NHS Funding Bill

Seema Malhotra Excerpts

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

[Matt Hancock]

We are using all possible means to get in contact with the 1,460 people whom we need to contact, and who we know have travelled to the UK from Wuhan and who have not as far as we know left the country. We are collaborating with Border Force, the airline and others, including universities, schools and cultural organisations to try to make contact.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

My constituency borders Heathrow, and many of my constituents will be working at Heathrow with the airlines and in many other roles. I appreciate that the risk may be low, but could the Secretary of State update the House on whether advice has been given to Heathrow and airlines on how to give advice to their staff who may have come into contact with people who might be affected so that everybody can be assured that all is being done and that any support they may need is available?

[Matt Hancock]

The hon. Member is quite right to raise this. There is a Public Health England unit or hub at Heathrow to meet all flights from China now; it met the one flight that has come from Wuhan directly since news of this outbreak reached the level it did last Wednesday. The advice is clear to anybody who is worried about having coronavirus, and that is to call 111. If they have travelled to Wuhan or elsewhere in China recently, they should declare that to the 111 service when they call, and the 111 service has the full advice available. It is important for them to call 111 or to call their GP rather than going to a GP or to A&E, for exactly the reason that we want people to self-isolate if they have been to the region or if they think that they may have the virus.

I will now move on to the Bill. As we have been highlighting with the NHS work on the coronavirus that originated in Wuhan, few things in life are certain. However, it is the job of Government to plan for the future, even though we cannot fully see it. We do not know for instance exactly how many babies will be born in four years’ time, but we can anticipate demand for maternity services. We do not know exactly how many people will make a 999 call in four years’ time, but we can and must plan for that. Indeed, we do not know if the Labour party will have a competent leader in four months’ time, let alone four years’ time, but I hope for the country’s sake to see the hon. Member for Leicester South (Jonathan Ashworth) on the Opposition Front Bench well into the next decade. There is one institution that, with this Bill, knows it will get the funding it needs in 2024, and that is the NHS, because this Bill injects the largest and longest cash settlement ever granted to the NHS and will enshrine it into law—£33.9 billion extra a year by 2024.

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[Jonathan Ashworth]

My hon. Friend is absolutely right. Of course, we are short of 44,000 nurses across the whole national health service. One of the most damaging policy decisions that George Osborne made—probably another of the Secretary of State’s ideas—was to cut nurse training places in 2011 and get rid of the training bursary. The Government say that they will bring back a grant, but they are not going to go the whole hog, are they? They are not going to get rid of tuition fees. They still expect people to train to be nurses and build up huge debts, because the nature of the training that they have to go through means that they will not be able to take a job on the side. I do not believe that is the way we should recruit nurses for the future; we should bring back the whole bursary for nurses, midwives and allied health professionals.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

My hon. Friend is making an important speech and has just made reference to the cuts to capital budgets. Does he agree that it is staggering that since 2014 we have seen five consecutive switches from capital budgets to revenue budgets, totalling about £4.29 billion? The consequences are now being felt by all our constituents throughout the country.

[Jonathan Ashworth]

My hon. Friend is absolutely right. Because of the austerity that the Government have imposed on the NHS, its leaders—trust bosses and clinical commissioning group bosses—have had to raid capital budgets repeatedly and transfer from capital to revenue, as my hon. Friend said. These sorts of smash-and-grab raids, which have happened five times, have taken around £5 billion out of the capital budgets, which is why so many of our hospitals now have this huge £6.6 billion-worth of repair backlog, with sewage pipes bursting and roofs falling in.

It is all very well for the Secretary of State to stand there and talk about 40 new hospitals, even though he has not outlined a multi-year capital settlement at all. He just went around the country telling Tory candidates, who have now become MPs—congratulations to them—that he will build a hospital here and they will have a new hospital there. I lost count of the number of times that he committed to new A&E departments and new hospitals that were not on any list that he has published in the House of Commons. We do not actually have a multi-year capital plan to deal with the more than £6.5 billion backlog that faces our hospitals. This is not a serious way to make policy for the national health service. Our trusts’ chief executives need certainty on capital, which is why we need to see the multibillion-pound capital plan. We do not even know whether we are going to get one in the Budget. We do not know when it is coming: the Secretary of State has given us no detail or clarity on that whatsoever.

Whether it is waiting for pre-planned surgery, for cancer treatment, for test results, in A&E or on trolleys, thousands of our constituents wait longer and longer in pain, agony and distress, thanks to years of austerity that the Secretary of State designed. As George Osborne’s right-hand man and chief bag carrier, he designed the years of austerity and is now asking the House to endorse the continued underfunding of the NHS.

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[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

It is an honour and pleasure to follow the hon. Member for Darlington (Peter Gibson), and to be the first to congratulate him on his excellent maiden speech. It was a delight to hear about his life and experience in the constituency, and also to hear his very generous tribute to the very highly regarded and excellent Jenny Chapman, as well as about his other predecessors. He made a very passionate speech, highlighting the issues of transport, the economy, education and health. I am sure the way he did it—with such confidence and such style, and with humour—will have been heard by his constituents. I wish him great success in his work in this House.

At the outset, I want to thank the British Medical Association, Mind, NHS Providers and others that have sent briefings for this very important debate.

It is a very small Bill—two clauses on five pages—which will put into legislation the current long-term funding settlement for the NHS, as set out 12 months ago. It sets a minimum that must be paid to the NHS for revenue spending in each year until 2023-24, when the provisions will cease to have effect. One might note that that is also likely to be the next election year. It came as a slight surprise to me that the Bill was drafted in this way. If spending needs to be locked in by legislation, it is almost as if the Government are seeking to prevent future Conservative Chancellors in this Government from making cuts to the NHS budget. That is a novel approach for a Prime Minister when the Government, as the House of Commons Library has noted, already have control over their own spending.

I want to focus on two areas that go beyond the Bill specifically and into the Government’s strategy for funding and the NHS. The first is capital funding, and the urgent support that is needed in my constituency to get the rebuild of the Heston health centre back on track. The second is community health services and social care, and the specific issue of neurocognitive rehabilitation services.

It is a matter of great concern for the medium and long-term health of our NHS that the NHS capital budget, which invests in our buildings, beds, equipment and IT, is today lower in real terms than it was in 2010-11. That has already been mentioned; indeed, we have had five consecutive switches from the capital budget to the revenue budget for the day-to-day running of the NHS since 2014 totalling over £4 billion. The consequence is that buildings and equipment are being left outdated, affecting increasingly the quality of patient care and the reliability of appointments. Poor buildings and equipment also have a knock-on effect on the morale, recruitment and retention of key NHS staff. The Minister has intimated that there will be additional funding for infrastructure, but we await further details.

I want to raise the important issue of the Heston health centre, because my constituents will not be the only ones to have been affected by changes in Government policy over the last few years. At the end of August I wrote to the Health Secretary and NHS England about Heston health centre when my local CCG contacted me. Among all London CCGs, Hounslow has the fourth highest number of patients per permanent qualified GP, while the amount of funding per registered patient is 7% below the London average and 12% below the England average.

The chair of Hounslow CCG has described the current Heston health centre as unsuitable to deliver 21st-century primary care. The buildings date from the 1970s, are in need of major repair and are no longer compliant with disability legislation. The proposed new development is desperately needed to provide patients with the quality of care they deserve, offering four GP services in one and providing disabled access as well as a more attractive place for GPs.

Hounslow CCG has been working on this development since 2014. In 2015 the project was the subject of a discussion between the Department of Health, Community Health Partnerships and NHS Property Services, at which the CCG, the LIFTCo and NHS England were all represented. At that meeting it was concluded that CHP would work with the West London Health Partnership, the LIFTCo, to take forward the project as a public-private partnership funded scheme. The problem, however, is that after that decision funding was cut and the CCG was informed in June 2014 that, following the Chancellor’s commitment in 2018, new off-balance PPP-funded infrastructure projects would not be taken forward.

I was fortunate to be able to raise this issue with the Chancellor in September, and I am grateful for his offer of having officials meet me. However, having originally been given the green light to go ahead—the project was identified by the Department of Health as the best value funding option—currently we are in limbo: we do not know how the project is going to go forward and there is no clear sense of direction for my CCG and therefore my constituents. I would be grateful if the Minister could still agree to a meeting with me so that direction can be given for a project that is desperately needed.

As we have also heard in this debate, NHS providers and others have also highlighted how funding is to be allocated under the Bill and what will be further funded. I make reference here to community healthcare and social care, particularly in relation to the urgently needed increase in public health budgets following an almost £1 billion reduction in real terms under this Government. I want to raise not just the issue of prevention but recovery from illness and make particular reference to post-stroke and brain-damage related services. Neurocognitive rehabilitation is a particularly underfunded service.

Too often we respond to brain damage as a result of illness or even early dementia with slow diagnosis and medication, when research suggests that better and more structured brain activity could help improve memory, planning skills and basic safety in performing day-to-day tasks that we currently take for granted. We are grappling with this in Hounslow, and I am grappling with it with my own mother, who had a stroke two years ago. At the weekend I was very moved when a constituent came to me and said, “What can I do, because I feel like I am starting to lose my memory, but there are no services available to help me? My daughter has said it is just part of getting old.” We must see whether more can be done not just in prevention but to help through these important services with rehabilitation for all our constituents.

Today’s debate is important; it goes beyond whether the Bill is actually needed into how the Government are going to be spending our collective resources on the NHS, because going forward we need a plan which funds the NHS properly and provides a comprehensive strategy, addressing all our sectors. I look forward to meeting officials about the Heston health centre, and to working with the Government on how we can ensure that the other essential services we need are delivered.

[Several hon. Members rose—]