NHS Performance: Darzi Investigation

Victoria Atkins Excerpts

Monday 7th October 2024 Commons Chamber

[Wes Streeting]

The hon. Member’s point is taken.

The NHS stands at a fork in the road. There is a choice before us, and the parties represented in the House have different opinions on the best way forward. The first option is for the NHS to continue on its current path—to head down the road to ruin, on a mismanaged decline, with a status quo so poor that patients are forced to raid their savings to go private, and with the worst yet to come, because many Opposition Members believe that all patients should have to put their hands in their pockets when they fall ill. Reform UK has openly stated that it wants to change the funding model and replace it with an insurance-based system, and plenty in the Conservative party want to head in the same direction, chasing Reform UK down the hard-right rabbit hole.

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

That is nonsense.

[Wes Streeting]

The shadow Secretary of State says that it is nonsense. She is very upset about it, so let me point out to her that earlier this year, the Conservative former dentistry Minister, who served in her team, under her leadership, proposed a monthly £10 insurance fee to see a dentist. That is what the Conservatives were planning before the election. [Interruption.] If the hon. Member wants to intervene, I will give way.

[Victoria Atkins]

I will happily intervene. That is simply incorrect. There are a couple of points that the Secretary of State has made that are completely wrong, which I will have to correct in my speech. He is no longer in opposition. He needs to be careful what he says on the record. That is not right.

--- Later in debate ---

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

On this, the first anniversary of Hamas’s horrific attack on Israel, our thoughts are with Israel, the victims of that horrific attack and their loved ones, and with all those who are trying to rescue the hostages, get aid where it is needed and bring peace to the region.

Day 95 of this fumbling Labour Government, and yet another general debate to talk about a report that we talked about three weeks ago. That seems to be the golden—or Gray—thread running through this Government: lots of talk, but where is the action? If the Secretary of State for Health and Social Care wanted to make a meaningful contribution to the nation’s health, why did he not bring forward the Second Reading of the Tobacco And Vapes Bill this evening, to help our children and bring about the first smokefree generation? That Bill is ready to go; why are the Government not?

The right hon. Gentleman could have provided an update to the House on the 40,000 more appointments that he promised many times during the campaign, which the latest answer from his Minister to a written parliamentary question suggests is nowhere near happening. It is perhaps about as likely as the Prime Minister paying for his own glasses. The right hon. Gentleman could have set out the steps that his Department is taking to prepare the NHS for winter. In the spring, I asked the system to start planning for this winter. How many beds, ambulances and care packages has he put into the system to prepare it for winter? He could have set out the terms of the royal commission on social care. We in the Conservative party stand ready to help on that royal commission, because we believe in constructive opposition, yet we have heard nothing from this Government. The right hon. Gentleman could have launched the much-hyped 10-year plan, which he promised before the election was “oven-ready”, but appears to be in the deep freeze. How many more Government resets will there be before that 10-year plan is launched?

Instead, in their first 95 days, this Labour Government have talked down the economy and the NHS, stopped new hospitals from being built, scrapped NHS productivity improvements, overseen GPs entering industrial action, been exposed in a health cronyism scandal, and opened a dispute with hundreds of thousands of nurses and midwives. They seek to justify all of that with the Darzi report. That report, from a former Labour Health Minister, has sunk as quickly as it was briefed out. It looks backwards, but not far enough to mark the last Labour Government’s policy and operational failures. If this Government are serious about reforming the NHS—and I genuinely hope they are—they and the Secretary of State need to transition quickly from opposing to governing.

[Jim Shannon (Strangford) (DUP)]

Will the right hon. Lady give way?

[Victoria Atkins]

I will finish this point. That transition must begin with the language that the Secretary of State is choosing to use about the NHS. Interestingly, we have heard a little bit of nuance for the first time tonight, perhaps because health leaders are raising concerns that his “broken” narrative is damaging public confidence and will lead to people not coming forward for care, as was reported on the day that the right hon. Gentleman gave his speech to conference. That narrative is hurting the morale of staff who are working tirelessly for their patients. As the confected doom and gloom of the new Chancellor damages business confidence, so too does the Health Secretary’s relentlessly negative language risk consequences in real life.

Let me say what the Health Secretary refuses to acknowledge: the NHS is here for us and is ready to help. Its dedicated staff look after 1.6 million people per day, a 25% increase from the days of the last Labour Government. That is why I am always a little concerned whenever the right hon. Gentleman harks back so far; I do not think he has quite understood the change in capacity and scale of the national health service since we inherited it from the last Labour Government. The majority of those 1.6 million people will receive good care. [Interruption.] These are just facts, but I know the Health Secretary finds them difficult to receive.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Will my right hon. Friend give way?

[Victoria Atkins]

In one moment.

Of course, it is important that we focus relentlessly on those patients who do not receive good care, but that will not be achieved by writing off the 1.5 million people who work in the NHS. In fact, the NHS has more doctors, nurses and investment than at any point in its history. It is delivering millions more outpatient appointments and diagnostic tests and procedures for patients than in 2010, and NHS mental health services are supporting 3.6 million people a year, a 10% increase in one year alone.

[Dr Evans]

rose—

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

rose—

[Victoria Atkins]

I will give way to the doctor behind me, and then I will give way again.

[Dr Evans]

It is interesting that Lord Darzi chose 2010, because there were some good points in what the Labour Government put in place, but there was also the problem of Mid Staffs. We had the Medical Training Application Service fiasco around medical careers, for which Patricia Hewitt had to apologise, and we had the £11 billion IT project that was put in place and has now failed as well. These things shape the NHS, and when we are trying to come up with solutions, they impact on the way that doctors, leaders and politicians come together. Does my right hon. Friend have suggestions for how we can take the politics out of this debate, enabling us to have a sensible debate on reform, which I think both sides of this House would like to see?

[Victoria Atkins]

I thank my hon. Friend, who brings his clinical experience and expertise to this debate. I say frankly to the Secretary of State that I wish he had taken the approach of the Defence Secretary, who has set up a cross-party commission on defence spending. Indeed, he has invited my former colleagues to sit on that review, because he understands that we bring an enormous amount of knowledge, experience, and—dare I say it?—some hard knocks from working in those massively complex Departments.

The right hon. Gentleman knows me. We have done good-humoured battle over the Dispatch Boxes for a long time now, and had he come to me and asked me to help him, I genuinely would have. [Interruption.] The public are hearing this. They want politicians to cut all the flim-flam and the bluster and work together, and had the right hon. Gentleman been serious about the Darzi report, he would have done exactly as his colleague around the Cabinet table has done and conducted a cross-party review of the NHS to ensure that we can make real progress. It is interesting that the Health Secretary does not appear to agree with the approach that his Cabinet colleague has taken.

[Peter Prinsley]

rose—

[Victoria Atkins]

I will listen to the hon. Gentleman. [Interruption.] I am very generous with interventions, and I know that he brings expertise and experience to the House as well.

[Peter Prinsley]

I am grateful that you have given way, and thank you for that. I have been sitting listening to you—[Hon. Members: “Shadow Secretary of State.”] I am sorry, I am getting the hang of this. To be honest, I am struggling to recognise what the right hon. Lady is talking about. The state of the health service is a disgrace; the Opposition, who I believe were the Government until quite recently, have totally messed the situation up over a period of 14 years. What Lord Darzi has had to say is a pretty accurate diagnosis of the situation we are in, so it is quite surprising to listen to the shadow Secretary of State talk as if everything was perfect over the last 14 years. That is simply not the case.

[Victoria Atkins]

I will help the hon. Gentleman, because I appreciate that he is new to this place. If he had been listening carefully to me, he would have heard that I am and have always been—in fairness, I hope the Health Secretary would acknowledge this as well—very open about the fact that the NHS needs reform. In fact, I said as Secretary of State that I wanted to reform our NHS to make it faster, simpler and fairer.

By the way, I speak with personal experience. I know there are some Members on the Back Benches who are new to this place and perhaps have not quite moved on from the natural competitiveness of a general election campaign, but I was diagnosed with type 1 diabetes at the age of three. I have seen the very best of the NHS, but I have also seen some of its darkest corners. The NHS is genuinely one of the reasons why I came into politics, and one of the most damaging things about political discourse and the healthcare system in this country is when people seek to attribute to others a lack of care or commitment to our healthcare system, just because we have different ways of tackling these challenges and different solutions.

This is why—I will say this again, because I am not sure that the right hon. Gentleman is listening—I will work constructively with him to improve the health service, but we have to do this on the facts. Some of the suggestions he made in the debate today and in his discourse during the general election campaign and so on are not accurate, and this is where I will pull him up. For example, he has not mentioned the introduction of Pharmacy First or the 160 community diagnostic centres. Just to help him, those were backed by the largest central cash investment in MRI and CT scanning capacity in the history of the NHS. Those, as well as the new surgical hubs that we introduced, are not only putting healthcare into the community but, critically, helping to improve the numbers of chest checks and scans going through the system, which means speedier diagnosis.

[Wes Streeting]

The right hon. Lady mentions Pharmacy First. How many pharmacies went bust on her watch?

[Victoria Atkins]

As the right hon. Gentleman knows, because I imagine he will have got exactly the same briefing I used to get when I was in his shoes and being advised by exactly the same civil servants—and I am having to let this flow back into my memory here—the average person in England is within walking distance of their pharmacy. He will know that in many high streets in our market towns, as well as in London and other urban areas, there is a density of pharmacies. We want to support those pharmacies to ensure they are able to provide the services that they can provide, and in fairness, to enable pharmacists to work at the top of their licences. He supported Pharmacy First when I introduced it, so I am a little surprised that he appears to be casting doubt on it, but I am grateful for his intervention.

The next point is that our women’s health strategy—it does not have the attention from his ministerial team that it should have at the moment, and I hope that will improve over the coming months—is seeing the roll-out of women’s health hubs across England into every integrated care board area by the end of this year, ensuring that women’s health issues receive the attention they deserve.

Of course, there are parts of the NHS that need to change and do much better. The NHS needs to reform for the future of healthcare, and our focus must be on improving outcomes for patients, not protecting structures, bureaucracy and vested interests in the NHS. As I have said repeatedly, we will scrutinise constructively and support any meaningful efforts to reform the NHS to improve outcomes and experiences for patients, because we all want the NHS to thrive.

However, after nearly 100 days, there has not been anything yet for us to scrutinise or indeed support from this Government. [Interruption.] The Secretary of State says he has just given me a list. Interestingly, I am pretty sure that three out of those four were started under my Government. [Interruption.] I am pretty sure that I was the Secretary of State who ordered the review of the Care Quality Commission, precisely because I was so concerned. He will be able to build on that report, and quite rightly so, but he should please be careful of his facts. Disappointingly, it is the right hon. Gentleman’s fondness for parties and concerts that has made the news recently, rather than his health policies. This Government need to sober up and start taking responsibility for their choices.

[Tom Hayes (Bournemouth East) (Lab)]

On Saturday, I had a surgery appointment with a young lady who has struggled to access support for her eating disorder and mental health issues. She has gone through some of the most difficult experiences anybody can go through. She asked me a simple question: “Why have I been unable to access NHS support for my mental health?” What would the shadow Secretary of State say to my constituent, who, when she looks back at the reasons, frankly blames the previous Government?

[Victoria Atkins]

First, I am very sorry to hear that. Again, the way we were trying to deal with the enormous increase we have seen in mental ill health across our country was first of all to boost mental health services for children and young people. Indeed, the hon. Member may not be aware of this, but we rolled out mental health support teams across nearly 45% of schools. We wanted to complete that to 100% of schools by the end of the decade, and I very much hope that the Secretary of State will be taking up that policy and delivering it.

The hon. Member for Bournemouth East (Tom Hayes) might know that there seems to have been a real increase in eating disorders since the pandemic. We know, for example, that the impact of social media sites, and the algorithms that sit behind them, can lead people who are already feeling very vulnerable into even darker places. So when the Secretary of State says that there should be a cross-Government piece of work, I very much agree with him—I hope he will achieve that through his mission board. But we really have to look at how we as a society can deal with some of these causes, because I do not think anyone is happy with seeing such a huge increase in anxiety and mental ill health among our young people since the pandemic.

[Jim Shannon]

One of the things that came up at our party conference some time ago was a recommendation from the British Medical Association and the General Medical Council to encourage medical students into local trusts by paying their fees, which would pay for itself given the cost of locum doctors in each of our health trusts. Would the shadow Secretary of State support that, and would she in turn encourage the Government to do likewise?

[Victoria Atkins]

I hope the hon. Gentleman knows by now that when he makes a suggestion, I will take it away. He will appreciate that, as part of a constructive Opposition, I want to look carefully at the ramifications—both the intended and unintended consequences—of policies suggested in the Chamber, but that sounds very interesting. I thank him for his contribution, as always.

[Several hon. Members rose—]

[Victoria Atkins]

I am going to make some progress.

One of the choices facing the Health Secretary is whether he will fight for the investment required from the Treasury to implement the productivity plan. At spring Budget, the Conservatives announced more than £3.4 billion of investment to upgrade IT systems, expand services on the NHS app and make better use of artificial intelligence, in order to reduce bureaucracy for staff and free up clinical time for doctors and nurses. Alongside the long-term workforce plan—the first ever in the history of the NHS—this plan will see productivity grow by 2% a year by the end of the decade and unlock £35 billion of savings, yet the productivity plan is not mentioned anywhere in this 163-page report.

This plan was made in partnership with NHS England and funded by the Conservative Government. While the right hon. Gentleman has talked a good game on productivity, we are still waiting for him to confirm his commitment to deliver the plan that was drawn up with NHS England to help improve productivity. I asked him three weeks ago whether he was cancelling this plan, and he failed to answer. I am very happy to give way now if he wants to commit to it. The whole NHS would like to know.

[Wes Streeting]

I am delighted that the shadow Secretary of State has so generously given way. I am not going to pre-empt the Chancellor’s announcements at the Budget and the spending review, but I say to her that the reason why so many of the things she said at this Dispatch Box as Secretary of State were a pile of nonsense is that they were plans built on a pillar of sand—a £22 billion black hole for which she and her party are yet to apologise. Will she do that now?

[Victoria Atkins]

As the right hon. Gentleman knows, calculations were made in the Treasury for this economic inheritance, but the Treasury cannot even explain how it has arrived at those calculations. If I were him, I would be a little bit careful of relying on that figure, because I fear it may trip up his Chancellor in due course. Perhaps the reason why he cannot answer the question about whether he is in fact committed to the productivity plan is that his friend the former Health Secretary, who has been walking in and out of the Department for Health with all of his private healthcare businesses, has not told him whether he plans to accept it, but we will find that out in due course.

The Secretary of State’s silence continues with new medicines, technology and trials. These will be at the forefront of the reforms needed in health services across the world, let alone the NHS, yet the Darzi report mentioned NICE only once in 163 pages. Even worse, I am hearing from the life sciences sector that he and his team are refusing to meet these businesses, putting at risk the hundreds of millions of pounds of investment that the Conservative Government secured, as well as the highly skilled jobs they provide and the life-enhancing treatments they promise our constituents. It is his responsibility to persuade the Chancellor to continue supporting and investing in this innovation for the future, because patients will not thank Labour if it refuses to engage in the medical revolution with these businesses.

Another choice that the right hon. Gentleman must make—we perhaps have a precursor of what he is going to say—concerns the workforce. We know that NHS staff are at the heart of our healthcare services, and that training, retaining and developing our workforce is critical to the future of the NHS. The Conservative Government created the first ever long-term workforce plan for the NHS—again, a plan that was asked for and welcomed by the whole NHS, and developed hand in hand with NHS England to train the doctors, nurses, midwives and other healthcare staff that we need now and in the future. The plan was described by NHS England’s chief executive as

“one of the most seminal moments in our 75-year history.”

Crikey, even the right hon. Gentleman supported it. Yet this supposedly independent investigation failed to mention the plan once. Will the right hon. Gentleman confirm that this Government stand by this plan and will fund it as the Conservatives would do? [Interruption.] He says that he talked about it, but he did not give an answer, because his job is to ask the Chancellor for this funding—has he done so?

[Wes Streeting]

I did.

[Victoria Atkins]

Right, okay. We have that on the record now and we will wait to see what happens at the Budget.

It is also striking that the report mentions pay and wages only twice in 163 pages, despite the fact that staff costs account for 65% of provider operating costs a year. If the report and the Secretary of State do not acknowledge the single biggest cost pressure for providers, how can they claim to have the answers on reform? He claims to have sorted out industrial action in the NHS, and I must again correct him on something. He keeps referencing when I last had a conversation with the junior doctors committee, as it then was. What he neglects to tell us is that we entered mediation with junior doctors in May—he never thinks to mention that when he is holding forth at the Dispatch Box.

[Wes Streeting]

How did it go?

--- Later in debate ---

[Victoria Atkins]

We entered into that negotiation in good faith, and I gently remind Labour Members of Parliament who were here before the last election that again and again I asked the right hon. Gentleman and Labour MPs to condemn the strike actions and they refused to do so, because we know of their links to their union paymasters—[Interruption.] I will just say “train drivers” and leave that hanging in the air.

When I asked the right hon. Gentleman during Health and Social Care questions in July whether he was going to cut services or whether the Chancellor was going to raise taxes for the junior doctors pay rise, he assured the House that any pay rise would be affordable. How affordable does his deal look now? He has given resident doctors an inflation-busting pay rise for being on strike, and he is paying them for the days they were on strike. He did that with no reform and no productivity improvements attached to it, and with more strikes threatened for next spring. Completely foreseeably, that has led to nurses and midwives asking why they should accept less. Simply telling nurses, “We’re on your side” will not heat their homes this winter. The report does not deal with the here and now; it looks only at the past. Indeed, the Darzi report talks about the importance of capital investment, so if the right hon. Gentleman intends to use the report to inform his policy decisions, as he says he does, why is he stopping new hospitals from being built?

There are now 24 hospitals whose futures are at risk, despite commitments from the right hon. Gentleman and Labour candidates during the election campaign. Labour candidates in Watford, Hillingdon, Milton Keynes, Leeds and Basingstoke made promises to their voters that are now at risk under this Labour Government. Patients in Chelsea and Fulham, Truro, Harlow, Plymouth and Kettering will not get the investment and upgrades that they deserve, despite the promises of their Labour candidates. [Interruption.] Do not believe a word when this Secretary of State says, as he is saying now, that it is because of the economy. The truth is that he had been planning to pause those hospitals since May 2023. For those who are wondering, the details are in his health mission paper, which was published to great fanfare in May 2023—page 6, if that helps. He was planning this since May last year, which is exactly why the promises made at the election were so cynical and now need to be revealed.

Take a perhaps unhealthy dose of salt with the right hon. Gentleman’s claim that the money runs only until March next year. Let me help this very inexperienced Secretary of State understand basic Treasury rules. The comprehensive spending review period finishes in March. I wish I could have bound this Labour Government to committing to those hospitals in the next CSR period, but I could not. It is his responsibility and his role to fight for funding from the Chancellor to ensure that the hospitals are built. We promised that we would allocate the money needed, and would prioritise the new hospitals in the next CSR period. It is now the job of this Secretary of State to secure the money from his Labour Chancellor.

Through our plans to invest in more capital projects, we also sought to improve cancer diagnosis and treatment. While outcomes have improved since 2010, there is much more to do. That is why we opened 160 community diagnostic centres, rolled out new lung cancer screening programmes, and expanded the use of artificial intelligence to speed up diagnoses. Again, we note the lack of any mention of those centres or hubs, which would reduce waiting lists and speed up diagnoses, in this supposedly independent review by the former Labour Health Minister.

I want a straight answer from the Minister in their winding-up speech on an issue that is worrying families up and down the country. Cancer is the single biggest killer of children under the age of 14. I launched the children and young people’s cancer taskforce, which brought together top clinicians, leading cancer charities and the Government to combat childhood cancer, and improve diagnosis and access to new treatments. Its launch was warmly welcomed by parents and charities, and experts were lending their time to the taskforce for free, yet this Secretary of State has chosen to pause it. Parents and charities including the Teenage Cancer Trust, Young Lives vs Cancer, and Solving Kids’ Cancer UK cannot understand why the Health Secretary has chosen to stop that work. That is his choice, and the Minister must please explain in the wind-ups why the decision was taken to pause it.

[Dame Siobhain McDonagh (Mitcham and Morden) (Lab)]

The right hon. Lady makes the point that cancer is the biggest killer of people under 40, but glioblastoma brain tumours are the biggest killer of people under the age of 40. What progress has there been in the last 30 years in the treatment and diagnosis of glioblastoma brain tumours?

[Victoria Atkins]

I think the hon. Lady did not hear me; I said that cancer is the biggest killer of children under the age of 14, not 40. I know only too well how that terrible brain cancer has hurt her family, and the great loss that she has suffered. I know that she has ambitions for the work that we were doing to get cancer treatments, particularly new cancer treatments, as quickly as possible to patients who are getting towards the end of their life. We will of course support anything that the Government do to help people such as the hon. Lady’s sister; again, I come back to the fact that we all want this to work.

[Rachael Maskell (York Central) (Lab/Co-op)]

rose—

[Victoria Atkins]

I will make some progress, because I know that I am trying your patience, Madam Deputy Speaker.

Lord Darzi says that prevention is better than cure. We agree. The Government say that they are committed to prevention, but actions speak louder than words. Scrapping the winter fuel payment for millions of pensioners will undoubtedly come at a cost to the NHS. The equality analysis estimates that 780,000 of the most vulnerable pensioners who are eligible for pension credit will miss out this winter, and the cut will result in 262,000 pensioners needing NHS treatment because they are living in cold, damp homes, at an additional cost of £169 million in a year. How has the Secretary of State stood by as the Chancellor made that appalling decision, which will affect vulnerable pensioners in his constituency, as well as the NHS?

Finally, we have heard the words that the right hon. Gentleman has used about the NHS in England; it is surprising, to say the least, that he has not used those same words times 100 to describe the state of the NHS in Labour-run Wales. On almost every measure, the NHS performs the worst in Wales, where one in four people is on an NHS waiting list. Wales has the longest waiting times; Welsh patients wait on average seven weeks longer than in England. More than 23,000 people wait longer than two years, compared with just 120 people in England. Given the Secretary of State’s rhetoric about NHS England, why has he not asked Lord Darzi to take a cold, hard look at how Labour has run the NHS in Wales for 25 years?

In conclusion, we Conservatives want to support good reforms and good policies for the better health of the nation, but this backward-looking report will not improve productivity. Headlines will not drive better outcomes for patients, and speeches will not improve the life chances of our constituents. This Government need to move from words to action quickly.