NHS and Social Care Funding

Victoria Atkins Excerpts

Wednesday 11th January 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is right. What we did not hear from the Labour party is that, in 2010, we inherited a £70 billion PFI overhang, which is making it incredibly difficult for hospitals to recruit enough staff, because they are having to pay so much money to financiers.

[Victoria Atkins (Louth and Horncastle) (Con)]

An example of how we are spending money practically on the ground to make sure patients get a better deal is in Lincolnshire, where, because there is a shortage of GPs, the local health authority is offering £20,000 as a golden hello to new GPs. Is that not the way to manage resources, to attract the best medical talent into our areas and to help ensure that patients get the best care?

[Mr Hunt]

My hon. Friend is absolutely right, and I talked about these issues when I visited her in her constituency. The truth is that, to solve this problem, we are going to have to have a dramatic increase in the number of people working in general practice, which is why we are funding the second biggest increase in the number of GPs in the NHS’s history.

It is a great shame that the Leader of the Opposition is not here, because this is the bit that I wanted to address to him—his proposal to put extra funding into the NHS by scrapping the corporation tax cuts. That reveals, I am afraid, a fundamental misunderstanding of how we fund the NHS. Corporation taxes are being cut so that we can boost jobs, strengthen the economy and fund the NHS. The reason we have been able to protect and increase funding in the NHS in the last six years, when the Labour party was not willing to do so, is precisely that we have created 2 million jobs and given this country the fastest growing economy in the G7, and that is even more important post-Brexit. To risk that growth, which is what the Labour party’s proposal would do, would not just risk funding for the NHS, but be dangerous for the economy and mortally dangerous for the NHS.

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[Dr Whitford]

I would be delighted to agree with that, but NHS England did not make it over 90% at any point in 2016, so perhaps the right hon. Gentleman might want to check the NHS England figures before having a punt at me.

NHS England is performing 8% to 10% lower than NHS Scotland, which has been the top performing of the nations for the past 19 months. We have not done that by magic. We face exactly the same ageing population, exactly the same increased demand and complexity, and exactly the same—indeed, often worse—shortages of doctors as NHS England does, because of our rurality. We are not using a different measure—we use exactly the same measure—but the data show that there is a significant difference, and it is being maintained.

The Secretary of State is right: winter is always challenging. Summer is often busier for attendances at A&E, because the kids are on the trampolines and people go out and do silly things, but hospitals are under pressure in winter because of the nature of admissions—the people who go to A&E are sicker, older and more complicated. However, we have not seen any summer respite in NHS England. The worst performance in the summer was 80.8%; the best was 86.4%. NHS England is under pressure in the summer, and when winter is added on top of that, it is no wonder that we are talking about the situations that doctors, nurses, patients and relatives are describing to us.

My first health debate after my maiden speech in this House was an Opposition day debate on the four-hour target. At the time, I commented, and still maintain, that this target is not a stick for each party to hit each other over the head with, but it is a thermometer to take the temperature of the acute service, and it does that really well, because it measures not just people coming in through the front door but how they are moving through the hospital and out the other end. At the moment, the system is completely overheated. The comments about this not being anything unusual but just a normal winter, and everyone whingeing, show that the Government are not recognising the problem. The first step to dealing with any problem is to recognise it, because then we can look at how we want to tackle it.

[Victoria Atkins]

I remind the hon. Lady of the point the Prime Minister made in Prime Minister’s questions, which is that on the Tuesday after Christmas, A&E received the highest number of visitors it has ever received in its history. Does that not show the challenges facing the NHS both nationally and locally? These are extraordinary figures, and the Secretary of State is very much doing his best to help the NHS, with the professionals, to deal with them.

[Dr Whitford]

I totally accept that the NHS has been under inordinate pressure with, absolutely, the busiest day in its history, but given an ageing population that has been discussed for years, we should have been able to see this coming.

If, in the next couple of months, we get a massive flu epidemic, we are going to see things keel over. We have already had debates in this Chamber about STPs taking more beds away. I totally agree with the Secretary of State that part of the issue is that patients could be seen somewhere else. However, it is not a matter of changing the four-hour target and saying to someone who turns up, “You’re not going to count;” it is simply a matter of providing better alternatives. If we provide better alternatives, people will go to them. The House has discussed community pharmacy use, and it has been recognised that the minor ailments services we have in Scotland can deal with 5% to 10% of those patients. We have co-located out-of-hours GP units beside our A&Es, so someone is very easily sent along the corridor or into the next-door building if they need a GP and not A&E. We do need to educate the public, but the public will use an alternative service if it is there. If it is not, they know that if they turn up at A&E and just keep sitting there, eventually someone will see them, and we should not blame them for that.

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[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.

[Victoria Atkins]

Will the hon. Lady give way?

[Dr Allin-Khan]

No, I will not. [Interruption.]

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[Jenny Chapman (Darlington) (Lab)]

It is a pleasure to follow the hon. Member for Telford (Lucy Allan). I have not heard her speak before, and I look forward to hearing many more speeches from her in the future, but I completely disagree with her implication that we are letting ourselves, the House and our constituents down by standing up and championing health services in our constituencies. It is an essential part of our work and the reason many of us sought election to this place, particularly those such as my hon. Friend the Member for Tooting (Dr Allin-Khan), who has such relevant experience of this subject and made a tremendous speech. I listened with great interest to what she had to say, and I think that Ministers ought to be doing the same.

We have had a lot of debate about whether the NHS is in crisis and whether it is a humanitarian crisis, an ordinary crisis or a winter crisis. I looked the word up and found that a crisis is “a period of intense difficulty or danger”, which strikes me as a good description of where the NHS is today. Intense difficulty is what I am seeing in my local hospital, and it is what my constituents are coming to tell me about.

I have been an MP for nearly seven years, and I keep track of the topics people come to talk to me about in my local surgeries. I am sure many of us do that; it is not hard to do. Someone comes to see me every week either about an experience at the hospital or, more often still, because of an experience in adult social care. That is not something that has occurred suddenly over the last few weeks; it has been growing over time. I would say that the crisis we are witnessing today has been long predicted and is something that we have all felt happening over time.

The Government have chosen—they made a decision—not to act to prevent the worsening of the crisis, which is why there is such anger on the Opposition Benches. When a quarter of patients wait longer than four hours in A&E, that is a crisis. I do not really care whether they are there with an minor ailment or a more serious one, because four hours is too long to wait. The fact that people are there with minor ailments is a very clear demonstration of the problems that exist elsewhere in the system.

When people cannot get a GP appointment they sometimes phone 111, and, more often than not, they will be directed to A&E. I think we need a selection of services available at a central point, whereby if people need a GP, they can see a GP; if they need a practice nurse, they can see a practice nurse; and if they need to be admitted, they can be admitted.

[Victoria Atkins]

In an effort to reassure her colleagues, I want to ask a genuine question—one that I would have asked the hon. Member for Tooting (Dr Allin-Khan). What impact does the hon. Lady believe the 2004 GP contract has had on out-of-hours care? This seems to be the nub of many of the issues discussed this afternoon.

[Jenny Chapman]

The GP contract was changed in 2004, but I did not notice the sort of issues that we face today until far more recently. I am not a scientist or a doctor, but I understand cause and effect, and it does not ring true to say that something that happened six years prior to the change in government can be blamed for something that is happening six years after the change in government. I am not saying that there were no consequences, but I believe that ample opportunity has been provided to put measures in place that would have prevented us from being where we are now.

The hon. Lady’s intervention leads me nicely to my next point, which is about the Secretary of State. I had not intended to speak today, but I was so frustrated listening to him on the “Today” programme, trying to blame anybody but himself, that I decided to do so. He has a pattern. The first thing he does is blame the Labour Government, who were in government until 2010. His party has been in government since then, but he will blame Labour for anything he possibly can. He will find something that happened, perhaps at a particular trust and say that that is why something has gone wrong today. If that does not work and cannot be evidenced, he will say, “Well, that particular trust is a basket case. It is the trust’s fault or the fault of the local managers and local clinicians who have not organised themselves right.”

If that does not work, he will then blame the public, and tell them that they are going to the wrong place, accessing their care in a way that he does not think they should. He might call them “frequent flyers” or point to a problem that is the public’s fault. He will say, “They do not look after themselves properly; it is clearly their fault.” If that does not work, he will blame the local council, and I think that is the worst thing that I have heard him do—blame the local authority.

My local authority has prioritised adult social care, but the pressures are not going away. They are going to get worse and more difficult to manage—and it is running out of things to cut. It is closing our central library in Darlington and making other hideous cuts, and I do not know where the next round will come from.