NHS: Long-term Strategy

Roger Gale Excerpts

Wednesday 11th January 2023 Commons Chamber

[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Roger Gale)]

Order. I am afraid I have to drop the limit to four minutes, and it may be necessary to drop it down further to three minutes later. That depends entirely on colleagues, and how generous or otherwise they are to their friends.

--- Later in debate ---

[Anna Firth (Southend West) (Con)]

Time is short, so I want to put on the record straightaway my thanks to all the hard-working hospital and ambulance staff at Southend Hospital and everyone working in the NHS across the city of Southend and picturesque Leigh-on-Sea, because none of them is on strike and all of them are treating patients with huge care and dedication. They are also innovating at high speed to tackle the unprecedented demand on their services. Two modular ambulance units have already been installed at Southend Hospital, providing 12 extra beds; an enhanced discharge service pilot was started last year; an active discharge ward has been opened with 12 beds and 12 comfy chairs; and yesterday 12 major treatment spaces were added, with more to come. I know this because I am in regular contact with my hospital and the local NHS and I have been visiting the hospital and seeing and supporting what it is doing on a regular basis. It is very impressive and it deserves all of our praise and recognition.

That is not to say that my inbox is not also full of people’s problems with accessing the NHS, and of course there is more to do. However, we have to look at this in context. We have to look at the international context, because these challenges are not unique to the UK. Countries around the world are facing an unprecedented double whammy from the combined upswings of covid and flu leading to hospitalisations. France currently has 22,500 people in hospital with covid, and Italy has more than 8,000. When it comes to flu, cases in Italy have hit their highest level in 15 years. Even Sweden, always held up as a great exemplar for the NHS, has a huge burden on its healthcare systems due to respiratory viruses.

Obviously the UK is not immune to these twin pressures, and obviously we are facing much higher rates of hospital bed occupancy than is normal at this time of year. We have 8.6% of our beds occupied by covid patients. Four years ago, there were none. Last year there were only 50 people in hospital with flu. This year there are more than 5,000—a hundredfold increase. As I have said, in Southend we are seeing identical figures on a local level. However, to suggest that we are not committed to our NHS is frankly outrageous.

In addition to the billions of pounds—I will come on to funding in just a minute—we delivered 9 million flu shots and 7 million autumn boosters into people’s arms last year. This was to prepare for what we knew was coming. We are putting in an additional 7,000 beds, and £500 million into delayed discharge before Christmas and another £250 million now. Over the last 12 months we have recruited 4,700 new doctors and more than 10,500 new nurses. Of course there is more to do, but to suggest that nothing has been done—which is what one might think, sitting here and listening to Opposition Members—is plainly not true. We have heard the PM’s plan to tackle the backlogs and waiting lists. If they think that is not much of a plan, they should consider what the Nuffield Trust said last week about Labour’s plans. It said that they would

“cost a fortune and stem from a failure of understanding and an out-of-date view”.

Last week—[Interruption.]

[Mr Deputy Speaker (Sir Roger Gale)]

Order. The hon. Lady is out of time.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Roger Gale)]

Order. I regret to say that I must now take the time limit down to three minutes. I am desperately trying to get everybody in, but we are trying to get a pint into a half-pint pot. I call Claudia Webbe.

[Claudia Webbe (Leicester East) (Ind)]

The first thing that needs to be said in this debate is that its title gives a false impression: “mismanagement” creates an impression that the Government have been doing their best to manage the NHS well but have failed to do so, whereas in fact the emergency in our NHS is the result of 13 years of deliberate policy decisions by the Conservatives. A staff shortage of 133,000 that has only grown in recent years is not “mismanagement”. A shortage of almost 40,000 NHS nurses is not “mismanagement”, especially not when the Government knew there was a huge shortfall and decided anyway to end the nurses’ bursary and make already-underpaid nurses pay a fortune to train while inflicting annual real-terms pay cuts on staff across the NHS.

Consistently allowing staffing numbers to remain far below safe levels is a decision, not something that was just badly managed, as was the intentional fragmentation of the NHS and the Health Secretary’s decision, along with the Government in 2012, to end statutory responsibility to provide a safe and fit health service. Cutting thousands of beds and millions of annual bed days in the NHS is a wrecking strategy—even more clearly so when it continued during the pandemic. It is part of an ideological push towards a rationed system that is more profitable for private providers and in which the NHS is in perpetual crisis not because of demand, but because beds, staff, hospitals and services have been intentionally slashed below the demand that was there. Even the current push to a so-called “integrated care system” is acknowledged by the King’s Fund and others to be, in reality, based on a US accountable care system that is designed to withhold treatment in order to cut costs and share the profits with private providers.

It is vital to be clear that the NHS is not merely collapsing; it is in a state of induced coma. There is not enough time in this debate to properly list all the damage that Conservative Governments have done to our health service in the past 13 years—and all in the full knowledge of what the consequences would be for those who need the NHS and who work in it and the deaths that it would cause.

The scale of this intentional damage is so great that playing around the edges with a little more cash that will end up in private company accounts—let alone talk of one-off payments to NHS staff who now rely on food banks—is just PR. The solution to all this is not better management; the only solution to 13 years of fragmentation and hollowing out is a return to the NHS’s original principles: a publicly owned, properly funded national healthcare service free to all.

[Mr Deputy Speaker (Sir Roger Gale)]

Order. I must ask hon. Members to keep one eye on the clock. I know that it is difficult when you are reading notes, but you really must watch the clock.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Roger Gale)]

Order. This is a test of your ingenuity—whether you can sell a bar of soap in 30 seconds—because you are going to have to go down to two minutes if I am going to get everybody in. Do your best. I call Robin Millar.

[Robin Millar (Aberconwy) (Con)]

I acknowledge the hard-working staff of Betsi Cadwaladr University Health Board, who serve us to the best of their ability and make terrific efforts to give us the care that we need and deserve in north Wales.

I want to mention Welsh colleagues from across the House, many of whom share my concern over the state of the health service in Wales. I know that some who are not present today will share that concern, even on the Opposition Benches, although it does raise the question of why they are not present. My right hon. Friend the Member for Vale of Glamorgan (Alun Cairns) and my hon. Friend the Member for Clwyd South (Simon Baynes) make the case for Wales as a case study of healthcare under Labour. I add to their observations that healthcare spending now accounts for some 55% of the Welsh Government budget.

I want to look briefly at the effects of the Labour prescription for healthcare in Wales. Our treatable mortality rate is 20% higher than in England. Last year, five out of seven of our health boards were in some form of special measures. My health board, the Betsi Cadwaladr University Health Board, was in special measures for six years. It got so bad that the BBC reported on a patient from Swansea who was forced to go to Lithuania for a hip operation when she discovered that she was on year four of a seven-year waiting list for treatment. The hon. Member for Batley and Spen (Kim Leadbeater), who is not in her place, was absolutely correct when she said that the Government have to take responsibility—the Welsh Government must take responsibility for their 25 years of stewardship of healthcare in Wales.

On the defence of the hon. Member for Ilford North (Wes Streeting) for the inequalities in Wales, I would say this: in 2015, the Nuffield Trust reported that the Welsh Government had used their powers to set different priorities and a different tone from their London counterpart. It has emphasised prevention—

[Mr Deputy Speaker]

Order. I call Paulette Hamilton.

[Mrs Paulette Hamilton (Birmingham, Erdington) (Lab)]

I was a nurse for 25 years and I returned to the frontline during the pandemic. I know at first hand that after 13 years of Tory mismanagement, our NHS is in crisis. Many health workers who have dedicated their lives to caring for others day in, day out are still living with the after effects of having worked flat out during and before the pandemic, all while trying to do the work of three or four people due to staff shortages. It is soul destroying for people to go on duty knowing that there will be inadequate staffing levels for nine or 12-hour shifts. Tory cuts have reduced A&E departments to shells of what they were under the last Labour Government—they are now so busy that staff feel that they can seem, at times, like a zoo.

Social care needs fundamental reform that truly brings together health and social care. People in Erdington, Kingstanding, Castle Vale and across the UK are finding it almost impossible to get a GP appointment, an ambulance or an operation when they need one, but the implications of stress on the health of staff can be tragic. The ongoing failure of the Government to address staffing levels can be a matter of life or death for patients. It breaks my heart to say that I just could not face the prospect of working in nursing right now.

In November, 140,000 people had to wait more than four hours to be admitted to A&E, and unfortunately my husband was one of them. If we add all that time together, collectively, the British public waited almost 65 years for emergency treatment, but the real question is: how much longer will they have to wait for a competent Government—

[Mr Deputy Speaker (Sir Roger Gale)]

Order. I know this is difficult, but we have to keep to the time. We will now not get everybody in.

--- Later in debate ---

[Liz Kendall (Leicester West) (Lab)]

Today’s debate has laid bare the dire state of our health and care system after 13 long years of this Conservative Government: more than 7 million people waiting for hospital treatment, 400,000 for more than a year; the worst ever waits for A&E, with 50,000 patients a week now waiting more than 12 hours in A&E; excess deaths this winter at their worst level since 1951, except for the pandemic years; ambulance response times plummeting; cancer targets missed; and waits for mental health care so bad that thousands of patients end up forced to go to A&E or even attempting to take their own lives. In social care, the situation is even worse: 165,000 staff vacancies, 30,000 more than in the NHS; more than half a million older and disabled people waiting to have their needs assessed in the first place, not even on a waiting list; and millions—millions—of families pushed to breaking point because they cannot get the help they need to look after their loved ones.

The question I want to focus on today is why we have ended up here. Labour Members have never claimed that everything was perfect in the NHS when Labour last left government, but Conservative Members squandered a golden inheritance of the lowest ever waiting lists and the highest ever patient satisfaction, with access to services we can only dream of now. Ministers want to blame all of the current crisis on covid and this year’s winter flu, but the truth is that waiting times were at record levels and staff shortages were soaring long before the pandemic struck.

The most glaring reason for the problems we face is the sheer incompetence of this Government. To take just one example, effective winter planning in the NHS is a non-negotiable and a key test for any Secretary of State. When Labour was in Government, winter plans were done and dusted well in advance. I know that from my time working in the Department of Health. So, it beggars belief that not a single penny of the original winter hospital discharge funding was out of the door by the end of November. Some £300 million of it still has not reached the frontline. Their latest flawed plan to buy up care home beds, when what most people need is care in the community or their own homes, was not even announced until 9 January. That is not effective planning; it is scrabbling to shut the stable door after the horse has bolted.

There are even more fundamental reasons for the current crisis than the Government’s sheer incompetence. The root cause is a decade of Conservative economic failure trapping Britain in a vicious cycle of low growth, low pay and high taxes, which in turn has failed to provide sufficient or sustainable funding for our public services, including decent pay for frontline staff. Einstein’s definition of madness was to keep doing the same thing over and over again but expecting a different result. Yet that is precisely what we saw in the Chancellor’s autumn statement, so Britain is once again set for, at best, anaemic growth by the end of the Parliament. Britain deserves so much better than this. Labour’s green prosperity plan, our industrial strategy and our plan to fix business rates set out a different path for the future. No wonder the chairman of Tesco says that in terms of a growth plan Labour is the

“only team on the field”.

Economic growth that delivers proper investment in the NHS and social care is vital, as Labour’s record in Government shows, but on its own it will not secure a care system fit for the modern world. It also requires reform. On that, Ministers have again utterly failed to deliver. Mr Deputy Speaker, you will forgive me if I take the House on a brief trip down memory lane. Remember the Lansley reforms? I am sure Conservative Members would rather forget. That legislation so large it could be seen from outer space, but no one understood what it was for. Years of time and effort were squandered on a disastrous internal NHS reorganisation that failed either to integrate care or to deliver the improvements in patient care that the Conservatives claimed. There was the Conservatives’ cap on care costs—[Interruption]—and their solemn promise that no one would have to sell their home to pay for their care. Remember that? [Interruption.] It was first promised in 2012, postponed in 2015 and 2017, and re-promised by the right hon. Member for Uxbridge and South Ruislip (Boris Johnson) on the steps of Downing Street. [Interruption.]

[Mr Deputy Speaker (Sir Roger Gale)]

Order. It is perfectly plain that the hon. Lady does not want to give way.

[Liz Kendall]

Thank you, Mr Deputy Speaker.

The promise was buried once and for all by the Chancellor in his autumn statement last year—a Chancellor, I remind the House, who said that his biggest regret as Health Secretary was failing to put in place a long-term plan for social care.

In contrast—[Interruption.] I am sure the right hon. Member for Vale of Glamorgan (Alun Cairns) will be interested to hear this. In contrast, Labour has a 10-year plan for investment and reform in our NHS and social care. It includes the biggest ever expansion of the NHS workforce, funded by scrapping non-dom tax status; ensuring that patients can see the doctor they want in the manner they want, whether that is face to face, over the phone or online; a new deal for care workers—[Interruption.] Maybe the hon. Member for Ashfield (Lee Anderson) would like to listen to our plan and suggest it to his Ministers. We will have a new deal for care workers to tackle staff shortages and give older and disabled people the support they need. Above all, we will have a relentless focus on prevention and early intervention. There will be a new principle of home first, shifting the focus of care out of hospitals and into the community, with more people being cared for in their own home, which is where they want to be.

Using new technology, providing genuinely joined-up care and support, putting people first, giving staff the support they deserve, providing investment with fundamental reform: that is Labour’s plan, not the failed sticking-plaster approach that we have seen from the Conservatives over the past decade. Britain deserves a fresh start. We deserve a better future. That is what Labour will deliver. I commend the motion to the House.