NHS and Social Care Funding
Rosena Allin-Khan Excerpts(7 years, 3 months ago)
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Maria Caulfield
I thank my hon. Friend, but that is obviously not of interest to Labour Members. I have been a nurse for over 20 years and have seen 20 years’ worth of winter crises. They are not unusual. There is no doubt that there is more pressure this year than ever before—we have heard about record numbers of people attending A&E—but there have been winter crises under many previous Governments. It was not unusual when I worked in A&E for patients to be treated in corridors or on chairs—wherever there was space. It was not unusual for ambulances to be queued up around the block, waiting for hours to unload patients—[Interruption.] I still work in the NHS and disagree with the chuntering from the Opposition Benches.
Maria Caulfield
I will not. I must make progress and others want to speak.
It was not unusual for my hospital to declare a major incident because we could not take any more patients. It was not unusual for us to take on the extra work when neighbouring hospitals declared major incidents. The truth hurts, but that is what has happened over my 20 years of working in the NHS and what has happened over the past few days of this winter crisis. It outrageous for Labour Members to suggest that it is something new. They are in denial if they believe that it has not been happening for many years.
The Labour Government was so fixated on the four-hour rule that managers used to bully us and tell us which patients would get a bed based not on clinical need, but on the need to meet a target that was about to expire. I want to tell the House a story. One night I was working in a busy A&E when an elderly gentleman was admitted. He had fallen at home and broken his hip and had to be nursed on a trolley in the middle of a busy corridor. The four-hour target was looming, and at three and a half hours he called out to me and said, “Nurse, I desperately need to go to the toilet.” I had no cubicle to put that man in. He could not get off his trolley owing to his broken hip. The best that I could do under that Labour Government was to wheel a curtain around him and he went to the toilet there in the middle of a busy hospital corridor, with his war medals on his chest. Now, he got to a ward within four hours—his target was met—but that was not good care. If Labour Members think that it was and think that this is a new problem, they have buried their heads in the sand.
Dr Rosena Allin-Khan (Tooting) (Lab)
After four years of having responsibility for the national health service, the Secretary of State for Health has declared:
“We need to have an honest discussion with the public about the purpose of A&E departments”.
We, who have seen his work from this House, and those who have felt the effects of his work on the frontline know exactly what he means:—“Let me tell you why everyone is to blame except for me.”
Earlier this week, the Secretary of State told the UK that nearly one in three visits to accident and emergency do not need to be made. That was his reasoning for weakening the target that every patient should be seen within four hours. That target applies only to people whose condition is serious and urgent enough, so I find staggering the sheer hubris of those comments, the avoidance of accountability in that decision and the danger inherent in both. As an A&E specialist doctor, I have treated patients who arrive in A&E with what seem like minor injuries or illnesses but develop into much more serious and life-threatening issues. The fact that the Secretary of State, both in his words and in that decision, is telling the people of the UK that they should self-diagnose before heading to A&E could have disastrous consequences, for which he would be responsible.
What if, because of the Secretary of State’s words, patients decided to stay at home after a serious bang on the head that turns out to be a life-threatening bleed to the brain? What about a potentially deteriorating case of pneumonia that is not serious enough to warrant being in A&E but eventually results in somebody becoming severely septic and dying?
As a citizen of this country and a patient of the NHS, I find the Secretary of State’s refusal to accept responsibility for the state of A&E departments deplorable. Instead, he blames patients for visits that “do not need to be made”. However, patients do not go to A&E for fun. They go because they are ill and cannot get a doctor’s appointment for two weeks. We have heard today from Members on both sides of the House who have taken their own young children to A&E. Did they do so for fun, or because they felt there was a need for their child to be treated? People go to A&E because their GP does not have resources at their practice, in some cases for something as simple as handing out crutches. They go to A&E because there is something wrong and they are worried sick and simply desperate to speak to somebody professional about their health.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. Let us just calm it down. Government Members did not give way before, and let us not get into the habit of shouting at each other. Let us have a nice, sensible debate.
Dr Allin-Khan
Many people who go to A&E know that they should not be there. I have had elderly patients saying to me, “I’m so sorry, doctor, for wasting your time.” But what other option are the Government leaving them? That is what we are debating today. The Secretary of State wants an honest conversation—well, let us have it. Let us talk about the impact that the current state of the national health service, which he has been in charge of for four years, is having on accident and emergency departments and throughout hospitals in this country. Let us talk about rock-bottom staff morale. Let us talk about the breakdown of staff marriages, a rise in depression among staff and the fact that waiting times are not the responsibility of patients. They are not to blame.
Rising waiting times are the Secretary of State’s responsibility, yet he blames them on the number of people going to A&E since the target was set. It is his responsibility to lead a national health service that can meet the needs of its people, but again he pleads innocence. He says that no other countries have such stringent targets, suggesting that it is unfair that we do. The meeting of the A&E target in particular, not watered down but in full, is what establishes the NHS as the best health service in the world, and one that we can, should and would be proud of under a Labour Government. After all, emergency departments’ ability to meet the four-hour target is directly related to the health of the NHS itself. It is simple: more people go to A&E when they have no other options available.
Sue Hayman
On those options, the use of A&E in my area of Cumbria is entirely down to the lack of GPs. With so many GPs reaching retirement age, the situation is only going to become more acute. Does my hon. Friend agree that the Government need to tackle this matter urgently?
Dr Allin-Khan
I wholeheartedly agree with my hon. Friend. She makes an eloquent point about the lack of GPs and the problems we will face when more retire. Three GPs in my constituency contacted me this week to say that they had been offered jobs that were subsequently retracted due to financial pressures.
The Secretary of State pleads innocence. He says no other countries have such stringent targets. We should not compare ourselves to the worst; we should be leading as the best. The explosion of waiting times is his failure and a sign of the dangerous erosion of one of the country’s greatest institutions. As we saw last week when the British Red Cross had to be drafted in to our hospitals, our NHS is in crisis. Yet instead of listening to doctors and fixing the systemic problems they have created, our Government are repackaging the A&E four-hour target to try to save face and take attention away from the real challenges: the challenge of social care packages not being in place, prohibiting flow through A&E departments; the lack of access to GPs across the country, making A&E the only resort; the chronic underfunding and significant cuts in funding at local authority level; doctors and nurses being forced to miss breaks, as we heard earlier today, and working 14 hours, some without a break, sleep-deprived and unsafe to practise clinical work; and an NHS staff who do not feel supported, encouraged or motivated by the Government. None of these things will be addressed by a watered down four-hour target.
Having spoken to the Royal College of Emergency Medicine, those working on the frontline at all levels, and those who are training our junior doctors, I would like to put forward questions for the Secretary of State to think about. Why has it been decided that the four-hour target will now be downgraded? Who has been consulted on that? Which body said it would be beneficial to patients and A&E staff across the trusts? How will he define major and minor health problems? How are doctors and nurses magically meant to know, at first sight without proper assessment, whether it is a major or minor health problem? Who is responsible if a seemingly minor condition is actually life-threatening? Will it be him? Who will be responsible? How will the Government explain that we will be going back to the days when patients could wait over 12 hours if they were not considered ill enough?
The Secretary of State must recognise the impact of this systemic crisis on A&E rooms across the country in his words and in this decision. In downgrading the target, the Secretary of State does neither, instead placing blame on patients and putting patients at risk. Let me tell it straight: I have been an A&E specialist doctor under a Labour Government and under a Conservative Government. There has been a change under this Government—and for sure it has not been for the better.
Mental Health and NHS Performance
Rosena Allin-Khan Excerpts(7 years, 4 months ago)
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Dr Rosena Allin-Khan (Tooting) (Lab)
It is great to see the Secretary of State here today in the Chamber after enjoying his Christmas recess. While he was away staff on the NHS frontline had to work double shifts, the London ambulance service computer system crashed and we found out that the Red Cross needed to be drafted into our hospitals. Will the Secretary of State tell us which hospitals he visited during the Christmas recess?
Mr Hunt
I was in touch with what was happening in the NHS every single day throughout the Christmas recess. As someone who has worked in a hospital, the hon. Lady might question whether it is particularly helpful for NHS hospitals to have visits by high-profile politicians right at their busiest periods. I have been very closely in touch. She talks about the problem at London ambulance service. That was a problem staff have been trained to deal with. The staff of her own hospital worked extremely well, but they do not welcome attempts—she is making one this afternoon—to politicise the problems the NHS faces.
Social Care Funding
Rosena Allin-Khan Excerpts(7 years, 5 months ago)
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David Mowat
The better care fund is predicated on the assumption that we will drive that integration. I also make the point that not just Leicester, for example, but many councils right across the country—something like 40%—have increased, and will increase, their social care budget in real terms next year.
Dr Rosena Allin-Khan (Tooting) (Lab)
By 2020, we will see a national shortfall of £2.6 billion in adult social care funding. If the Government are forcing councils to increase council tax, what percentage will they be expected to increase it by? How much of that percentage increase would go solely to adult social care services? How will the Government ensure that that happens?
David Mowat
The spending review increased the precept by 2%—that is what we brought in at that time. As I said earlier, this is not the local government settlement, and I have nothing to say on council tax.
National Health Service Funding
Rosena Allin-Khan Excerpts(7 years, 5 months ago)
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Mr Hunt
As the hon. Gentleman knows, those things would certainly be unsustainable if we had followed the Labour party’s investment plans at the time of the previous general election. If he wants to know what is happening to staff, let me tell him that in the period I have been Health Secretary, we have got 5,000 more doctors and 10,000 more nurses. That is what happens when we have a Government who are prepared to invest in the NHS.
The shadow Health Secretary talked about A&E—he is right to say that we are not hitting the target, and we are doing something about that—but he did not tell the House that, since Labour left office, we have recruited 1,200 more doctors for A&E departments, which is a 25% increase, including a more than 50% increase for consultants. Every day, we are seeing 2,500 more people within four hours.
Dr Allin-Khan
I am a junior doctor in A&E, of which the right hon. Gentleman speaks, and I can say that morale is at an absolute all-time low. We have a recruitment and retention crisis in A&E. We are losing all the fantastic staff whom we have been able to recruit because this Government are not recognising and accepting the fantastic workforce on our A&E frontline. All the doctors are leaving.
Mr Hunt
With respect, the hon. Lady might be on the wrong side of the House, because I started my speech by recognising the brilliant work done by doctors and nurses, something that the shadow Health Secretary conspicuously failed to do. Let us look at her own hospital: since 2010, St George’s has—[Interruption.] I do not know whether she is interested in hearing my response to her intervention. Since 2010, her hospital has had 884 more nurses and 240 more doctors, and her CCG had a £10 million funding increase this year.
Dr Allin-Khan
I thank the right hon. Gentleman for allowing me to speak again. I shall refer at length to St George’s hospital in my speech, but it is very unfair of him to bring it into this debate. It is because of this Government that St George’s hospital is operating at a £50 million deficit. It is because of this Government that we are now in special measures. It is—
Madam Deputy Speaker (Natascha Engel)
Order. The hon. Lady is hoping to catch the eye of the Chair later in the debate. As it is, there will be a five or four-minute time limit, so Members who intervene must do so very briefly and not very frequently. If they do not do so, I am afraid that they may not be called to speak.
Dr Rosena Allin-Khan (Tooting) (Lab)
For all the wrong reasons, St George’s hospital in Tooting has been in the news recently. First, it appeared on the front page of a national newspaper because it was requiring people to show an ID before coming in and giving birth. Secondly, it was rated inadequate in a recent CQC inspection. Finally, figures were released showing that one patient waited 36 hours in A&E before being admitted to the hospital.
The one question we are all asking is: why? Why are the roofs in the theatres leaking? Why are the computer systems inadequate? Why has Wandsworth Council been forced to cut almost £10 million from social care budgets? Why does my local hospital trust have a deficit of £50 million? Everywhere we look, the answer is a lack of funding.
We should not leave our hospitals with the bare minimum to function; we should prioritise their funding. It is a healthcare system: we cannot take risks. If we do, it will result in a loss of life—people die. The Health Secretary can point the finger at whomever he wants, but it is not because of our doctors, who always go the extra mile, our trainee nurses, who have had their bursaries cut, or our carers, who are overworked and underpaid. I am afraid the Conservative Government are to blame.
I have worked in our NHS under a Labour Government and under a Conservative Government, and there is a significant difference. Staff morale is at an all-time low, as is patient morale. This Government are failing patients. Government Members know it, and Opposition Members know it. St George’s has not had significant resources put into it since Labour was in government. This is not a one-off story; it is happening up and down the country.
When Labour was in government, our healthcare system was a truly national health service: we saw more doctors, better equipment, new hospitals, and happier and healthier patients. Under this Conservative Government, waiting times are rising, buildings are falling apart and patients’ lives are being put at risk. We are making life and death decisions on the basis of costs. Our NHS is in crisis, and this crisis is turning into a disaster before our very eyes. The NHS was built by a Labour Government, it was saved by a Labour Government and it will be a Labour Government who rescue it.
Social Care
Rosena Allin-Khan Excerpts(7 years, 5 months ago)
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Dr Rosena Allin-Khan (Tooting) (Lab)
They say that growing up is optional, but growing old is inevitable. Our social care system is on its knees and, regardless of what has been said today, a lack of funding is the cause.
I invite you to picture this, Mr Speaker. You are sitting in your living room, unable to read or watch the TV as your sight is failing; you are unable to stand or go to the bathroom because your mobility has failed; and you are unable to delve into your deepest, happiest memories because your cognition has failed. This is the reality for millions and millions of people in this country. This is what they live with, day in, day out. They may be lucky to have family members who can help, or they may be reliant on the kindness of strangers to help them with basic everyday things such as washing, going to the bathroom or eating—things that you and I, Mr Speaker, may take for granted in our younger years.
Many councils, including Wandsworth Council, have removed vast amounts of money from their adult social care budgets. The most vulnerable in our society need safety, not insecurity. We need to ensure that robust systems are in place to provide care for people, many of whom might have fought so that we can have the liberty that we enjoy today. We do not need an unretainable workforce or the reduction of funds year on year.
The vast cuts and insecurities do not merely amount to cancelling a bus to the seaside for a day, or cancelling over-80s bingo; real, core care treatments are being cut. They are being cut to the bone. This is happening to many people who have given the country so much in their lifetimes. They have paid their taxes, they have worked hard and they have raised their children, yet all that the Government can do at the moment is leave them high and dry. I say that that is not good enough: they deserve more.
What about the personal carers who leave their jobs because they do not want to leave their families to the will of local provision? There are 19,000 people caring for family members in Wandsworth alone, and they have to choose between heating and eating every winter just to make ends meet. We are failing those people.
The people who work in our care system dedicate their lives to working in social care, and they work very hard. I want to put on record my personal thanks and admiration for the work that they do day in, day out. It is not easy for them to leave their own families and work so selflessly and for such long hours to help others. They do so in the hope that they can provide even just a small amount of support and can put a smile on someone’s face, as the Secretary of State said earlier. He has now left the Chamber, so he will not hear my peroration. Anyway, it is great to be able to make someone smile, just for a day.
The current provision in Wandsworth, however, is the “most economically advantageous”, which is a euphemism for “cheapest”. Our country deserves better. It may be said that we are providing high-quality cheap care, but in many cases we are not, certainly in Wandsworth. Both the Secretary of State and the hon. Member for Faversham and Mid Kent (Helen Whately) spoke about CQC inspections and high ratings. That is great, but Wandsworth council is having to contract out to agencies whose CQC ratings describe them as “requiring improvement”. Let me ask Members this, if they will look up from their phones for a moment. Would that be good enough for their families? Would it be good enough for my family? I think not. I think that all the families in the United Kingdom deserve care from people who do not “require improvement” but are delivering the best possible care, because they deserve nothing less.
In Tooting, I have heard reports of patients sitting in their homes waiting for the knock on the door from a carer who has not shown up. Day after day, I hear of family members having to hide in their cars just to prove to the council that the carers are not showing up, because the carers are saying, “Unfortunately, your dad has dementia. He did not remember that we came.” That is not good enough. It is not good enough for our families. This is a cross-party issue. I implore the Government: please listen to what I am saying, and do the right thing.
I spent 11 years working in the NHS, in A & E, on the frontline. Our staff at St George’s hospital in Tooting worked incredibly hard, but NHS staff throughout the UK also work hard. Day after day, I saw families in crisis. They brought their elderly family members to the door, crying, saying, “I cannot cope: I do not know what to do any more.” Such people are treated by our wonderful NHS staff, but, as we have already heard, that causes bed-blocking, because there is no adequate social care provision that would allow them to leave hospital.
The Government are allowing contracts to be awarded to companies that do not pay the living wage. It is fantastic that the living wage is going to go up, but how are staff to be retained and provide the high-quality care that they so wish to deliver if there is not the budget to pay for it?
As I said earlier, I spent 11 years on the NHS frontline. Now I am in the House of Commons, and I am flying the flag for every single carer, every single NHS worker and every single patient. I am flying the flag for every single person in the United Kingdom who deserves better for their loved ones: for your parents, for my parents, for absolutely everyone. Not investing in social care leads to avoidable mistakes. Not investing in social care leads to more pressures on our already pressurised NHS. Not investing in social care costs lives and dignity.
How much more time do the Government need to recognise that not addressing the current funding crisis in social care is severely affecting lives and crippling our public services? Respectfully, I call on them to wake up and do the right thing.
Junior Doctors: Industrial Action
Rosena Allin-Khan Excerpts(7 years, 8 months ago)
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Mr Hunt
In response to my hon. Friend’s last point, we have been clear from the outset about what we mean by a seven-day NHS for hospital care, but a huge amount of misinformation has been put out. This time last year, for example, the BMA was telling many people that our plans were to cut pay by between 30% and 50%. That is why strikes are damaging. Positions get entrenched on both sides and misinformation sometimes gets out, as it has done, causing a lot of anxiety.
I agree with my hon. Friend about the GMC’s significant intervention. The medical regulator is completely independent of Government and has been clear that doctors have a responsibility not to take a decision under any circumstances that would lead to their patients being harmed.
Dr Rosena Allin-Khan (Tooting) (Lab)
As the Secretary of State knows, prior to taking up this office in June I was an emergency medicine junior doctor on the frontline of our NHS for the past 11 years. Today, doctors have listened and have halted strike action, putting patient safety first.
This is not the first time I have stood before the Secretary of State to say that I worry that the imposition of the contract does not put patient safety first. The Government can train all the extra doctors they want, but current junior doctors are leaving. The risk of having a contract imposed on them is causing them to move further afield to places such as Australia. I have always maintained that a safe seven-day NHS cannot be created with an overstretched five-day team and the rota gaps are proof of that. Doctors have listened today. Will the Secretary of State listen and please halt the imposition?
Mr Hunt
I thank the hon. Lady for what she did alongside many colleagues working in A&E departments over many years, but to call this an imposition is a mischaracterisation given what actually happened. The contract was not only agreed, but recommended and supported by the leaders of the BMA. Before she was elected, we had many discussions in the House about whether negotiations were possible and what I should do, and there were a range of different views. In the end, I listened—just as she has asked me to today—and sat down and negotiated a deal that was supported by the BMA’s leaders. That is why it is so incomprehensible that those same leaders—the people who represent her and her profession—have now called the most extreme strike in NHS history.
NHS Spending
Rosena Allin-Khan Excerpts(7 years, 10 months ago)
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Mr Hunt
I am sure that that is analysis we can do, but I cannot do it at the Dispatch Box as a direct response to the hon. Gentleman. However, as I am sure he is well aware—we made this point during the whole Brexit referendum debate—we have reciprocal health arrangements with other EU countries at the moment. Those are immensely convenient to people travelling to and visiting other European countries, because they mean those people can access healthcare completely free of charge. The bill is actually sent to the Government, and that arrangement includes pensioners who have retired to Spain and France and Italy as well. It would be very sad if, as a result of the new relationship with the EU, we lost that convenience. That is one of the reasons why I am confident that other EU countries will be happy for British pensioners to remain in them. As long as those countries are able to charge us for the healthcare costs, the burden to them should be minimal.
Dr Rosena Allin-Khan (Tooting) (Lab)
The Secretary of State spoke about NHS spending. Does he agree that cuts to local government spending on social care are putting increased financial pressures on the NHS? At St George’s hospital, a cost of £1.3 million has been attributed to inefficient discharges.
Mr Hunt
First, may I welcome the hon. Lady to her place as a doctor and as someone who knows a great deal about NHS matters? Although I am sure we will not agree on every health matter, it is always valuable and a great asset to have someone with medical experience in the House, and I am sure she will make a huge contribution in that respect. She is absolutely right to say that what happens in the social care system has a direct impact on what happens in the NHS, and that we cannot—as, in fairness, happened under Governments of both colours over many years—look at the NHS and the social care system as completely independent systems when we know that inadequate provision in the social care system has a direct impact on emergency admissions in A&E departments. She is right to make that point.
Let me make a broader point in concluding my comments. I think that there would be agreement across this House on the huge pressure on the NHS frontline at the moment, and that there is recognition of some fantastic work being done by front-line doctors and nurses to cope with that pressure. I shall give a couple of examples of the extra work that is happening, compared with six years ago. The A&E target is to see, treat and discharge people within four hours. Every day, we are managing to achieve that, within the four-hour target, for 2,500 more people than six years ago. On cancer, we are not hitting all our targets, but every single day we are doing 16,000 more cancer tests, including 3,500 more MRI scans, and treating 130 additional people for cancer. There are some incredible things happening.
However, we all recognise, and this perhaps lies behind the Opposition’s concerns in bringing this motion to the House, that in healthcare we now deal with the twin challenges of an ageing population, in that we will have 1 million more over-70s within the next five years—a trend that is continuing to grow—and of the pressure of scientific discovery, which means we have new drugs and treatments coming down the track. They are exciting new possibilities but also things that cost money. I for one, as Health Secretary, believe that as soon as economic conditions allow, we will need to start looking at a significant increase in health funding. That is why it is incredibly important, as we go through the next few years negotiating our new relationship with Europe, that we work very hard to protect the economic base that we have in this country, the economic success that we have started to see, and the jobs that do not just employ a lot of people but create tax revenues for this country. It is incredibly important that we pilot the next few years with a great deal of care, because what happens on the economy will have a huge impact on the NHS.
Oral Answers to Questions
Rosena Allin-Khan Excerpts(7 years, 10 months ago)
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Alistair Burt
The hon. Gentleman’s support for these services is well known and what he says is right. The regulations do protect the more vulnerable, but when I next look at them, I will make sure that they fulfil his requirements.
Dr Rosena Allin-Khan (Tooting) (Lab)
12. What assessment he has made of the potential effect of the proposed removal of NHS bursaries on the number of applications from mature students for nurse training places.
The Parliamentary Under-Secretary of State for Health (Ben Gummer)
Mature students represent a significant proportion of the nursing, midwifery and allied health professions’ workforce. Looking at what happened following the introduction of the maximum £9,000 per annum tuition fees in 2012, the latest UCAS data for last year show that full-time mature student numbers have now significantly exceeded previous levels.
Dr Allin-Khan
I am proud to have served on the front line of our national health service for the last 10 years, and to ask my first question on its 68th birthday.
St George’s hospital in my constituency is operating at a significant deficit, partly owing to expensive agency staff costs. Does the Minister agree that cutting NHS bursaries for nurses, midwives, radiographers and other allied health professionals will prevent the recruitment and retention of high-quality trained staff and make the problem worse?
Ben Gummer
I welcome the hon. Lady to her seat. She fought a courageous campaign, and it is good to see her in the Chamber. She brings expertise to the House, which is also very welcome.
I agree with the first part of the hon. Lady’s question—the deficit at her local hospital is indeed partly caused by the excessive costs of agency nurses, and we are trying to put a cap on those costs—but I am afraid I disagree with the second part. I believe that changes in nurse bursaries will enable us to get more nurses and healthcare professionals into the NHS. There has been a similar development in the rest of the higher education sector, and I want to replicate that success in the NHS so that we can provide it with the workers that it requires.