NHS Performance: Darzi Investigation

Nusrat Ghani Excerpts

Monday 7th October 2024 Commons Chamber

[Helen Morgan]

I thank the right hon. Gentleman for his intervention. There is a general problem with care in the community of all types not being there for people. We have people in places where they will not get better as quickly—in some cases, their situation may be deteriorating—because that care is not available. Mental health provision in my constituency is absolutely appalling. People register with a doctor over the border just to access better mental health care. I could not agree with him more.

In conclusion, the Darzi report is shocking, but it is not surprising based on the experience of my constituents. Poor access to primary care—whether that is GPs, dentists or early mental health intervention—is leaving people in pain and distress. Long waiting lists and crumbling hospitals are leaving people unable to get back to work, with their situation deteriorating, and the crisis in social care—the elephant in the room—is depriving people of their independence and leaving them in hospital when they could be at home. The new Government must make fixing the NHS and care their No. 1 priority. Liberal Democrats will be here to provide constructive opposition to ensure that they do.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Ben Goldsborough to make his maiden speech.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. As the Front-Bench contributions went on for so long, Back Benchers will now be limited to three minutes, and I ask that maiden speeches be limited to five minutes to squeeze in as many people as I can. I call a tieless Dr Luke Evans.

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[Valerie Vaz (Walsall and Bloxwich) (Lab)]

It is a pleasure to follow the hon. Member for Hinckley and Bosworth (Dr Evans).

The report is a tour de force from Lord Darzi, and I thank him for his work. The Secretary of State rightly commissioned the report as a benchmark for future improvement. I was a member of the Health Committee from 2010 to 2015. Given the evidence we heard, there was no alternative but to pause the Bill—the Committee played an important role in that. Chapter 10 of the report sets out the structure. Lord Darzi points out that the 2012 Act was three times the size of the original Act setting up the NHS. The 2022 Act moved into integrated care, and in paragraph 15 on page 121, he raises some concerns about how the ICBs—integrated care boards—operate, and their accountability. Could there be a review into how they operate? Paragraph 37 highlights that trust chief executives’ pay is based on the turnover of the organisation, which encourages trusts to

“grow their revenue rather than to improve operational performance.”

Some are even paid more than the Prime Minister.

The flow of patients is important, which is where working with local authorities is so important. We can move planes around the world, but it seems we cannot move people out of hospital. The Select Committee visited Torbay, which was set up in 2009. We followed Mrs Smith from a single point of contact all the way through. As Lord Darzi said on page 77, collaboration is not the same as integration. On page 5, paragraph 13, he points out that too great a share of the money is spent in hospitals rather than in the community. On page 81, he said that “GP…contracts are complex” and doing the right thing for patients is the wrong thing for GP income. He said, “That cannot be right.”

Our mantra should be “prevention, prevention, prevention”. In our report, we said that public health should be moved into local authorities. As Lord Darzi said, health visitors are dropping. He also said that the NHS is missing an opportunity to intervene early. We had Sure Start, which is where health visitors were focused. He talked about clinical negligence. Some £2.9 billion— 1.7%—of the budget is spent on settling claims. Can the Secretary of State pursue the duty of candour and ask each trust to look at whether they can move cases into arbitration?

Sadly, disparities by ethnicity make very grim and sad reading. Paragraph 24 refers to the median age at death as 62 for white people, 40 for black people, 33 for Asian people and 30 for those from a mixed background. There was supposed to be a chart in the report, but it is not there. Will the Secretary of State look at producing it?

Lord Darzi’s report gives the Secretary of State and the health team an important opportunity to re-set the NHS. It is the envy of the world and free at the point of use. As Lord Darzi said, we cannot afford not to have an NHS.

[Madam Deputy Speaker]

I call Monica Harding to make her maiden speech.

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[Madam Deputy Speaker]

I call Terry Jermy to make his maiden speech.

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[Alex McIntyre (Gloucester) (Lab)]

I congratulate my hon. Friends the Members for South Norfolk (Ben Goldsborough), and for South West Norfolk (Terry Jermy), and the hon. Member for Esher and Walton (Monica Harding), on their wonderful maiden speeches.

I first wish to pay tribute to my predecessor, Richard Graham. Richard represented Gloucester and its residents for 14 years, and I thank him for his service. In the last Parliament, he worked to make spiking a specific criminal offence—something I am proud that this Government will deliver.

It is the most incredible privilege to stand here on behalf of Gloucester residents and to make my maiden speech in this debate, and it is particularly appropriate for three reasons. First, my local NHS hospital, Gloucestershire Royal, has played an important part in my family’s life. It was where my wife and I spent our first night with our little boy, who turns one later this month. I have also spent much of my professional career representing NHS trusts up and down the country, and I have heard at first hand some of the challenges they face, particularly in the recruitment and retention of frontline key workers, to whom I am sure we all owe a personal debt of gratitude. It is also appropriate because I know how many families in my constituency are struggling to get the NHS care they need and will recognise many of the findings in Lord Darzi’s report. Seeing a GP, going to the dentist for a check-up or arriving at A&E in an ambulance and going straight through the doors—those might seem like the basic requirements of a functioning health service, but for my constituents they have become a luxury.

Gloucester is a city rich with potential. We are a city small in size but giant in stature. We have a proud history stretching back to the Roman colonia of Glevum, one of the administrative capitals of Roman Britain. We are one of only three cities in the UK to have hosted a coronation, and our mighty cathedral soars above the city skyline. Younger Members of the House will recognise the cathedral’s cloisters as part of the magical world of Hogwarts, while older Members may recognise our city and our tailor as part of the magical world of another famous Potter—Beatrix.

Last month, we celebrated Gloucester Day, which marks the end of the siege of Gloucester, in which our city stood tall when all hope appeared lost. You can still find brilliant examples of our wonderful heritage across the city, perhaps on a visit to the Folk of Gloucester or on a tour with the Gloucester Civic Trust. We also have a proud military history, from the Glorious Glosters to RAF Quedgeley, which is now Kingsway; and our historic docks, recently designated a heritage harbour by the Maritime Heritage Trust, are home to the brilliant Soldiers of Gloucestershire Museum.

Gloucester also stands out as a place of great innovations: the vacuum cleaner, the ferris wheel, the first jet aircraft and, of course, Viennetta were all pioneered in our great city. But our potential to be great is not confined to the history books—and no, I am not just talking about the country’s finest rugby team, Gloucester-Hartpury, who have won the premiership women’s rugby title two years in a row. The seeds of change were sown in recent years—first under Parmjit Dhanda, Richard’s Labour predecessor, and then under Richard—with the regeneration of the Quays, the Forum and the exciting new university campus, which is due to open next year. But we can and we must go further; plans for the redevelopment of Podsmead and Matson must be brought to life, and brownfield sites across the city turned into the social housing of the future. This Government’s mission to get Britain building can and should unlock our city’s potential.

However, it is not in development that our city’s greatest potential lies; that potential is, of course, in our people—the brilliant people of Gloucester, who are community-minded, fiercely proud and quite happy to tell me exactly what they are thinking. As the new MP for Gloucester, I know that although potential is found in all residents in our city, opportunity is not. I entered politics because I see the potential of every child in Gloucester, and I want to fight to ensure that opportunities like the ones I had growing up in a working-class family under the last Labour Government are open to every single family like mine in our city. When I visit schools in my constituency, I see the next generation of solar and wind engineers, the next cohort of developers and cyber-security experts, and the carers, nurses and doctors who will look after me when I am old.

Gloucester is a diverse city, with over 70 different languages spoken on Barton Street alone—a city that stood united during the uprising of racism and Islamophobia we saw elsewhere in the country this summer—but more needs to be done. At a recent meeting of the Gloucestershire Race Collective, I promised to use my position in this House to give voice to the concerns of our diverse communities in Gloucester, and to work with this Government to tackle rising levels of racism and Islamophobia in our country.

As I work with this Government to deliver on their mission to provide opportunities for everyone in my constituency, regardless of their background, I hope that those opportunities will strengthen the already incredible bonds that bring our city together. Those bonds are best demonstrated by some of the amazing community organisations and charities working in our city, like Gloucestershire Gateway Trust, whose Bridging the Gap programme helps break down barriers to work and gets local people into sustainable employment; like Gloucester Feed the Hungry, whose warm welcome, hot coffee and delicious samosas put a smile on the faces of so many in our city; and like the Holly Gazzard Trust, which is tackling domestic abuse and stalking, turning that family’s personal tragedy into a safer future for all. There are many more such organisations—I could go on all day, but I am conscious of time—that demonstrate the very best of our city: a community that is driven to help others to achieve their potential.

In closing, I make a simple promise to the constituents of Gloucester and the community that I am so proud to serve: I will work tirelessly to deliver a better future for our city. It will be a future in which everyone can access the NHS care they need and every child has the opportunity to thrive; a future that celebrates our heritage, our potential, our diversity and our community—our Gloucester.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Ian Sollom to make his maiden speech.

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[Rachael Maskell (York Central) (Lab/Co-op)]

Is a real pleasure to follow the new hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom). I am sure that he will be a rising star on the Liberal Democrat Benches. It is a pleasure to follow all hon. Members who have made their maiden speech today.

I am really grateful for the analysis that Lord Darzi has set out for us. The NHS has never been under such duress, nor have its staff, but following a diagnosis, we need a prescription. That is what I want to talk about today. We live in an ageing society, and while we celebrate the medical advances since Labour was last in power—in diagnostics, treatments, digital and technology—we know the urgency with which we need to apply them. Transformation has to be central to the agenda. I congratulate the Secretary of State on his focus on the NHS bringing about the transformation that is needed.

However, before we can look at that, we need to look at the financial flows in the NHS, which are not working, and the governance structures. I am not talking about reorganisation; I am talking about having one controlling mind in the right place in the service, overseeing the system. At the moment, there is too much focus on secondary care. That is sucking resources and work into that part, and driving inefficiency. Moving services into primary care is the key to unlocking the productivity and savings that are needed. It will improve health as well.

In the short time that I have, let me point to two examples in my community. First, in mental health, 30 Clarence Street is set up to be open access, so that there are no more long queues to see mental health practitioners, and multidisciplinary, with the public sector and the voluntary sector working hand in hand to meet people’s needs. I invite the Secretary of State to come and see that service, because it is what we should be doing across our NHS. Two more hubs are to be set up in my constituency, leading the way on mental health. Then there is the work of Nimbuscare in primary care settings; it is pulling out from the NHS all the services that do not need to be in the secondary part. It is unplugging the backlog at the front door of the health service, while ensuring that we are looking after people at the back door. That is the transformation that our health service truly needs. I wanted to share those examples, and set out how they can be extended to build the NHS of the future.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Susan Murray to make her maiden speech.

[Susan Murray (Mid Dunbartonshire) (LD)]

Thank you, Madam Deputy Speaker, for calling me to make my maiden speech. It is a pleasure to speak after the many excellent maiden speeches we have heard, including from the hon. Members for South Norfolk (Ben Goldsborough) and for South West Norfolk (Terry Jermy), my hon. Friend the Member for Esher and Walton (Monica Harding), the hon. Member for Gloucester (Alex McIntyre) and my hon. Friend the Member for St Neots and Mid Cambridgeshire (Ian Sollom). That took a bit of time, but it is important that those excellent speeches are acknowledged. I enjoyed listening to them all.

It is a great privilege for me to stand here today representing Mid Dunbartonshire, and the communities that are close to my heart. I have lived there for 30 years, and it is where both my sons went to school. Mid Dunbartonshire is in Scotland, in case Members had not noticed. It is a new constituency, following boundary changes this year. It sits 100% inside the East Dunbartonshire council area, as did the old constituency of East Dunbartonshire, but it now includes Lennoxtown and Milton of Campsie to the north and some of Lenzie to the east. I am delighted that these towns are now in the constituency I represent, but my sorrow is that it does not include Kirkintilloch East and Twechar, which are also dear to my heart and where I have been a councillor since 2017. I am sure that the hon. Member for Cumbernauld and Kirkintilloch (Katrina Murray) will look after the community there, and it was good to hear her highlight the problems with local bus services in her maiden speech.

It goes without saying that Mid Dunbartonshire is the best constituency in the UK. Local towns are regularly promoted as the best place to live in the UK—Bearsden in 2021 and Kirkintilloch in 2024—and in 2017 “Woman’s Hour” revealed East Dunbartonshire as the best place in Britain for women to live. Incidentally, that was when Jo Swinson began her third term as the Liberal Democrat MP for East Dunbartonshire, so I thank Jo for all her work in the constituency. I also want to recognise her successor, Amy Callaghan, and particularly the personal challenges that Amy overcame during her time as an MP. She has shown such courage in her service to the community, and I wish her well in the future. I also thank Stuart McDonald, who was the MP for the newer part of the constituency. I know that he is held in very high regard and with much affection in that area.

I am pleased to speak in the debate on Lord Darzi’s report, because I know only too well the challenges that individuals and families have to face when our health lets us down. In 2006 my husband had a brain haemorrhage, which changed our lives in an instant. I became his full-time carer and could not continue in my profession, and he was never able to return to his career. From being comfortably off, life changed to watching every penny. Without the support of our family, we could have lost our home, and we were very fortunate. Friends and our community helped me to survive and get on with life. I cannot praise NHS Greater Glasgow and Clyde enough. My husband spent months getting well enough to come home from hospital. Perhaps we were lucky with the timing, because at that time the excellent, talented and caring staff had the resources, which I have seen decline ever since.

I worked in the NHS before a career in medical marketing. I know the NHS from working in it and with it, and from my experience of visiting my husband. Latterly, I have been aware of the integration of health and social care through my role on the council. I know the pressures that good, kind, caring professionals are under to become as efficient as possible, and they are absolutely doing their best.

Looking back, that was the beginning of my involvement in politics. I was thrown into the space that our society refers to as “community”. I know why it is important for Government to fund local authorities and communities and to give them real power. They prevent costs to the NHS every day by stopping the revolving door of treatment, discharge home and relapse back into treatment, and they support self-care and wellbeing. They are our CPS—not the Crown Prosecution Service, but our community prevention service, which pays back investment in spades by preventing costs.

What makes Mid Dunbartonshire special is its people and communities. Like in other places, during covid the community stepped up to support each other, and groups are still helping with shopping and patient transport. There are groups of volunteers fighting climate change, reducing social isolation, providing mental health support and peer support, supporting carers, providing financial advice, helping with housing problems, looking after community buildings, preserving our heritage, knitting for peace, and promoting fair trade, performance art and more—tackling problems at home and internationally. Mid Dunbartonshire people care and take action. From listening to other maiden speeches, I know that that is happening all over the UK. Liberal Democrats want to harness that power for good.

One message that came across loud and clear on the doorsteps was that residents in Mid Dunbartonshire are tired of voting against things; they want to vote positively for things. Thomas Muir of Huntershill in Bishopbriggs was a famous son of Mid Dunbartonshire. At the end of the 18th century, he was a strenuous advocate of equal representation of the people in the House of the people, where I stand today. He said:

“I have devoted myself to the cause of the people. It is a good cause. It shall ultimately prevail. It shall finally triumph.”

The fight for fair votes prompted revolution at the end of the 18th century, and Thomas Muir was found guilty of sedition and transported to Australia for his efforts. In the 19th century, it took three reform Acts of this House to slowly extend voting rights for men. In the 20th century, the Representation of the People Act 1918 gave voting rights to some women and to men aged over 21. But it was not until 1928 that all adults had the right to vote. Today, in the 21st century, the call for better democracy continues.

The turnout in Mid Dunbartonshire at the last election was almost 72%, but many constituencies had a turnout in the low 40 per cents. The result shows a clear failure to engage a huge number of voters. I call on the Government to consider carefully the mandate that the result gave them, to treat every potential voter with dignity and respect, and to make the change to give every vote an equal weight, no matter where it is cast. This is an opportunity to end self-serving and self-obsessed politics, and to truly introduce the politics of service.

I will join my colleagues in this place in scrutinising Government proposals and working constructively with them to improve the quality of life for my constituents and all residents of the UK who make up the rich diversity of our communities.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Luke Murphy to make his maiden speech.

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[Several hon. Members rose—]

[Madam Deputy Speaker]

I call Adrian Ramsay, who has two minutes, and I can then squeeze in one more speaker.

[Adrian Ramsay (Waveney Valley) (Green)]

Thank you, Madam Deputy Speaker. It is a pleasure to follow the new hon. Member for Basingstoke (Luke Murphy) and hear about his pride in his constituency.

Our NHS provides amazing life-saving, dedicated care every day, but we also know that people are too often let down. Too many patients languish, often in pain, on long waiting lists. In rural constituencies such as mine, people often have to travel lengthy distances to access treatment. Lord Darzi points to systemic and chronic under-investment caused by austerity in funding and capital starvation. Resilience was stripped from the NHS before covid, and we owe it to those whose lives were lost or changed forever by the pandemic never to repeat these same mistakes and to do things differently. However, the Chancellor’s arguments about tough decisions and a black hole of £22 billion are alarmingly similar to those made by the previous Government. It is good to see the Chancellor signalling some movement on fiscal rules, and I hope this logic will apply to supporting our public services, which are a crucial investment in our future.

Putting wellbeing at the heart of what we do should help us navigate how we support the NHS. Bad planning, poor housing, weak transport and divisive social policies have a huge impact on health outcomes, for example. So I welcome the Secretary of State’s comments and he has been bullish about reform, but he has not been specific about exactly what he means by private sector involvement in the delivery of NHS services. There are real reasons to keep delivery of the NHS public, and not to outsource it to private providers. The Secretary of State has made statements about using the private sector to reduce waiting lists, but he has not explained whether he considers this to be a short-term plan while the NHS is being rebuilt, or a permanent policy. Lord Darzi’s diagnosis was helpful and the emphasis on prevention is hugely welcome, but to deliver it we require bold action and investment.

[Madam Deputy Speaker]

Order. Thank you so much, but please be seated.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

Fixing the NHS is our great task and our solemn promise, for there is much to fix after 14 years of managed chaos and decline under the neglectful eyes of our mostly absent predecessors. The candid assessment of the state of the NHS from Lord Darzi is truly alarming, and as my right hon. Friend the Secretary of State has said, it presents an accurate diagnosis of our difficulties. The report makes clear many of the problems of resources, management and structure, but today I would like to speak up for medical research, of which this country has such a proud record.

We all know of the catastrophic potential of infection, witnessed so very recently during the covid pandemic. Indeed, like many of us new Members, I too caught covid right here in this House in the crush to hear the King’s Speech. I do hope that hon. Members of a certain age, such as myself, will remember to get vaccinated. However, let us remember Jenner, who devised vaccination, Lister, who pioneered antisepsis, and Fleming, who discovered penicillin. These British scientists leading the fight against infection were probably responsible for saving more lives than any other people in the long history of medicine.

Last week, we learned of the first successful trials from Oxford of vaccines for ovarian cancer, and we will see many amazing advances in the year to come. Today, we can be excited about molecular genetics, artificial intelligence and the huge power of our people’s NHS data to unravel so many of the mysteries of modern medicine. I know that our Government will develop bold plans to repair the embattled NHS, but on this day I urge our brilliant new Government to pledge to do their utmost to support vital NHS medical research, which carries such promise.

[Madam Deputy Speaker]

Order. Thank you so much, but you must not continue speaking when I am standing. I call the shadow Minister.

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Motion lapsed (Standing Order No.9(3)).

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. We did manage to get in 16 speakers even though we had a short amount of time due to Front-Bench contributions.