NHS 10-Year Plan

Philippa Whitford Excerpts

Tuesday 19th February 2019 Commons Chamber

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

I welcome the principle of the long-term plan, as it certainly makes things easier for those who are running the health service, particularly after over eight years of real-terms cuts over the term of the last three Governments. It is trumpeted that there will be £20 billion extra by 2023-24, but that is still quite some time away, and on an annual basis that is 3.4% uplift. That is better than the real-terms cuts but less than what the NHS got in every year from its inception to 2010—and actually less than the 3.6% promised by the Prime Minister last August. It shows little recognition of growing demand and it should be considered per capita. In Scotland, we spend £163 per head more on health than is allocated in England. It is unfair to have just an overall figure and not recognise the growing demand on those services. It again focuses all the money on NHS England, basically to make it sound good, with cuts for public health and insufficient funding for training and for capital projects, and again insufficient funding for social care.

Social care will get a 2.9% increase, but it is estimated that the pressures are growing, at nearly 4%, and it cannot meet unmet need. Age UK estimates that 1.2 million people across the UK are not getting the care they need. In England, although need has almost doubled since 2010, the number of local authority-funded patients is down by over a quarter.

In Scotland, we have allocated £113 more per head for elderly care, which allows us to provide free personal care and keep people in their own homes for as long as possible. If they can stay in their own homes, rather than in hospitals or even in care homes, that is more cost-effective. We are still waiting for the Green Paper on adult social care—I seem to have been hearing about it almost since I was first elected.

The Secretary of State talks about the prevention agenda, and how prevention is better than cure, but public health funding will be cut by £200 million, and that comes on top of the £500 million cut it has already faced since 2014-15. The hon. Member for Central Suffolk and North Ipswich (Dr Poulter) mentioned alcohol and addiction services, and we have heard about cuts to sexual health services. The long-term plan talks about reducing the burden of cancer, but it makes no mention of cuts to smoking cessation services, or of an obesity strategy that does something to stop junk food being advertised to children on television before 9 pm.

The Secretary of State has mentioned the “making every contact count” approach, which has been in place for most of my career. When I am dealing with a breast cancer patient, I always get them to promise me that they will come back, once we have got through the stress of their treatment, and that they and their partner will commit to giving up smoking, but I cannot deliver their smoking cessation; I still need a service that I can refer them to, such as Fresh Air-shire, where they will get support to achieve it.

As has been mentioned, the biggest challenge of all is workforce. It runs right through the long-term plan, which will not be deliverable unless the workforce challenge is dealt with. NHS England faces 100,000 vacancies, including 41,000 nursing vacancies, yet Health Education England is not facing an uplift in its funding and has previously faced a real-terms cut. The Minister talked about the move to community nursing, but there is a 50% cut in district nurses, and in 2021 none will graduate because the course is being lengthened. That will not support moving services into the community.

The nurse vacancy rate is 11.6% in England, which is more than twice the rate in Scotland. Indeed, Scotland has already reached what is supposedly the target for NHS England by 2028. In fact, the Royal College of Nursing estimates that in the next 10 years vacancies will grow to 48,000. That creates more stress on staff, encourages more people to leave, reduces quality of care and increases waiting times.

It is absolutely critical to tackle that, but what do we have? We have the removal of the nursing bursary and the introduction of tuition fees. We did not do that in Scotland, which is why we have a 14% increase in the number of students starting degree courses. In England the number is actually down by 4%. The Minister might well respond by talking about apprenticeships, but only 300 of those were taken up in 2017-18, instead of the thousands that were trailed, so they will not replace the drop of 900 in degree students. That means the Government are simply not producing enough nurses ever to fill the 41,000 vacancy rate. With a 90% drop in those coming from the EU, that will only get worse.

The Secretary of State loves to talk about digital. I have to say that I think he has a bit of an obsession with replacing GPs with apps. As a surgeon, I cannot promise that rubbing a mobile phone over the belly will diagnose appendicitis, so good luck with the app. But there are parts of the NHS where digital could really help. In Scotland, we have a system called PACS—the picture archiving and communications system—which allows radiologists elsewhere in the country to look at images. We have electronic prescribing, which saves time and effort as well as being a safety action, because we cannot prescribe a drug that the patient is allergic to, and it will pick up interactions. Electronic records make cancer pathways easier.

The Government’s response is integration and I have supported that on many occasions in the Chamber. However, it is important how it is done. The NHS in England has gone round and the round the loop of reorganisation. It is critical that those integrated care systems have a statutory body at the top and that section 75 of the Health and Social Care Act 2012 is repealed to stop forcing the outsourcing of contracts. Tariffs also need to be tackled. Tariffs reward hospitals for admitting, when it is important that people are treated in the community.

We will make a difference only when the Government take a “health in all policies” approach. Poverty is the biggest driver of ill health, so stopping the welfare cuts would be a good start.