NHS: Long-term Strategy

Wes Streeting Excerpts

Wednesday 11th January 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I beg to move,

That this House condemns the Government for failing to recognise the current crisis in the National Health Service; regrets that, as a result of Government mismanagement, hundreds of lives may be being lost every week due to the collapse of emergency care while patients are finding it impossible to get a GP appointment, ambulance or operation when they need one; calls on the Prime Minister to acknowledge the crisis and act with the necessary urgency to mitigate the impact on patients; and further calls on the Secretary of State for Health and Social Care to ensure the NHS is never in this situation again by bringing forward a long-term strategy which will end delayed hospital discharges, provide the NHS with the necessary staff to treat every patient in good time, and reform primary and community care to reduce the number of people needing hospital treatment.

I rise to support the national health service, which is going through the biggest crisis in its history, and most importantly, to defend the patients who are suffering as a direct result of 13 years of Conservative mismanagement of the NHS. This winter has shown just how high a price patients are paying: NHS staff are walking out on strike—in the case of nurses, for the first time in their history—patients are waiting entire days for an ambulance to arrive, and then days on end in A&E before they are admitted; there were 50,000 needless, preventable deaths last year, which experts have blamed on unacceptably long waiting times; and there have been hundreds of avoidable deaths every week this winter, because emergency care has collapsed.

The Secretary of State for Health and Social Care says that he disputes those figures from the Royal College of Emergency Medicine and the Office for National Statistics, but I invite him to listen to some of the stories behind the numbers. An 89-year-old fell in the bathroom and waited nine hours for an ambulance. The sepsis that caused him to fall killed him. His consultant said:

“Had I seen him within a couple of hours it could have been avoided. Maybe.”

Teresa Simpson, a 54-year-old woman from Hull, suffered a cardiac arrest and lost oxygen supply to the brain. She waited 16 hours for an ambulance, which arrived only when her husband phoned 999 a second time, after she had become lifeless. She passed away. A consultant in the north of England described a scene in a hospital waiting room this winter when a patient collapsed:

“They get CPR on the floor. I am forced to declare his time of death in front of frightened, horrified members of the public and his wife. On the floor of the waiting room. He was elderly and frail and hadn’t wanted to bother us. We had run out of trolleys and beds. In the whole hospital. This was by 10am.”

The Prime Minister refuses to describe this as a crisis.

Our motion before the House calls for a long-term plan to end delayed discharges, give the NHS the staff it needs to treat patients on time, and reform primary and community care, so that fewer people end up in hospital.

[Alun Cairns (Vale of Glamorgan) (Con)]

Will the hon. Member give way?

--- Later in debate ---

[Wes Streeting]

The Government do not have a plan, but perhaps the right hon. Gentleman will surprise me by telling me, against all hope and expectation, that they do.

[Alun Cairns]

Clearly, some of the statistics and cases that the hon. Member highlights are distressing and no doubt need to be investigated. The Prime Minister has rightly prioritised waiting times as one of his key commitments this year. How does the hon. Member account for the performance in Wales, which is worse than in England on all the statistics that we highlight, in spite of the Labour party having been in charge of the NHS there for more than 20 years?

[Wes Streeting]

I am grateful for the right hon. Gentleman’s intervention, because it brings me directly to the Government’s amendment to the motion, which is not a plan but a litany of excuses for the situation across the United Kingdom, including in Wales. I will run through them. By way of excuse, they say that the situation is challenging across the United Kingdom, and they are right: in Wales, the NHS is struggling; in Scotland, the NHS is struggling; and in Northern Ireland, the NHS is struggling. What do all parts of the United Kingdom have in common? Thirteen years of Conservative underfunding.

I will tell the right hon. Gentleman that, as he knows perfectly well as a Welsh Member, the reason why the Welsh NHS struggles more than England overall is the age profile of the population, the number of disabled people in Wales and the level of deprivation. The same disparities between Wales and England overall also explain the enormous health inequalities within England, which is why health outcomes in my city—in London—are so much better than in so many parts of the north or south-west of England. And you know the way to deal with that? It is genuine levelling up. But if people want a Government who tackle health inequalities so that every person in every part of the United Kingdom gets good-quality healthcare, they need to elect a Labour Government here in Westminster. That is the truth that the right hon. Gentleman does not want to admit.

I know that SNP Members will not be here today, because we are talking about England, but here is another truth that Nicola Sturgeon does not want to admit either: people in Scotland will be better off under a Labour Government too. She knows that just as well as anyone else.

When Conservative Members are not talking about other parts of the United Kingdom, they say that health pressures exist right across the world, but international pressures do not explain why the average wait for an ambulance is 14 minutes in France, while heart attack victims and stroke victims routinely wait an hour for an ambulance here in England. International pressures do not explain why it is that, over the past year, one in six UK adults had a pressing need for medical examination or treatment but could not get access. They do not explain why this is the highest figure out of 36 European countries and almost triple the EU average. Their excuses about international pressures do not explain why cancer outcomes in England are behind other comparable countries. None of that explains why the state of the NHS is as bad as it is today, but perhaps the hon. Member for Bosworth (Dr Evans), who was trying to intervene, wants to stand up and justify why it is that, after 13 years of Conservative Government, his constituents are waiting an average of an hour for a heart attack or stroke case.

[Dr Luke Evans (Bosworth) (Con)]

I am grateful to the hon. Member for giving way, and there are two points that I would like to pick up, seeing as he has come back to me on the second one. The first one, about comparable data, is really important. Does Labour have a position on sharing data between Wales, for example, and England, because the data is not comparable, which makes it very difficult to work out what is going on? Secondly, a plan was brought forward by the Government. It is called the NHS White Paper, which was brought forward by the NHS to transform the NHS with the integrated care boards, which are now in place. The people on those boards—42 of them—are the best people to make that change.

[Wes Streeting]

I find it astonishing. The hon. Gentleman’s position seems to be this: the Government have a plan, after 13 years, and apparently that plan is in progress. So why is it that so many Conservative Members just this week have stood up to talk about the fact that their constituents cannot see a GP, they cannot get an ambulance when they dial 999, and they are waiting hours on end in A&E departments? I know they like three-word slogans, but is the latest Conservative slogan on the NHS really “Crisis, what crisis?”?

[Lee Anderson (Ashfield) (Con)]

I have received several emails from Labour party members in Ashfield asking me to back the Labour party’s fully costed NHS plan. Could the hon. Member please send me a copy?

[Wes Streeting]

I would be delighted. I can barely believe it. Honestly, I can barely believe it. This is the second time this week that Conservative MPs have said, “We need to see Labour’s plan, because we haven’t got one.” I would be absolutely delighted. The hon. Member can even sign it and put it in one of his party’s fundraisers—God knows he is going to need it at the next general election. I will tell him what the plan is: it is a fully funded, fully costed plan to deliver the biggest expansion of NHS staff in history—doubling the number of medical school places; 10,000 more nursing and midwifery clinical training places; 5,000 more health visitors; and doubling the number of district nurses. That is my plan. Where is their plan?

The Government amendment refers to funding and states that they are putting in an extra £14.1 billion. I wonder how much of that will be swallowed up by the inflation caused by their catastrophic mismanagement of the economy. People are not just paying the Truss and Kwarteng premium; this is the price of 13 years of low growth, low productivity, high taxes and stagnation. Every penny will be swallowed up by higher inflation. That is the truth. Why do people talk about 13 years of underfunding? It is because they know it did not need to be like this, and because they saw what the last Labour Government did. With Labour, per capita spending on health increased by 5% each year, and we were able to do that because we grew the economy. Under the Conservatives, spending per capita fell during the coalition years, fell in the following two Parliaments, and even the increases that the Government promise today will not match the investment that Labour put in. That is the price of Tory economic failure.

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

My hon. Friend is making an outstanding opening speech. My constituent told me last week about his relative who has multiple myeloma and had a stem cell transplant last year. She had a bad viral infection for three weeks, which is a serious issue after chemotherapy and a transplant. My constituent was asked by her consultant to take his relative to another hospital, because no beds were available at the hospital where she was being treated. She was treated in the corridor and waited 24 hours for a bed. Does my hon. Friend agree with my constituent that that hospital and its staff were not to blame and that, with underfunding and no strategy for the NHS now or in the future, the fault lies squarely with this Government?

[Wes Streeting]

I wholeheartedly agree. We hear this time and again. When patients are struggling to get access, and experiencing appalling delays in accident and emergency, they do not blame the staff. They know that the staff of the NHS are busting a gut, but those staff are suffering in the same way as patients because of 13 years of Conservative mismanagement. The only part of the Government’s amendment that I agree with is the part that praises NHS staff. Why is the Secretary of State’s Prime Minister bringing in his “sack the nurses” Bill next week? How many nurses will he sack? How many paramedics or junior doctors will he sack? The only people who need the sack are this Government—[Interruption.] Perhaps the hon. Member for East Worthing and Shoreham (Tim Loughton) agrees.

[Tim Loughton (East Worthing and Shoreham) (Con)]

When the last Labour Government left power, they were spending 8% of GDP on the NHS. Last year that figure was 10.6%, which is average for the EU nations. Why did the last Labour Government so chronically underfund the NHS?

[Wes Streeting]

The hon. Gentleman has got some brass neck. I have already given him figures showing that per capita funding increased by 5% under the last Labour Government—[Interruption.] And as for GDP, perhaps he should look at growth figures and ask why the economy is so much smaller than it would have been if we had had a Labour Government managing the economy well. That is the truth; it is a simple fact. If not, perhaps he wants to explain how his Government will put more money into the NHS, but I did not hear that commitment.

[Mr Toby Perkins (Chesterfield) (Lab)]

I thank my hon. Friend for his excellent speech. I do not quite know why I have intervened, because I am very much enjoying watching him flay the bowling to the boundary when he gets questions from Conservative Members. He is absolutely on to something in relation to the money that has been wasted in our NHS by the failure to plan for NHS staffing. Is not the reality that far too much money is being spent on agency workers because there is no long-term strategic plan for NHS staffing?

[Wes Streeting]

My hon. Friend is absolutely right. We are spending £3 billion on agency costs that would surely be better spent on ensuring that we have a serious workforce plan, and on hospital departments that are staffed by regulars who get to know their shift, get to know their colleagues, and get to know their patients and communities.

Let me turn to what the Secretary of State for Department for Business, Energy and Industrial Strategy said about ambulance staff, because I think he irresponsibly suggested that ambulance staff have not committed to minimum service levels for category 2 calls today, which is just not true. I think he ought to apologise to ambulance workers.

[Dr Luke Evans]

rose—

[Dame Angela Eagle (Wallasey) (Lab)]

rose—

[Wes Streeting]

I will give way to my hon. Friend the Member for Wallasey (Dame Angela Eagle), who has been waiting.

[Dame Angela Eagle]

On minimum service guarantees, does my hon. Friend think that the Conservative party has a brass neck to try to enforce minimum service guarantees, which are always made by agreement on any strike anyway, but says nothing at all about the catastrophic loss of service guarantees because of their mismanagement and underfunding on every other day?

[Wes Streeting]

My hon. Friend brings me neatly to the argument that I want to make about minimum service levels. Let me tell the Health Secretary who they are talking about when the Government attack ambulance crews. Donna Wilkins called an ambulance when she became concerned that her disabled son James may have been having a stroke, which is a listed side-effect of the medication that he takes. She and James waited in an ambulance for nine hours outside the Royal Bournemouth Hospital because there were no beds. Paramedics waited with them for the full nine hours. They chatted with James, loaded his favourite TV shows on their phone for him to watch and ran into the hospital to bring tea for Donna and soft food for James, who has problems with swallowing, which they spoon fed him. This is who NHS staff are. This is who ambulance crews are. These are the very staff the Government would have sacked with the legislation that they are bringing forward next week. As my hon. Friend said, what brass neck from this Government to talk about minimum standards on strike days when they cannot deliver basic minimum standards on any other day of the year.

The two-month target from GP referral to cancer treatment has not been met since 2015. Four in 10 people are waiting more than four hours in A&E. The four-hour target for A&E waits has not been met since 2015. The 18-week treatment target for elective care has not been met since 2016. One in seven people cannot get a GP appointment when they try. More than 1.3 million waited more than a month to get a GP appointment in November. How much more evidence do the Government want that they are incapable of delivering the minimum basic standards that patients deserve every single day of the year?

This has to be seen to be believed: the Government are planning an advertising campaign to urge patients to stay away from the NHS with the tagline “Help us help you.” Do they not see the risk in patients not coming forward for help when they need it? Can they not understand that people are fed up with being told that they have to protect the NHS, rather than the other way round? Instead of asking the public to help the NHS, the public want the Government to help the NHS to help them.

[Andy McDonald (Middlesbrough) (Lab)]

I do not know whether my hon. Friend is as horrified as I am by the juvenile and facile comments from the Conservative Benches, or whether he heard today on Radio 4 about the 600,000 people who every single month are waiting for four hours or more to get into A&E and be treated. As a direct result, horrifyingly, each and every month, hundreds and hundreds of people are dying needlessly in our country. That is on this Government’s watch. Should they not be hanging their heads in shame?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend—avoidable and preventable. The Chancellor wrote an entire book about getting the number of preventable deaths down to zero, because that is where the figure should be, so to have 50,000 preventable, avoidable deaths reported is a badge of shame for the Government.

Worst of all, the height of the Prime Minister’s ambition is to stop making things worse. If we have 7.1 million people waiting for treatment, rather than 7.2 million people, apparently that is a job well done in the Prime Minister’s book. Our NHS needs to be rebuilt and renewed, but all he offers is managed decline. His five pledges have the bar set so low that even his predecessor could meet those promises.

If hon. Members want to know what real ambition and action look like, it is this: 89,000 more nurses; 44,000 more doctors; waiting times cut from 18 months to 18 weeks; 3 million more operations carried out each year; banning smoking in pubs; the largest hospital building programme in history promised and delivered; 100 new walk-in centres; GP appointments guaranteed within two days; free prescriptions for cancer patients; appointments with a cancer specialist within two weeks of referral; waiting lists cut to their lowest point in history; and patient satisfaction at its highest levels in history. That is the difference that a Labour Government make.

[Mrs Natalie Elphicke (Dover) (Con)]

On delivery by Labour, over the many years of a Labour Government, Dover and Deal saw its health service absolutely decimated, service by service. What has happened under a Conservative Government? There has been a new hospital built for Dover, the first dementia village in the country, built for Dover and Deal, one of the first 40 diagnostic covid hubs, delivered for Dover and Deal, and a new GP training centre, delivered for east Kent. Of course, there is more to do on health, but we have the plan—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Interventions must be brief by definition.

[Wes Streeting]

I cannot believe that the Member for Dover and Deal seems to be standing up and telling her constituents that when it comes to the NHS they have never had it so good. I know she is desperate and scraping the barrel because Prime Minister after Prime Minister have broken their promises on immigration and the Prime Minister is not dealing with small boat crossings, but I am afraid that pretending the NHS is working will not save her at the next general election.

To govern is to choose and the last Labour Government showed that investment plus reform equals better standards for patients. You do not need to do A-level maths to get to that equation. The right hon. Member for Gainsborough (Sir Edward Leigh) asked his Health Secretary:

“What is our long-term plan? We cannot leave the Labour party to have a long-term plan while we do not. How are we going to reform this centrally controlled construct?...What is the Secretary of State’s plan?”—[Official Report, 9 January 2023; Vol. 725, c. 297.]

What indeed is the Secretary of State’s plan? He has been in power for 13 years. His Government have presided over this record and still, after 13 years, they have no plan. Conservative Members asked what my plan was and I outlined it: a fully costed, fully funded plan to deliver the biggest expansion of NHS staffing—[Interruption.] They are saying, “Where is it?” I will repeat it for them again: double the number of medical school places; 10,000 more nursing and midwifery clinical training places; 5,000 more health visitors; and doubling the number of district nurses qualifying, paid for by abolishing non-dom tax status, because we believe that people who make Britain their home should pay their taxes here, too.

I understand that, in their partisan fury, because they cannot bear the fact that Labour has a plan and they do not, Conservative Members cannot swallow humble pie enough to take our plan and run with it. If they do not believe me, they should at least believe their own Chancellor, because this is what he said about Labour’s plan:

“I very much hope the government adopts this on the basis that smart governments always nick the best ideas of their opponents.”

If we were in any doubt already, this is not a smart Government and it will take a Labour Government to deliver Labour’s plan. That is why we end up with these sticking plasters, as we saw on Monday, to deal with this crisis.

Why did the Government choose to leave 230,000 patients languishing on NHS waiting lists when the spare capacity was there for them to be treated in the private sector? We know what our priority is: get patients treated as quickly as possible, pull every lever available to make it happen and make sure that patients do not have to pay a penny. The Government could act on doctors’ pensions to stop doctors retiring early for no reason other than that there is a financial disincentive to stay, but they still have not done it. They could bring strikes to an end by negotiating with the unions instead of threatening to sack the staff, but they still have not done it.

[Tim Farron (Westmorland and Lonsdale) (LD)]

I want to give the hon. Member an idea to nick. He mentioned earlier the chronic situation with cancer waiting times, with 40%-plus of people diagnosed with cancer waiting two months to be seen. I wonder if he is aware of the work of the all-party parliamentary group on radiotherapy; I chair the group and his hon. Friend, the hon. Member for Easington (Grahame Morris), is a vice-chair. Fifty per cent. of people with cancer need radiotherapy. We spend 5% of the cancer budget on it. The average across developed nations is about 9%. Will he agree to give a bit of time to come to the group’s inquiry on 18 January? In looking at Labour’s plan, will he consider how we can fund radiotherapy, so we can treat people and do not have so many avoidable deaths?

[Wes Streeting]

Unlike the Government, we are happy to look at good ideas wherever they come from. I do not know whether I can make 18 January, but I am certainly happy to meet the hon. Gentleman so that we can ensure that Labour’s plan tackles the appalling waits that we are seeing for cancer treatment.

[Vicky Ford (Chelmsford) (Con)]

Will the hon. Gentleman give way?

[Wes Streeting]

I have to make progress. I know that Conservative MPs were not interested in speaking in this debate, but many Labour Members were.

We cannot continue pouring money into 20th-century healthcare that is not fit for the future. We do not focus nearly enough on prevention, early intervention and care in the community. Because people cannot see a GP, they end up in A&E, which is worse for them and more expensive for the taxpayer. Because people cannot get the mental health support they need, they reach a crisis point, which is worse for them and more expensive for the taxpayer. Because people cannot get the social care they need, they are left stuck in hospital, which is worse for them and more expensive for the taxpayer. That is why the next Labour Government will agree a 10-year plan with the NHS to shift the focus of healthcare out of the hospital, into the community and closer to patients, which is where it should be.

[Marsha De Cordova (Battersea) (Lab)]

My hon. Friend makes an excellent case, showing that Labour is the only party with a plan to deliver for the NHS. He will know that prevention and early intervention are key for people who are losing their sight. More than 650,000 people are currently on waiting lists. We know that 50% of all sight loss is avoidable, but many people are completely losing their sight because they are not getting early intervention and appointments. Does he agree that the Government need to get on with having a plan to tackle the eye health crisis in our NHS?

[Wes Streeting]

My hon. Friend has campaigned so determinedly on the issue, and she is absolutely right. When I spoke about self-referral in an interview with The Times, it was partly with ophthalmology in mind. In the vast majority of cases and for the vast majority of conditions, self-referral will not be appropriate and it is right that people see a GP before being referred to specialist services. But when people go and see someone who is trained and qualified to investigate their eyes, and that person makes a clinical judgment that they need to see a specialist, how can it be that, rather than being referred straight to the specialist, they are sent off to a GP first? That is absolutely crazy. It is wasting valuable doctors’ appointments and is lengthening waiting times for patients.

Labour is willing to look with an open mind at how we improve the patient journey. It is that fresh thinking that the NHS needs and is so badly missing from this Government. That touches on what I have been saying about the need to fix the front door to the NHS in primary care, with more care in the community. Our plan to recruit more doctors will deliver better access to GPs and ease pressure on accident and emergency departments.

We have to take a look at the GP partnership model, which under this Government is withering on the vine. By 2026, a majority of GPs will be salaried. There are three routes: let it wither on the vine, as the Conservatives are doing; accept that it is in decline and have something better to follow as it phases out over time, which is how we would approach it; or accept that GP partnership is valuable, in which case we should rebuild it. I am open-minded about whether we phase out GP partnerships or whether we rebuild general practice, but what we cannot do is what the Conservatives are doing, which is allowing general practice to wither on the vine. That is exactly what they have done.

Do you know what I found most remarkable today, Mr Deputy Speaker? In advance of this debate, I received a letter from the Minister, no less—the hon. Member for Harborough (Neil O’Brien), who is unfortunately not in his place—telling me that the current system of general practice is working. Bad news for you guys sat opposite, who are facing the patients and the voters at the next general election: your Ministers think that general practice is working. Your Ministers are therefore not looking at plans to fix it. Your Ministers are leaving you hanging out to dry at the next general election, because patients can see that only Labour is thinking about how to fix the front door to the NHS and rebuild general practice.

Our plan to recruit 8,500 mental health workers and provide community mental health clubs in every community—a plan championed by my hon. Friend the Member for Tooting (Dr Allin-Khan)—will deliver faster treatment, supporting schools and easing pressure on hospitals, as well as general practice.

Then there is the exit door of the hospitals to social care. Labour’s commitment to deliver better pay and better terms and conditions for care workers will reduce the 400,000 delayed discharges every month and provide a better quality of care for not just older people but working-age disabled people. There are so many people in hospital who would not need to be there if we could provide quality care in their homes, which is why our commitment to double the number of district nurses qualifying every year is central to our policy. We will also give every child a healthy start to life, with 5,000 more health visitors. [Interruption.]

The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield) has just said, from a sedentary position, “We need more GPs.” I know we need more GPs. Patients know we need more GPs. So why have the Government cut more than 5,000 GPs in the last decade?

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

We have seen 13 years of failure in social care, with promises made and nothing ever delivered. There are now 165,000 social care vacancies, which is why the NHS is logjammed. Does my hon. Friend agree that it is time to pay our social workers a fair wage? Agenda for Change is a framework already built; let us give social workers a decent wage for the excellent work that they do.

[Wes Streeting]

My hon. Friend has consistently made the powerful case that pay and terms and conditions are directly linked to retention. No wonder we are losing so many people, not just from the NHS but from social care, to other employers in sectors such as retail. Earlier today, in this Chamber, I heard the Prime Minister say that as the minimum wage increased care workers would benefit, which tells us that care professionals are on the minimum wage while doing a really difficult job. No wonder they are going off to other jobs that cause less stress and anxiety and are better paid. This is not the way to run a social care system. We understand that, but the Government do not.

[Vicky Ford (Chelmsford) (Con)]

Will the hon. Gentleman give way?

[Wes Streeting]

No, because I must conclude my speech now. So many other Members want to speak that it would be unfair to take up more of their time.

This year marks the 75th anniversary of the NHS. For 75 years it has been there for us when we need it, founded by Labour but built by the British people, a public service, publicly funded, free at the point of need. Those are the values that are written into the DNA of the NHS. They are British values, they are Labour values, and it now falls to us, the party that created the NHS, to make sure that it is fit for the future.

I know, and the Opposition know, that the biggest obstacle to that change is no longer a busted, discredited Conservative Government on their way out, but the belief among too many people in our country that voting does not change anything, that politics does not matter, and that things cannot get better. I urge people throughout the country to ask themselves this simple question: are you better off than you were 13 years ago? Are your NHS services better off than they were 13 years ago? Are your public services better off than they were 13 years ago?

Labour has a plan; the Conservatives do not. Labour has a proud record of 13 years in government; the Conservatives do not. Only Labour can offer Britain the fresh start that it needs.

[Several hon. Members rose—]