Future of the NHS

Will Quince Excerpts

Tuesday 24th October 2023 Westminster Hall

[Janet Daby (Lewisham East) (Lab)]

It is an honour to speak with you in the Chair, Mr Pritchard. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing such an important debate.

The NHS was set up in 1948. It was the first of its kind in the western world, leading the way for free medical care—what a great achievement. So many societies still wish that they had what we have.

As has been said by other hon. Members, we have already had 13 years of the Conservatives leading the way—unfortunately with much failure and neglect. We do not have enough doctors or nurses, there are long waiting lists for appointments, and primary care is also not what it should be. People are finding it very difficult to get a GP appointment, there are no NHS dentists, and even pharmacies are really struggling to ensure they have enough medicines to give to people. In addition, mental health services remain the poor relative to the NHS. Under this Government, there has never been enough investment in NHS mental health services.

I will focus my remarks, conversations and questions on the future of the NHS for sickle cell patients. Sickle cell disease is a serious condition which predominantly occurs in people with African and Caribbean backgrounds, and approximately 15,000 to 18,000 people live with it. It has been two years since the “No One’s Listening” report was published by the Sickle Cell Society, which found evidence of serious failings. Failings were found in acute services, and there was evidence of attitudes “underpinned by racism”, meaning that patients were not treated with care. They were ignored, often not believed, and not given the pain relief and oxygen they needed. Unfortunately, we have seen many fatalities because of this.

In January, the NHS Race and Health Observatory found that sickle cell patients undergoing a crisis were deprioritised and undermined. This is in keeping with the “No One’s Listening” report, which presented evidence regarding the death of Evan Nathan Smith in North Middlesex University Hospital in April 2019. The inquest found that Evan’s death would not have happened if it were not for failings in the care that he received. It is shocking every time I say that and every time I mention that.

I have worked with Government Ministers, the NHS and other important bodies to get implemented in full the recommendations that have come out of the “No One’s Listening” report. I ask the Minister to go further and to focus more on those recommendations. If we are looking at the public purse, which has been mentioned a few times in this Chamber, we see that it is more cost-effective to put in preventative measures that help and support people to not get into a crisis where they need to be in hospital.

I therefore ask the Minister: will the NHS develop individual care plans in partnership with the sickle cell patient? Will all NHS trusts require haematology teams to be told when a sickle cell patient accesses outpatient or inpatient care? Will the Minister instruct all integrated care systems to develop plans to provide community care in this area? Will the Minister ensure specialist training opportunities for nurses? Will the Department co-ordinate work between organisations and senior sickle cell service representatives to engage in effective workforce planning for sickle cell services?

If the Minister cannot answer all of those questions towards the end of this debate, I ask him to put it in writing, to do his best, and to also attend the all-party parliamentary group on sickle cell and thalassaemia, which I chair.

[Will Quince]

indicated assent.

[Janet Daby]

The Minister is nodding, so I take that as an indication that he is willing to do that, which is really good. I also implore him to consider that sickle cell is a long-life disease, a hidden disease, a disability, and very serious.

The disease, however, has not had the research funding that it really needs. Looking at people with cystic fibrosis and haemophilia, we that they have had so much more funding invested into medicines to improve the treatment of those illnesses. The National Institute for Health and Care Research funds research programmes, but sickle cell research is woefully inadequate compared with the diseases that I have already mentioned. According to the data produced by that organisation, approximately 18,000 people are living with sickle cell, compared with the 10,000 that are living with cystic fibrosis, but in 2017-18 over a million pounds more was spent on research for cystic fibrosis. In the present day, 2022-23, still over a million pounds more is being spent on research for cystic fibrosis compared with sickle cell. That is entirely unacceptable, especially when there are more people living with sickle cell. I do not wish to take away funding from other research, but I do want equality of funding. I am sure the Minister also wants this as well.

As I draw to a close, I have already mentioned that prevention has to be the ultimate way to help people live a good quality of life and to keep them out of hospital, and it also helps to take of care of the public purse. In conclusion, the NHS is a wonderful creation that has helped every single person in this Chamber, and indeed every single person in our country.

--- Later in debate ---

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. I am grateful to the hon. Member for Wirral West (Margaret Greenwood) for securing a debate on this important matter. A debate of this nature is almost impossible to respond to in a relatively short period of time—although it is slightly longer now. I could easily fill the 90 minutes on the future of the NHS, as I know could all hon. Members across the Chamber today. I will endeavour to respond to as many of the issues and themes raised as possible in the time left available to me and, if I can, before the Front Benchers in the main Chamber conclude and we are all summoned over to vote.

While we will not always agree on the best approach—in fact, I strongly disagree with so much of what the hon. Lady said in her opening speech—I can assure her and Members across the House that I share her passionate desire to see an NHS that delivers and continues to deliver excellent care to all its patients, both now and in the future. Similarly to the Opposition Front-Bench team, the Government believe that the NHS should be free at the point of delivery and that its offer should be comprehensive, with services provided based solely on need. Let me absolutely clear: that will never change. In response to the themes raised in the debate, I will start by focusing on three broad areas: funding, workforce, and finally transformation and innovation.

Turning first to funding, as my hon. Friends the Members for Shrewsbury and Atcham (Daniel Kawczynski) and for Southend West (Anna Firth) set out, we have invested record amounts in the future of our healthcare system. By the end of this Parliament, core spending will have increased from £140.5 billion in 2019-20 to £193 billion in 2024-25. For those good at maths, that is a cash increase of £52.6 billion or 37%. At the beginning of this debate, several of us got a little excitable when the issue of privatisation was raised, and you rightly shut us down, Mr Pritchard. People have managed to make their contributions, but this is perennial accusation levelled at the Government, so let me absolutely clear: it is not our policy and it is not our plan. The NHS is not, and never will be, for sale.

Look at the actual facts on this. In 2013-14, around 6.1% of NHS funding was spent on the independent sector. Now let us jump to 2021-22, when it was 5.9%. What we are doing, however, is using the independent sector to enable us to fully realise our healthcare system’s capacity, and of course to improve performance. This is an approach that I understand is supported by the shadow Secretary of State for Health, the hon. Member for Ilford North (Wes Streeting). It is an approach that is better for patients and for our NHS. We are giving our patients greater choice and control, and empowering them to shape and manage their own healthcare.

[Daniel Kawczynski]

I am very grateful to my hon. Friend for highlighting the extraordinary increases in Government funding for the NHS, but has he recognised during the course of this debate my concern that, seven years after securing the £312 million for modernisation of A&E services in Shropshire, not a single brick has been laid? How sustainable is this NHS model when the managers of our local trusts are so incapable of delivering the construction with what we have secured for them?

[Will Quince]

I hear my hon. Friend’s concern. I have met with him and other Shropshire MPs on this issue and committed to meet with him to discuss it again. We are very keen to resolve the situation.

Before I move on from privatisation, let me gently say to Opposition Members—some of whom raised it and some of whom did not—that patient choice and the ability to use the private sector has been part of the NHS since its formation. It is a fundamental part of the NHS constitution. Let us be clear what those who call for private sector involvement to be entirely removed from the NHS are calling for: they are calling for charities, independent sector providers, GPs, dentists and community pharmacies to be removed. So let us be very careful, and very clear about exactly what we are calling for, because the independent sector plays an important role.

[Margaret Greenwood]

While the Minister is on the subject of privatisation, I would like him to respond to two points. First, the Health and Social Care Act 2012 allowed NHS foundation trusts to earn 49% of their money from private patients. Can he explain how that benefits ordinary patients? Clearly, if half a hospital is given over to private patients, the waiting time doubles. Secondly, representatives of private companies sit on integrated care partnerships, which are responsible for preparing the integrated care strategy for an area. How can it be right that a private company can influence how a huge amount of public money is spent?

[Will Quince]

I thank the hon. Lady for her question. I have already committed to write to her on some of the points relating to the 2012 Act, because she raised a number of questions. On the broader point about whether the independent sector should be part of integrated care boards and partnerships, I think it is helpful if it is, because individual systems need to know the full capacity available to them, and that includes the independent sector, which plays an important role because it is part of the health ecosystem in an area.

[Margaret Greenwood]

rose—

[Will Quince]

I will come back to the hon. Lady, but I am conscious of time.

The second area widely covered today was workforce. I echo the hon. Lady’s thanks to our NHS staff. I want to put on record my personal thanks to all those working in our health and care system: doctors, nurses, allied health professionals, managers, carers—all those who work in our NHS—for their hard work and dedication. We remain deeply grateful to them for all their work during the pandemic, in facing the new challenges of tackling the backlog, and of course the routinely excellent care they provide day in, day out. Our long-term workforce plan embodies the Government’s commitment to NHS sustainability: we are funding more doctors, more nurses and healthcare workers employed on NHS terms and conditions by NHS providers. That is backed by an additional £2.4 billion over the next five years, and at the heart of it is a significant increase in training places.

The third theme I want to focus on is transformation and innovation, which has also been touched on. We are committed to making our NHS more integrated, more strategic and better able to tackle the challenges it faces. The hon. Lady referenced the Health and Care Act 2022 numerous times—I hear her questions and points, and I will write to her on them. We put those issues on a statutory footing. We know that an increasing number of people are living with chronic medical conditions and complex care needs, which is where more integrated services can and will make an enormous difference. We want partners focusing on improving services rather than competing with each other when it is not in the interest of patients. I believe—we believe—that is the right approach because local areas know best, and certainly know far better than Ministers in Whitehall how best to organise themselves and design and deliver the best possible care for patients.

[Ian Lavery]

Will the Minister give way?

[Will Quince]

I have to make some progress—I am conscious of time.

In addition, we have digital transformation and technology, which are critical to the future of the health and social care system. Embracing digital provides a significant opportunity for us to improve clinical service to deliver better care for patients and reduce pressures on the NHS. That is why we are investing around £1.5 billion a year in digital transformation to run live services and drive those transformation ambitions. That also includes plans to improve our NHS app, digitise the frontline and improve services. We are also working with trusts to deliver things such as electronic discharge and electronic bed management systems, which also improve efficiency within the NHS.

The hon. Member for Lewisham East (Janet Daby) mentioned NIHR research, which I want to touch on briefly. We spend around £1 billion a year on that, but the Government do not commission research directly; indeed, it would be totally wrong for any Minister or shadow Minister to direct our clinicians and researchers to look into a particular area. However, we encourage and rely on organisations to come forward with bids for research, which clinicians then look at. That is rightly independent from Government, and I will be happy to work with the hon. Member to see how we can get more research into that area.

I wanted to say so much more, but time is short and I want to ensure that the hon. Member for Wirral West has time to respond. The hon. Member for Birmingham, Edgbaston (Preet Kaur Gill) touched on the life sciences space. We are putting a huge amount of work into life sciences with the Life Sciences Council and the life sciences vision, and we have launched the dementia, mental health, cancer, obesity and addiction missions, with more than £210 million in Government investment and world-leading chairs to support them. There is also our additional investment in genomic medicine, which the hon. Member rightly touched on and which is a hugely exciting field. The ability to screen for and identify the prevalence of future disease and the ability to screen babies in future will be hugely exciting. This is definitely the future of medicine.

This is a hugely important debate and I have far more to say, as you can tell, Mr Pritchard. The NHS is a vital part of the fabric of our public life. It is beloved by the public and rightly held in the highest esteem. The Government believes in the NHS; I believe in the NHS. That is why we are taking the right long-term decisions to protect its future.

[Mark Pritchard (in the Chair)]

Margaret Greenwood to wind up. The Minister has very generously given the hon. Member three rather than two minutes.