul Farmer taskforce report on mental health, but it includes the proposal to roll out comprehensive maximum waiting time standards in mental health, so that someone with mental ill health has exactly the same right as anyone else to get access to good-quality, evidence-based treatment on a timely basis. We put this in an amendment that we tabled for this debate but which was not selected, but I urge the Government, as they have accepted that report, to make sure it is now implemented. The current situation amounts to a discrimination in the health service; how can we possibly justify the fact that someone with mental ill health does not have the right to timely treatment that other people enjoy? We have to end that discrimination.

The final thing I wish to address relates to the question I asked the Prime Minister today. I asked her to meet a group of cross-party MPs who are proposing that the Government should establish what we are calling an NHS and care convention. We feel that is an opportunity to engage with the public in a mature debate about the scale of the challenge we all face. We can trade insults across this Chamber, but we all know in our heart of hearts that the system is under unsustainable pressure—that is the truth of it, and we know it. At some point, as the hon. Member for Lewes conceded, we will need extra resources in the future, so let us plan now. Let us get everybody on board and get cross-party support, because sometimes, just as we saw with Adair Turner in the last decade under the Labour Government, we need a process to unlock a problem that ordinary partisan politics has not been able to resolve.

I welcome the fact that the Prime Minister agreed today to meet a group of us who are making this call. We have also set up a petition on the Parliament website, so that any member of the public can join this call. I urge hon. Members from across this House who support this call to join in, because not only is it in the Government’s political interest to do this, but it is fundamentally in the interests of the citizens of this country that we in this House collectively address an enormous existential challenge to the NHS and the care system. We surely cannot tolerate more than 1 million older people not getting access to the care and support they need. I do not want to live in a country where someone’s access to care and support in old age depends on whether they can pay for it, but we are at genuine risk of slipping towards that situation. If we all believe that that is not tolerable, we have a duty to act. We must be prepared to act together, not just trade insults at each other. There is a real opportunity now to do what the public are desperately pleading for us to do: bury our differences and work together to achieve a long-term, sustainable settlement for the NHS and the care system.