NHS Funding Bill

Patrick Grady Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Matt Hancock]

I want to finish this section, Madam Deputy Speaker. The crucial thing in this Bill is the certainty: the Bill provides everyone in the NHS with the certainty to work better together to make long-term decisions, get the best possible value for money, increase the productivity of the NHS and improve how the health system is organised and delivered. That is not just tied to what has been done in the past, but is driven by a clear view of what the NHS needs to do in future, exactly as my hon. Friend the Member for South Dorset (Richard Drax) said.

[Patrick Grady (Glasgow North) (SNP)]

If the Secretary of State is so proud that these figures represent a floor and not a maximum, why have the Government tabled such a restrictive money resolution? It means that it will be impossible for Members to table their own suggestions about higher amounts—bringing UK health spending in line with per capita spend in Scotland, for example, despite the fact that the Bill is subject to the English votes procedure.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Having spent 33 years as a surgeon at the very sharp end of the NHS, I welcome the multi-year funding because it should allow better planning, but it does come after a decade of drought. Between 2010 and 2015, the average annual uplift was 1.1%. Between 2015 and 2018, it was only 2%. That means that over that period of eight years—during a time of inflation, and particularly rising demand with an ageing population—the NHS in England faced a real-terms cut, which is why quoting the spend per head is actually more realistic and more accurate. Scotland spends £136 a head more on health, which is why the Secretary of State is forever claiming that Barnett consequentials are not passed on in Scotland. Every penny of resource consequentials are passed on, but here is a little explanation of percentages: if the starting amount is bigger, the same amount will be a smaller percentage. We have explained this before, but we keep hearing this nonsense. In actual fact, if the Scottish Government used the same per capita spend on health as the UK Government does for England, Scotland would be £740 million worse off.

[Patrick Grady]

I have raised with the Minister the concern about the cap that the Government have put on the spending figures through the use of the money resolution, but the whole Bill is going to be committed to the English Legislative Grand Committee, so Members from Scotland are not going to be able to table amendments to pursue exactly such points with the Government. We are not going to be able to inquire, as other Members from the rest of the UK will be able to do, table probing amendments or question the impact of the Government’s spending. Does my hon. Friend agree that that really undermines the point of this being a sovereign UK Parliament?

[Dr Whitford]

The whole issue of English votes for English laws applying to Bills that have direct Barnett consequentials for the three devolved Governments is obviously complete nonsense, and certainly makes all devolved MPs second class.

The Government are committed to £33.9 billion a year in cash terms by 2024. As has already been pointed out, that is actually just the same £20 billion that was promised in 2018. It is not extra, new money. It is not on top of the £20 billion. It is the same amount. It has been described as a 3.4% increase in real terms, but the Health Foundation has already suggested that, due to inflation, it is actually only 3.3%, and the Institute for Fiscal Studies predicts that it will be only 3.1%. The key problem of making a commitment in cash terms is that if inflation rises post Brexit—by which I mean at the end of 2020—as is likely, the commitment would simply wither on the vine. It should be front-loaded because the urgent need is now, and it should be in real terms; otherwise, talking about 2024 in cash terms is actually just pie in the sky. The three main health think-tanks and the British Medical Association think that 4% is required to restore the service to the performance that is expected. More than that would be required for service redesign, to match the shopping list we heard the Secretary of State recite.

I am glad that the Secretary of State has moved away from talking about apps. The idea that people are going to rub a mobile phone over their tummy to diagnose appendicitis is for the birds. People need doctors. Healthcare is delivered by people, and the idea that an app on our phones can replace that is just nonsense. However, I was glad to hear the Secretary of State talking about internal IT in the NHS in England because, frankly, it has fallen behind since the Care.data scandal. There is a lot that could be done IT-wise to utilise the existing workforce in a much better way. In Scotland, radiologists can view any X-ray anywhere in Scotland through the picture archiving and communications system. We have electronic prescribing, which is not only efficient, but a patient safety issue because doctors cannot prescribe a drug to which the patient is allergic. These are things that should be focused on, rather than gimmicky apps on mobile phones. Again, this is just money focused on the NHS revenue funding.

The NHS long-term plan, exactly like the 2015 five-year forward plan—we are seeing a bit of a theme here—was predicated on game-changing investment in both public health and social care. The public health grant for local authorities that is currently proposed is only expected to rise by 1%. That means a significant real-terms cut, on the back of £850 million of cuts that have already happened, resulting in a reduction in smoking cessation, sexual health and addiction services. That does not make sense, as even the Secretary of State admits that prevention is better than cure.