Building an NHS Fit for the Future

Richard Fuller Excerpts

Monday 13th November 2023 Commons Chamber

[Richard Fuller (North East Bedfordshire) (Con)]

May I join my right hon. Friend the Prime Minister in thanking His Majesty for his Gracious Speech, as there was much in it to commend? As this issue is dear to my heart and the hearts of many councillors in Bedford borough, let me thank the Government for saying that they will introduce changes on estate management charges to homeowners. Those charges affect perhaps 1 million homeowners across the country and this is an unregulated area. It is important that those people have improved rights to challenge and I look forward to seeing what the Government come forward with.

Let me also say what a pleasure it is to follow the hon. Member for Salford and Eccles (Rebecca Long Bailey). Like many of her colleagues, she bemoaned the fact that the King’s Speech contained so few Bills and that the Government were not trying to do more. Let me make a counter point: many people think that the Government are already trying to do too much. These people are fed up with their businesses and lives being too regulated, and their taxes being too high. They are fed up with being told what they can and cannot say, and when they can and cannot demonstrate. People want to be free to live their lives. Government can play an important enabling role, but I say to her that the most important thing is the quality of the legislation proposed, which we all have a role in forming, rather than the quantity.

The topic of today’s debate is an NHS fit for the future. When I became the MP for North East Bedfordshire, it was clear that growth in population and in housing was driving many of the issues that affected my generally rural constituency. That is why “infrastructure first”, whereby we get the infrastructure in place before putting in more housing, was important for the future, while recognising that the growth over the previous two decades had had a significant impact, most importantly on primary care.

I have visited literally every GP practice in my constituency and spent an hour there, with one exception—it is still to come. I have found out about discrete issues that are important in how local residents feel about their GP services, including the choice of phone system. I think that the move to the cloud-based phone system by the NHS is welcome. I found out how people feel about the skills mix, where we have more non-GPs. Some parts of the community find that making the transition from seeing their normal GP to seeing another differently qualified member of staff creates problems, but in the long term it is useful. I found out that the different methodologies for accessing primary care—not just walking in or getting an appointment by phone, but getting access through email, the net or an app—have created extra pressures on primary care doctors. However, they are there to see it through to the end and they think it will have long-term benefits.

I thank all my local GPs across the constituency. A couple had particular difficulties, but I am pleased to say that progress in those two practices has been substantial since changes have been made. Despite the fact that all Members here feel that primary care has gone through quite a difficult process after the covid experience, in my constituency we have made progress, although there is still more to be made. It is a shame to see my hon. Friend the Member for Harborough (Neil O’Brien) moving from his role in primary care, not least because I had just arranged a meeting with him and the leader of Central Bedfordshire Council to discuss the Biggleswade health hub. May I make a quick plea to those on the Front Bench that that meeting should be put back on the schedule as soon as possible?

Social prescribing was mentioned by the Minister in her opening remarks and it is a positive initiative. I visited the Bedfordshire Rural Communities Charity, which has taken on that responsibility. What a great form of outreach that charity and its volunteers and recruits have taken on with this role of social prescribing. In addition, there is a bit of pressure on local pharmacies, with some of the national changes altering their strategies. Others, however, are coming forward with positive initiatives, including Jardines pharmacy in Biggleswade, which has just launched its out-of-hours, Amazon box-type option for people to get their prescriptions.

In discussing improvement, I wish to mention four areas where there is change. On capital for the NHS, the issue is not primarily one of needing more money. Capital for the NHS in this five-year period will be 60% greater than it was in the previous five-year period. The issue is the process by which that capital is allocated and the choices that are made. We are also seeing people coming forward to help with capital. We recently had a change in the elected mayoralty in Bedford, with the replacement of a Liberal Democrat Mayor by a Conservative one, Tom Wootton. I am delighted that as one of his first measures, he has provided capital from the council’s budget to bring forward the provision of primary care services in the constituency and the rest of the borough. I look forward to those improvements being made in Great Barford and in other constituencies—I know it is happening in Wixams and Wootton. I commend an elected Conservative Mayor as the way to get local primary NHS facilities improved. Well done, Mayor Tom Wootton.

We need to provide more access for private capital if we are to enable a range of diagnostic centres across the country. I think that people are prepared to put private capital in place, but decision rights on how we all access diagnostics need to be given to us, not held by the NHS. Because of the limitations on time, I will mention compensation briefly. How on earth did we end up with a GP pay system that means that those who choose their hours and do not take on the responsibility of being a partner end up getting paid more lucratively than those who are full time or who are partner GPs? We need to reinforce the partner GP model, not turn our back on it.

I know that the Government are in discussion with junior doctors about this, but the circumstances in which we train our doctors has changed substantially. There is much greater global competition, both in terms of trying to bring people to the UK—the NHS brand is not as strong as it used to be—and in what people will do when they leave their training, such as moving to the middle east or to other health markets. We also need to recognise that many of our junior doctors now carry student debt, which the original model did not anticipate that they would have, and therefore the charging of ongoing fees for annual training is important. We must also recognise that junior doctors want to spend most of their time training and being with patients. The Government should look acutely at ways they can reduce the admin burden.

On decision authorities, it seems odd to have a system where integrated care boards bring together local councils and the local NHS—my area has a £2 billion annual budget—yet local people who understand local health needs have almost zero decision rights over how that money is spent. I do not see how the future of the NHS in the long term can be such a top-down, budget-driven system with so little local discretion if it is to succeed.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

It is a real pleasure to close this important debate and to follow my hon. Friends the Members for North Tyneside (Mary Glindon) and for City of Durham (Mary Kelly Foy) who spoke powerfully about the need to take more action to help people quit smoking and not take up smoking in the first place. As a former smoker myself, I wish to goodness that I had never ever taken it up, and I can reassure Members that a Labour Government would do everything within our power to take further action in this area.

My right hon. Friends the Members for North Durham (Mr Jones) and for Walsall South (Valerie Vaz), and my hon. Friends the Members for Tooting (Dr Allin-Khan) and for Putney (Fleur Anderson) rightly held the Government to account for once again failing to bring forward legislation to reform the Mental Health Act 2007, despite all the serious problems that need addressing, all the promises that have already been made and the cross-party agreement that there is on the need to act.

My hon. Friends the Members for Blaydon (Liz Twist) and for Liverpool, Wavertree (Paula Barker) talked about the importance of reforming social care—another area where promises have repeatedly been made and repeatedly been broken—and the real importance of giving older and disabled people more support in the community, rather than their ending up in hospital, which is worse for them and worse for taxpayers.

My hon. Friends the Members for Ellesmere Port and Neston (Justin Madders) and for Ealing North (James Murray) rightly talked about the desperate need to build more affordable housing, including social housing, to tackle problems in the private rented sector, and to reform leasehold. Those are huge issues in my constituency. My hon. Friend the Member for Nottingham South (Lilian Greenwood) talked about the terrible problems of people waiting in huge pain and distress in ambulances or on trolleys in A&E, and many hon. Members talked about the need to improve GP access and dentistry care.

Last but by no means least was my hon. Friend the Member for Luton South (Rachel Hopkins), who talked about the fantastic work her council is doing to tackle health inequalities, and the need to understand that a good job is part of a healthy life, and good health is vital to getting a job.

The point that I wish to make today is that the health of our nation is critical to the health of our economy and that, after 13 years of the Conservatives, both are in a perilous state. There was nothing in the King’s Speech to address these problems or meet the scale of the challenge we face. But Labour has a plan: to improve the health of the nation; to get Britain working again; and to give our country its future back.

Ministers repeatedly attempt to claim that everything in the garden is rosy when it comes to the state of our economy and to employment, but the truth is that we are the only country in the G7 with an employment rate that still has not returned to pre-pandemic levels. The underlying reason for that is the increasing number of people out of work due to long-term sickness. Some 2.6 million people are now shut out of the labour market due to ill health, which is the highest number ever. Frankly, that is a scandal in what is still, despite all our problems, one of the richest countries in the world. Around half of this group are more than 50 years old—that is more than double that of any other age group—and musculoskeletal problems, such as bad hips, knees, backs and other joints, are the most common problem.

Many of the over-50s are also caring for elderly, sick or disabled loved ones, for which there is precious little help and support. Women are consistently more likely to be workless due to long-term sickness than men. Indeed, women account for more than two thirds of the increase that we have seen over the past decade. But the rise in worklessness due to long-term sickness is not just an issue for older people; there has been a sharp and hugely worrying increase in the number of young people not working due to ill health, predominantly driven by mental health problems—an issue that many of my colleagues have raised. The number of 18 to 24-year-olds who are workless due to ill health has doubled in the last decade, while the number of 24 to 35-year-olds has almost trebled. Those problems are even more likely for young people who lack basic qualifications and who live in parts of the country that are struggling economically, often outside our big cities in towns and rural and coastal areas.

The fact that such problems are more likely to affect certain parts of the country in the midlands and the north comes as no surprise to Opposition Members. In Conservative Britain, people are twice as likely to be out of work due to ill health if they live in one of the most deprived areas in England than if they live in the least deprived areas, with rates of economic inactivity due to long-term sickness in the north-east and midlands almost double that of London and the south-east.

That really matters to families, to our economy and to wider society. Being shut out of work because of poor health is terrible for individuals, especially during a cost of living crisis. It is bad for businesses, which need to draw on the skills and talents of all our population if they are to grow, expand and thrive. It is also bad for taxpayers, who are now paying an extra £15.7 billion a year in lost tax revenues and higher benefits bills, compared with before the pandemic. The Office for Budget Responsibility says that the rise in health-related economic inactivity poses a significant risk to our fiscal sustainability, because it reduces our prospects for growth, reduces tax receipts and puts ever-increasing pressure on health and welfare spending.

Yet despite all that, we have not seen a plan from Conservative Members that is anywhere near serious enough to get Britain working again. No doubt, when he rises to speak, the Secretary of State for Work and Pensions will tell us about work coaches and health MOTs for the over-50s. I am not against those measures—I support them; I have met work coaches in my own jobcentre, and I know how hard they are working to try to support people back into work—but they are nowhere near big or fundamental enough to get to grips with the root causes of worklessness, or to reform the way the system runs.

Britain deserves so much better, and that is what Labour will deliver. Our top priority will be to ensure that everyone who can work does work. We believe that the benefits of work go beyond a payslip to the dignity and self-respect that good work bring. We will tear down the barriers to success, tackle the root causes of worklessness and get Britain working again.

Our long-term plan for the NHS will invest an extra £1.1 billion a year, paid for by abolishing the non-dom tax status to provide 2 million more appointments a year and clear the NHS backlog—[Interruption.] The hon. Member for North West Norfolk (James Wild) laughs, but I say to him: if you were a woman stuck on a waiting list, waiting for help and treatment for your hips, for your knees, for your back, you would not be laughing. We will recruit 8,500 more mental health staff, with support in every school and every community to tackle mental health problems in young people early on.

But that is not all. We will transform jobcentres so that they provide personalised help and support, work in genuine partnership with local employers and services, and help people not just to get work, but to get on in their work, with all the benefits that progression from low pay brings. That is an issue that the Government’s own review said they needed to tackle, but they have completely failed to act on it.

[Richard Fuller]

For a shadow spokesperson, the hon. Lady is making some good points, but she has just raised the interaction of the non-dom status and the health service. As she will be aware, the General Medical Council said today how important it was that we continue to attract doctors from overseas, but many would be impacted by a change in the non-dom status. How will Labour’s policy affect our ability to recruit people from overseas for our health service?

[Liz Kendall]

I have spoken to many doctors who come to work in the hospitals in my constituency—