NHS Funding Bill

Victoria Prentis Excerpts

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

[Jeremy Hunt]

I suggest to the hon. Lady, whom I greatly respect, that the overall figure is actually what counts. I agree that public health spending matters, but it is absolutely the case that we are heading to being one of the higher spenders in our commitment to health. That is very significant and should not be dismissed.

Often, the debate about funding can distort some of the real debates that we need to have about the NHS. One of those is the debate on social care. If we do not have an equivalent five-year funding plan for social care, there will not be enough money for the NHS. That is because of the total interdependence of the health and social care systems. It is not about finding money to stop people having to sell their homes if they get dementia, important though that is; it is about the core money available to local authorities to spend on their responsibilities in adult social care. I tried to negotiate a five-year deal for social care at the same time as the NHS funding deal we are debating today. I failed, but I am delighted to have a successor who has enormously strong skills of persuasion and great contacts in the Treasury. I have no doubt that he will secure a fantastic deal for adult social care to sit alongside the deal on funding, and I wish him every success in that vital area.

The second distortion that often happens in a debate about funding is that while everyone on the NHS front line welcomes additional funding, their real concern is about capacity. The capacity of staff to deliver really matters. I remember year after year trying to avert a winter crisis by giving the NHS extra money, and most of the time I gave the money and we still had a winter crisis, because ultimately we can give the NHS £2 billion or £3 billion more, but if there are not doctors and nurses available to hire for that £2 billion or £3 billion, the result is simply to inflate the salaries of locum doctors and agency nurses and the money is wasted. Central to understanding capacity is the recognition that it takes three years to train a nurse, seven years to train a doctor and 13 years to train a consultant, so a long-term plan is needed. It is essential that alongside the funding plan, we have in the people plan that I know the NHS is to publish soon an independently verified 10-year workforce plan that specifies how many doctors, nurses, midwives, allied healthcare professionals and so on we will need.

[Victoria Prentis (Banbury) (Con)]

Will my right hon. Friend give us his views on the maternity safety training fund, which I understand is up for renewal soon, and its importance to the midwives of the future?

[Jeremy Hunt]

When we talk about the workforce, training is vital. We know from the 2018 “Mind the Gap” report on the issues at the Shrewsbury and Telford and the East Kent trusts, among others, that only 8% of trusts supply all the care needs in the saving babies’ lives bundle, so the maternity safety training fund is essential. I hope the Health Secretary will renew it, because it makes a big difference.

It is vital that we have an independent figure for the number of doctors and nurses the NHS needs, not a figure negotiated between the Department of Health and Social Care and the Treasury because the Treasury will always try to negotiate the number down and we will end up not training enough people. I know the Health Secretary is on the case.

The final distortion when we talk about funding for the NHS is the link between funding and the quality of care. It is totally understandable that many people think that the way to improve the quality of care is to increase funding, but in reality the relationship is much more complex. As the Health Secretary knows well, we pay the same tariff to all hospitals in the NHS, and with the same amount of money some of them deliver absolutely outstanding, world-class care and others do not. Almost without exception, hospitals rated good or outstanding by the Care Quality Commission have better finances than those rated as requiring improvement or inadequate, which are often losing huge sums. The reason for that, as every doctor or nurse in the NHS knows, is that poor care is usually the most expensive type of care to deliver. A patient who acquires a bedsore or an MRSA or C. diff infection, or has a fall that could have been avoided, will stay in hospital longer, which will cost more. It will cost the hospital more, it will cost the NHS more, and finances will deteriorate. Invariably, the path the safer care is the same as the path to lower cost. That is why it is so important that we recognise that the safety and quality agenda is consistent with the plan to get NHS finances under control.

It is also why it is important to remember that the Mid Staffs scandal happened in a period of record funding increases for the NHS. So when it comes to NHS funding, transparency, openness, a culture that learns from mistakes, innovation and prevention are every bit as important as pounds and pence.

--- Later in debate ---

[Victoria Prentis (Banbury) (Con)]

It is a pleasure to follow such a great speech and to see the hon. Member for Rhondda (Chris Bryant) looking so well.

There is no complacency on this side of the House, but there is a feeling that this is an upbeat debate. I am thrilled to support the Bill and, indeed, to support the great Health team. It is hard to choose a favourite among them, because I have so many asks.

No one will be surprised that I start with the exciting developments at Horton General Hospital. First, we have a new award-winning, nurse-led clinic for deep vein thrombosis. It is a one-stop diagnostic clinic for patients who need urgent treatment, and it is up and running now. Secondly, we have the Horton hip fracture clinic, which has been named as one of the best in the country for the past seven years in a row. Thirdly, we have a new chemotherapy service, launched last September, for children aged up to 19. The service provides intravenous chemo for patients who would otherwise travel to Oxford. We are now in a good place at Horton General Hospital.

We are recovering from that dreadful period in which I was first elected, when we all went to court against the clinical commissioning group. There was a botched consultation and relationships fractured. It was town versus city, and all was not a happy place. We have worked hard on repairing those broken relationships. Lou Patten, the head of our clinical commissioning group, deserves a special mention. Sadly, she moves on in March, but I spoke to her this morning and we have high hopes that her successor will continue to take things forward. We are united in our desire to make sure the Horton is fit for the future.

We have plans for a new modular building, and the Department will be hearing from us on those plans very shortly. I say to colleagues that it is worth working together to rebuild those fractured relationships. We are making real progress locally.

There is certainly no cause for complacency on primary care. GP appointments continue to be an issue, and the Horsefair surgery is in the local news a great deal at the moment. We have a great campaigning local journalist, even though she has stood against me at several general elections, and this is one example of how we can work together to put things right. Following those stories, and following the complaints I have received from constituents, I spoke this morning to the clinical commissioning group, which told me that it will investigate the issues that have been raised.

The Horsefair surgery recently changed ownership, and it is moving from the locum model to having more employed GPs, which can only be good, but bravery is needed to tackle the systemic difficulties in how GPs operate, particularly in areas of the country where the building’s ownership can make a real difference to a practice’s sustainability.

We have been hearing a great deal about palliative care in the national news this week, with our brilliant Katharine House hospice featuring heavily. We have real concerns about the funding model for palliative care. We want to enable people to die at home, or as near to home as possible, and I will be writing to the Department further about this.

I have been involved with the all-party parliamentary group on baby loss since the beginning, when I was vice-chairman because it seemed to me that other Members had more current stories to tell. This afternoon, those other Members either having left this place or having moved to ministerial office, I was elected as chairman. The hon. Member for Washington and Sunderland West (Mrs Hodgson) and I have always been involved with the APPG, and we all share in its extraordinary success so far.

I would like to claim some credit for how the APPG bolstered the Government’s ambition to reduce stillborn and neonatal deaths and also for Jack’s law, which is about to be enacted in April, but we have much more to do. My hon. Friend the Member for Dover (Mrs Elphicke) spoke very movingly about Tallulah-Rai, and we must make certain such mistakes do not happen again.

I have two specific requests of the Department this evening. The first is for data. The Department has an ambitious target to reduce the number of stillborn and neonatal deaths. We need to see what we have been doing for the past five years and we need to see what works to enable us to take forward the “Saving Babies’ Lives” care bundle in the most strategically useful and efficient way, so I will be writing to the Department on behalf of the APPG specifically to ask for data.

My second major ask is about the national bereavement care pathway. I am glad to say that only nine trusts, a very small number, have not engaged with the APPG on this at all. I will be naming them in the future, so I strongly advise them to engage pretty soon. Many trusts are starting to establish services, but the APPG is calling this year for the Department to support the roll-out of the national bereavement care pathway. We want both policy and financial support and real oomph behind this initiative.

I am particularly grateful to the Department for telling CQC inspectors that the national bereavement care pathway has to be part of the maternity section of their inspections. Can the pathway also be included in the A&E and gynaecology sections? Only if hospitals have to consider this on a nitty-gritty level will they insist that it is taken forward seriously.

I have trespassed long enough on your indulgence, Mr Deputy Speaker, but I welcome this initiative, and I really think there is hope for the future.