NHS Funding Bill

Philippa Whitford Excerpts

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

[Matt Hancock]

Yes and yes; my hon. Friend anticipates my whole section on Mr PFI sitting over on the Opposition Front Bench. During his time in the Treasury, the hon. Member for Leicester South, managed to sign off some of the worst PFI deals. [Interruption.] The hon. Gentleman sighs, but I do not think he understands the damage he has done.

This Bill confirms that spending on the NHS will rise from £115 billion last year to £121 billion this year, to £127 billion, then £133 billion, £140 billion and £148 billion in 2023-24.

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

To clarify the point, are the Government committed to buying out the PFIs that are currently a burden on health boards and trusts?

[Matt Hancock]

We absolutely will be looking at doing that where we can. Unfortunately, that is difficult to do, because, over time, and especially during the time that the hon. Member for Leicester South was in the Treasury, the legals on these PFI deals got tighter and tighter. There are 106 PFI deals in hospitals and we are going through them. We will work towards making them work better for patients, and if that means coming out of them completely, I will be thrilled.

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[Dr Whitford]

The right hon. Gentleman’s overall figure for health spend is correct, but the public health spend—as opposed to private patients—is only 7.5% of GDP, and that is the figure the public are interested in, not the figure including people who can afford to go private.

[Jeremy Hunt]

I suggest to the hon. Lady, whom I greatly respect, that the overall figure is actually what counts. I agree that public health spending matters, but it is absolutely the case that we are heading to being one of the higher spenders in our commitment to health. That is very significant and should not be dismissed.

Often, the debate about funding can distort some of the real debates that we need to have about the NHS. One of those is the debate on social care. If we do not have an equivalent five-year funding plan for social care, there will not be enough money for the NHS. That is because of the total interdependence of the health and social care systems. It is not about finding money to stop people having to sell their homes if they get dementia, important though that is; it is about the core money available to local authorities to spend on their responsibilities in adult social care. I tried to negotiate a five-year deal for social care at the same time as the NHS funding deal we are debating today. I failed, but I am delighted to have a successor who has enormously strong skills of persuasion and great contacts in the Treasury. I have no doubt that he will secure a fantastic deal for adult social care to sit alongside the deal on funding, and I wish him every success in that vital area.

The second distortion that often happens in a debate about funding is that while everyone on the NHS front line welcomes additional funding, their real concern is about capacity. The capacity of staff to deliver really matters. I remember year after year trying to avert a winter crisis by giving the NHS extra money, and most of the time I gave the money and we still had a winter crisis, because ultimately we can give the NHS £2 billion or £3 billion more, but if there are not doctors and nurses available to hire for that £2 billion or £3 billion, the result is simply to inflate the salaries of locum doctors and agency nurses and the money is wasted. Central to understanding capacity is the recognition that it takes three years to train a nurse, seven years to train a doctor and 13 years to train a consultant, so a long-term plan is needed. It is essential that alongside the funding plan, we have in the people plan that I know the NHS is to publish soon an independently verified 10-year workforce plan that specifies how many doctors, nurses, midwives, allied healthcare professionals and so on we will need.

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[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.

[Alison Thewliss (Glasgow Central) (SNP)]

My hon. Friend is making a very good point about cutting away at prevention services. One of the services in England that has seen huge cuts is breastfeeding support. If such services are properly invested in, they can be a huge investment for the future of health, as well as for the here and now.

[Dr Whitford]

My hon. Friend does a lot of work on this topic. There is no doubt that a lot of investment must go into children’s earliest year, because our risk of so many conditions in later life is actually laid down between conception and the age of two. Energy and funding should therefore be focused at that point.

We have been waiting for three years for the promised Green Paper on social care, and there was absolutely nada in the Queen’s Speech. But this is a discussion about how to come up with an innovative system of raising the funds for social care. It is not an argument about whether social care needs to be funded. The answer is quite simple: it does. The gap is currently more than £6 billion. As well as spending more on health in Scotland, we also spend £130 a head more on social care, but that allows us to provide free personal care, which allows people to stay in their own homes and live their later life with dignity, where they want to be—where we would all want to be if we needed support. Last April, this care was extended to people under the age of 65 who need it because they have degenerative conditions such as Alzheimer’s, multiple sclerosis or motor neurone disease. This would be a worthwhile investment for the UK Government to consider, because we simply cannot fix the NHS without fixing social care.

The Prime Minister enjoys trumpeting his 40 new hospitals, when we know that there will actually be six, but there is no mention of additional capital funding to cover the more than £6 billion backlog in maintenance and repairs that the shadow Secretary of State described so vividly; one could almost smell some of the problems he was describing. This backlog built up when NHS trusts slid into £2.5 billion of debt after the introduction of the Health and Social Care Act 2012, because the transactional costs—the bidding and contracting—were taking so much money away from the frontline. Year after year, we saw this repeated movement from capital to resource just to keep services afloat. That has to be stopped.

The biggest challenge in all four health services is workforce shortages, and that challenge is already being made worse both by Brexit—with a 90% drop in European nurses and European dentists coming to this country—and by the issues around pension tax reforms that are driving senior clinicians, particularly doctors, to cut their hours and their shifts. These factors are making workforce shortages an acute issue. In their manifesto, the Government committed to 50,000 extra nurses, and we saw the Secretary of State leaping up and down in delight, boasting about it. We are to expect the extra nurses over the next five years, but the problem is that we are still waiting for the 5,000 extra GPs that were promised for the last five years, and there are actually 1,000 fewer GPs in England than there were five years ago.

Everyone should welcome the expansion of the nursing workforce from 280,000 to 330,000, whether it is done through recruitment or training, or whether it is due to retention; I do not have an issue with that. But this expansion was costed in the manifesto at £879 million. Now, I am sure that everyone welcomes the return of the nursing bursary, even if it is only half of that which we provide in Scotland. Unlike in Scotland, nursing students in England will still have to pay tuition fees, which is likely to deter some mature students, who have a tendency to specialise in mental health and learning difficulties—areas of huge nursing shortage. It is not clear what the £879 million is actually for. Surely it cannot be for the salaries, because they would each cost only £17,500 a year, which is not even the real living wage. If it is for training and the bursary, have the Government forgotten to add the salaries into this Bill, because 50,000 extra nurses is a significant hike in the NHS salary bill? If it is the former and they are planning to recruit on a salary of £17,500 a year, then good luck with recruiting anybody.

This Government simply need to reverse the real-terms cuts they have made over the past decade. On a point of principle, they also need to go back to discussing funding of the Department of Health and Social Care in the round, not picking out the NHS in England to make it sound like a big number while cutting everything else. It is critical to invest in prevention and in social care, so a return to departmental spending and departmental investment would be very welcome. In all of this, they need to make sure that they are wrapping services around the patient. The patient is the person who should be at the centre of NHS and social care.

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[Andrew Bowie]

I am perfecting it. I am delighted to be called to speak at this time in this debate on a Bill that demonstrates our commitment to implementing our promise to the British people in the last election to invest in our NHS: to invest a record amount in our NHS. In fact, we are talking about the biggest cash increase in the history of the NHS, delivering new hospitals, more nurses, more doctors, more primary care professionals in general practice and millions more appointments in GP surgeries every year across England; we are demonstrating once and for all that the NHS is safe in the Conservatives’ hands and putting an end, I hope, to the disgraceful, lazy, scaremongering trotted out every election by the parties opposite, which is in place of—in fact, caused by—a dearth of realistic policy proposals that appeal to the British people.

This is a debate about NHS funding. It has been rightly certified as relating exclusively to England, as this matter is fully devolved, and it has focused on the areas— how and where—the extra money will be best spent south of the border. However, it would be remiss of this House to let this Bill pass on Second Reading today without at least mentioning the effect that this transformative amount of money being invested in the NHS, coupled with decisions on funding in education, local government and policing taken by this Conservative Government, will have north of the border in Scotland.

Thanks to this Conservative Government, the block grant to Scotland will increase by an unprecedented £1.1 billion this year, to £29.3 billion, with £635 million of that increase due to our commitment, cemented here today, to boost spending on health to record levels, as it could be transformational. Indeed, it needs to be, for despite the bluff and bluster of the Scottish National party—or, in fact, because of the bluff and bluster of a Scottish National party obsessed with stoking division and grievance, and foisting upon the Scottish people another referendum that they do not want—the health service in Scotland is suffering.

Before I go on, I wish to put on record my thanks to the amazing people who work in NHS Scotland, particularly those at NHS Grampian. They do incredible work, going above and beyond to serve the people of Scotland and north-east Scotland. Their service and sacrifice are something that everybody in this Chamber is grateful for, and I include the hon. Member for Central Ayrshire (Dr Whitford) in that, not just for her service in Scotland, but her service overseas. My admiration for what she has done in Palestine knows no bounds. However, I do think that health service workers are being let down by the Scottish Government, for whom everything—investment in our NHS, the education of our children and the delivery of policing—plays second fiddle to the obsession of separation from the rest of the United Kingdom.

The story of the SNP’s management of Scotland’s NHS is, sadly, one of underfunding. Spending on the NHS in England increased by 17.6% between 2012-13 and 2017-18, whereas it increased by only 13.1% in Scotland in the same period.

[Dr Whitford]

The hon. Gentleman was not in his place when I spoke earlier to point out the fact that if the global funding in Scotland is higher, the Barnett consequential makes a smaller percentage. Scotland spends £136 more per head on health and £130 more per head on social care. I think he should go and work out a little bit of mathematics, because percentages relate to what the starting point is.

[Andrew Bowie]

I thank the hon. Lady for her intervention, but my figures were from the Scottish Parliament Information Centre, and that is a Parliament oft quoted by SNP Members. Moving away from funding, the story of the SNP’s record on the NHS in Scotland is also one of failed waiting time targets. The 12-week treatment time guarantee unveiled by Nicola Sturgeon when she was Health Secretary in 2011 has never been met—not once. For the quarter ending September 2019, just shy of 30% of in-patient and day cases were not treated within 12 weeks. The situation is even worse for my constituents living under the NHS Grampian umbrella, where more than a quarter of patients—34.6%—were not seen within the mandated 18-week referral time in the month ending September 2019. That is not the fault of the amazing people at NHS Grampian; how can they hope to meet targets when they are being so chronically underfunded by the SNP? According to the Scottish Parliament Information Centre, the 2019-20 cash allocated to the NHS Grampian health board was £7.7 million short of the target set by the NHS Scotland Resource Allocation Committee. The total shortfall over the decade for NHS Grampian is estimated to be £239 million.

I am sorry to say that the cancer waiting times are little better, with a fifth of people with urgent cancer referrals waiting more than two months for treatment. The target is that 95% of patients with urgent referrals are seen within 62 days, but this was met for only 83.3% of patients in the quarter ending September 2019. We have a GP crisis in Scotland—a shortage. It is shameful that the Royal College of General Practitioners expects a shortfall of 856 doctors across Scotland by 2021. There are delays to the promised Inverness medical centre, and fears over the same happening at the Aberdeen cancer and maternity units. There is a completed children’s hospital in Edinburgh, but it is sitting empty due to “ongoing safety concerns”. We also face a shameful, tragic situation at Queen Elizabeth University Hospital in Glasgow, where children have died and it has emerged that Health Protection Scotland reports had identified contamination risks as far back as 2016, with dozens of individual cases.

[Andrew Bowie]

I thank the hon. Gentleman for his intervention, and I tend to agree with him, but I have deliberately avoided getting into, “England is better than Scotland.”

[Dr Whitford]

indicated dissent.

[Chris Bryant]

indicated dissent.

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[Simon Hoare]

I would not be seen dead in my hon. Friend’s patch. I have enough issues with my own.

There are two community hospitals in my constituency: Westminster Memorial in Shaftesbury and the excellent Blandford Community Hospital. I am a friend of both, and both friends’ organisations do a huge amount of vital fundraising work. The Minister is well apprised of the important role such hospitals play, particularly in rural settings after discharge from A&E, just before people can go home. Community hospitals need support and fresh attention.

Likewise—I am pleased that the Department prioritised this earlier in the year—community pharmacists play a huge and important role. I am told by our CCG that it is almost a cardinal sin to even consider this, but I would love to see a representative of the community pharmacies on the boards of each CCG, by mandate, because they have a vital role to play in our NHS family. As the previous chairman of the all-party parliamentary group on multiple sclerosis, may I also urge a greater rapidity with regard to the prescribing of medical cannabis?

NHS dentistry needs a fillip. I am often contacted by constituents about this—indeed, I was contacted by a lady from Stalbridge the other week who has now been trying to get on an NHS dentist waiting list for two years. That is simply not good enough when dental health is coming under pressure.

Speaking with another APPG hat on, I know that my right hon. Friend the Secretary of State is alert to the need for a speedy renewal of the health grant for those suffering as a result of thalidomide. That takes place in 2022-23. We all know the story of thalidomide; I am not going to rehearse it. We owe the victims of that scandal our support, and I hope that the grant will be renewed, either from new money from the Treasury in the comprehensive spending review or from the current NHS budget.

This is an opportunity to think about the future of the national health service, as my hon. Friend the Member for Watford (Dean Russell) said. We would all hold it in even greater esteem if all of us, as patients, were alert to the cost—the actual cost—of our medicines and our treatments. There would be far fewer medicines flushed down the loo and far fewer appointments missed if people knew the true cost to them, as taxpayers.

A number of hon. and right hon. Members have referenced the need to bolster preventive health still further. There is far more that we can do. Very often, the NHS is a national ill-health service; it merely picks up the problems that a more proactive preventive agenda could have solved. In that regard, I make a plea, in particular, for bowel cancer and prostate cancer—indeed, for the male cancers generally, which often get overlooked.

[Dr Whitford]

In a debate in August 2017, the Minister at the time agreed to reduce the starting age for bowel cancer screening in England from 60 to 50—as it has always been in Scotland—but here we are, two and a half years on, and there is no sign of that. Does the hon. Gentleman agree?

[Simon Hoare]

I do. The stasis of the past few years, as we have wrestled with and resolved the issue of Brexit, has almost pushed everything else out of public attention and political action. I rather hope that now, having got Brexit done, we can move on, with a comfortable majority, to deliver on exactly these things. Forgive me, Mr Deputy Speaker, but I should have declared an interest, although non-remunerative, as a trustee of a bowel cancer research charity.

Representing North Dorset, a heavily rural constituency, I know that we are all alert to—I do not think anybody has the solution to this in short term—how we are going to address the demographic time bomb of huge numbers of rural GPs retiring.