I beg to move,
That this House
notes with concern that the deficit in the budgets of NHS trusts and foundation trusts in England at the end of the 2015-16 financial year was £2.45 billion;
further notes that members of the Health Committee wrote to the Chancellor of the Exchequer about their concerns that Government assertions on NHS funding were incorrect and risked giving a false impression;
and calls on the Government to use the Autumn Statement to address the underfunding of the NHS and guarantee sustainable financing of the NHS.
I begin by reminding the House that, six years ago, the then Conservative leader promised to
“cut the deficit and not the NHS.”
“investment in public services would come before tax cuts.”—[Official Report,
Vol. 453, c. 837.]
My hon. Friend is eagle-eyed, and I congratulate him on reminding us that the Government should have balanced the books by 2015, and that they completely failed on that pledge.
Then the new Prime Minister made this promise:
“We will be looking to ensure that we provide the health service that is right for everyone in this country.”—[Official Report,
Vol. 614, c. 333.]
Fine words, but it is by their deeds that they shall be known. What did we actually get? An NHS that is going through the largest financial squeeze in its history. Far from protecting the NHS through the years of this Tory Government, NHS spending will represent an average annual increase of just 0.9%—a decade of barely any increase in spending despite an ageing population with increasingly complex needs.
I will give way in a few moments.
By 2017, NHS spending per head will level out, and, head for head, by 2018 NHS spending will be falling under this Conservative Government. Trusts ended last year in deficit for the second year running—they were £2.45 billion in deficit and they are reported to be heading for a deficit of around £670 million at the end of this financial year.
My hon. Friend makes a very important point. I will be coming on to those secret plans as I develop my speech.
We will be spending less on the NHS as a proportion of GDP than our European neighbours such as Germany, France and the Netherlands. The NHS maintenance budgets have been repeatedly raided, with billions that had been allocated to capital routinely being switched to revenue to plug gaps.
Public health budgets, which fund projects to tackle teenage pregnancy, excessive alcohol consumption, sexually transmitted infections and substance misuse and to provide anti-smoking interventions, will have been cut by 9.7% by the end of this Parliament. That is a completely false economy leading to greater demands on the acute sector. As my hon. Friend Barbara Keeley so brilliantly outlined last week, the adult social care budget has been slashed.
I am so grateful to the hon. Gentleman. The House would take him somewhat more seriously if he pointed out that, by 2019-20, the real-terms increase in spending on the health service will be £10 billion. During the last election, his party promised to increase spending in this Parliament by only a quarter of that— £2.5 billion.
No, I want to make a bit of progress.
We are seeing unprecedented cuts to social care, which means that the number of people aged over 65 accessing publicly funded social care will fall by 26%. UK public spending on social care is set to fall to less than 1% of GDP by the end of this Parliament.
Just yesterday, Baroness Altmann, the former Conservative pensions Minister who was appointed last year to great fanfare by David Cameron, said that we are “sleepwalking into a crisis” and that the NHS will not be able to pick up the pieces of a “broken system”.
Does my hon. Friend agree that when funding is cut, our hospitals seek to raise cash in other ways, such as the unacceptable level of car parking charges at our hospitals—charges which the Government promised before the last election to clamp down on?
I shall make a little progress because many other Members want to speak and I want to give them a chance.
The scale of the financial pressures engulfing the NHS are such that the chief executive of NHS Providers, Chris Hopson, said recently:
“The gap between what the NHS is being asked to deliver and the funding it has available is too big and is growing rapidly.”
The King’s Fund said, with respect to the NHS deficit, that
“it signifies a health system buckling under the strain of huge financial and operational pressures.”
In the most damning assessment of the Government’s handling of the NHS, the National Audit Office concluded today that financial problems in the NHS
“are endemic and this is not sustainable.”
“in 2010 we knew we had to implement a tight budget squeeze for five years, but we never thought it would last for ten.”
Surely the hon. Gentleman has seen the report from the Nuffield Trust on the four health systems of the United Kingdom, which shows very clearly that there is only one part of the United Kingdom that has seen a real-terms cut in NHS expenditure, and that is Wales under a Labour Government.
In Enfield we are short of 84 GPs going forward and we have just had a hospital crisis at the North Middlesex hospital, where there were not enough doctors for our A&E to be safe for patients, yet the only thing we hear about is the sustainability and transformation plan locally which, as far as we can see, is not only secret but about taking £22 billion out of the NHS.
My right hon. Friend is right and she is a brilliant campaigner for the health service in Enfield. The points that she makes about the staffing crisis in the NHS are well made. I hope that the Secretary of State will respond to her.
Things are so bad for the Health Secretary that even the NHS chief executive told the Health Committee that
“2018-19 will be the most pressurised year for us…will have negative per-person NHS funding growth.”
Those were the chief executive’s words. Will the Health Secretary sit up and listen, and respond to the chief executive, or will we get what we saw in the Sunday newspapers—briefing against him. We heard that the Government are “gunning for” Mr Stevens and are going to “fix” him. I hope the Secretary of State will repudiate that briefing when he responds to the debate and distance himself from it.
The only people who do not appear to accept the need for more money for the NHS are the Prime Minister and Secretary of State. We anticipate what the Secretary of State will tell us from the Dispatch Box. Sir Simon Burns alluded to it and I will now answer his question. The Secretary of State will not only tell us that we have a generous, munificent Conservative Government who have given the NHS the money it asked for, but persist with the fiction that the NHS is receiving an extra £10 billion. However, we all know—and I suspect that the Secretary of State knows, because he now distances himself from the figure when he does interviews—thanks to the Health Committee and others that this £10 billion claim is bogus. It is a claim universally derided and discredited, apart from in the drawing room of 10 Downing Street.
The chief executive of the NHS, whom the hon. Gentleman has just mentioned, welcomed that additional £10 billion and said that it gives the NHS the extra headroom we need. Will the hon. Gentleman repudiate his criticism now and make it clear that he associates himself with the chief executive of the NHS in welcoming that £10 billion of extra funding?
The chief executive’s comments to the Select Committee speak for themselves. Talking of repudiation, when are we going to get £350 million a week, or were the Tories typically saying one thing before the people voted and something completely different after they had had their say? That is what the ex-Education Secretary should be telling us.
“The continued use of the figure of £10 billion for the additional health spending up to 2020-21 is not only incorrect but risks giving a false impression that the NHS is awash with cash.”
She is sitting only a little further down from Michael Gove. Perhaps he can have a word with her if he disagrees.
The Secretary of State hopes we do not notice that he is stretching the timeframe over which he presents this funding allocation. He hopes we do not notice that NHS spending has been redefined by the most recent spending review. He hopes we do not spot that he is cutting billions from public health budgets and other Department of Health funding streams—a £3 billion cut. But we have noticed.
In a few moments.
We have spotted the Secretary of State’s conjuring act because we have seen this Tory trick before—robbing Peter to pay Paul. The result of this trick is cuts and underfunding, more pressures flowing through to the frontline, and, as the NAO said,
“Financial stress…harming patient care”.
In all our constituencies we see ever-lengthening queues of the elderly and the sick waiting for treatment. Across the board, we see the worst performance data since records began.
What world is the Secretary of State living in? Half a million patients have waited for four hours or more in A&E in the past three months—the worst performance for this time of year for more than a decade—and he says it is nonsense. Some 350,000 of our constituents are waiting longer than the promised time for elective treatment—some have been waiting more than a year—and he says it is nonsense. Delayed discharges from hospitals are at record levels, and he says it is nonsense. The number of people waiting for 12 hours or more on trolleys has increased by over 700% since 2011-12.
Will the hon. Gentleman tell the House why it is that, after 12 minutes, he has yet to praise all our hard-working doctors, nurses and other health professionals? Why is he constantly talking down our great NHS, including the hospitals in Leicester?
I praise the hard-working staff in the NHS every day of the week, but I rather suspect that staff in the NHS will have more sympathy with the position I am outlining than with the right hon. Lady’s position, not least when, according to surveys, 88% of NHS staff think that the NHS is under the most pressure they can remember, and 77% think that there is less access to resources, putting the quality of patient care and clinical standards at risk. That, I say to her, is what NHS staff are saying.
Perhaps I can just allow the hon. Gentleman to break off from reading his press release. I think we are moving towards a consensus on this issue, in that we do need to integrate acute clinical care and adult social care, and I understand that. In that vein, why was it that, in 13 years, when there was significant demographic change, the Labour Government failed to bring forward a better care fund or a precept for social care?
It beggars belief! We tripled investment in the NHS, and the hon. Gentleman and his hon. Friends voted against every penny piece. When we left office, we had the best waiting times and the highest satisfaction levels on record. That is the difference between a Labour Government and a Conservative Government on the NHS.
Well, reconfigurations are always going ahead. [Interruption.] If Conservative Members are so concerned, I look forward to the hon. Gentleman campaigning against the STPs for his area, when they are published in a few weeks.
I am going to make a bit of progress, because I am aware that Members want to speak.
We have seen what the reality of six years of Tory underfunding and cuts in our NHS are all about, and there are more stealth cuts to come, which will add further pressures. For example—these are small things, but they all add up—cuts to the Care Quality Commission mean that it will increase its fees for NHS hospitals, other trusts and other providers. Some trusts will have to pay over £100,000 as a result of these cuts. Reductions in education and training tariffs will put more pressures on trusts and on the frontline. In the House the other week, we debated how cuts to community pharmacies will lead to increased demands on the NHS.
Only last week, news slipped out about the privatisation of NHS Professionals. A body that makes a profit for the NHS and ploughs that back into the NHS is going to be privatised, and that profit will presumably go to private companies.
The combination of all these cuts and privatisations, the utter failure to deal with the crisis in adult social care, and the lack of planning for an ageing population with complex needs will directly lead to greater demands on the NHS, bigger cuts, and deficits across the board. It is in this context that the NHS is also expected to find £22 billion of so-called efficiencies and to redesign services across England completely as part of the sustainability and transformation process.
Where sustainability and transformation plans are about transforming services in the interests of patient care, reversing fragmentation and ensuring more collaboration in geographical areas, we will consider them carefully. We will want to look at every single STP to see whether those plans are genuinely jointly owned, and whether they tackle the crisis in social care, guarantee better access to care for the long term, and are transparent and financially viable. What we know so far, though, is far from reassuring, because we can see from the 19 or so STPs that have been published that the ground has shifted. It has become obvious that what began as a project to transform services for patients and build up community services is now more about closing the financial gap:
“Of course, the driving force behind STPs is the emergence in the last two financial years of substantial deficits.”
Those are not my words, but those of Andrew Lansley just a few weeks ago. The STP areas that we have seen so far have been racking up shortfalls of about £10 billion that can be filled only by cuts to hundreds of beds, closing hospitals, downgrading A&Es, downgrading maternity wings and withdrawing treatments.
Does my hon. Friend agree that proposals to downgrade A&E in an area such as Warrington, which is surrounded by motorways as well as containing many people who suffer from health deprivation, is a recipe for disaster? If people have to travel further for emergency care, that will not improve their care in any way.
My hon. Friend is extremely knowledgeable about the health service and has been campaigning vigorously on the STPs. She is completely right. We will see hospitals merged in the Merseyside area and in London, hospitals lost in Durham, and efficiencies found by changing staffing levels. In fact, the STP for Cheshire and Merseyside, the area that she represents, talks enticingly of
“Exploration of a Factory Model”.
Doesn’t that sound nice?
With cuts to services and rock-bottom staff morale, we have the Sports Direct approach to the NHS, with the Secretary of State playing the part of Mike Ashley. The public deserve better than this bargain basement approach. Scaling back the acute sector while not investing in the community sector simply does not work. The Prime Minister might have ruled out extra funding—
I have listened with great interest to the hon. Gentleman. He has spoken eloquently of his concerns about the NHS, but has not, in the course of 18 minutes, put forward a single positive policy or explained where a single penny of additional funding would come from. He has secured the time for this debate, so would he at least put forward a positive policy for the NHS, or a suggestion as to where the money should come from?
The right hon. Gentleman really does have a brass neck. We still do not know when we are going to get the £350 million from him, but next time he intervenes perhaps he will tell us.
This is exactly the sort of point that we are making; my hon. Friend is absolutely correct. That is why we need to look carefully at all these STPs. Of course, we do not know much about them at the moment, because all we see is glossy brochures that tell us that everything is going to be all right and not to worry. We want transparency. The Secretary of State should insist that every single STP is published and that we have the details of the cuts that will be made in our communities.
Is not one of the problems with local planning the recruitment of GPs and the lack of GPs locally? Would it not help if we were to amend the Health and Social Care Act 2012 so that clinical commissioning groups and NHS England could provide directly salaried GPs instead of being prevented from being doing so, as is the case at the moment? That is a practical example of something that would save money and increase the local provision of GP services.
Is my hon. Friend aware that the Cheshire and Merseyside group has not only refused to publish details about the STP, but refused my Freedom of Information Act request for information about the meetings that were held on the STP and who was present at them? Does that not simply give rise to suspicion that this whole process is being driven by cuts rather than the need to improve care?
My hon. Friend is absolutely right. I will now make a bit of progress because I know that other Members are anxious to speak.
The Chancellor should respond tomorrow to the growing body of evidence that the NHS has not been given the money that it needs. Tomorrow, we need an end to the scandal of crumbling hospitals. Tomorrow, the Chancellor must put right the Government’s greatest betrayal on adult social care. Tomorrow, the Government must deliver the long-overdue investment that our NHS needs.
What sense does it make to carry on cutting inheritance tax, capital gains tax and corporation tax, at a cost of billions to the Exchequer, while at the same time failing to fund our national health service or to give social care the money it demands? The Prime Minister lets the CBI know that she is prepared to give away billions extra in corporation tax, but she tells us that there is no more money for the NHS. The Chancellor will be prevented from acting tomorrow not by financial constraints, but by the ideological constraints that the Government have placed on themselves. It is time to give the NHS the funding that it needs. I commend the motion to the House.
I beg to move an amendment, to leave out from “House” to the end of the Question and add
“welcomes the Government’s investment, on the back of a strong economy, of significant additional funding and resources each year for the NHS during the 2015 Parliament;
notes that this settlement was frontloaded at the specific request of the NHS in NHS England’s own plan to deliver an improved and more sustainable service, the Five Year Forward View;
and further notes that the NHS will receive a real terms increase in funding in each year of the Spending Review period, while the Labour Party’s Manifesto at the last election committed to only an extra £2.5 billion a year by 2020, far less than the NHS requested.”.
As I did in last week’s debate on social care, I want to start by recognising the fantastic work done by NHS staff up and down the country. This autumn, I met a mental health nurse who told me how she had had to cope with the pressure of one of her patients throwing himself off a bridge the day after a consultation. I am sure that all Members have stories of the incredible dedication of NHS staff—not just people doing their jobs, but people putting their heart and soul into their work, staying late, going the extra mile, and sacrificing home time and holidays to be there for patients. As I did last week, I also want to recognise the 50,000 NHS staff from EU countries, including 26,000 low-paid staff, who do a brilliant job. Today we have heard concerns about funding, A&E—
I will give way in a moment, but I just want to finish this sentence, if I may.
We have heard concerns about funding, A&E performance, waiting times and morale, and I want to answer them all. There are many pressures in the NHS, but I also want to recognise some successes, because one of the things that is most damaging to morale is not giving credit where it is due.
Can the Secretary of State explain why he has made scores of redundancies in north Staffordshire? In my 15 years as an MP, I have never seen the local NHS in such a meltdown, with a scorched-earth policy of cuts and closures, and more to come with next year’s still-secret STP. When will the Government realise that pressures on social care and the NHS are such that those services are unsustainable without decent further funding and investment?
As the hon. Gentleman knows, those things would certainly be unsustainable if we had followed the Labour party’s investment plans at the time of the previous general election. If he wants to know what is happening to staff, let me tell him that in the period I have been Health Secretary, we have got 5,000 more doctors and 10,000 more nurses. That is what happens when we have a Government who are prepared to invest in the NHS.
The shadow Health Secretary talked about A&E—he is right to say that we are not hitting the target, and we are doing something about that—but he did not tell the House that, since Labour left office, we have recruited 1,200 more doctors for A&E departments, which is a 25% increase, including a more than 50% increase for consultants. Every day, we are seeing 2,500 more people within four hours.
I am a junior doctor in A&E, of which the right hon. Gentleman speaks, and I can say that morale is at an absolute all-time low. We have a recruitment and retention crisis in A&E. We are losing all the fantastic staff whom we have been able to recruit because this Government are not recognising and accepting the fantastic workforce on our A&E frontline. All the doctors are leaving.
With respect, the hon. Lady might be on the wrong side of the House, because I started my speech by recognising the brilliant work done by doctors and nurses, something that the shadow Health Secretary conspicuously failed to do. Let us look at her own hospital: since 2010, St George’s has—[Interruption.] I do not know whether she is interested in hearing my response to her intervention. Since 2010, her hospital has had 884 more nurses and 240 more doctors, and her CCG had a £10 million funding increase this year.
I thank the right hon. Gentleman for allowing me to speak again. I shall refer at length to St George’s hospital in my speech, but it is very unfair of him to bring it into this debate. It is because of this Government that St George’s hospital is operating at a £50 million deficit. It is because of this Government that we are now in special measures. It is—
Order. The hon. Lady is hoping to catch the eye of the Chair later in the debate. As it is, there will be a five or four-minute time limit, so Members who intervene must do so very briefly and not very frequently. If they do not do so, I am afraid that they may not be called to speak.
The shadow Health Secretary also did not talk about cancer. In 2010, we had the lowest cancer survival rates in western Europe. Since then, we have referred for cancer tests 2,200 more people every day, and 100 more people are starting cancer treatment every day. The cancer charities say that this is saving 12,000 lives a year. On mental health, he did not mention the fact that we are treating 1,400 more people every day, with record dementia diagnosis rates.
Would not Opposition Members be a little more straightforward and honest about the wider context if they admitted the demographic challenge that this Government face, as they would have faced? The number of over-60s will increase by 50% in the next 15 years. Should they not also admit that the private finance initiative was an appalling millstone—£64 billion —to bequeath to this Government? That has had an impact on front-line care.
My hon. Friend is absolutely right to raise that point. People will be astonished to hear Labour Members wasting their time talking about a privatisation of the NHS that is not happening when they were responsible for PFI, the worst possible privatisation that has done such enormous damage.
Another point that the shadow Health Secretary did not mention was the quality and safety of care in our NHS that Labour left behind. The Francis report revealed massive problems—short staffing; a culture of denial and cover-ups—and they were not just at Mid Staffs but, as we now know, at Basildon, Morecambe Bay and many other trusts. Since we have been in office we have changed that. We have put 31 hospitals into special measures, which is more than 10% of hospitals across the entire NHS, and we have recruited record numbers of doctors and nurses.
I want to tell the House about one hospital that was put into special measures. Care was unsafe at Wexham Park in Slough—so much so that fewer than half the hospital staff were prepared to recommend the care provided there to their own friends and family—but it has gone from having six of its eight clinical areas rated as requiring improvement or inadequate, to having all eight of them rated as good or outstanding. It has come out of special measures, as have 15 hospitals in total, and we should all commend the staff who have worked incredibly hard to turn around those hospitals.
The right hon. Gentleman has the nerve to talk about the inheritance from a previous Administration, when what we inherited in 1997 was people dying on waiting lists of more than 18 months for heart operations.
I have often from this Dispatch Box been prepared to praise some of the achievements of the last Labour Government. They did bring down waiting times, but they did not focus on the quality and safety of care.
What we now know from the CQC’s new regime, which has just finished its first round of inspections, is that 56% of our hospitals are good or outstanding. One could say that it is disappointing to know that 44% of hospitals are not, but to those who would use that as a political weapon I say this: we are the only country in the world brave enough to set up an independent inspection regime, and if we want to have the safest, highest quality care, the first thing we need to know is where it is good and where we need to improve it. I thank the chief inspector of hospitals, Professor Sir Mike Richards, for his outstanding work in raising quality.
The right hon. Gentleman talks about the inspection regime, but I think I am right in saying that it was not something he and his Government introduced. The Care Quality Commission was introduced by a Labour Government, as far as I am aware. As I know from North Middlesex hospital, hospitals end up in special measures because they are underfunded and under-supported, and cannot get the doctors they need.
The right hon. Lady is right that the Care Quality Commission was set up by the last Labour Government, but it did not have independence from the Government in its inspection reports. When we legislated for that, Labour tried to vote it down. We got it through and changed the inspection system, and it is working extremely well.
I want to move on to the substance of the debate, which is about the funding of the NHS. I congratulate Jonathan Ashworth on his courage—indeed, his chutzpah—in confronting the issue of funding, despite inheriting a Labour policy to cut NHS funding by £5.5 billion a year by the end of the Parliament. He is right that there has never been greater financial pressure—we have had the financial crisis in 2008, the deficits and the growth in demand from the ageing population—but he must accept that that makes it all the more extraordinary that Labour wanted to cut the NHS budget in 2010 and to cut it from the current levels in 2015. I simply say that we could, as a Government, have chosen to cut NHS funding from this year’s level by £1.3 billion, as under Labour’s plans, but we would have had to lay off 11,000 doctors or 40,000 nurses.
The problem with the Conservatives’ script is that they talk about NHS funding, but they completely neglect social care. There can be no debate about the fact they have cut social care every year for the last six years, taking support away from half a million older people, many of whom are now trapped in hospital beds. Greater Manchester says that it has a shortfall of about £80 million in social care; the figure is £1 billion nationally. Has the Secretary of State raised this issue with the Chancellor? Has he made an emergency bid for funding? Will there be more money for social care this year?
That is not the problem with our script; it is the problem with the right hon. Gentleman’s script, because as shadow Health Secretary he sanctioned a policy that would have given the NHS £1.3 billion less this year, and at the last election the then shadow Chancellor said he would give not a penny more to local authorities, whereas we are seeing social care funding go up by £600 million this year. More money is going into the NHS and the social care system under a Government who are committed to funding them both.
What is especially wrong with the argument made by the shadow Health Secretary, whom I welcome to his place for his first Opposition day debate, is his suggestion that the Government have not honoured their promises to the NHS. What did the independent commentators say at the time of last year’s spending review? Simon Stevens, whom he quoted, said
“our case for the NHS has been heard and actively supported.”
NHS Providers, which he quoted, said it was
“a good settlement for the NHS.”
The King’s Fund, which he quoted, said it was
“a good settlement for the NHS”.
In fact, because of the Government’s commitment to the NHS, we are spending 10% more on it as a proportion of GDP than the OECD average—that is more than Norway, Finland, Korea, Australia and New Zealand.
Does my right hon. Friend agree that without that investment since 2009-10 to last year there would not have been the 1.6 million more operations within the NHS that benefit all our constituents?
My right hon. Friend has been very gracious in taking interventions from all sides, and also in citing independent voices. Has not the independent King’s Fund also pointed out that the sustainability and transformation plans that he is overseeing are the “best hope” of securing long-term improvement for both health and care in this country? Does he agree that the Opposition should pay rather more attention to those independent experts, rather than repeating their own press releases?
My right hon. Friend is right that just occasionally we should listen to experts—but only very occasionally. In the spirit of listening to experts, and as the Leader of the Opposition is here, I will tell my right hon. Friend something else the King’s Fund has said that he will agree with, which is that
“claims of mass privatisation were and are exaggerated.”
Let us not go chasing down rabbit holes.
The result of this Government’s commitment to the NHS is that real-terms spending per head has gone up by 4.6%, which is double the rate in Scotland and three times the rate in Wales. The hon. Member for Leicester South also mentioned the National Audit Office. He did not mention that the numbers quoted in the NAO report are last year’s figures. He chose not to mention this year’s numbers, which were published last week. They show that 40 fewer trusts are in deficit. Yes, a year ago, half of trusts were missing their financial plans, but now 86% are hitting those plans.
The latest figures, from Friday, show that the deficit will fall 73% from last year, and even lower than the year before. Why is that? It is because of a sustained effort by the NHS to tackle the problem. [Interruption.] The Opposition do not want to hear this, but the truth is that the NHS is gripping the very problem the shadow Health Secretary called a debate on. Agency spend, one of the biggest challenges, is on track to go down from £3.7 billion to less than £3 billion. The rates paid for agency nurses are down 18% on a year ago, and for locum doctors they are down 13%. Our procurement changes are on track to save half a billion pounds. The money we raise from international visitors is up three times, from £84 million to £289 million.
It is important that we focus not just on the level of spending but on where we spend the money. With long-term conditions such as diabetes, is it not essential to focus on preventive work, which in the long term will save the national health service a huge amount of money?
I congratulate my right hon. Friend on the calm and dignified way he is dealing with this debate, as compared with the Opposition. May I put in a plug for local community hospitals, not just in my constituency but right across the country, and how vital their retention is for good quality care in the future?
I thank my hon. Friend, who himself personifies calm and dignity. Community hospitals are indeed extremely important. Their role may change, but they will none the less continue to be a vital part of provision in most of our constituencies.
I will make some progress, but I will find time to give way to hon. Friends who I know want to come in.
“aggressive efficiency targets have contributed to deficits”.
That is a curious thing to say, first because his own spending plans would have meant £5.5 billion more efficiencies. If he thinks our plans are aggressive, I just wonder how he would describe Labour’s approach. Secondly, I know we are all Corbynistas now, but basic economics suggests that efficiency plans do not increase deficits, but reduce deficits. That is what we need to do in the NHS, because we want the money to go to patient care.
There is another danger in the shadow Health Secretary’s argument, a trap that is very easy not just for him but for many commentators to fall into: the suggestion that this is a uniform problem across the NHS that it is powerless to grip without further Government intervention. The reality is that there is huge variation across the system. The deficits at good or outstanding trusts are five times less than the deficits at other trusts. If all trusts had the same financial performance as the good or outstanding ones, we would have a surplus of nearly half a billion pounds. Half the deficits are from just 22 trusts. We see this variation on a very specific level. For example, the amount paid for a pair of surgical gloves, which are very important to all hospitals, is £1.27 in some hospitals and just 50p in others. As for waiting lists, of 1,000 people who are waiting more than a year for their treatment, which is unacceptable, there is just one person from an outstanding trust who has been waiting that long. Some 93% are from trusts that require improvement or are inadequate. This is why we have a huge programme to support and improve those trusts and deal with the challenges they face.
I do recognise that. It has been going up in Scotland as well. It is short-sighted of both Administrations not to work with us to tackle the problem; otherwise, staff living in border areas play off one system against the other.
The Secretary of State is trying to blame hospitals for the deficit, but the point is that the spend on agency staff has ballooned in England over the past six years. The reason is that the Government, and their predecessor, cut nurse training places and left hospitals in the grip of private staffing agencies. It is therefore simply not fair of the Secretary of State to stand at the Dispatch Box and blame hospitals for a problem of the Government’s making.
I am not blaming hospitals. We are supporting hospitals to deal with the problem. The root cause of the problem, set out in the Francis report, was hospitals covering up bad problems. We said no to that and said that we were going to sort it out by having more nurses on our wards. That is why, in the four years that I have been Health Secretary, we have had 10,000 more nurses on our wards.
Does my right hon. Friend agree that the public are finally starting to see through the usual Labour smokescreen that is high on rhetoric and low on alternative solutions, with very patchy and poor delivery when Labour is given the chance? My right hon. Friend’s approach to the health service—a quiet delivery of change and proper funding—is what the public are looking for.
It is noticeable that the two potential solutions we have heard have been from Opposition Back Benchers—Keith Vaz and the former shadow Chief Whip, Dame Rosie Winterton—and not from the Opposition Front Bench. My hon. Friend makes an important point.
The shadow Health Secretary is right to hold the Government to account for the funding of the NHS and the social care system, but it is a big mistake to distil all issues around the NHS into the simple issue of money. That subcontracts the responsibility for safe, high-quality care to politicians. If we are going to be the safest and the best quality system in the world, that has to be everyone’s job, everyone’s focus and everyone’s commitment—politicians, yes, but managers, doctors, nurses, porters, healthcare assistants and every single person working in NHS.
On the way forward, we first need to move to accountable care organisation models and the “Five Year Forward View”, including the STP process. The shadow Health Secretary called STPs “secret plans”, but in fact 28 of the 44 have been published and the rest will be published before Christmas. Many in the House, on both sides, objected to the Health and Social Care Act 2012 because they felt it did not do enough to support integrated care. Well, now we have a process that is bringing together the NHS and the social care system, acute trusts and primary care, at a local level. That is a big prize and we should support it, not try to make political capital out of it.
In Stoke-on-Trent, the CCGs sit on the STP group. We have still not seen the report, but we have seen an executive summary. When the STP group suggests one thing, the CCG undermines it by closing community hospitals and cutting community beds. They are not working together; they are working against each other.
That is exactly what we need to sort out. We have the STP process to stop people doing their own thing, instead of having a co-ordinated, well-planned strategy. If we stick with this process, embrace innovation and technology and retain a relentless focus on safety and quality of care, in this Parliament we will see a million more people accessing mental health treatment every year; 5,000 more doctors working in general practice and a transformation of services through GPs; a new four-week cancer waiting time standard that will save 30,000 lives a year; more failing hospitals turned around; the weekend effect tackled; more doctors and nurses; and an NHS staying true to the promise made to patients in 1948 that safe, high-quality care would be there for everyone, regardless of income. That is what this Conservative Government will deliver, and I urge the House to support the amendment.
Obviously the hon. Lady has no speech limit, but the speech limit has been calculated with her mind. I am just saying that the longer someone speaks for, the less time everyone else will have.
Okay, well that is fairly disappointing, given what I have prepared.
UK-wide, the NHS faces sustainability issues. One of the key issues is the increase in demand from an ageing population and the increasing complexity of those demands. The way to tackle that demand is through public health and social care that ensures that those people do not end up in the most expensive place. Secondly, we have a lack of staff, both nurses and doctors. The lack of training nurses has been referred to. We also face the threat of losing some of our staff from the EU. The third threat to sustainability is money, but the money is the one we can fix, because money is a decision; the others will take a decade each to fix—by training more nurses and doctors, preventing illness and finding better ways to look after an ageing population.
As I have said in the Chamber before, I welcome the idea of STPs, because they should mean a return to place-based planning and integration and a move away from fragmentation and competition. The problem is, however, that they have to be based on patient-centred care, whereas, according to what is leaking out, they are being discussed on the basis of budget-centred care. We heard in the Health Committee that the STP groups were being given a figure that they had to meet by 2021 and then were working back from that. That will never work.
If we want to decrease inefficiency and increase efficiency we need to target the inefficiencies in the system, not just take an axe to the whole thing. When hospitals or GPs run out of money and take urgent action, it will be poorly-thought-out and immediate-survival action. We need to look at where the fat is and at the natural inefficiencies in the system, and some of that comes down to the lack of integration. STPs are a great opportunity but an opportunity we will look back on as missed if we do not do it properly.
The Secretary of State says that there is no privatisation in the NHS, but there certainly is marketisation and outsourcing. I graduated in 1982, so I have lived through every single iteration from both sides and three Governments. In 1982, we were just skimped. Basically, the NHS got 5% of GDP and it dropped to 4.5% over the ’80s. Instead of increasing that to where it is now, what we had was constant redesign.
The first was the internal market and GP purchasing. A GP would refer to our clinic, but if I decided the patient was not surgical and I referred them to gynaecology, the GP would refuse to pay. What started to happen? Surgeons and clinicians began sending the patient back to the GPs, so that they would refer them. Of course patients fell through the cracks; some never got that second referral and things were missed.
After the purchaser-provider split, we started to change the whole shape. We went from 100 health authorities to 300 primary care trusts, even though the leaders of the PCTs earned the same money as the leaders of the health authorities. People were made redundant and transitional change was hugely expensive. In the mid-2000s, we went from 300 PCTs to 150—again with redundancy and transition. As we move on, we start to see the private finance initiatives. As has been said, the NHS has paid over £60 billion for £11 billion-worth of buildings. That was not an effective thing to do.
Eventually, of course, we come to the Health and Social Care Act 2012, which got rid of the 150 PCTs and replaced them with 211 clinical commissioning groups. This is described as “putting power in the hands of the GPs”, but following a freedom of information request I know that less than 18% of CCGs have a GP majority on them. Some 47% of CCGs do not even have a clinical majority, so the idea that the power of the CCGs is giving power back to primary care is, I am afraid, a complete fallacy.
What we have seen, I am afraid, has come from all Governments. It was the Labour Government that took the purchaser-provider split and introduced independent treatment centres, giving them block grants. All the talk about patient choice was not really patient choice at all: the GP had to send the patient to the ITCs for their hips, because it had already been paid for. To try to counteract that, we have seen payment by results, which was the forerunner of the tariff. What that did was increase activity, so it helped with waiting lists and waiting times, but what we now have is activity that is just growing and growing. Hospitals get paid for activity, not for whether that activity is right.
In Scotland, we abandoned trusts in 2004, and we abandoned primary care trusts in 2009. Let us look at our costs book, which publishes the costs of administration. This is not just the costs of the market; it deals with all the administration of the NHS. Ours has fallen from 7.6% in 2006-07 to 6.7% in 2015-16. When it comes to the Department of Health or NHS England, no one has any idea. A piece of work was done for the Department of Health in 2005, which estimated admin costs at that time as being 14%. I suggest that the current market is an awful lot more complex than it was then.
I think some things can be done around procurement. In Scotland, our national procurement gives hospitals a choice of 9,000 items. The supply chain in England has 600,000 items. It is not limiting; it is not national procurement. Our logistics division, which delivers that, will pick items per ward and deliver them all the way from a central depot to that ward. That allows us to cut some of the costs, as suggested in the Carter review.
We absolutely need to keep agency prices down. It is important to try to keep staff on a staff bank rather than get them through agencies. Why are we not asking the bigger question? Why are nurses choosing to work for an agency rather than the NHS? Is it that they earn more money? Is it flexibility? Is it family-friendliness? Would it not be better to look at how we let them work, so that they work for us rather than feeling that they have to go and work in an agency? From the point of view of job quality and job satisfaction, they would all rather be in one place than be in a different place every week.
There are things that could be done. There could be a better use of community pharmacies, and a better use of community hospitals for “step up” and “step down” services. It is crucial that we fund social care so that elderly people are looked after in their own homes. I think that STPs have potential. However, I ask the Secretary of State not to go on and on with marketisation, given that no cost-benefit analysis has ever been carried out and there is no evidence of benefit from it. The NHS could save an amount that is estimated conservatively at £5 billion a year, and that would have a significant impact on the debt.
Michael Gove suggested that we needed to bring solutions. I am offering the ones that I can think of from Scotland, and I recommend them to the Secretary of State.
It is a pleasure to follow my hon. Friend Dr Whitford.
I want to touch briefly on the importance of clear data, the current financial position, and the need to agree on a settlement for the future in this House rather than continuing to have such confrontational debates.
I can see how the £10 billion figure has been arrived at: by adding an extra year, starting from 2014-15, and by transferring budgets to NHS England. When the Secretary of State refers to the NHS, he is actually referring to NHS England. He is not including public health. He is not, for example, including Health Education England. However, it is crucial that they are considered. As my hon. Friend the Member for Central Ayrshire said, when we talk about transferring money from public health to the NHS England budget, we are cutting off our ability to control the increase in future demand. We face significant challenges, which we will not address unless we invest in those future services.
We sometimes talk about public health as if it were not front-line care, but it is. We are talking about, for instance, services to help people with addictions and sexual health services—really important costs for the NHS. There is also the challenge of the reduction in Health Education England’s £5 billion budget, £3.5 billion of which is spent directly on the wages of health service doctors who are undergoing training, but also delivering front-line services. Cuts to Health Education England cut us off from future sustainability, because that is the budget that trains, retains and sustains our existing workforce. This is all crucial to front-line services.
The other way in which the £10 billion figure has been arrived at is by changing the baseline from which we calculate real-terms increases. I would say that it has never been more important than it is now for the public to have confidence in the data that we use. Trying to return us to talking about total health spending is not trying to be awkward; it is trying to be honest with the public. It is difficult to argue that more funding for health and social care is necessary if a £10 billion increase has been claimed. It is important that we continue to use the same consistent baselines that have been used in the past, so that the public can see what has happened to total health spending.
I welcome the front-loading of the settlement, and I welcome the fact that the NHS has been relatively protected in comparison with other departments, but the scale of the increase in demand is extraordinary. When Simon Stevens talked about welcoming the increase that had been granted, he made it clear that it was dependent on a fair settlement for social care and a radical upgrade in public health, and those two aspects are lacking.
I think that both sides are correct. I can see how the Secretary of State has arrived at the £10 billion figure, but whenever that figure is used we should also present a figure that refers to total health spending in the way in which it has always been referred to in the past. I think that that would help to build the Secretary of State’s case for an increase in funding as we go forward.
Like others, I hope that we shall see an uplift for social care in the autumn statement, because the impact of social care on the NHS is now profound. There cannot be a Member in the House to whom it has not been made clear by people who come to his or her surgery that the state of the care system is in collapse and providers are in retreat. Even those who can afford to pay are finding it difficult to gain access to care.
We know it does, and the CQC report describes social care as being at a tipping-point; it is in a very fragile state and we owe it to all our constituents to try to come together to agree where we go from here. Many have proposed a royal commission to look at future sustainability, but we have had commissions: the Barker commission set out the options, and the House of Lords is looking at future sustainability and the range of options.
I urge colleagues across the House to try to agree, rather than having this continual confrontational debate. The best way forward would be for all parties in this House to agree that this is an enormous challenge. My personal belief is that we should stick with our current very equitable system of state funding of our NHS, look at the various options and agree between us that we need to address this. We cannot keep ducking it; we owe it to all our constituents to adopt a much more constructive tone to our debate.
We know that the current position is unsustainable, and that was reiterated in today’s National Audit Office report. We can continue to shout across the Chamber about how much is spent, but we know this will be a challenge whoever is in power, and I urge all colleagues to focus instead on a different approach. Yes, more can be done within the NHS, but I am afraid that the elastic is stretched far too tight for social care to make any more efficiencies. We now need to work together to see how we can fund this going forward.
The NHS in Wirral is facing its gravest crisis, which is why I am grateful for the opportunity to speak in this debate. Cheshire and Merseyside’s so-called sustainability and transformation plan was published last Wednesday, and it is a piece of work that is shocking in its complacency, Orwellian in its use of language and potentially devastating in its consequences.
The Secretary of State has described these plans as open and transparent, but Wirral borough council has had zero involvement in the development of this plan. The first it knew about it was when it was posted on the NHS website last Wednesday.
I want to make three quick observations about the flaws in the STP process, which have become increasingly apparent as it has developed. The first concern is that the NHS has been starved of money and these plans are more about cutting the finances than reconfiguring the services. The second concern is that this has been a top-down process organised in a secretive way by the NHS. The third concern is that the extremely tight deadlines imposed on the process make it impossible to achieve any meaningful consultation or public buy-in.
The plans developed for Merseyside and Cheshire will affect services in Wirral. The plan was published on Wednesday. It confirmed that our local health services have been massively underfunded by this Government to the tune of £1 billion. But rather than providing the necessary resources to meet patient needs, the plan sets out massive cuts. It confirms the existence of entirely new meanings for some familiar words and phrases in the English language as well as elevating management gobbledygook to a form of high art.
In NHS-speak we now know that “sustainability” really means closing all deficits, and in Merseyside and Cheshire this means £1 billion of cuts; “openness and transparency” actually means developing these plans in secret and in total isolation from local partners; and
“the current acute configuration within this footprint is unsustainable” is gobbledegook for mass hospital closures, mergers and the downgrading of accident and emergency services.
The report aims to make these huge savings by merging existing hospitals across the region, downgrading accident and emergency services and cutting access to maternity provision. It makes the heroic assumption that if care is provided closer to home, services will become cheaper and demand will go down. The report is silent on the future for Wirral acute services, despite its ominous observation that there needs to be a review to
“determine future options for hospital reconfiguration”.
Wirral health trust’s annual report has let the cat out of the bag, however, by confirming that the merger of Arrowe Park hospital, the Countess of Chester hospital and parts of Clatterbridge hospital is being considered. This threatens to leave Wirral devoid of any acute services and to leave my constituents with increasingly difficult journeys if they are to access any acute care at all. It is a fact that Wirral local authority has had zero opportunity to be involved in the development of the plans despite the NHS planning guidelines for STPs asking those NHS managers developing them to
“engage with local authorities and other partners in their development”.
It is a fact that this process has been the opposite of transparent. It is also a fact that the proposals contained within it are unacceptable.
The NHS needs more funding urgently. The STP process must be slowed down so that there can be meaningful consultation. The Government should end the top-down planning in secret and open up the process to involve the public and patients in their local communities, as well as other statutory authorities and staff. That is why I have launched a petition to ask the Government to press the pause button on these plans so that they can be properly considered by patients, the public and staff. It can be found at www.savewirralnhs.com. Please visit and sign the petition. Together we have to fight to save Wirral NHS.
I want to make five constructive proposals to help NHS funding. The first relates to prevention, which we have not heard nearly enough about in the debate so far. It is wholly unacceptable that a third of our children are obese by the age of 11. We have learned today that many children typically consume the equivalent of a bathful of sugary drinks every year. We also know that England and Wales are ranked at D minus in the global fitness matrix, and that Scotland is ranked at F.
If we could get these things right early on in our children’s lifetimes, we would be in a much stronger position. One way of doing that would be to extend the excellent work of St Ninian’s primary school in Stirling, which has pioneered the use of the daily mile. All the children run—if they cannot manage that, they walk—a mile at some point each day. This has had dramatic results: not one of the school’s 57 children is overweight, and there has been a significant reduction in coughs and colds. The exercise has helped to develop the children’s social, emotional and mental wellbeing as well as their physical wellbeing. The idea has been taken up across the Netherlands and Belgium, and I would like to see a lot more of it across our own country.
Secondly, we need to do a huge amount of work on health literacy in relation to self-care. I commend to Members the report from the all-party parliamentary group on primary care and public health, which came out in March this year. It showed that there were 3.7 million visits to A&E and 52 million visits to GPs for self-treatable conditions in 2014. It is estimated that if we could deal with that by persuading people to go to the appropriate place, we could save the NHS more than £2 billion a year.
My third point relates to gatekeeping in our hospitals. I commend the initiative taken in Fife in Scotland, where having senior consultant input in A&E has led to a reduction of 30% in acute surgical admissions. My own local hospital, the Luton and Dunstable, has introduced a similar methodology for patients with acute conditions, and that is also bearing fruit.
My fourth point relates to quality, which we have not heard nearly enough about today. I urge Members to look more fully at the work of the Getting it Right First Time initiative, which the Government have now spread across 18 medical specialties. It started in orthopaedics, and the Government estimate that it will save £1.5 billion a year. This is about not only a financial saving, but better outcomes for patients, who may have undergone the wrong operation or received poor-quality care and had to have significant revisions. That project is getting data from across the country. For example, the rate of return for another procedure within 90 days following oral and maxillofacial cancer surgery varies from 8.33% in some hospitals to over 80% in others. That degree of variation is simply unacceptable. If we can get a higher level of quality, that can lead to much better outcomes for patients and the NHS saving money, too.
Finally, enhanced recovery programmes, such as the advanced transfer team in South Warwickshire, have led to significant increases in productivity with better outcomes for patients. We need to see much more of that across the country.
The “South West London Five Year Forward Plan”, published last week, states its intention to save a staggering £828 million by 2020—a contribution to the attempted national saving of £22 billion by 2020. However, that draft sustainability and transformation plan, published by the south-west London partnership, does not shed much light on how it will actually be managed other than by reducing A&E attendance by 40% in three years. That is a totally implausible aim that has not been achieved by any health system in the world—let alone one so strapped for cash.
That unsustainable ambition brings us to the long-standing proposal, which has so often been denied, to reduce the number of acute hospitals in south-west London from five to four or even—God help us—three. The five acute hospitals are St George’s, Croydon, Kingston, Epsom and St Helier, whose closure I have been fighting for 18 years. Of those five acute hospitals, St George’s will rightly be protected from closure. It is also clear that Croydon university hospital or Kingston hospital are unlikely to close, which leaves just St Helier and Epsom, both of which have been under threat before. No amount of vaguely-worded statements from the partnership will change the fact that the intention is to close St Helier. The STP clearly states that the partnership needs to
“Review our acute hospitals to ensure that we meet the changing demands of our populations, and to ensure that acute providers deliver high quality, efficient care…
we will need four acute hospital sites in south west London”.
It continues by stating that the partnership will
“undertake further work, including analysis of revenue implications on 3, 4 and 5 site options”.
Not only will one acute site definitely close, but commissioners are considering the closure of two sites. We know from the STP’s former iteration in 2011, the Better Services Better Values programme, that the closure of St Helier was the main recommendation. Despite that, however, colleagues on the Government Benches, including the hon. Members for Wimbledon (Stephen Hammond) and for Twickenham (Dr Mathias), have been taken in by the STP, peddling the myth that no hospitals will close.
When is a closure a closure? If A&E and maternity services, and all the associated diagnostic and other services, are removed, that is precisely a closure. I want to make it clear to the House, the Government, the partnership and, most importantly, my constituents that we have come together as a community before to fight the closure of St Helier hospital and will do it again. We will do that not only for those who use St Helier, but for those who use every hospital in south-west London. The closure of St Helier would mean the undermining of all those other hospitals.
I start by commending all the hard-working people in our national health service—doctors and nurses—for the increased activity in our NHS over the past several years. The NHS has never worked harder. We have never seen so many patients treated in our NHS and standards are certainly improving. However, we must face up to the fact that indices of mortality and morbidity that are amenable to healthcare are poor against reasonable international comparators. I am not satisfied by comparing the UK with the OECD average; I want to compare the UK with countries with which my constituents would wish it to be compared, such as France, Germany, Holland, Belgium and Denmark. I am afraid that our performance is behind the curve on such comparisons, and that is the challenge that we face.
Like my hon. Friend Dr Wollaston, I am increasingly cautious about the £10 billion figure, so I urge my Front-Bench colleagues to provide clarity on it. We need to be clear about what it actually relates to. I commend the Government for spending this amount on our NHS, despite the opposition from Labour Members. If we are to have a collaborative and collegiate debate, we need some humility from them on this point, as Labour undoubtedly opposed such an amount at the last general election. However, we need to understand what the £10 billion is and what it is not. According to the Nuffield Trust, the King’s Fund and the Health Foundation, we are more likely to be talking about £4.5 billion. The reason for that, which was elegantly laid out by my hon. Friend, relates to which year we use to baseline, which year we use to base our prices on, and whether we include or exclude the money that has been removed from the public health function of local government and from Health Education England. I would contend, as I believe she would, that those moneys need to be included in the sum total for healthcare in this country, and I think that that is what our constituents would understand as the totality of healthcare. That alternative figure therefore seems to be more reasonable.
I am also worried about the £22 billion in savings on which Simon Stevens based his five year forward view. The National Audit Office report published today suggests strongly that this process is not likely to result in anything like £22 billion and that those savings are “untested”—that is polite speak for unachievable. We know that the deficit is being dealt with through a transfer from capital to revenue, and from the sustainability element of the sustainability and transformation fund. That is not sustainable in the long term. We want more transformation; we do not want to have to rely increasingly on the sustainability bit.
Tomorrow, we must look for a big cash injection to sort this out, but I submit that we then need a long-term commission—perhaps not a royal commission, as royal commissions take for ever and cost the earth—that will involve a debate about how we pay for our health service in the long term, given the pressures that we face. That might involve a hypothecated tax. The end to the triple lock could save £2.1 billion by 2020-21, and that money could then be hypothecated to the NHS in the interests of generational fairness, given that the elderly consume the largest portion of healthcare spend. We also need to look at fiscal incentives relating to employees’ private medical insurance. But we need to do all this within a Beveridge envelope that delivers an NHS that is free at the point of need.
It is a pleasure to follow Dr Murrison, whose points about hypothecation were particularly interesting.
Long-suspected proposals to downgrade Darlington Memorial hospital were confirmed by the leak of the STP by Hartlepool Borough Council. I am grateful to the council for allowing the document to enter the public domain. Darlington Memorial serves not only the town of Darlington, with its population of about 100,000, but communities living far into the Durham and the Yorkshire dales—Barnard Castle, Northallerton and beyond. Darlington is also the closest major town to Catterick garrison, the largest army base in Europe, which is set to expand yet further. Nearby hospitals have already been downgraded in recent years, with changes to emergency cover at Bishop Auckland hospital and to maternity services at the Friarage hospital in Northallerton. When those changes were made, in the face of enormous local opposition, residents were assured that services at the next nearest hospital, Darlington Memorial, would be safe.
Darlington Memorial is special to me, perhaps even more so than it is to many of my constituents—I make no apologies for that. Both my parents were nurses, and we lived in nurses’ accommodation at Darlington hospital for a while when I was eight or nine. My dad died at that hospital, as did my grandmother. My two sons were born there, and have made regular and at times unexpected use of its services ever since.
I do accept that, for some specialist services, there is a benefit to centralisation. I absolutely support clinically driven decision making. When cardiac services were moved from Darlington to Middlesbrough, it did not lead to a campaign—it was the right choice for patients, it improved outcomes and I supported it. However, major trauma is already located at James Cook University hospital in Middlesbrough, and the argument now is about centralising services that do not have problems in their outcomes. There is also no clinical gain for patients through such a change, which makes the proposal just wrong.
Another concern relates to the amount that has been spent on so-called engagement activity with the local community to explain the downgrading plans to residents and find out what they think about them. Answers to written parliamentary questions show that £4.6 million has been spent on such activities so far. That is a disgrace, and those responsible should be held to account, as they have wasted public money and are now misleading the public about the fact that there is absolutely nothing to show for that.
In recent months, a campaign to save Darlington hospital has been growing. People from SOS Darlington have been out campaigning in the town centre, knocking on doors, and holding coffee mornings, and they have done it all for free. They have managed to engage 6,000 people. They are doing a better job of engaging the public and they are doing it for absolutely nothing. There is no clinical case for downgrading services at Darlington hospital. Everyone involved knows that, which is why so much time and money is being spent on making up ways to persuade patients that it is a good idea.
The STP’s description of my constituents as “passive recipients of care” is not helping. The trouble is that the nirvana that the STP tries to support is not achievable without massive—as yet unquantified—amounts of up-front spending.
I admit that my attachment to my local hospital goes beyond the utilitarian, but I understand enough about how this process is unravelling to know that staff at Darlington Memorial hospital and their patients—my constituents—deserve an awful lot better.
Our national health service is, and always has been, valued and cherished by my constituents who rightly expect an excellent standard of care to be provided free at the point of use when they need treatment. We are all deeply committed to the future of the NHS, but to ensure that it can continue to provide the quality of care that our constituents expect, it cannot stand still. It needs to continue to transform the way in which it delivers services so that more resources lead directly to better care for patients.
Both the total NHS budget and the amount of NHS spending as a proportion of total Government spending have increased in every single year since 2010. Spending is now 10.1% higher per head in real terms than in 2010, and that increase has brought our health spending as a proportion of GDP broadly in line with that of our western European neighbours. In order to achieve best value from its resources and to deliver £22 billion of efficiency savings—those are savings that the NHS identified as achievable in its five year forward view—it is necessary to reconfigure the way in which health and social care services are delivered at a local level. That is a huge issue, and until we amalgamate social care budgets with health budgets to deliver a truly health-driven service with proper health-led care in the community, we will struggle with this for many years. I mention that not to cause controversy, but to highlight the difficult decisions ahead. Too often those decisions and the long-term sustainability of our local services are hindered by ideology, local politics and empire protections over budgets.
A few weeks ago, the West Yorkshire and Harrogate STP was published, setting out the vision, ambitions and priorities for the future of health and care in the region. This built on the significant work that was completed locally by both the Calderdale and the Greater Huddersfield clinical commissioning groups, which have been working together to address the significant challenges facing the health economy across our whole area. The decision to proceed with the development of a full business case was met with considerable concern from some members of the public who have been vociferous in their opposition to what they perceive to be a complete withdrawal of urgent care treatment at Huddersfield royal infirmary. Although the process has been challenging, to say the least, I would argue that it has been absolutely essential. What is certain is that the current model through which health services in Calderdale and Huddersfield are delivered is not sustainable in the long term, and that changes are needed to ensure that we have a local health service that continues to provide excellent care.
Amid some of the sensational media headlines from the local press and the comments of some of my opponents at the last general election, it can be easy to forget that these proposals are being put forward not by politicians or by the Government, but by our senior local clinicians and doctors—the very people who understand how our local health services can best be delivered in the long term. They have taken an independent view about how the additional resources that the Government are making available can directly lead to better care for patients locally, and we have to trust their judgment. However, if we are to receive the support of our constituents for transforming the way in which we deliver their care, we must vastly improve the way in which we communicate any proposed changes and not keep scaremongering about cuts and reduced services, especially when the annual NHS budget spend is increasing in real terms.
I want to talk about the Cheshire and Merseyside sustainability and transformation plan and the documents relating to it, which were finally published last Wednesday, although details had been repeatedly leaked. The plans are every bit as full of unrealistic proposals and management newspeak as many of us feared. They amount to a catastrophic financially driven plan drawn up by managers in secrecy under pressure from the Secretary of State for Health. They are already being implemented, without any of the affected stakeholders or the people of Cheshire and Merseyside ever being asked what they think.
If fully implemented, the STP would involve the merging of the Royal Liverpool, Broadgreen and Aintree hospitals, with the Liverpool Women’s hospital being “reconfigured” and merged into the new organisation at a later date. It is planned to be rebuilt nearer the Royal, but there is no NHS money available for the new hospital building. The plans entail the downgrading of hospital A&E services at Whiston hospital, where many of my constituents go, or at Warrington or Southport hospitals, or some combination of all three. Details are not provided.
These shocking cuts and mergers have very little chance of being accepted by the people of Garston and Halewood, for a number of reasons. First and foremost, it is clear that the Cheshire and Merseyside STP is financially driven. This has been admitted by those who have drawn it up. Katherine Sheerin, chief officer of Liverpool clinical commissioning group, accepted this in an interview that she gave in the Liverpool Echo. When asked what would happen if these changes were not made, she said:
“If we did nothing, we would not have enough money to run the services. This is about managing that, rather than letting it happen.”
When asked if these changes were being driven by cuts, she replied:
“The financial component has been a strong driver”.
The King’s Fund agrees with her. In its report entitled “Sustainability and Transformation Plans in the NHS”, it says:
“The original purpose of STPs was to support local areas to improve care quality and efficiency of services . . . The emphasis from national NHS bodies has shifted over time to focus more heavily on how STPs can bring the NHS into financial balance (quickly).”
Quite so, and we can see this in Katherine Sheerin’s answers.
The Cheshire and Merseyside STP has to deal with the pressure of almost a £1 billion gap in its funding by 2021, so making cuts in spending to meet the Government’s financial requirement is at the core of these plans. The people of Merseyside are not daft— they can see this. The Cheshire and Merseyside STP requires £755 million of capital funding, which is now no longer available. In Liverpool alone, our hospitals’ deficit is estimated to be £276.5 million. In her Liverpool Echo interview, Katherine Sheerin suggested that Liverpool City Council would provide the missing capital funding.
Neither Liverpool City Council nor Knowsley Borough Council has been consulted at all about the plans. However, when asked where she was going to get the money for the new hospital, Katherine Sheerin said:
“There’s limited capital available but there are options to explore. Councils tend to be able to access borrowing at a very cheap rate.”
There we have it: Liverpool City Council is expected to stump up the money to implement what is supposed to be a key part of the strategy—building a new women’s hospital. However, this is the same Liverpool City Council that has had 58% of its money from central Government removed—first by the Lib Dem-Tory coalition and then by the Tory Governments after 2010—and that relies for almost three quarters of its income on that Government grant. This is the same Liverpool City Council that already spends £151 million on adult social services for its ageing population, but that can raise only £147 million in council tax. This is the same Liverpool City Council that is expected to find another £90 million of savings over the next three years and that is facing some extremely invidious choices to balance its budget.
My second point is this: these plans have been drawn up in near secrecy by NHS managers, and without consultation with those who are now being exhorted to help. Neither Knowsley Metropolitan Borough Council nor Liverpool City Council has been asked what it thinks. Consequently, both say, unsurprisingly, that they are opposed to the plans. In Liverpool, the ruling Labour group has made it clear that it will oppose any STP that proposes cuts, and the Mayor of Liverpool has said publicly that he opposes the proposed closure of the Women’s hospital and will campaign to keep a women’s hospital in Liverpool. I agree with him. Labour in Liverpool will support any change to existing provision only if it improves services to women in Liverpool.
The current plans are already being implemented, and that is another thing we cannot allow to go ahead without proper consultation.
My starting point is that funding in the NHS must be used effectively and efficiently. To that end, we expect the NHS to deliver savings and best value for money.
There are a number of issues relating to social care in the NHS where there is considerable scope for solving existing problems, for ensuring that better health care is delivered and for achieving sustainability, and there is no better place to start the discussion of those issues than bed-blocking.
Oxfordshire’s historical performance on bed-blocking is poor. It came 151st in terms of headcount last November, with 158 people. Bed-blocking decreases the availability of beds and has adverse effects on patients, particularly when they are elderly—for example, incontinence in the over-65s increases, and muscle wasting in the over-80s after 10 days of hospitalisation is equivalent to 10 years of muscle wasting otherwise.
By September, the headcount had fallen to 113 people, improving the county’s performance to 108th—a massive improvement of 50 places over that period. That was achieved through a joint initiative by the clinical commissioning group, Oxford University Hospitals, Oxford Health NHS Foundation Trust and the county council, all working to move people out of hospital when they have been appropriately treated.
However, that improvement was also achieved by putting £2 million into funding extra temporary care beds in care homes, where people can stay until they are ready to return to their own homes, move to a permanent care home or receive care in their own homes. That joint and positive thinking is something I would encourage as we integrate social care and the NHS.
I do, and that is precisely what the organisations in Oxfordshire have been trying to achieve.
The second point I would make relates to how we produce better-serving hospitals. In my own area, the Townlands Memorial Hospital, which is in Henley but which serves the whole of south Oxfordshire, has recently gone through a major reprovision. It now has an increased number of facilities serving the population of the area, but the beds are not in the hospital. Although limited in number, they are in an adjoining care home, whose opening I happened to attend with the Duke of Gloucester only the other day. It is good to see the issues at the hospital finally resolved.
That is the way forward for local hospitals: better treatment for people in their home through a system of what has come to be called ambulatory care. Such a system prevents the problems I mentioned, with patients suffering when they stay in hospital for a long time. This view comes not from politicians but from clinicians both local and national. The national clinicians I would point to are those in the Royal College of Physicians, who are fully behind this process. This method costs more in the first instance but provides better value for money and increases better patient outcomes.
The third area I want to discuss is what can happen when we integrate the staff providing care who are employed by the county council and those who are employed by the NHS. This allows us to ensure that the pay and service requirements of both groups of people, who are doing exactly the same job, can be harmonised in a much more positive way. That sets out a good scope for efficiency in the operation of social care within the NHS model. I agree with my hon. Friend Craig Whittaker, in that I would like to see them fully integrated, but until then I have set out a very good method of being able to operate in those circumstances and to co-operate in order to achieve the outcomes that I have mentioned.
Sustainability and transformation plans focus on organisations working together and are the best hope of improving health and social care services in the long term. That is not my view but that expressed by the King’s Fund when it looked at the plans. I fully agree with its assessment of the situation and of these plans, which are working towards achieving the same outcomes.
The funding crisis in the NHS is no accident. It is a political choice made by the Tories for which patients and NHS staff are paying the price in longer waiting times, delayed operations, and increasingly stressful working conditions. It is a crisis driven by the Government’s demand that the NHS make £22 billion-worth of efficiency savings—or cuts. This is impossible without huge damage to our national health service.
An analysis by The Guardian of 24 of the 44 STPs stated:
“Thousands of hospital beds are set to disappear, pregnant women will face long trips to give birth and a string of A&E units will be downgraded or even closed altogether as part of controversial NHS plans to reorganise healthcare in England…Dozens of England’s 163 acute hospitals look likely to have services, including cancer, trauma and stroke care, removed as a result of the plans”.
In the 2015-16 financial year, the NHS reported a record net deficit of £2.45 billion—nearly three times higher than in 2014—and so we see the crisis in services accelerating. Last week, the chief executive of NHS Providers, Dr Chris Hopson, said:
“The NHS simply cannot do all that it is currently doing and is being asked to do in future on these funding levels.”
STPs are supposed to facilitate the integration of health and social care, for which they require the support of council leaders, yet the leader of Wirral Council has said in the past 24 hours that he has not been given the opportunity to feed into the development of the local plan. The STP for Cheshire and Merseyside is of great concern to my constituents because it requires nearly £1 billion to be taken out of local health services. If this goes ahead, the impact on the NHS will be devastating; it is impossible that it would be otherwise.
There was recently a proposal to close Arrowe Park hospital, Clatterbridge hospital and Countess of Chester hospital and build a new hospital in Ellesmere Port, and there has been no denial that such a conversation has taken place. The annual report of the foundation trust that runs Arrowe Park and Clatterbridge says:
“The Trust will explore with Countess of Chester Hospital the potential for the development of a single acute general hospital covering Wirral and west Cheshire within the next 10-15 years …Another option is to move all planned surgery and procedures to Clatterbridge, while Arrowe Park will become a ‘hot site’
dealing mainly with emergencies.”
It is not clear what a “hot site” is if it is not a hospital. Surely the point about an A&E is that it needs to be in a place where there is a very wide range of expertise on how to deal with any emergency. I have very real concerns about the future of Arrowe Park hospital, which is a major hospital highly valued by my constituents who use its services and who work there; indeed, it is a major employer in my constituency. The STP talks of “hospital reconfiguration”. It is no wonder that local people are up in arms about the plans.
The STP for Cheshire and Merseyside appears to set a great deal of store by the development of ACOs, or accountable care organisations. These are an idea brought from America, where of course there is no national health service. They integrate health and social care, and have a strong emphasis on cost reduction. The core issue is that people in England often pay for social care, but certainly do not expect to pay for healthcare, other than through direct taxation. There is real concern that the introduction of ACOs through STPs is part of a desire on the part of the Government to introduce a private insurance-based healthcare system in England instead of our national health service. I would be grateful if the Minister could give some clarification on that point.
It is my belief that the Government are cutting the supply of healthcare in the public sector to create demand for a private health insurance marketplace like the one in America, and there is nothing in the STP to reassure me that that is not the case. The document is riddled with the language of the market, talking of increased customer satisfaction, better user experience and “commercially sustainable” clinical support services. If the STPs go ahead across England, we can expect to see A&E closures, hospital closures, downgrading of services, patients waiting longer for treatment, and deterioration in the pay and conditions of staff as the drive to cut costs takes its toll. I urge the Government to use the autumn statement to address the underfunding of the NHS and to give it the funds it needs.
May I just make an apology to Hansard? It is one thing reading a speech, but that was a record level of reading into the record. I appreciate that time is short and that the hon. Lady wanted to put those things on the record, but if she speaks a little bit slower and allows other Members to understand what she is saying, it will give them an opportunity to intervene and she will gain some extra time.
Speaking for myself, I was impressed by the pace of the hon. Lady’s speech.
In this short contribution, I want to address the supply of practitioners, not just the supply of money. I suggest to my hon. Friend the Minister that since we have regulated many more practitioners, many more practitioners should be available on the health service. The Professional Standards Authority chief Harry Cayton has called for a much greater use of those on his register. He says:
“We all know we need to deliver new, innovative ways to improve people’s health…That means looking beyond the traditional confines of our health and care system and the traditional health professions.”
The 23 organisations on his register—including the Federation of Holistic Therapists, the Society of Homeopaths and the British Acupuncture Council—regulate 20,000 practitioners.
The treatment of lower back pain needs much greater consideration. Since the regulation of chiropractors and osteopaths in Bills that I was involved with 20 years ago, there has been far too little communication with orthopaedic surgeons. There is an organisation called ARMA—the Arthritis and Musculoskeletal Alliance—but I ask my hon. Friend to look at the matter and see how much more effective integration can be. NICE now recommends acupuncture for lower back pain, as I hope it will continue to do, and that should be brought in.
On Brexit, we have the European legislation to consider. Three directives need close scrutiny when we take them over. The traditional herbal medicines directive has struck out proven Chinese medicines and other herbal medicines, the food supplements directive is very restrictive and tougher regulation will be needed when we get our hands on the food additives directive.
The chief medical officer wrote a report in the last Parliament on antimicrobial resistance. One of the most effective ways of stopping antibiotic use is to use homeopathic medicine, which has a proven record in upper respiratory tract infection treatment. We also need to go back to the ’90s to look at the GP fundholding system that was available in John Major’s Government, whereby doctors could commission complementary and alternative medicine practitioners. A clinic known as “The Crypt” in Marylebone saved £500,000 in one year using homeopathic treatments. When that was struck out by the new Labour Government, the clinic overspent its drug budget by £1.5 million.
There have been a lot of attacks in the past few years on homeopathy, which is an honourable and well-served practice of medicine with its own doctors, regulated in this country and used in 41 of 42 European countries. Some of those attacks have been from an organisation called the Good Thinking Society, which really consists of one man and a dog. It spends £100,000 a year, £20,000 of which comes from the taxpayer through its charitable status; I think that that is an absolute scandal. I urge my hon. Friend the Minister not to listen to the siren voices of that small, badly represented group. We need to use the discipline of homeopathy. We must not allow lawyers sending letters to clinical commissioning groups and others to derail the availability in the health service of that very well-established and popular system of medicine.
For all the wrong reasons, St George’s hospital in Tooting has been in the news recently. First, it appeared on the front page of a national newspaper because it was requiring people to show an ID before coming in and giving birth. Secondly, it was rated inadequate in a recent CQC inspection. Finally, figures were released showing one patient waited 36 hours in A&E before being admitted to the hospital.
The one question we are all asking is: why? Why are the roofs in the theatres leaking? Why are the computer systems inadequate? Why has Wandsworth Council been forced to cut almost £10 million from social care budgets? Why does my local hospital trust have a deficit of £50 million? Everywhere we look, the answer is a lack of funding.
We should not leave our hospitals with the bare minimum to function; we should prioritise their funding. It is a healthcare system: we cannot take risks. If we do, it will result in a loss of life—people die. The Health Secretary can point the finger at whomever he wants, but it is not because of our doctors, who always go the extra mile, our trainee nurses, who have had their bursaries cut, or our carers, who are overworked and underpaid. I am afraid the Conservative Government are to blame
I have worked in our NHS under a Labour Government and under a Conservative Government, and there is a significant difference. Staff morale is at an all-time low, as is patient morale. This Government are failing patients. Government Members know it, and Opposition Members know it. St George’s has not had significant resources put into it since Labour was in government. This is not a one-off story; it is happening up and down the country.
When Labour was in government, our healthcare system was a truly national health service: we saw more doctors, better equipment, new hospitals, and happier and healthier patients. Under this Conservative Government, waiting times are rising, buildings are falling apart and patients’ lives are being put at risk. We are making life and death decisions on the basis of costs. Our NHS is in crisis, and this crisis is turning into a disaster before our very eyes. The NHS was built by a Labour Government, it was saved by a Labour Government and it will be a Labour Government who rescue it.
I am very pleased to pick up where Dr Allin-Khan left off. Quite frankly, I find it extraordinary that Labour Members have the audacity to come into the Chamber and trumpet their views about the national health service when they know that they have had 18 years of running the NHS in another part of the United Kingdom and that, on any of the performance indicators that are looked at, the NHS in Wales is performing less well than the NHS in England. I do not for one minute want anyone to think that I am criticising NHS staff—the nurses and doctors—because I am not, and I am not running down Wales either, because I know exactly where the blame lies. It lies at the feet of the Labour party for implementing exactly the same policies that Labour Members are now calling on the Minister to implement.
There is no need to take my word, or that of any Conservative, for this; one can simply get hold of the Nuffield Trust report on “The four health systems of the United Kingdom: how do they compare?” This independent report looked at a range of indicators, and it makes this very clear. I am very happy to read from the report, which in its own way is far stronger than anything the Conservative party could publish. It says that waiting times in Wales have lengthened since 2010, with striking rises in waits for common procedures such as knee and hip replacements. When language such as “striking rises” is used, surely people should take notice of the report, especially when, as Labour Members must realise, those striking rises are being caused by the policies they are asking my hon. Friends to implement.
The report talks about how amenable mortality rates are lowest in England. In other words, people live longer in England. It also talks about waiting times, which are an absolute disgrace. There is a target waiting time of 26 weeks in Wales, whereas it is just 18 weeks in England. More than that, the report shows that some people are waiting for up to 170 days for knee and hip replacements in Wales, as opposed to just 70 days in England.
The report shows that funding in Wales has been cut in real terms. Wales is the only part of the United Kingdom where funding for the national health service has been reduced; in England it has been going up.
The report shows that there is a shortage of GPs. My hon. Friends have increased the number of GPs to 0.75 per 1,000 people, compared with 0.66 per 1,000 in Wales. On stroke care, 39% of patients spent 90% of their time in a stroke unit, as opposed to 51% of patients in England—a much higher amount. The figures for MRSA show, once again, that England is ahead of Wales. The figures for ambulance response times show that 75% of ambulances make it within eight minutes in England, as opposed to 65% in Wales.
Perhaps one of the most shocking differentials in service between England and Wales is in the access to cancer drugs. Constituents have come to see me because they have had to go sofa-surfing with relatives in England to get access to standards of care that patients on this side of the border take for granted.
I issue a challenge to everyone in this House. If Opposition Members think that the Welsh NHS, the policies of which they want to follow, is as good as the English national health service, they should allow patients to choose. I constantly write to my colleagues on the Front Bench asking them to allow patients from Wales to access the national health service that they are delivering so well in England. Unfortunately, it is not always possible to do so. We should have a truly national health service that allows people in Wales to go and be treated in England if they want and, indeed, people in England to be treated in Wales if they want, and adjust the block grant accordingly.
In the meantime, I very much hope that my hon. Friends will stick with the policies that are delivering higher standards of healthcare in England because, if nothing else, it means that my constituents have something to aim for and can demand that the Labour party in Wales follows the successful policies that are being followed in England.
A couple of Members who were on the list are not in the Chamber and will be written to. That means that the last two speakers have up to six minutes each.
It is not often that the people who come last get more time to speak, so thank you very much for that, Madam Deputy Speaker.
The speeches by right hon. and hon. Members from all parts of the Chamber have been exceptional. We should focus on the good things in the NHS, which everyone in this Chamber acknowledges. The passion that we hear in debates like this often comes out of what our constituents tell us.
Does the hon. Gentleman share my concern about the introduction of ACOs through the STPs, which come from America and are often used in insurance-based models of healthcare? Because people here do not pay for healthcare, except through direct taxation, but do pay for social care, there is a lot of concern about the blurring of the boundaries and a worry that we will wind up with people being asked to take out health insurance.
I agree wholeheartedly with the hon. Lady. Madam Deputy Speaker mentioned how fast she speaks; perhaps she is trying to take away my record. Kate Hoey says that I do more words to the minute than anybody else in the House. Perhaps Margaret Greenwood is trying to take that mantle, but we will see.
I am the health spokesperson in the House for the Democratic Unionist party. It is a portfolio that needs to be balanced, and we should look for the greater good at every stage. In my opinion, it is the most difficult portfolio for anybody to hold. I am glad that I am not in the position of the Secretary of State for Health, because I would find it difficult to say to a person, “We cannot supply the drugs that you need to prolong your life, but we are hoping to save the life of the person beside you. We need the money to save, rather than prolong, life.” David T. C. Davies referred to sofa-surfing and the lottery for those who need access to drugs. Although I do not envy the Government in having to make such decisions, I cannot sit back and not highlight the difficulties that exist within Government funding and the fact that the NHS must have more designated funding to keep it running.
I read with interest the briefing provided by Macmillan. It sent chills down my spine. By the end of this Parliament, about one in every two people will be diagnosed with cancer in their lifetime. I look around the Chamber today and remember that those statistics include us and our loved ones. Indeed, there are some Members in the Chamber who have experienced cancer and are survivors. My own father battled and won against cancer three times. I am aware of what that battle entails, and how much of it is based on the right diagnosis and treatment, the availability of that treatment, the skill of the surgeon’s knife and the prayers of God’s people—those are all very important. It is clear that improvements in diagnosing and curing the disease mean that more people surviving it are living for longer with it; some 2.5 million people are living with or beyond cancer in the UK today.
In my opinion, more must be done to help those with rare diseases and rare forms of cancer. Will the Minister give us an indication of what funding and resources will be set aside for them? Those rare diseases and cancers are increasing. Put together, those conditions affect a large number of people. I know that funds are not infinite, but we must focus on those with rare diseases and with rare forms of cancer.
I will mention a tremendously courageous lady—I hope she will not mind me mentioning her name in this Chamber—who works in my constituency, called Aundrea Bannatyne. She watched her son battle cancer and triumph, only to be told that she had pancreatic cancer and that there was no treatment for it in Northern Ireland. The help she needs will cost up to £100,000 and the people of the area where she lives, Dundonald, have dug deep to help fund that.
That lady’s story could be replicated in the constituency of every Member in this Chamber, across the whole of the United Kingdom of Great Britain and Northern Ireland, but the postcode lottery says that she cannot have treatment because she lives in Northern Ireland. However, she would be able to access it in other counties on the mainland, which is something that David T. C. Davies referred to. That lottery is not what is needed. We need treatment in all areas. That must be addressed by additional funding. Aundrea needs more than us wringing our hands and being sympathetic. She needs practical, physical help. That is the only thing that can change her hopes for her future and her son.
Macmillan has said that one in four people living with or beyond cancer face disability or poor health following their treatment. That can remain the case for many years after the treatment ends. It is vital that they can access the best care—the care that is right for them—when they need it. The NHS must be able to meet the changing needs of cancer patients. That would not only increase the quality and experience of survival, but ensure that resources are invested in the most effective way. That is key, given that the five year forward view projections indicate that expenditure on cancer services will need to grow by some 9% a year, to £13 billion, not to get ahead but simply to stand still. That level of spending is likely to yield outcomes that continue to be below average when compared with similar international healthcare systems. We must therefore act now to ensure that the money is spent as effectively as possible, to give England and the United Kingdom of Great Britain and Northern Ireland a better chance to achieve world-class cancer outcomes and deliver the Government’s manifesto commitment.
The health service currently spends more than £500 million a year on emergency care for people with the four most common cancers alone. If we are spending £500 million on emergency treatment for cancer, there is something wrong with the system that we have to address effectively. Emergency care should be a last resort for people living with cancer. Such a vast amount of emergency care spending is symptomatic of a system that is not geared towards helping people take control of their health.
I am conscious that Jo Churchill is waiting to contribute, so I will conclude with this comment. Let us make the right decisions to sustain the NHS as it is—never mind give more, which is what people actually need. If that means taking simple things such as paracetamol off the prescription list, to save £80 million, let us do it.
Let us look at real issues that can make a change. Let us do the simple things for the greater good, and let us determine to be more efficient where possible and cut unnecessary red tape rather than services. Let us ensure that our NHS can withstand not only the surge of cancer diagnoses but the surge of diabetes—other Members have referred to that—heart disease, and all other major illnesses, which are only worsening. I do not envy the Minister’s task, but we have to make hard choices. We have to get the funding in the right place, and make decisions that take away bureaucracy and restore funds where they are needed—to cancer, rare diseases and rare cancers.
I want to start by saying a huge thank you to everybody in our hospitals, our GP surgeries and our care homes. Listening to the debate, one might be under the impression that brilliant things are not going on, but nine out of 10 people in A&E benefit from being seen within four-hours. This discussion therefore needs to be balanced. I have heard that there are problems up and down the country, but the West Suffolk hospital in my constituency has just been rated as outstanding not for its buildings or anything peripheral, but for its care. That is the most important thing we can ask anyone to give.
Dr Allin-Khan said that things were better under Labour. I was diagnosed with my second and third cancers when Labour was in government. The radiotherapy machines were under a sheet and not working because of a lack of staff. This problem has been coming down the track for ages. We do not do anybody a service if we deny that it is a problem and that it is looming.
GPs in Suffolk are under pressure. I talk to them regularly. I engage with social care, which is struggling. It is about the service, as my hon. Friend Craig Whittaker said, but we should remember that every patient is a person—a daughter, a mum, a dad. For the five year forward view, we listened and we came to the table with the money. Demand has outstripped us, and we need to look at streamlining services. Having one pot of money will help us to understand the blockages in the system to which so many people, including my hon. Friend John Howell, alluded. We can then look to unblock the system. It is ridiculous to have people on delayed discharge because we cannot get them into the community, and then for GPs to send to A&E people who cannot get into the hospital to be treated. We all know the problem; let us look at the solutions.
Prevention is also an issue. The motion today is about far more than cash. The year 1948 is a long time ago and the system has always been a mix of private and public. It is stronger today, but there are 1.4 million in its workforce.
I said “Thank you” earlier. I would especially like to thank junior doctors, many of whom speak to me on a regular basis. They tell me that just a little thank you from people for the hard work they do would make a difference in their daily lives, so I ask for that. Some 92% of the pot of money goes to the acute sector. Our GPs, who we are expecting to do more, receive 8%. Working together would help us to look at what funds are needed for social care.
Moving people through the system is tricky. With an ageing population and comorbidity, 17% of the health budget is spent on long-term conditions. Some 22.4 million people visited A&E last year—up 600,000. I applaud the doctors who are beginning to say, “Do you know what? You can do the odd thing at home. You don’t always have to come and see us.” We need to be more responsible for our own health.
It is important that we look at new ideas. My hon. Friend Dr Murrison mentioned in The Telegraph the other day that we should perhaps look at the triple lock. Today, Stephen Dalton, interim chief executive of the NHS, talked about using the private sector more slickly. The provision of care relief for patients could be moved around so that home services are sorted. We need to consider community diagnostics. We need to be able to talk about these new ideas. Let us think about the future.
A young medic told me on Friday how much a 10-hour operation involving nine professionals cost. People need to understand what things cost. A young clinician said to me only yesterday that when somebody does not attend they should be asked to pay. They are sent a text, and there has to be more responsibility.
In this country, where a diabetes crisis is looming, 66% of people are obese; one third drink too much; and 20% smoke too much. We have to decide what we want out of this overburdened system and what we want to put in. As Jim Shannon mentioned, the NHS spends around £85 million on paracetamol, yet it can be bought for just 16p. Should we be investing money in different places? If we treasure the NHS, we should treasure ourselves and its resources. The rise in cancer diagnoses is linked to obesity. Some £3.5 billion is spent on treating alcohol-related illnesses. The system is in crisis, but we have ways of addressing it. I do not want this to be a blame game. We have recruited more doctors and nurses, but now we need to step up, talk about the problems and develop a streamlined system.
This has been at times a high-quality and passionate debate that has made clear the concerns across the House about the sustainability of our health service. The Chancellor sadly could not be with us this afternoon—I assume he has a few other things on right now—but had he been here to hear the contributions from Members on both sides of the House, he would be in no doubt about the severity of the challenges facing the health and social care sector, or about the dire consequences that will follow if he does not deliver the rescue package that is needed tomorrow.
We have heard some excellent contributions. As right hon. and hon. Members have said, while we might have our political differences, we all appreciate the work that our staff in the NHS do—as we do the work of all public sector workers—and we thank them for it. Dr Wollaston, the Chair of the Health Committee, calmly and clearly explained how cuts to the health budget were used to help the Secretary of State reach his figure of £10 billion. Despite the huge volley of figures he mentioned in his speech, he failed to mention that amount at all. The hon. Lady pointed out how many of the cuts will store up other problems in the long term, and she is right that the moving of the goal posts that has taken place does nobody any credit.
My hon. Friend Siobhain McDonagh, who described the savings required in her area as implausible, is clearly going to fight the closure of St Helier hospital. She rightly pointed out that that closure will undermine other services and hospitals in her area, and I have no doubt that her constituents will be relieved to have such a doughty champion on their side. Jim Shannon spoke with great sincerity and passion about the variations in cancer treatment and alarming statistics setting out anticipated increases in incidences of cancer. He also rightly highlighted the expenditure on emergency cancer treatments, showing that much more needs to be done on earlier detection.
My hon. Friend Jenny Chapman said that there seemed to be a focus in her area on consolidating services where there was no problem with clinical outcomes, and she made it clear that her constituents would not be fooled into accepting a downgrade in their local hospital. Her local health chiefs have won the award for the worst use of management speak today by calling patients “passive recipients of care”. My hon. Friend Dr Allin-Khan brought her recent experiences of the health service to the Chamber and said of the NHS that everywhere we look the answer is a lack of funding. She told us that staff and patient morale were now at all-time lows, and she should know what she is talking about.
We also heard from the hon. Members for South West Bedfordshire (Andrew Selous), for South West Wiltshire (Dr Murrison), for Calder Valley (Craig Whittaker), for Henley (John Howell) and for Bosworth (David Tredinnick), although none of them referred to the deficits their own STPs were facing—perhaps they do not think there is a problem. I can tell the House, however, that in South West Bedfordshire, the deficit is £311 million; in South West Wiltshire it is £490 million; in Calder Valley it is a staggering £1.07 billion; in Henley it is £479 million; and in Bosworth it is £700 million.
I am well aware of the financial challenges in my own area, but I noted in my STP the 26% increase in funding up to 2020-21, which I think is quite commendable.
How much worse does the hon. Gentleman think that the deficit in South West Wiltshire would have been had Labour won in 2015 and uprated NHS spending by just £2.5 billion, rather than the figure we are currently enjoying?
Our manifesto was very clear that we would put in £2.5 billion immediately, plus whatever was needed. Indeed, research by the House of Commons Library has shown that if health spending had continued at the levels maintained by the previous Labour Government, there would be an extra £5 billion a year by 2020.
The NHS has deteriorated on every headline performance measure since the Health Secretary took office. It now faces the biggest financial crisis in its history, with providers reporting a net deficit of almost £2.5 billion last year. That deficit was covered only by a series of one-off payments and accounting tricks that do not disguise the true picture of a service that is creaking at the seams, of a workforce stretched to the limit, and of a Health Secretary in denial about his own culpability for this shocking state of affairs. While he rightly paid tribute to the work of NHS staff, he must know that when morale is so low, his platitudes are just not enough.
Only last week Cheshire West and Chester Council, which covers the Ellesmere Port area, put forward a resolution indicating that it was not satisfied with its level of involvement in the STP. Indeed, I do not think any council in the Cheshire and Merseyside area is satisfied, including even the Conservative-controlled Cheshire East Council.
Faced with an unprecedented crisis, what did the Secretary of State have to say for himself when asked by the Health Committee about investment in the NHS over the next five years? He said:
“Whether you call it £4.5 billion or £10 billion does not matter.”
Well, it might not matter to him, but it matters to people up and down the country who are desperately worried about the future of their local health services. This is not loose change down the back of the sofa. We know the Secretary of State will not accept what the Chair of the Health Committee said about giving a
“false impression that the NHS was awash with cash”,
so perhaps he will listen instead to the head of the National Audit Office, who said yesterday:
“With more than two-thirds of trusts in deficit in 2015-16 and an increasing number of clinical commissioning groups unable to keep their spending within budget, we repeat our view that the financial problems are endemic and this is not sustainable.”
Perhaps he will listen to the Nuffield Trust, King’s Fund and the Health Foundation, which in a joint statement released this week said:
“The Department of Health’s budget will increase by just over £4 billion in real terms between 2015/16 and 2020/21. This is not enough to maintain standards of NHS care, meet rising demand from patients and deliver the transformation in services outlined in the NHS five year forward view.”
Ministers need to stop trying to hoodwink the public, patients and even their own Back Benchers about the extent of the crisis engulfing our health and social care sector. Every day we hear more about a service crumbling as six years of underinvestment and cuts in social care and public health come home to roost. At the weekend, we heard about the Yorkshire ambulance service piloting a new scheme that might involve heart attack victims waiting up to 40 minutes to get an ambulance. Only yesterday, there were claims from GPs that very young and elderly patients are dying because of worsening delays involving 999 calls. Indeed, the most recent ambulance figures were the worst on record, but what did we hear from the very top of the Government about the NHS this weekend? The only comment we heard was one reportedly attributed to one of the Prime Minister’s assistants that they were going to “fix” Simon Stevens, the chief executive of the NHS, because he had dared to contradict the Prime Minister over funding. I have a suggestion: instead of trying to fix him for telling the truth, why do they not try fixing the NHS instead?
It is time to be honest about where we are and the true nature of the STPs, which are now finally starting to emerge. Let me be clear that we are not opposed to the idea of a more localised strategic oversight of the NHS and the health sector, but it is becoming increasingly obvious that these plans are putting money ahead of everything else. As the British Medical Association set out yesterday:
“There is a real risk that these transformation plans will be used as a cover for delivering cuts, starving services of resources and patients of vital care.”
The few documents released so far reveal cuts to hospitals, services, beds and, in some cases, staff. As we have set out previously, we are deeply concerned by the lack of public, political and even clinical consultation, with two thirds of doctors not having been consulted on the plans and a third of them not even aware that the STPs exist. What a shambles!
It is also clear that without adequate resourcing, these plans will not lead to financial sustainability, and the only transformation that they will deliver will involve reduced services and longer waiting times. If the plans are as wonderful and transformative as Ministers claim, why will they not let us see them? The secrecy and the deliberate instruction not to release any of the information relating to the plans has only increased concern and cynicism among the public. That was, I believe, a serious error of judgment that the Government will come to regret.
We therefore call on the Government to publish immediately the plans that are not already in the public domain. We also ask them to ensure that there is a full consultation process before any of the changes are implemented. Consultation with the public does not mean presenting people with a completed plan and asking them whether they support it; it means involving them from day one, and the bigger the change, the better it is to start the consultation early. We are already playing catch-up, but genuine engagement can start now.
As we heard from my hon. Friends the Members for Wallasey (Ms Eagle), for Garston and Halewood (Maria Eagle) and for Wirral West (Margaret Greenwood), there are major concerns about the Cheshire and Merseyside STP. My hon. Friend the Member for Wallasey identified the three fatal flaws in the STP process: it is more about finances than patients; it is secretive; and it is run to deadlines that make consultation impossible. Every Member who talked about the Cheshire and Merseyside proposals rightly expressed concern about the devastating effect that they might have on local services. It seems that just about every council in the area has rejected them, or has said that it has not been involved. Indeed, there has been very little involvement with anyone.
My hon. Friend the Member for Garston and Halewood produced what I think was the runner-up in the competition for the worst use of management speak when she quoted the phrase
“The financial component has been a strong driver”.
That is the nub of it—this is all about money. Ministers must stop trying to pull the wool over our eyes and be realistic about the extent of the crisis that is engulfing our health and social care sector, because not one serious commentator or senior NHS manager believes that the sector will be financially sustainable without additional funding.
The Nuffield Trust, the Health Foundation, the King’s Fund, Unison, the Health Committee, the Association of Directors of Adult Social Services, the Local Government Association, NHS Providers, the British Medical Association, the Joseph Rowntree Foundation, the NHS Confederation and Age UK are all calling on the Government to act urgently to address the funding gap. I do not know whether that list was long enough for the Secretary of State—he does not appear to be too hot when it comes to numbers at the moment—but there were a dozen respected organisations there. Will he listen to them? Will he implore the Chancellor not to repeat the mistakes of his predecessor, and to ensure that the health and social care sector is given the funding that it needs? This is the last chance before the crisis overwhelms us. I commend the motion to the House.
I am very pleased to be able to close what Justin Madders described as an interesting debate I would describe it as an occasionally high-pitched debate, to which a number of Members made constructive contributions. I must say to the hon. Gentleman that those constructive contributions came from Dr Whitford, who made a characteristically impressive speech, and from Back Benchers on my side of the House, whose contributions, I might add, outnumbered those from Back-Bench Labour Members by four to three—or one third—although this was an Opposition day debate. Where are the Labour supporters for the motion, I ask the hon. Gentleman? We shall have to see whether they turn up to vote; they certainly were not prepared to turn up to speak.
The funding of the NHS is clearly a subject that is close to the hearts of most Members in the Chamber, precisely because it, along with the contribution of all who work in the NHS—to whom I pay tribute, as did the Secretary of State, but as the hon. Member for Ellesmere Port and Neston failed to do—is what keeps the NHS going. The Government are committed to the NHS, and committed to ensuring that it is free at the point of use.
Order. It has been put on the record, and it is a matter of public record, but I will say that speeches were made by nine Opposition Members and eight Government Members. Speeches were made by six Labour Members and eight Conservatives. That may help the House, and may prevent any further arguments.
I do not question the fact that the NHS faces a significant challenge. Increasing demand for healthcare is a consequence of our ageing and growing population. It is our determination to look after each and every NHS patient with the highest standards of safety and care. These all contribute to the challenge, but, despite increasing pressures, the NHS is rising to meet this challenge, carrying out more than 5,000 operations every day compared with 2010, and handling 780,000 more accident and emergency attendances in the second quarter this year. That is 15.1% more than in the same quarter in the last year that Labour was in office. Today it is the Conservative party that is the party of the NHS. That is why we pledged more than Labour and why we are delivering more funding, with a higher proportion of total Government spending going into health in each year since 2010.
Some hon. Members have drawn international comparisons on spending. I gently remind the more excitable Opposition Members that, according to the OECD, total health spending in the UK for 2014 is 9.9% of GDP, which is 10% above the OECD average of 9% and just above the EU15 average of 9.8%.
Several hon. Members have today also questioned the figures around the rises in funding that we are providing over the term of this Parliament. I welcome confirmation from my hon. Friend Dr Wollaston, the Chairman of the Select Committee, that she can see how the Secretary of State arrives at his figures, and she graciously conceded that both sides are correct. I want to focus directly on the straightforward maths.
All I clarified was that the way it had been arrived at is not a way that the public would understand health spending, so I think the Minister is perhaps taking my words out of context, if he will forgive me.
We never claimed that we were increasing the Department of Health’s budget; we were talking about the increases to the NHS. For complete clarity, in 2014-15 the NHS budget was £98.1 billion; in 2020-21, it will be £119.9 billion. For Opposition Members who cannot do the maths, that is a £21.8 billion increase in cash terms to NHS England, or £10 billion in real terms. We promised £8 billion; we are delivering £10 billion.
We also listened to NHS leaders’ requests for a front-loaded settlement and delivered on that—it was welcomed by hon. Members in today’s debate—with £6 billion of the £10 billion increase coming by the end of this year, including a £3.8 billion real-terms increase in this year alone.
We have also created a £1.8 billion sustainability and transformation fund for the current year to help providers to move to a sustainable financial footing. This fund will mainly be allocated to emergency care provision, which faces some of the greatest demand growth and financial pressures within the system.
This brings me to the next important point I want to address. While more funding is obviously welcomed, hon. Members have drawn attention to rising deficits in the budgets of NHS providers. We recognise that stronger financial management is required to turn this situation around, and we have introduced robust governance arrangements to get things back on track. There are four main elements to this plan: extra investment in the spending review, as I have discussed, and freeing up local government to spend more on adult social care; restoring financial discipline in the short term, through the measures set out by NHS England and NHS Improvement in July, with a wide-ranging set of actions; reducing demand for acute care in the longer term; and driving efficiency and productivity across the provider sector, building on the work of Lord Carter, who has identified large variations in efficiency across non-specialist English acute hospitals, and controlling cost pressures. The need to reduce variations was raised by my hon. Friend Andrew Selous in his very constructive contribution, and by Jim Shannon. We agree that we need to reduce the variability in the poorly performing trusts and bring them up to at least the average standard, if not higher.
We are now beginning to see the first fruits of the plan, with the publication last Friday of the figures for the second quarter deficit, which has been reduced to £648 million, down from £1.6 billion in the same period last year, representing a £968 million improvement. Progress halfway through the financial year is therefore encouraging, but there is no room for complacency. That is why the system needs to stick to its strong financial plan, supported by our investment and by a series of measures set out to help hospitals to become more efficient and to reduce the use of expensive agency staff.
Several hon. Members talked about the sustainability and transformation plans, 28 of which have now been published. The remainder will be published by the end of next month. Half of the Labour Members who spoke in the debate talked specifically about the STP covering Cheshire and Merseyside. It was disappointing that only one of those three Members was able to attend the Westminster Hall debate earlier today in which we discussed conditions in Cheshire and Merseyside. I remind Labour Members that that STP was led by the chief executive of Alder Hey hospital in Liverpool, with whom I would strongly encourage hon. Members who are complaining about a lack of engagement to have a conversation.
Order. If the Minister wishes to give way, he will do so. The bottom line is that the hon. Lady is quite right to ask him if he will do so, but we cannot have people standing up and shouting—[Interruption.] We do not want people on one side saying no and people on the other side saying yes. The bottom line is, I want the Minister to get to the end. He may give way if he wishes to; otherwise, he should carry on.
Thank you, Mr Deputy Speaker. I have explained to the hon. Lady that I do not intend to give way to her. I have only a limited amount of time left, and I would like to remind her of what Chris Ham, the chief executive of the King’s Fund, said. He regards the STPs as
“the best hope to improve health and care services”.
Hon. Members referred to the role of the independent sector in the provision of NHS care. The test for commissioning decisions must always be the value provided for patients and taxpayers, not the type of provider. The vast majority of NHS care has been and will continue to be provided by public sector organisations, but Opposition Members would do well to listen to Stephen Dalton, the chief executive of the NHS Confederation, which represents commissioners and providers of NHS services, who wrote today in The Guardian, of all papers, that private and wider independent sector health care providers
“increase the system’s capacity to respond to demand, help meet waiting time targets and enable investment bring important benefits for patients—most of whom are entirely relaxed over who provides their care, so long as it’s of high-quality and remains free at the point of use.”
I entirely agree with him.
My right hon. Friend the Secretary of State and I have acknowledged that the NHS faces challenges, and I recognise concerns raised by many in the House today. As I have made crystal clear, however, this Government are fully committed to the NHS.
claimed to move the closure (
Question put forthwith, That the Question be now put.
Question agreed to.
Question put (
The House divided:
Ayes 213, Noes 306.
Question accordingly negatived.
Question put forthwith (
Question agreed to.
The Deputy Speaker declared the main Question, as amended, to be agreed to (
That this House welcomes the Government’s investment, on the back of a strong economy, of significant additional funding and resources each year for the NHS during the 2015 Parliament; notes that this settlement was frontloaded at the specific request of the NHS in NHS England’s own plan to deliver an improved and more sustainable service, the Five Year Forward View; and further notes that the NHS will receive a real terms increase in funding in each year of the Spending Review period, while the Labour Party’s Manifesto at the last election committed to only an extra £2.5 billion a year by 2020, far less than the NHS requested.