NHS and Social Care Funding

– in the House of Commons at 1:29 pm on 11th January 2017.

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Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health 1:38 pm, 11th January 2017

I beg to move,

That this House
supports NHS England’s four-hour standard, which sets out that a minimum of 95 per cent of all patients to A&E will be treated within four hours;
notes the widespread public and medical professional support for this standard;
further notes that £4.6 billion has been cut from the social care budget since 2010 and that NHS funding will fall per head of population in 2018-19 and 2019-20;
and calls on the Government to bring forward extra funding now for social care to help hospitals cope this winter, and to pledge a new improved funding settlement for the NHS and social care in the March 2017 Budget.

I begin by paying tribute to the staff working in the NHS. To nurses, midwives, GPs, consultants, junior doctors, paramedics—all staff—we say thank you for your hard work, goodwill, commitment and dedication though this winter crisis. I had the pleasure of meeting some of those hard-working staff with my hon. Friend Dr Allin-Khan at St George’s hospital on Monday, and they told me of the pressures they face. Last night, I convened a summit of representatives of various royal colleges and trade unions working in the health service to meet staff and hear directly from the frontline of the pressures we now see in hospitals every day. Many royal colleges have spoken out today, warning of underfunding and understaffing. Over the past few days, I have received messages from doctors and clinicians from across the country who tell of the immense pressure, strain and, yes, crisis that we face this winter.

Let me share with the House some of the stories that I have been told, and I deliberately exclude the names of hospitals and trusts so as not to cause undue stress and alarm. This is a flavour of what I have heard. One doctor told me:

“There was a point when A&E was completely full and we had no space for a major trauma call that was coming in. The trauma case was going to have to be put into a corridor because the resuscitation area was full.”

Another story:

“In my A&E ‘Corridor Care’ isn’t unusual, it’s now the norm. Patient buzzers have actually been installed on the walls in said corridor.”

How about this:

“We’re…trying our best to keep patients safe but there aren’t enough of us and we’re on our knees. Doctor and nurses in tears”?

Another story:

“Over the weekend my bosses repeatedly asked for ambulances to be diverted away from our hospital because we had no beds, but we had multiple requests denied.”

Finally, another one:

The A&E is perpetually rammed with the corridor full of ambulance trolleys and paramedics.”

I have many more examples, but I am sure the House understands the broader point that I am trying to make.

Photo of Angela Eagle Angela Eagle Labour, Wallasey

There is unprecedented pressure in Wirral, too. As recently as last week A&E attendances and GP referrals were massively up. Unprecedentedly, 84 additional beds are being laid on, and they are now full. Last week, all elective in-patient appointments were cancelled and ambulance turnarounds reached up to five hours. At Prime Minister’s questions, the Prime Minister did not seem to think that there is a crisis in the NHS. If this is not a crisis, can my hon. Friend tell us what is?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

My hon. Friend makes her point eloquently and represents her constituents powerfully, as she always does in this place. I hope the Secretary of State will respond to some of those points.

Photo of Rob Flello Rob Flello Labour, Stoke-on-Trent South

The Royal Stoke in my city is under intense pressure. No doubt we will hear shortly from the Secretary of State that that is winter pressure. Winter has not really started. We have not really had a winter, yet we have been under this pressure not for a few weeks but for months. The whole NHS system is broken. That is the problem that we really face.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

My hon. Friend makes an eloquent point about the particular situation that has been facing Stoke for some time, of which many of us are aware. I hope the Secretary of State will touch on the situation in Stoke, because sadly it is one that we have had to raise previously.

Several hon. Members:

rose—

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

If I may, I will make a little progress. I promise to try to give way to as many hon. Members as possible.

I assure the Secretary of State that I will pass on the names of the trusts and hospitals that I highlighted, so perhaps he can look into them. Let us be absolutely clear that these desperate stories are not the words of politicians trying to score political points but are the honest, heartfelt, considered testimonies of doctors and clinicians on the frontline in our hospitals. They simply want to do the very best for their patients. Indeed, many clinicians want to speak out but feel that they cannot, which is why the remarks were made anonymously.

According to reports on the BBC’s “You and Yours”, the Prime Minister has sent instructions to hospital trust chief executives telling them not to speak out. I would be grateful if the Secretary of State could verify those reports.

Photo of Maria Caulfield Maria Caulfield Conservative, Lewes

I worked in the NHS over the Christmas period. Although it has been a very tough winter so far, this is nothing new. I have worked in the NHS for more than 20 years, and under previous Governments we had ambulances queuing around the block to get into A&E. Major incidents were declared in A&Es because they were too full. Will the hon. Gentleman accept that this is not a new problem?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I entirely respect the hon. Lady’s work as a nurse before she came into this place—[Hon. Members: “She still is.”] I beg her pardon. She is still a nurse, and I genuinely respect her, but if we are not raising these matters on behalf of our constituents, we are failing in our responsibility as Members of Parliament. We must never forget that this is not just about the staff in our NHS; it is about patients and their safety, which must always be our absolute priority.

Photo of Luciana Berger Luciana Berger Labour/Co-operative, Liverpool, Wavertree

I am grateful to my hon. Friend for kindly giving way and for his important remarks. I echo his point that this is about patients across the country. My constituent’s mother, Angela, has been waiting for an acute mental health bed for more than a week. She was taken in an ambulance to A&E, but she could not be treated locally in Liverpool because it was full. She was treated for the physical effects of her mental health condition in an ambulance and sent home. Her family are devastated and are concerned about her condition. Her story is one of countless stories across the country, and we need to recollect and focus on those stories today.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

My hon. Friend speaks passionately, as she always does, on behalf of her constituents and, more broadly, on mental health provision. Again, I hope the Secretary of State will respond to her on the specifics of that case.

My hon. Friend talks about patient care, and she is absolutely right. All of us, or at least many of us, in this House will have been getting stories from constituents telling us of their recent experiences in hospitals. I have been given a few, and I will share some heart-breaking examples with the House. Again, I will not reveal the names of trusts and hospitals, but I will pass them on to the Secretary of State after the debate.

Example No. 1 is of a mum of four children under 10 years old who has a secondary tumour in her liver. She was due to go into hospital this Thursday to have the tumour removed. Her surgery has been delayed for at least two weeks so that the hospital could cope with the winter crisis and because no beds are available. She has not yet been given a new date.

Someone else got in touch with me this morning. Their wife has been on the waiting list for a knee replacement since April last year. An appointment for early December was cancelled owing to the hospital being on black alert. A few weeks later, the hospital phoned with an appointment for today, which was cancelled yesterday.

Again, these patients are not trying to score political points or to politicise matters. They are decent, hard-working people who are simply desperate for something to be done.

Photo of Helen Whately Helen Whately Conservative, Faversham and Mid Kent

Conservative Members care deeply about patients. I personally follow up on the individual stories and challenges experienced by my constituents, but the hon. Gentleman has surely seen the guidance this week from NHS Providers, which is not always a friend of the Government, that said that we need to be careful when extrapolating from individual incidents in hospitals that are under particular pressure and implying that they constitute a wider trend. Yes, times are tough in the NHS, and there are winter pressures, but he should not make inappropriate use of individual stories.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

The hon. Lady should be careful. I will be charitable, but she would not want to give the impression that she is dismissing the stories and examples that I am highlighting. NHS Providers has continually warned of the chronic underfunding of the NHS under this Government, and it has continually warned that, head for head, spending in this country will fall next year. If she wants to quote NHS Providers, she should quote all the facts from NHS Providers.

Photo of Stephen Doughty Stephen Doughty Labour/Co-operative, Cardiff South and Penarth

My hon. Friend is telling some shocking stories. Was he as shocked as I was to hear Government Members shouting at and heckling the Leader of the Opposition during Prime Minister’s questions? They shouted, “What about Wales?” Does my hon. Friend agree that there is actually a stark contrast in Wales? Welsh Labour is delivering 6% more funding than in England for the NHS and social care. We have brand new hospitals, including in my constituency, and an £80 million new treatment fund was announced yesterday to allow better access to treatments.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

My hon. Friend makes a powerful point about Wales. As a Member for Cardiff, he understands what is happening in the Welsh health service. I wish Conservative Members understood that better.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I will give way to the right hon. and learned Gentleman, but I will then make some progress.

Photo of Kenneth Clarke Kenneth Clarke Conservative, Rushcliffe

Does the hon. Gentleman accept that every winter, for as long as I can recall, we have had a winter crisis in the NHS? It usually happens after Christmas. In winter the demands on the service become unpredictable, infections spread and the NHS starts losing staff. There are bound to be parts of the system that come under very real strain, and no one is trying to minimise the fact that they do. Apart from just producing this year’s crop of stories of very unfortunate incidents in various places, does he have any policy proposal at all, apart from simply spending more money wherever the reports are coming from?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I am very grateful to the right hon. and learned Gentleman, who is a very experienced parliamentarian, for his intervention, but he will know that this is one of the worst winters for probably 20 years. He casually suggests that this happens every year, but I remember the years of a Labour Government when it did not happen. I remember the years of a Labour Government when we went further than the financial settlements he delivered as Chancellor of the Exchequer and were more than doubling the money going into the NHS—and tripling it in cash terms.

Several hon. Members:

rose—

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

If I may, I would like to make a bit of progress. I promise my hon. Friends, and indeed Conservative Members, that I will try to give way as much as possible, but I am very aware that many Members have put in to speak.

We are all becoming familiar—far too familiar perhaps—with the grim statistics: in December, 50 of the 152 English hospital trusts called for urgent action to cope with demand; the number of patients being turned away from A&E and sent to other hospitals is at a record high; A&E departments have turned patients away more than 140 times; and 15 hospitals ran out of beds in one day in December. Last night, the BBC revealed that leaked documents from NHS Improvement showed that there were more than 18,000 “trolley waits” of four hours or more; that almost a quarter of patients waited longer than four hours in A&E last week, with just one hospital—just one—hitting its target; and that since the start of December, hospitals have seen only 82.3% of patients who attended A&E within the four-hour target. We will return to the issue of the four-hour target in a few moments.

Ministers can try to deny what is going on but they cannot deny these facts about what is happening this winter in the NHS on their watch. We know that what happens in the NHS in the winter is a signifier of a wider crisis, because across the piece bed occupancy levels now routinely exceed the recommended maximum levels of 85%—often to levels higher than 95%. As I have said, the NHS is going through the largest financial squeeze in its history. Indeed the former Secretary of State, Lord Lansley, said that five years of NHS austerity had been planned for, but having 10 years of it was never expected. We have seen £4.6 billion cut from social care budgets—

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I will give way in a moment. As the King’s Fund said, the reason there is a problem is quite simply because there is a

“mismatch between funding and activity” affecting our hospitals. The response of Ministers, from the Prime Minister downwards, has been one of utter complacency. The Secretary of State told “Sky News” on Monday that things had only been

“falling over in a couple of places”.

When he came to the House on Monday to make his statement, he did not commit to extra emergency funding for social care and he did not promise that the financial settlements would be reassessed in the March Budget. It is worse than that, because while he was making his statement, his spin doctors were telling the Health Service Journal—this on the day when the winter crisis is leading the news and he is making a statement in the House—and letting it be known that there is “no prospect” of

“additional funding to support emergency care any time before the next election.”

So there is nothing for social care, nothing for emergency care, nothing to tackle understaffing and nothing to tackle underfunding—well thank you very much. What did we get as a response? We got a downgrade of the four-hour A&E target.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

The Secretary of State shakes his head and says, “Nonsense”, but let me remind him of what he said in the House on Monday:

“we need to have an honest discussion with the public about the purpose of A&E departments.”

He began by saying he wanted to provoke a discussion. He has certainly provoked a backlash, not least by blaming the public, it seems, for turning up at A&E departments.

He went on to say that the four-hour target

“is a promise to sort out all urgent health problems within four hours”, but he added a little clarification, continuing:

“but not all health problems, however minor.”—[Official Report, 9 January 2017;
Vol. 619, c. 38.]

That is what he said in the House, and now we have seen the letter from NHS Improvement to trusts a few weeks ago, which talks of

“broadening our oversight of A&E”.

On the four-hour standard, it said that it believed

“there is merit in broadening our oversight approach, beyond a single metric”.

So in the interests of that discussion the Secretary of State wants to engage in, perhaps he can answer our questions, although I know he avoided the questions on Sky yesterday. Does he recall that in 2015 when he asked Sir Bruce Keogh to review these matters on waiting times, Sir Bruce said:

The A&E standard has been an important means of ensuring people who need it get rapid access to urgent and emergency care and we must not lose this focus”?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I will give way in a few moments. Sir Bruce continued:

“I do not consider that there is a case for changing the 4 hour standard at this time.”

Does the Secretary of State still agree with Bruce Keogh? If he does, why did he make his remarks on Monday about needing to have a discussion about the future of the A&E standard?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I will give way in a few moments. If the Secretary of State wants to lead a discussion about the future of the four-hour A&E standard, will he tell us what discussions he has had with the Royal College of Emergency Medicine? It argues that the four-hour standard is a vital measure of performance and safety, and believes the standard should apply to at least 95% of all patients attending emergency departments. If he says he is still committed to that four-hour standard, is he still committed to maintaining it at 95%?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

My hon. Friend has had one bite of the cherry, so if he does not mind I shall make a little progress and then I will do my best to get as many people in as possible.

Does the Secretary of State agree—

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I will give way in a few moments.

Does the Secretary of State agree that the four-hour standard is a reasonable proxy for patient safety? Does he agree that every breach of the four-hour standard can be regarded as a potentially elevated risk?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I will give way to the hon. Lady, as she has been very persistent.

Photo of Seema Kennedy Seema Kennedy Conservative, South Ribble

If the hon. Gentleman were to read the Government amendment, he would see that the Secretary of State says he “supports and endorses” the 95% target for A&E waiting times.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I pay tribute to the hon. Lady for the work she is doing on tackling loneliness. I know that all Labour Members very much appreciate the work she is doing on that, along with my hon. Friend Rachel Reeves. The Government amendment is conspicuous in not referring to all patients.

The Secretary of State did distinguish between “urgent” and “minor”—[Interruption.] Graham Stuart says I should get a haircut. Did he say that? No? I beg his pardon, but he heckles so much it is sometimes difficult to hear what he is saying. Can the Secretary of State tell us how he would define the difference between “urgent” and “minor” care for instances relating to this four-hour standard? Can he tell us what will be the minimum severity of physical injury or other medical problem which will be needed for a patient to qualify for access to an A&E? How will we determine these new access standards? How quickly will they be available? Will patients with visible injuries be exempt from a new triage system? If so, which injuries will qualify? If the Secretary of State is not moving away from this four-hour standard, he needs to clarify matters urgently, because the impression has been given that he is doing so. [Interruption.] Not by me, but by his own remarks in the House on Monday. If he is not moving away from that standard, will he guarantee that he will not shift away at all from it throughout this Parliament and that it will remain at its current rate?

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

I, too, was in the Chamber on Monday and I listened carefully to the Secretary of State then. He was challenged by Mr Bradshaw on the target and was asked whether he was watering it down. He said explicitly that “far from watering down” he was recommitting the Government to it. He was generous to the Labour party in saying that it was one of the best things the NHS did. I think that was very clear.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

Let me say to the former Chief Whip that the Secretary of State said that

“we need to be clear that it is a promise to sort out all urgent health problems within four hours, but not all health problems, however minor.”—[Official Report, 9 January 2017;
Vol. 619, c. 38.]

The Secretary of State did not need to come to the House to make those remarks and set these various hares running, so Mr Harper should make his objections not to me, but to the Secretary of State—

Several hon. Members:

rose—

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I am going to move on a little.

If the Secretary of State is not abandoning the four-hour standard, as he insists he is not, we look forward to hearing him make that absolutely clear. He also said and has implied that we need to educate the public better so that they do not turn up at A&E departments. That was the implication of his remarks on Monday. Will he tell us how he is going to do that? What will be the cost implications of explaining to the public that they must not turn up at A&E departments? Are we expecting to see a large advertising campaign? Will the cost fall on local authorities’ public health budgets, which have already been cut? Will local authorities be given more resources for this new public education campaign?

Photo of Derek Twigg Derek Twigg Chair, Statutory Instruments (Joint Committee), Chair, Statutory Instruments (Select Committee)

My hon. Friend is making an important point. The key similarity is that back in 1997, when Labour took over, the health service was in crisis, and it is again today. Is not part of the problem that people are having to go to A&E because they cannot get in to see their GP?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

Absolutely. It is so difficult to get to a GP, which is why there are all these pressures on our A&Es. Of course, it is only going to get worse, because this year we are going to see cuts to community pharmacies—3,000 will be lost from our towns and streets because of the cuts that are being pursued. Let us not forget that the figure of 3,000 community pharmacies being lost was what the previous Minister, Alistair Burt, told MPs.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I will give way one last time, but then I really must make some progress.

Photo of Anne Main Anne Main Conservative, St Albans

I led a debate in Westminster Hall this morning on pharmacies and integrated services in the NHS, and not one single Back-Bench Labour MP could be bothered to take part—not one!

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

Labour MPs have been raising these matters in this House for weeks, including at urgent questions and in Opposition day debates.

Photo of Bill Esterson Bill Esterson Shadow Minister (Business, Energy and Industrial Strategy), Shadow Minister (International Trade)

I presume what Mrs Main meant to say was that two Back-Bench Labour Members took part in the debate—I was one of them. Does my hon. Friend agree that the point about community pharmacies, GPs and investment in social care is that they save the Government money? That is why they should invest in them now to take pressure off A&Es.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I thank my hon. Friend for correcting the record about that debate in Westminster Hall.

The Secretary of State denies that he is going to water down the A&E target; we welcome that, but we will watch carefully to ensure that he does not sneakily water it down throughout the remaining years of the Parliament. Will he tell us what he expects to happen next as we go through the winter? Weather warnings have been issued, and we could be heading for a cold snap. Will he update us on what urgent preparations he is putting in place to ensure that the NHS can cope? Is the NHS prepared for a flu outbreak, and what is his assessment of whether overstretched hospitals will be able to cope if there is one? It appears that, so far, Ministers have been burying their heads in the sand, but that will no longer do.

Photo of Lucy Frazer Lucy Frazer Conservative, South East Cambridgeshire

My right hon. and learned Friend Mr Clarke and my hon. Friend Maria Caulfield both made the point that the issues in the NHS are historical. On Radio 4 this morning Andy Burnham said he accepted that the previous Labour Government had not spent the right amount of money on social care. Will the hon. Gentleman accept that these issues are historical—they are not new—and that Labour does not have all the answers?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

The hon. Lady refers to history; under this Government the NHS is going through the largest financial squeeze in its history. When we had a Labour Government we more than doubled investment into the NHS.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

Because he is a Member from the east midlands, I shall give way to the hon. Gentleman from Corby.

Photo of Tom Pursglove Tom Pursglove Conservative, Corby

I agree with the shadow Secretary of State that we need to have an honest debate, so does he accept that he stood on a general election manifesto that would have seen Labour spend billions less on our national health service? Will he set out for the House exactly what NHS services he would be spending less on now?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

We stood on a manifesto that would have delivered more doctors and nurses for our NHS; the hon. Gentleman stood on a manifesto that said the Conservatives would cut the deficit and not the NHS. They are cutting the NHS and failing on the deficit.

I have a few direct questions for the Secretary of State about Royal Worcestershire hospital. I was grateful for his remarks on Monday, but I want to press him a little further. It has been reported that NHS England was warned of a bed crisis as early as 22 December. Will he update the House on what urgent meetings he is having on Royal Worcestershire? When will we be closer to knowing the outcome of an inquiry? In that context, there is a proposal in the sustainability and transformation plan for the Worcestershire area for a significant reduction in the number of acute beds. The Secretary of State will say that these are local plans and so on, but in the context of the issues in Worcestershire, will he comment on whether he thinks that is the right proposal to follow?

On STPs more generally, the NHS is going through a winter crisis, and it is about to go through another top-down reorganisation—[Interruption.] Someone says it is bottom-up, but it is not; we know it is coming from the top. Those making the STPs are being told that they have to fill a financial gap of £21.764 billion—that is the reality that STPs throughout the country now have to face. We have seen the plans, so we know that that is going to mean a number of community hospitals being closed, a number of A&Es being downgraded, and acute beds being lost.

In places such as Devon, where the STP talks of an over-reliance on hospital beds, the implication is that beds will be lost. Closures and downgrades are being considered throughout Somerset, with their priority list of vulnerable services including maternity and paediatrics. In London, a city with the very worst health inequalities, the STPs are expected to deliver better health outcomes for the city’s growing 10 million residents with £4.3 billion less to spend. Will the Secretary of State explain to the House how he expects the NHS to perform in future winters, when we have a growing elderly population and STPs are pursuing multibillion-pound cuts to beds, A&Es and wider services?

Photo of James Heappey James Heappey Conservative, Wells

I was recently briefed by an excellent and well-respected local GP and a clinical psychiatrist, who were the authors of our county’s STP. Will the shadow Secretary of State explain how on earth they are responsible for a top-down reorganisation?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

Because they were being told by NHS England, which was in turn told by the Secretary of State.

Photo of Neil Coyle Neil Coyle Labour, Bermondsey and Old Southwark

Mr Clarke mentioned infections spreading in the NHS. Does my hon. Friend share my concern about the infection that is spreading on the Government Benches? It is the infection of arrogance, complacency and being completely out of touch with the patients and their families who are suffering under the current crisis. We are witnessing inaction on an epic scale.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

My hon. Friend makes his point extremely well, although I would not want to be so mean about the Secretary of State—[Hon. Members: “Go on!”] No, I am not going to be mean about the Secretary of State.

Photo of Toby Perkins Toby Perkins Labour, Chesterfield

In the past few moments, we have heard the ludicrous suggestion that Labour did not deliver on either spending or performance, but in fact our track record was excellent. That is not just my opinion; the former Prime Minister, David Cameron, said in 2011:

“I refuse to go back to the days when people had to wait for hours on end to be seen in A&E, or months and months to have surgery done. So let me be absolutely clear: we won’t.”

He knew that Labour had a good record and that the NHS used to be good; why will these Tories not admit it?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

My hon. Friend makes a powerful point. Indeed, I remember, when we were in government, shadow Health Secretaries standing at this Dispatch Box opposing every penny piece of money that Labour was putting into the NHS. I remember a shadow Health Secretary, who now sits in the Cabinet as the Secretary of State for International Trade, standing at this Dispatch Box and saying that the A&E target was “indecent.” That was the Tories’ attitude when we were in government, so it is no wonder that we are sceptical about the Government’s intentions for the A&E target when we look at their history.

Photo of Henry Smith Henry Smith Conservative, Crawley

The shadow Secretary of State is talking about the Labour record on the NHS; does he recall Labour closing not only maternity at Crawley hospital, but accident and emergency in 2005?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I do not have the details of the Sussex STP to hand, but presumably if it contains any suggested closures the hon. Gentleman will be campaigning against them and knocking on the door of the Secretary of State, if those remarks are an indication of his point of view on these matters.

Photo of James Cartlidge James Cartlidge Conservative, South Suffolk

The hon. Gentleman is saying that everything was rosy under Labour, but he should remember that it was 10 years ago when the scandal at Mid Staffs broke, in which hundreds more elderly patients died than was projected. It was a terrible scandal and he should remember that. What our shadow team was doing at the time was holding the Labour Government to account.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health

I take all deaths in hospitals seriously. My commitment to patient safety is unswerving. I will continue to raise matters, whether it is at Royal Worcestershire or elsewhere, but not in a partisan way with the Secretary of State—[Interruption.] I was not being partisan when I was asking questions about the Royal Worcestershire. The Government Whip, Graham Stuart, really needs to calm down. I will raise these matters, because that is the responsible thing to do. It is unbecoming to play politics with patients in that way.

Culpability for the state that the NHS is in today lies at the door of Downing Street. The Government promised to protect the NHS and to cut the deficit, and they have not done so. The Government give away billion-pound tax cuts to corporations—[Interruption.] Yes, this Government. The Government waste billions, pushing the NHS in the direction of fragmentation and greater outsourcing while ignoring the ever-lengthening queues of the sick and the elderly in all of our constituencies.

Yesterday, we saw the Secretary of State on Sky losing his ministerial car and being chased down the street. It was his whole approach laid bare: not a clue where he is going; nothing to say; and not facing up to the problems. Last year, he blamed the junior doctors. On Monday, he blamed the patients. Today, he blames Simon Stevens. Tomorrow, he will blame the weather. It is time that the Health Secretary started pointing the finger at himself and not at everybody else. The NHS is in crisis, and Ministers are in denial. I say to the Government, on behalf of patients, their families and NHS staff, please get a grip. I commend our motion to the House.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health 2:11 pm, 11th January 2017

I beg to move an amendment, to leave out from “House” in line 1 to the end and add:

“commends NHS staff for their hard work in ensuring record numbers of patients are being seen in A&E;
supports and endorses the target for 95 per cent of patients using A&E to be seen and discharged or admitted within four hours;
welcomes the Government's support for the Five Year Forward View, the NHS's own plan to reduce pressure on hospitals by expanding community provision;
notes that improvements to 111 and ensuring evening and weekend access to GPs, already covering 17 million people, will further help to relieve that pressure;
and believes that funding for the NHS and social care is underpinned by the maintenance of a strong economy, which under this administration is now the fastest growing in the G7.”

I thank the shadow Health Secretary for bringing this afternoon’s debate to the House. He is right to draw attention to the pressures in the NHS, but, regrettably, I will have to spend much of my time correcting some totally inaccurate assertions that he has made, and that is a shame. This is an important debate for our constituents—for his and for mine—and for the NHS. The country deserves a proper debate, but that is difficult when we are given misinformation at a time when the NHS is under sustained pressure.

I am also very pleased to see the Leader of the Opposition in his place. I think that he has become rather a fan of my parliamentary appearances—[Interruption.] It is a Jeremy thing, he says—if only. I wish to address one part of my speech to him, because it is an area of policy for which he is perhaps more personally responsible.

Winter is always challenging period, and I want to repeat the thanks of the shadow Health Secretary and the thanks that I gave on Monday to NHS staff. According to NHS Improvement, on the Tuesday after Christmas the NHS had its busiest day ever. Earlier in December, it treated a record number of patients within four hours. Overall, as the Prime Minister said this morning, we are seeing 2,500 more patients within the four-hour standard every single day compared with what happened in 2010. As we discussed on Monday, the NHS made record numbers of preparations for this winter, because it is always a difficult time, including having 3,000 more nurses and 1,600 more doctors in full-time employment.

Let me address what the shadow Health Secretary said with regard to Worcestershire. I met colleagues from Worcestershire on Monday. A huge number of actions are now being taken, but we must say right up front that it is totally unacceptable for anyone to wait 35 hours on a trolley and that we expect the hospital to ensure that that does not happen again. There are plans in place to open additional bed capacity this week. We have already had capacity made available by Worcester Community Trust to support the flow. The trust has deployed its chief operating officer on the task of facilitating discharges. The trust is in special measures so we have a big management change, and a new chief executive will be starting later on in the spring.

What is wrong with what the shadow Health Secretary has just said is the suggestion that winter problems are entirely unusual. As my right hon. and learned Friend Mr Clarke said, the NHS had difficult winters in 1999, 2008, and 2009. He remembers difficult winters from his time as Health Secretary, but there are things that are different today. One of them is that, compared with six years ago, we have 340,000 more over-80s, many of whom are highly vulnerable or have dementia. We know that when people of that age go to an A&E at this time of year, there is an 80% chance that they will be admitted to hospital.

Photo of Derek Twigg Derek Twigg Chair, Statutory Instruments (Joint Committee), Chair, Statutory Instruments (Select Committee)

The Secretary of State talks about correcting the points that have been made so that the House has the right information. May I repeat the question that I asked him on Monday? What are the latest figures—he should have them up to this week—for the number of people who could be discharged but have to remain in hospital because there is no community support available for them? Can he give us that figure now? He said that he would write to me, but he must know that figure now.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Last year, on average, it involved around 7,000 beds, which is far too many. That is why the Secretary of State for Communities and Local Government announced in December a new package of support worth around £400 million—

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Let me answer the hon. Gentleman’s question. I said that I would write to him, and I will do so. He may have noticed that there are other issues that we are dealing with, which is why I may not have had time to sign the letter. The £400 million extra for local authorities over the next two years will make a significant difference and he should recognise that.

Photo of Richard Fuller Richard Fuller Conservative, Bedford

I am attending this debate because there will be constituents in Bedford and Kent who are concerned about the headlines that they have read. I am pleased that the Secretary of State will correct some of the points that have been made. What our constituents want to know is what is being done, or what should be done. I listened for 33 minutes to the shadow Secretary of State—the Labour spokesman on the NHS—on this issue, and there was not a single new idea other than spending money. Will my right hon. Friend please provide some practical answers to the problems that are being raised in the papers?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend is absolutely right, which is why I will be talking later about our solutions to these problems.

Several hon. Members:

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Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I will give way, but first I want to make some progress.

I want to talk about something else that is different in our A&E departments today compared with six years ago. Although we are sticking to the four-hour target, we also insist on much higher standards of safety and quality.

On Monday, I congratulated Labour on the introduction of the four-hour target—I support it—but we should also remember that four years after that standard was introduced, we started to see some horrific problems at Mid Staffs, many of which were in the A&E department. Some were caused because people thought they would be fired if they missed the target. Robert Francis said that the failures at Mid Staffs were

“in part the consequence of allowing a focus on reaching national access targets.”

Therefore, although we retain targets, we will not allow them to be followed slavishly in a way that damages patient care.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I have already given way to the hon. Gentleman. There are many other Members who want to intervene.

That is why we have a new inspection regime that makes it harder to cut corners in the way that used to happen when beds were not being washed, there was poor infection control, and ambulances were being used as waiting rooms.

Photo of Toby Perkins Toby Perkins Labour, Chesterfield

I am grateful to the Health Secretary for outlining some of the steps that he is taking in the face of this immediate emergency. Does he also recognise that the major cause of the problems in A&E is simply a lack of staff? Consequently, does he regret the huge cuts to training budgets in 2010, 2011 and 2012, which are having a real impact now on the number of nurses and doctors in our NHS?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I agree that staff numbers are critical, but we have, since 2010, 1,500 more doctors in our A&E departments and 600 more consultants. Across the NHS, we have more than 11,000 additional doctors, so we do recognise the pressures that the NHS faces. Indeed, we have 1,600 more doctors than this time last year, so we are doing a great deal to solve the problem.

Photo of Graham Evans Graham Evans Conservative, Weaver Vale

Does my right hon. Friend agree that we need to learn best practice in the NHS? The hospitals that manage to integrate health and social care, such as those in Wigan and Salford which have managed to create those beds, are providing examples of best practice from which the whole of the NHS can learn.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend is absolutely right. It is a mistake in this debate to try—as I understand Opposition parties want to do—to boil this all down to the issue of Government funding when there is actually a lot of variability in the country. At this time of year, which is always difficult, some hospitals are doing superbly well in extremely challenging circumstances. We have just heard about some of the hospitals that are doing well, and there are a number of them.

Several hon. Members:

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Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I will give way to as many people as I can, but I also want to address the substantive points made by the shadow Health Secretary. He talked about the four-hour target. In his motion and his speech, he made the totally spurious suggestion that we are not committed to that target. I remind him of what my right hon. Friend the former Chief Whip quoted me as saying on Monday. I did not just commit the Government to the target; I said that it was one of the best things that the NHS does. However, I also said that we need to find different ways to offer treatment to people who do not need to be in A&E. It is hardly rocket science. When there is pressure in A&E, it is sensible—indeed, I would argue that it is the duty of the Health Secretary—to suggest that people who can relieve pressure on A&E by using other facilities do so.

Photo of Henry Smith Henry Smith Conservative, Crawley

Just yesterday at Crawley hospital, an acute care unit was opened, which is designed precisely to ensure that people who do not need to attend A&E are properly directed to the most appropriate care, which is good for them as individual patients and good for the whole system.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That is absolutely right. To back up my hon. Friend’s point, yesterday’s OECD report said that in Australia, Belgium, Canada, France, Italy and Portugal, at least 20% of A&E visits are inappropriate. NHS England’s figure is up to 30%, which is why we need the public’s help to relieve pressure and that is what I meant when I talked about an honest discussion.

Photo of Luciana Berger Luciana Berger Labour/Co-operative, Liverpool, Wavertree

The Secretary of State told us just a moment ago that there are now over 300,000 more people over the age of 80. Surely he would have known that information from census and Office for National Statistics data when his Government took over seven years ago, so why is it that we are now seeing on the front pages of our newspapers that one in four of our A&E wards is unsafe and that we have so many challenges across the country, including in my constituency?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

We did know that information and that is why we thought it was totally irresponsible to want to cut the NHS budget in 2010, and not to back the NHS’s own plan in 2015. As a result of that, we have 11,000 more doctors. In the hon. Lady’s local hospital, 243 more people are being treated within four hours every single day.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I will make some progress and then give way. I could have put what I said on Monday another way. I could have said:

“We have to persuade those people not in medical emergencies to use other parts of the system to get the help they need”.

I did not actually say that, but I will tell you who did. It was the then Labour Health Minister in Wales, Mark Drakeford, in January 2015. Frankly, when the NHS is under such pressure, it is totally irresponsible for the Labour party to criticise the Health Secretary in England for saying exactly the same thing that a Labour Health Minister in Wales also says.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I would be privileged and honoured to give way to a Welshman.

Photo of Owen Smith Owen Smith Labour, Pontypridd

The Secretary of State has sowed confusion in the House and in the country on this question this week, and he is doing so again today. If he is saying the same as my friend the former Health Minister in Wales—that we want to divert people who do not need to go to A&E from doing so—I am sure that everybody in this House would support him. But we suspect that he is saying that the four-hour wait target will be disapplied to some people turning up to A&E, and that that is the downgrading he is talking about. If that is the case, the Secretary of State should come clean, and he should be clear about whose job it will be to disapply the target to some people with minor ailments.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I did not say that because we are not going to do it. As we have had an intervention from a Welshman, let me tell the hon. Gentleman a rather inconvenient truth about what is happening in Wales. Last year, A&E performance in Wales was 10% lower than in England, and Wales has not hit the A&E target for eight years. We will not let that happen in England.

I noticed that the shadow Health Secretary quoted a number of people, but one that he did not quote was the Royal College of Emergency Medicine. I wonder if that was because of what it said about Wales this week. It said:

“Emergency care in Wales is in a state of crisis…Performance is as bad, if not worse, as England, in some areas.”

There we have it: in the areas in which Labour is in control, these problems are worse.

Several hon. Members:

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Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

Let me make my point. I do not say that to make a political point, but to show that it is patently ridiculous to try to play politics when there are winter pressures in the NHS. This happens in the whole NHS—in Wales as well as in England.

Several hon. Members:

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Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I want to make some progress but I will give way to my hon. Friend Maria Caulfield, who is a serving nurse.

Photo of Maria Caulfield Maria Caulfield Conservative, Lewes

May I reiterate the Secretary of State’s point about the four-hour target? During the Labour Government, I was working in the NHS. Significant pressure was put on us by managers to meet the four-hour target, negating clinical need. Patients were often prioritised according to meeting the target, rather than by clinical need. That was a disgrace.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That is exactly the problem we had with Mid Staffs. We had a culture in the NHS where people were hitting the target and missing the point. Although targets are important management tools in all organisations, it is important that they are followed in a sensible way that puts the interests of patients first.

Several hon. Members:

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Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I would just like to make another point about Wales while we have the privilege of having someone here who aspired to lead the Labour party, as the current leader of the Labour party is no longer in his place.

Something that Wales and England have in common is the need to ensure that, if we want alternatives to A&E, people are able to see their GPs. I have said many times that people wait too long to see their GPs. In all honesty, I think that the GP contract changes in 2004 were a disaster. The result was that 90% of GPs opted out of out-of-hours care. But we have been putting that right. Now 17 million people in England—about 30% of the population—have access to weekend and evening GP appointments. More than that, we have committed to a 14% real-terms increase in the GP budget by the end of this Parliament. That is an extra £2.4 billion and we expect that to mean an extra 5,000 doctors working in general practice.

Photo of Margaret Greenwood Margaret Greenwood Shadow Minister (Work and Pensions)

I can see Wales from my constituency, to continue the theme. I received an email this morning from a very distressed senior NHS manager, who says:

“I truly despair that there will not be an NHS this time next year”—[Interruption.]

You need to listen on the Government Benches, and understand what your Secretary of State is doing to the health service. I will give a precis of what my constituent is talking about.

Photo of Natascha Engel Natascha Engel Second Deputy Chairman of Ways and Means

Order. The hon. Lady will resume her seat. First, when she says “you”, she is addressing the Chair. Secondly, she is making an intervention. There are 33 Members who wish to speak in this very important debate. If she can keep her intervention very brief, I will let her continue.

Photo of Margaret Greenwood Margaret Greenwood Shadow Minister (Work and Pensions)

Apologies, Madam Deputy Speaker. I should not have used the word “you.”

My constituent has written to me saying:

“The NHS is in crisis, the government knows this, CCGs have failed, foundation trusts are failing. GPs are on their knees. So they’re”— the Government—

“handing it back to local areas and saying, ‘you fix it, and by the way there’s no money.’ It’s a whole system reorganisation”, and there is no money.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

All I would say is that I hope that people in the NHS do not listen too much to what the Labour party says about the state of the NHS and that they listen to what the Government are saying, which gives a much more accurate picture as I will go on to explain.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I will make some progress before giving way again.

The second part of the motion talks about funding. There is no doubt at all that we will need to look after 1 million more over-65s in five years’ time and we will need to continue to increase investment in the NHS and social care system. That is happening with an extra £3.8 billion going into the NHS this year. Can I just remind Labour Members that that is £1.3 billion more than they promised when they stood for election last year? I just say this: it is not enough to talk about extra funding—you have to actually deliver it. Labour Members have to answer to their constituents as to why, for two elections in a row, they have promised less money for the NHS than the Conservatives, and why, in the one area where they are responsible for the NHS, they have cut funding.

Photo of Julian Knight Julian Knight Conservative, Solihull

The Secretary of State is taking exactly the right, measured tone, which was absent earlier in the debate. We recognise that many trusts are under financial pressures, but some of these situations are historic, and in my area they reflect very poor private finance initiative contracts, which were thrust on them in a Gordon Brown sleight of hand.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend is right. What we did not hear from the Labour party is that, in 2010, we inherited a £70 billion PFI overhang, which is making it incredibly difficult for hospitals to recruit enough staff, because they are having to pay so much money to financiers.

Photo of Victoria Atkins Victoria Atkins Conservative, Louth and Horncastle

An example of how we are spending money practically on the ground to make sure patients get a better deal is in Lincolnshire, where, because there is a shortage of GPs, the local health authority is offering £20,000 as a golden hello to new GPs. Is that not the way to manage resources, to attract the best medical talent into our areas and to help ensure that patients get the best care?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend is absolutely right, and I talked about these issues when I visited her in her constituency. The truth is that, to solve this problem, we are going to have to have a dramatic increase in the number of people working in general practice, which is why we are funding the second biggest increase in the number of GPs in the NHS’s history.

It is a great shame that the Leader of the Opposition is not here, because this is the bit that I wanted to address to him—his proposal to put extra funding into the NHS by scrapping the corporation tax cuts. That reveals, I am afraid, a fundamental misunderstanding of how we fund the NHS. Corporation taxes are being cut so that we can boost jobs, strengthen the economy and fund the NHS. The reason we have been able to protect and increase funding in the NHS in the last six years, when the Labour party was not willing to do so, is precisely that we have created 2 million jobs and given this country the fastest growing economy in the G7, and that is even more important post-Brexit. To risk that growth, which is what the Labour party’s proposal would do, would not just risk funding for the NHS, but be dangerous for the economy and mortally dangerous for the NHS.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

I just want to understand exactly what the Secretary of State was saying on Monday about the four-hour A&E target. Is it conceivable that some of the people who are currently within the A&E target will, at some stage, fall outside the A&E target?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I am committed to people using A&Es falling within the four-hour target, but I also think that we need to be much more effective at diverting people who do not need to go to A&E to other places, as is happening in Wales, as is happening in Scotland and which, frankly, is the only sensible thing to do.

However, going back to the funding issue, I just want to make this point: for all the heat in this Chamber in debates on the NHS, probably the biggest difference between the two sides of the House is not on NHS policy but on the ability to deliver the strong economy that the NHS needs to give it the funding that it requires. I am afraid that the proposals in the motion today reveal that divide even more starkly.

Several hon. Members:

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Photo of Mark Harper Mark Harper Conservative, Forest of Dean

We had the debate at the election about the need for a strong economy to pay for the NHS, and the public decided that the Conservative party won that argument. May I give my right hon. Friend another example, from yesterday, from his friend Jeremy—the Leader of the Opposition? He proposed to cap high pay, but the top 1% of taxpayers pay 27% of income tax revenues. That proposal would cut the funding available to the NHS and damage the services that hard-working members of staff produce.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My right hon. Friend is right. That is the worst kind of gesture politics, because it may get the Leader of the Opposition a few votes or a few more Momentum supporters, but it would damage the NHS.

Photo of Helen Whately Helen Whately Conservative, Faversham and Mid Kent

Does my right hon. Friend agree that Opposition Members, rather than making meaningless and totally unfunded promises of more money for the NHS, contrary to their manifesto back in 2015, would do better to recognise demographic changes, such as the ageing population, and the need for the NHS to change, and support the locally developed plans for change in the national health service—the sustainability and transformation plans?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

My hon. Friend is absolutely right. I think people in the country will find it hugely ironic that the party that spent so much energy in the last Parliament campaigning against top-down reorganisations is now campaigning against locally driven changes.

Several hon. Members:

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Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I will give way a couple more times, and then I am going to conclude my comments.

Photo of John Woodcock John Woodcock Labour/Co-operative, Barrow and Furness

As the Government often point out, they want to hand decisions to local groups, but could the Secretary of State explain to worried patients in the south and west of Cumbria why local health services are suggesting the changes to A&E in the west and potentially the south? I know he has spent a lot of time looking at this area.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

First, I would like to use this moment to congratulate the hon. Gentleman’s local trust on coming out of special measures last year and on the progress it is making. In a way, that is the answer to his point. His local trust was in special measures, and North Cumbria is still in special measures. We had some profound worries about patient care in both trusts, and we still do in the North Cumbria trust. That is why the status quo is not an option, but we understand the concerns of his constituents and many others about some of the proposals being made.

Photo of Catherine West Catherine West Shadow Minister (Foreign and Commonwealth Affairs)

What does the Secretary of State make of the talk among professionals at the moment about the potential for a flu epidemic? What does he make of the comments by the doctor who wrote to me on Sunday saying that she is extremely concerned that staff are too busy to isolate patients who are coming in—who need oxygen—in order that others do not potentially catch flu?

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

There is a concern at the moment about a growth in respiratory infections, and that is causing capacity constraints. We are watching what is happening on flu very carefully, but we have a record 13 million people vaccinated against flu, and I hope that that will put the NHS in a good position.

Photo of Robert Jenrick Robert Jenrick Conservative, Newark

Money is of course important, but may I support the Health Secretary in not viewing these issues solely through that lens? My local trust, Sherwood Forest, which has some of the worst finances of any trust in the country—almost all due to a PFI deal signed by Gordon Brown—is actually improving. It is under pressure this winter, but the management have said it is definitely not in crisis. That is an example of a trust improving due to quality management, reform and good-quality processes.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

That is absolutely the point, and the last point I want to make before concluding on funding is that we miss a trick—I think the shadow Health Secretary is in some ways more reasonable than his leader on these issues, which is probably terminal for his career—if we say that this is just about money. We forget the debate we went through on schools in this country 20 years ago, when there was, again, a debate about money, but we realised that the issue is actually also about standards and quality. That is what has happened in Sherwood Forest, and I congratulate the trust. It is important that we do not let debates about funding eclipse that very important progress that we need to make on standards.

Photo of Jeremy Hunt Jeremy Hunt The Secretary of State for Health

I am going to conclude now because lots of people want to come in, I am afraid.

The shadow Health Secretary’s central claim—these are his words—was that the culpability for what is happening in the NHS “lies at the door of Downing Street”. I owe it to the country and this House to set the record straight on this Government’s record on the NHS. It is not just the fact that there are 11,000 more nurses and 11,000 more doctors; not just the fact that, on cancer, we are starting treatment for 130 more people every single day, and have record cancer survival rates; not just the fact that we have 1,400 more people getting mental health treatment every day and some of the highest dementia diagnosis rates in the world; and not just the fact that we are doing 5,000 more operations every day and that, despite those 5,000 more operations every day, MRSA rates have halved. We have an NHS with more doctors and more nurses, and despite difficult winters, with patients saying they have never been treated more safely and with more dignity and more respect.

Next year the NHS will be 70 years old. This Government’s vision is simple: we want it to offer the safest, highest quality care anywhere in the world. When we have difficult winters and an ageing population, of course that makes things more challenging, but it also makes us more determined. It means that we are backing the NHS’s plan, it means more GPs and better mental health provision, and it means an NHS turning heads in the 21st century just as it did when it was founded in the 20th century.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health) 2:40 pm, 11th January 2017

Here we are again debating the NHS. [Interruption.] I am all on my own because obviously this is predominantly a crisis in NHS England, not a crisis in NHS Scotland, as I will discuss as we go on.

The problem is that we are talking about patients who are suffering—who may suffer from more infections, as we have heard. We are talking about staff who are in tears and who are desperate, and who feel that they cannot deliver the care they would expect to deliver. This is not just a matter of isolated stories of “Joe from Wiltshire” and “Mike from Leeds”: it is happening on a major scale. We hear from NHS Improvement that only one trust out of 152 met the four-hour target in December, and only nine made it to over 90%. Fifty out of 152 trusts declared a black or red situation over December, and there were 158 diversions of ambulances over that time. This is not just about normal winter pressures. It is not what Maria Caulfield, who is an A&E nurse, and people like me and other medics in the Chamber have seen in our careers—it is a really bad winter. Yet we have not had bitter weather and we have not had a flu epidemic.

The most recent four-hour data were published in October, when NHS England managed to achieve the four-hour target for 83.7% of the time. That is 5% down on the same time in the previous year, and it compares with 93.9% in Scotland. Scotland managed 93.5% in Christmas week. We have our challenges in Scotland, but the crisis is not the same as what is being discussed here.

Photo of Simon Burns Simon Burns Conservative, Chelmsford

Will the hon. Lady confirm, though, that throughout the whole of 2016, which includes winter, summer, autumn and spring, the Scottish Government’s A&E target was met in only seven out of the 52 weeks?

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

I would be delighted to agree with that, but NHS England did not make it over 90% at any point in 2016, so perhaps the right hon. Gentleman might want to check the NHS England figures before having a punt at me.

NHS England is performing 8% to 10% lower than NHS Scotland, which has been the top performing of the nations for the past 19 months. We have not done that by magic. We face exactly the same ageing population, exactly the same increased demand and complexity, and exactly the same—indeed, often worse—shortages of doctors as NHS England does, because of our rurality. We are not using a different measure—we use exactly the same measure—but the data show that there is a significant difference, and it is being maintained.

The Secretary of State is right: winter is always challenging. Summer is often busier for attendances at A&E, because the kids are on the trampolines and people go out and do silly things, but hospitals are under pressure in winter because of the nature of admissions—the people who go to A&E are sicker, older, and more complicated. However, we have not seen any summer respite in NHS England. The worst performance in the summer was 80.8%; the best was 86.4%. NHS England is under pressure in the summer, and when winter is added on top of that, it is no wonder that we are talking about the situations that doctors, nurses, patients and relatives are describing to us.

My first health debate after my maiden speech in this House was an Opposition day debate on the four-hour target. At the time, I commented, and still maintain, that this target is not a stick for each party to hit each other over the head with, but it is a thermometer to take the temperature of the acute service, and it does that really well, because it measures not just people coming in through the front door but how they are moving through the hospital and out the other end. At the moment, the system is completely overheated. The comments about this not being anything unusual but just a normal winter, and everyone whingeing, show that the Government are not recognising the problem. The first step to dealing with any problem is to recognise it, because then we can look at how we want to tackle it.

Photo of Victoria Atkins Victoria Atkins Conservative, Louth and Horncastle

I remind the hon. Lady of the point the Prime Minister made in Prime Minister’s Questions, which is that on the Tuesday after Christmas, A&E received the highest number of visitors it has ever received in its history. Does that not show the challenges facing the NHS both nationally and locally? These are extraordinary figures, and the Secretary of State is very much doing his best to help the NHS, with the professionals, to deal with them.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

I totally accept that the NHS has been under inordinate pressure with, absolutely, the busiest day in its history, but given an ageing population that has been discussed for years, we should have been able to see this coming.

If, in the next couple of months, we get a massive flu epidemic, we are going to see things keel over. We have already had debates in this Chamber about STPs taking more beds away. I totally agree with the Secretary of State that part of the issue is that patients could be seen somewhere else. However, it is not a matter of changing the four-hour target and saying to someone who turns up, “You’re not going to count”; it is simply a matter of providing better alternatives. If we provide better alternatives, people will go to them. The House has discussed community pharmacy use, and it has been recognised that the minor ailments services we have in Scotland can deal with 5% to 10% of those patients. We have co-located out-of-hours GP units beside our A&Es, and that means that someone is very easily sent along the corridor or into the next-door building if they need a GP and not an A&E. We do need to educate the public, but the public will use an alternative service if it is there. If it is not, they know that if they turn up at A&E and just keep sitting there, eventually someone will see them, and we should not blame them for that.

Photo of Toby Perkins Toby Perkins Labour, Chesterfield

The hon. Lady is right to say that we have an ageing population but that is predictable. Does she think it is also significant that in 2008 the UK was spending about the same as all the major EU nations, whereas the OECD now says that we are spending considerably less than most of the other major nations? Is that not actually causing this problem?

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

Money is not the only problem. I accept that part of it is about how things are done. The Secretary of State talks about variations and many hospitals performing well, but, as I said, only one trust is meeting the target and only nine are at over 90%, so it is not that the majority are doing well and a few are failing.

The ability to look at how we deliver the NHS is crucial, but change costs money. We must therefore invest in our alternatives so that our community services and primary care services can step up and step down to take the pressure off. One of the concerns about the STPs is that because people do not have enough money, a lot of them start by thinking that they will shut an A&E, shut a couple of wards, or shut community beds—even though those are what we need more of—to fund change in primary and social care. Then the system will fall over. We need to have double running and develop our alternatives and then we will gradually be able to send the patients there.

Photo of Andrew Murrison Andrew Murrison Conservative, South West Wiltshire

I always enjoy listening to the hon. Lady’s well-informed remarks. I agree that most people do not want to go to A&E if they can avoid it. Does she agree that part of the problem is that when people phone general practices, they tend not to be offered an appointment that they regard as being within a reasonable timeframe, or they cannot get to see the doctor with whom they are closely associated, which particularly applies to people with chronic and long-term conditions? As today’s National Audit Office report makes clear, we need to address that as a matter of urgency. Paradoxically, seven-day-a-week general practice may militate against being able to provide people with such continuity of care during core hours.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

Many doctors in general practice would accept the argument for having access to a GP on Saturday morning, particularly for people who are otherwise at work. However, someone who cannot see their favourite doctor is very unlikely to go to A&E and wait eight hours to see a doctor they have never seen before in their life. This is not about that; this is about the fact that people feel they cannot find an alternative. If it takes three or four weeks to get any appointment with their GP and they do not yet have a community pharmacy offering such a service, they will eventually end up at A&E. It is therefore the service of last resort for people who go there and just stay there. We have to develop alternatives first, but as the hon. Gentleman says, no one in their right mind would choose to go and wait four hours in A&E if they could be seen in half an hour in a community pharmacy.

Photo of Andrew Murrison Andrew Murrison Conservative, South West Wiltshire

The hon. Lady is being very generous in giving way. I have to disagree with her, because winter pressures and the pressures we are seeing at the moment tend to involve not people with short-term, self-limiting conditions, but the chronically sick. Those people in particular, and with good reason, want to have a relationship with a particular practitioner who understands their needs and their family context. That is surely the essence of general practice.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

I totally agree, but in fact the chance that their doctor will be on duty would actually be lower on a Saturday morning or a Sunday afternoon. One of the things we have done in Scotland with SPARRA—Scottish patients at risk of readmission and admission—data is to identify that 40% of admissions involve 5% of the patients. Those patients are all automatically flagged and will get a double appointment no matter what they ring up about, because it will not just be a case of a chest infection or a urine infection, but of having to look at all their other comorbidities.

That is the challenge we face; it is not a catastrophe of people living longer. All of us in the House with a medical background will remember that that was definitely the point of why we went into medicine, and it is the point of the NHS. However, we are not ageing very well. From about 40 or 50 onwards, people start to accumulate conditions that they may not have survived in the past, so that by the time they are 70 they have four or five comorbidities that make it a challenge to treat even something quite simple. My colleagues and friends who are still working on the front line say that it is a question not just of numbers, but of complexity. Someone may come in with what sounds like an easy issue, but given their diabetes, renal failure and previous heart attack, it is in fact a complex issue.

That is part of the problem we face, and we need to look forward to prepare for it. We need to think about designing STPs around older people, not around young people who can come in and have an operation as a day case and then go away, because that is not what we are facing. Older people need longer in hospital, even medically, before they reach the point of being able to go home. It takes them a couple of days longer to be strong enough to do so. They probably live alone and do not have family near them, so they will need a degree of convalescent support and they may need social care. That is really where the nub of the problem lies. Social care funding has gone down, and therefore more people are stuck in hospital or more people end up in hospital who did not actually need to be there in the first place.

Photo of Andrew Selous Andrew Selous Conservative, South West Bedfordshire

On the frailties of older people, does the hon. Lady think that just as Scotland led the way with St Ninian’s primary school in Stirling introducing the daily mile, there is something we could learn from countries, such an Andorra, that have a real focus on exercise for older people, so that they are a lot less frail in their 70s and 80s?

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

The whole prevention and public health message is crucial, and that is one of our other challenges. I am very grateful to the Secretary of State for no longer talking about a figure of £10 billion, because the increase in the Department of Health’s budget is actually £4.5 billion. Part of that relates to the reduction in public health funding, just at a time when we need to move it on to a totally different scale. Whether that is children or, indeed, adults doing the daily mile—perhaps we should run up to Trafalgar Square and back every lunchtime, which I am sure would do all of us a power of good—we need to invest in such preventive measures. One of my points is that when we end up desperate—patching up how the NHS runs, or dealing with illnesses we did not bother to prevent—we always end up spending more money.

Photo of Graham Evans Graham Evans Conservative, Weaver Vale

The hon. Lady knows how much I respect her and what she says. As the chairman of the all-party group on running, I endorse the daily mile and encourage all adults to do it. Park runs, which happen across the nation, are a good example. There is huge expertise in Scotland, so can NHS England learn from Scotland? What is best practice, and will she give us some examples of it in hospitals and hospital trusts in Scotland that we can take away and learn from?

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

The whole issue comes down to sustainability, which is obviously the idea behind the sustainability and transformation plans. As those who have heard me speak about STPs will know, I support the idea in principle. The idea is to go back to place-based planning on an integrated basis for a community. The difference in Scotland is that we have focused on integration. We got rid of hospital trusts in 2004, and we got rid of primary care trusts in the late 2000s—in 2009 or 2010. Since April 2014, we have set up integration joint boards, where a bag of money from the NHS and a bag of money from the local authority are put on the table and a group sit around it and work out the best way to deal with the interface and to support social care. Anyone in the Chamber or elsewhere with family members who have been stuck in hospital will know that people get into a bickering situation: Mrs Bloggs is in a bed so the local authority is not interested, because she is safe there, and the local authority is instead busy with Mrs Smith, who has fallen off a ladder trying to put up her curtains and who is not considered safe because she is leaving the gas on. Such boards get rid of all that perverse obstruction.

Photo of David Rutley David Rutley Conservative, Macclesfield

The hon. Lady is making an important point, and I welcome the tone that she, unlike the shadow Secretary of State, has brought to this debate. She makes the point that the integration of care—social and health—is important, but does she agree that, with further devolution to the sub-regions and major cities in England, there is a huge opportunity to move forward that agenda south of the border?

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

The whole idea of STPs is to go back to areas. We simply have geographical health boards—the only layer we have—so we are not wasting huge amounts of money on having layers and layers, which could be integrated. For an STP to work it must make sense geographically, which might be a county or something bigger or smaller. I think that they should be put on a statutory footing. We have 211 CCGs. There will be an average of six CCGs for every STP, which means that is a waste of layers, and it will be very difficult to integrate.

One of the biggest differences is that, in 2004, we got rid of the purchaser-provider split. In the past 25 years, there has been no evidence of any clinical benefit from the purchaser-provider split, the internal market or, as it now is, the external market. It is estimated that the costs of running that market are between £5 billion and £10 billion a year. That money does not actually go to healthcare, but on bidding, tendering, administration or profits. We cannot have an overnight change, but if we simply made a principled decision to work our way back to having the NHS as the main provider of public health treatment and to integrate care through the STPs, we could reach a point of sustainability.

As I said earlier, we must protect things such as community hospitals and community services and, indeed, invest in them. Our health board has rebuilt three cottage hospitals as modern hospitals, because that is where we should put an older person who is on their own and has a chest infection, who just needs a few days of antibiotics, TLC and decent feeding. We do not want them in big acute hospitals, we want them to be close to home. The danger is that under the STPs people will see community hospitals as easy to get rid of, but that is an efficiency saving only if it gets rid of inefficiency. If we slash and burn, we will end up spending more money in the end.

Photo of Victoria Prentis Victoria Prentis Conservative, Banbury

Much of what the hon. Lady says is music to my ears as somebody who is campaigning to save their local general hospital. May we have the benefit of her views on the role of consultation with patients and the wider community when sustainability and transformation plans are being considered?

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

Public consultation is important, and not just in the way it has often been done in the past—“We’ve made a decision, it’s a fait accompli, and we’re coming and telling you about it.” Unfortunately, that is very much what we have heard about the STP process, partly because it has been so short and partly, I am afraid, because it is about budget-centred care, not patient-centred care. Areas have been given a number and told, “If you’re not reaching this number, don’t bother submitting your plan,” and they are working back from that. That will not achieve an efficient, integrated service, so the public must be involved.

Frontline clinicians must also be involved. They work in a service and know exactly what the bottlenecks are and exactly what horseshoe nail is missing and holding a service back. If we have clinician-led redesign, such as I was involved in for breast cancer in my health board 17 years ago, we can track a patient’s path. We can quickly imagine ourselves as a patient, see the bottlenecks and focus investment on them.

I read an article yesterday stating that three hospitals in Manchester have spent £6 million on management consultants to say, “Shut a ward, sack hundreds of people and jack up the parking charges.” I am sorry, but that was not good value for £2 million each.

Photo of Jo Churchill Jo Churchill Conservative, Bury St Edmunds

I thank the hon. Lady for, as ever, eloquently expressing issues that face all of us, no matter where we come from and who we are. Does she agree that having good healthcare data for clinicians enables patients to be put through the system seamlessly? Many individuals do not realise that their data do not go from their GP into acute care and then back into social care. If we could improve that—I make a plug for my private Member’s Bill on Friday—it would help patients.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

I would not say that we are super IT wizards in Scotland, but we did not get involved in care.data, which unfortunately is a black shadow over the whole issue of NHS data in England, and now all our referrals are electronic, so nothing goes in the post. All our letters back are also electronic—I dock my dictation machine during a clinic, and when I finish I sit and check it, and the letters go off. After a Friday morning bad news clinic, the letters are on their way by 2 o’clock. A GP can email my colleagues and say “I don’t know whether you need to see this person.” I have heard clinicians here in England say, “No, we can’t email about a patient.” Unfortunately, the wrong move that was made on care.data has ended up holding people back.

Our GPs in Scotland use a care summary. If they have a palliative care patient who has been accepted as being in terminal care, that patient’s care summary will be put on the out-of-hours system. That means that if there is a call about the person, the doctor who goes to see them knows that they will not be throwing them in an ambulance but will be keeping them comfortable. The discussion has already been had, and the aim is for them to be at home. England has to gain the ability not just to analyse data at a later point but to share information as a first step.

In finishing off my speech—[Interruption.] I am sorry if I was taking too long for an hon. Lady at the back of the Opposition Benches. Integration is the key, and it is possible to get it through the STPs—but only if they are designed around patients, safety and services rather than just starting with the bottom line and working backwards.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

Order. Before I call the next speaker, it will be obvious to colleagues that a great many Members wish to speak this afternoon and that although the debate has advanced a long way in time, it has not advanced very far in the number of Members called. We therefore now have to have a time limit of 10 minutes. [Interruption.] I can see that there is some surprise about that; it is 10 minutes for the moment, but anyone who can do any arithmetic will be aware that it will have to be reduced later, so I suggest that Members start working on their speeches now.

Photo of Sarah Wollaston Sarah Wollaston Chair, Health Committee 3:05 pm, 11th January 2017

I will try to be mindful of those comments, Madam Deputy Speaker, as I follow Dr Whitford, my colleague on the Health Committee. As always, she made thoughtful and thought-provoking comments, and I would like to endorse her points and expand on some of them.

First, I thank NHS and care staff. We have heard that they are facing unprecedented demand over the winter, but it is not just winter pressures that they face now—the pressures extend into the summer. As we have heard, that is not just about numbers but about the complexity of conditions and the frailty of those presenting in our accident and emergency departments. The Health Committee heard in its recent inquiry that the trusts that are most successful in getting close to the four-hour target are those that see it as an entire-system issue, and in which both health and care staff contribute to the effort, not as a tick-box exercise but because they recognise that it is fundamentally about patient safety and the quality of patients’ experiences. That is why the four-hour target matters, and the Secretary of State is right to endorse it.

The Secretary of State is also right that we sometimes need to be more nuanced about our targets, and that he needs to be open to listening to what clinicians are telling him about how we can improve the way in which targets are applied. It would be a great shame if we in this House prevented those sensible discussions from taking place because of political furore. I urge him to continue to have them, and to take advice and listen to clinicians about how we can improve the use of targets, but he is absolutely right in being clear that he will keep the four-hour target.

We must talk about this as a whole-system issue. Accident and emergency is a barometer of wider system pressures, as has been pointed out, and I want to focus my remarks on the integration of health and social care.

I agree with colleagues throughout the House who have called for a convention on reviewing funding as a whole-system issue. We have heard that next year is the 70th birthday of the NHS, and what could be a better present than politicians changing the debate and the way in which we talk about the funding of health and social care, so that we do so in a collaborative manner that works towards the right solution for our patients? The consequences of our not doing that would be profound for our constituents, who would not thank us for not being prepared to put aside party differences and work towards the right solution.

Ultimately, this issue is about a demographic change that we are simply not preparing for adequately. In the case of the pension age, we recognised that there had to be a different debate given the change in longevity. Over the decade to 2015, we saw a 31% increase in the number of people living to 85 and older. Of course, that is a cause for celebration, but there has not been a matching increase in disease-free life expectancy.

I welcome the Prime Minister’s focus on tackling inequality, but unfortunately we are not making sufficient progress on that, either. In her very first speech in the job, she talked about tackling the “burning injustice” of health inequality. We in this House have a role in doing that together in a consensual manner.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health)

I very much agree with the hon. Lady. Does she share my welcome for the Prime Minister’s response today in which she stated that she was prepared to meet us and other Members of Parliament from across the House, and my hope that it might start a more constructive approach?

Photo of Sarah Wollaston Sarah Wollaston Chair, Health Committee

Absolutely. It was extraordinarily encouraging to hear the Prime Minister say that she was prepared to consider that and to meet Members from across the House. I urge colleagues who feel that this is a better way forward to sign up to it, speak to their party Whips and make it clear that it has widespread support.

Photo of Barbara Keeley Barbara Keeley Shadow Minister (Mental Health and Social Care)

I wonder, on this vital issue, whether the hon. Lady wants to say something about what her own party did on the two previous times we tried to get important cross-party working on health and social care: it made it an election issue, producing posters about a “death tax”; and on the second occasion the Secretary of State just walked away from the talks.

Photo of Sarah Wollaston Sarah Wollaston Chair, Health Committee

I am afraid that that intervention is exactly not the kind of debate we want to be having. Let us look to the future. We are in a different part of the electoral cycle. I accept the hon. Lady’s comments—I was still an NHS clinician when that happened and, like many of those working in health or social care, I looked at the yah-boo debate in this place and thought that surely there had to be a better way—but I ask her to put them aside and to look to the future rather than backwards, otherwise we will not get anywhere. I think our constituents want us, as politicians, to recognise the scale of the challenge and to get to grips with it.

Photo of Jim Cunningham Jim Cunningham Labour, Coventry South

Looking to the future, does the hon. Lady not agree that there should be a new funding settlement for the NHS and social care budgets that brings both together? At the moment, there have been cuts of £4.6 billion.

Photo of Sarah Wollaston Sarah Wollaston Chair, Health Committee

That is exactly what I am hoping. We must end the silos of health and social care. We should stop thinking about money as a social care pound or a health pound, and instead think about a patient pound and a taxpayer pound, and how we get the very best from that.

That brings me on to a point I would like to raise directly with the Secretary of State. There is an example of where this has happened: in my constituency, Torbay and South Devon NHS Foundation Trust has formed an ICO—an integrated care organisation. Across health and care, passionate people recognised the benefits and sweated blood to get the organisation off the ground. Torbay’s integration is talked about not just nationally but internationally as a recognised way of doing this better. I regret to say, however, that because of the scale of the financial pressure on the ICO, we are now hearing that next year the NHS will be pulling out of the risk-sharing agreement.

That is totally unacceptable. I hope the Secretary of State will meet me to discuss the particular pressures facing the ICO, which has achieved exactly what we are talking about in this debate. It is able to pool finances better through risk-sharing and to work together to get people out of hospital who do not need to be there more rapidly than happens in other areas. It can put people from social care into hospitals to see how we can speed up that process. Unfortunately, if that risk-share falls apart, one of the key pillars of how we want to improve the flow through hospitals and out the other end will break down. Part of the reason, as I understand it, is that unless the control totals are met the funding it hopes to use to improve the facilities in the A&E department will be at risk. The challenge for Torbay is not how it works together to get people out of hospital; it is the facilities at the front door, and it could do so much to improve the facilities. We have the odd paradox whereby we could end up improving A&E infrastructure but worsening the ability of the system to respond at the point where we are trying to get people cared for in the community.

A certain degree of financial challenge can have the effect of bringing health and social care organisations to work more closely together because they know it makes sense, but when unrealistic targets are set it can go the other way. It can start to mean that people have to retreat to protect their budget silos. I hope the Secretary of State will closely at what is happening and meet me to discuss whether we cannot just get this back on track for next year. I am confident that the local authority and the NHS staff across the CCG and the provider trust will continue to work together—they have an extraordinary tradition of doing so—but there are threats, which I hope can be addressed. This is about the entire flow from the front door right the way through to getting people cared for back at home.

More widely, we now have more than 1 million people in communities who are unable to receive the care they need. Mears, the prime provider in my area, is in special measures. These are financial issues. Yes, there is much that the NHS can do that is not about money—we know there is a lot of variation that cannot be explained by financial challenge and demographic changes alone—but finance and the workforce inevitably are the key challenges we have to face, and we have to work together across all political parties to resolve them.

In closing, I would like to raise with the Secretary of State the front page of today’s The Times, which is extraordinarily disappointing. This is the second time a major national newspaper has reported briefing against the chief executive of the NHS, Simon Stevens. I invite the Secretary of State or the Minister closing the debate unequivocally to support the chief executive of the NHS. When the chief executive appears before the Health Committee and I, as the Chair of the Committee, ask him to respond to questions, I expect him to be truthful and transparent in his answers. He should be commended for doing so and not find himself the subject of negative briefings. I therefore invite the Minister unequivocally to support him and ask for this to stop.

Photo of Rosie Winterton Rosie Winterton Chair, Finance Committee (Commons) 3:16 pm, 11th January 2017

The debate so far has shown the huge level of concern from the public and NHS staff about the crisis in the NHS and social care. Dr Wollaston reflected some of the views of the Select Committee, but I ask all Government Members to take those concerns seriously and not to dismiss them. All hon. Members must surely be receiving representations from staff and patients about what is happening locally.

I want to pay tribute to all the health and social care staff in Doncaster, in particular those at Doncaster Royal Infirmary whose work I have seen at first hand. I know how dedicated and committed they are to caring for patients in these most difficult of circumstances. At the end of December, they had managed to achieve 90% against the 95% target and had good ambulance handover times, as well as good support from the council and community partners, but they are facing real pressures and they are fearful about the pressures still to come, especially if, as predicted, there is a cold spell. That is why the mixed messages from the Secretary of State have been extremely damaging.

I was a Health Minister for four years and had responsibility for emergency care. I know how important it is to work with NHS staff to help to implement targets, and not to give the impression that the NHS is somehow giving up on those targets. The lead from the top is incredibly important. There has always been controversy about targets, but as Health Minister I visited many, many A&E departments. There is absolutely no doubt in my mind that the A&E target led to improved care for patients and that it reduced waiting times dramatically. The evidence is clear: it shows that that is what happened. One striking thing about those visits was seeing how consultants, nurses, ambulance teams and all members of the healthcare team worked together. For example, they would work out protocols so that emergency nurse practitioners could take over some of the work previously done by consultants in order to ease the burden and share the work among the team. Triaging—seeing who needed urgent treatment by a consultant and who could be seen by a nurse practitioner—became the norm.

I would ask staff, “Is the target getting in the way, or is it helping?”, and invariably the answer would come back, “It helps us to work together more effectively.” I vividly remember a nurse practitioner saying, “Please don’t abandon the target, because it is making the consultants sit down with us and look at the whole team.” For patients, the difference was crucial, as it was for practitioners’ working lives, because they were not having to see patients who had been sitting around for hours and were feeling thoroughly depressed and demoralised. That made a difference to the healthcare team as well, because it improved their working life as well as patient care.

Photo of Andrew Murrison Andrew Murrison Conservative, South West Wiltshire

Does the right hon. Lady agree that it is not so much meeting the target that is important as getting patients seen expeditiously and well? There is not an A&E department in this country that does not want to improve its position in the league table, if you like, of response times. The difference that now applies, and which perhaps did not apply quite so much when she was a Minister, is that the level of informatics and comparison is much improved. I suggest to her, ever so gently, that while the four-hour target was important when she was a Minister, its importance has degraded over time, because everybody is trying to see patients more quickly.

Photo of Rosie Winterton Rosie Winterton Chair, Finance Committee (Commons)

I do not agree with the hon. Gentleman. The four-hour target led to much better diagnoses and much improved provision of the type of treatment that people needed, as well as better interaction with communities. And I want to come on to that point because the Secretary of State has been trying—perhaps the hon. Gentleman is guilty of this as well—to separate the target for A&E departments from what happens outside, whereas I see the importance of putting the two together. Providing alternative treatment, which is perhaps part of what the hon. Gentleman was getting at, means having proper support in the community. It was bringing those two things together that made it possible to achieve the target, so it was a driver.

Photo of Rosie Winterton Rosie Winterton Chair, Finance Committee (Commons)

I give way to the hon. Lady, who I know has some experience of this.

Photo of Maria Caulfield Maria Caulfield Conservative, Lewes

In my experience of trying to meet the four-hour target, it is often—or was in the past—prioritised over everything else, including patient care and clinical need. It was sometimes abused, with huge pressure put on staff to meet the target, and as a result patient care suffered. I saw that myself.

Photo of Rosie Winterton Rosie Winterton Chair, Finance Committee (Commons)

It is always important to look at the feedback from clinicians, and I did that as a Health Minister. It started during my time as a Minister, and I remember that we had constantly to consider whether there was a clinical reason for reducing the 95% target. It became clear that some patients needed longer to be assessed owing to their particular condition. In such cases, I could see why the target might need to be reduced, but that was based on clinical need. By contrast, the impression given last week was, “My goodness! We’re going to have to cope with some winter pressures. Let’s reduce the target in order to meet it,” rather than there being an assessment of clinical need. That sent completely the wrong message to the NHS. I think it was the wrong thing to do.

I want briefly to set out some areas in which we can bring the community input together with what is happening in emergency departments in order to reduce some of the pressures. The first point was that made by my hon. Friend Jonathan Ashworth, who spoke from the Front Bench. Good social care is vital to ensuring that people do not end up in A&E. I have previously raised problems with the Government’s current proposition to, in a sense, move responsibility for raising money to local councils. That is particularly unfair in areas such as mine, which simply cannot raise the same amount of money through a council precept as better-off areas can. It simply does not work. We need it probably more than any other area, but we will be less able to raise the money.

On shortages, I have been talking to senior NHS staff in Doncaster, and there are real problems with emergency care staffing. They tell me that although more doctors are being trained—I accept that—it will take years for them to come through. The single most effective step we can take to ease pressure on A&E departments is immediately to increase funding for social care, because it would keep people out of A&E departments, and it could be done straightaway. The personnel are out there; the Government just need to increase the funding, as my hon. Friend said from the Front Bench.

We also have to look seriously at the problem of GP shortages. As others have said, if patients are waiting three weeks to get an appointment with a GP, they are bound to end up in A&E. This needs to be addressed very quickly, with proper forward looks at exactly where the gaps are in GP services. I have said before that PCTs—now clinical commissioning groups—or NHS England should be able to take over practices and employ salaried GPs. That would make a huge difference. Furthermore, on community pharmacies, if people are confident that going to a pharmacy will save them a visit to A&E, again that will relieve pressure on the system. I hope, therefore, that the Minister will assure us that he is looking seriously at the community pharmacy forward view, which sets out how pharmacies can be integrated into the NHS and social care.

Briefly on mental health, the Prime Minister answered a question today about mental health and the crises that people can get into which mean that they end up in A&E—she talked, in particular, about young people. I urge the Minister to consider the role that educational psychologists can play in children’s mental health and in keeping them out of A&E.

It was my experience as a Health Minister that we needed people on the ground locally to help organisations across the spectrum—local government through to social care, pharmacies, GPs and ambulances—to work with A&E departments, yet the £2 billion reorganisation that removed PCTs and strategic health authorities has made it much more difficult to drive through the necessary changes. I hope, therefore, that the Minister will look very seriously at what has happened, because local knowledge can be vital.

On the basis of the Secretary of State’s contributions, it seemed that he was trying to use every excuse not to face up to the reality of what is happening. I think that sends a terrible message to NHS staff. I hope that, as a result of today’s debate, the concerns raised will be taken on board by Ministers and the Secretary of State and that they will come back to us with a proper plan that recognises the problems and offers real solutions.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

Order. The House was right to assume that 10 minutes per person is unsustainable. After the next speaker, I shall reduce the time limit to seven minutes. The House will be glad to know, however, that the time limit remains 10 minutes for Sir Simon Burns.

Photo of Simon Burns Simon Burns Conservative, Chelmsford 3:29 pm, 11th January 2017

Thank you very much, Madam Deputy Speaker.

I certainly welcome today’s debate and the opportunity to discuss an issue that is extremely important to all hon. Members in all parts of the House. During recent weeks, there has been a significant problem because of the increasing number of people needing services at A&E and from local health services. I would like to pay tribute to the magnificent work, often in very difficult circumstances, that doctors, nurses, consultants, ancillary staff and people in general practice carry out on a day-to-day basis—not simply during a winter crisis period, but throughout the year—looking after people to the best of their abilities.

My own hospital, Broomfield hospital in Chelmsford, is doing a fantastic job, in difficult circumstances, to provide the best possible care in good times and in more difficult times. As a constituency MP, I am certainly aware that there have been some problems for some of my constituents over the last week or so, because of the demand and the pressure.

We have to look at what we can do to move forward in a positive—not a partisan, politicised—way to make sure that our constituents get the best treatments possible. There is no point in just shouting. As the Chair of the Health Select Committee, my hon. Friend Dr Wollaston, said, it is no good engaging in yah-boo politics. We have to be mature and come up with sensible suggestions.

Funding is, of course, a key issue. I have to say that I am extremely proud of this Government’s record and commitment to funding the NHS over the last seven years and their commitments for the next three to four years. We made sure when we came into office, at a time of austerity when Government Departments’ budgets were cut, that the Health Department’s budget was one of the few to be protected, so that we got a real-terms increase in funding every year we were in power—albeit, I accept, a modest real-terms increase. It nevertheless showed our commitment and our intent to invest in improving the national health service.

I am also proud of the fact that I and all my hon. and right hon. Friends fought the last general election on a commitment that over the five-year period of this Parliament, we were going to increase NHS funding substantially—to what has turned out to be to the tune of £10 billion. That is more, I say in a very gentle way, than was on offer to the country from certain other parties. I am pleased, too, that my right hon. Friend the Secretary of State and the Minister of State have been planning for any potential strains of demand during this winter period with the provision of £400 million to local health economies, and other measures such as the vaccination programme, a preventive health measure that has got a record number of 13 million people vaccinated to try to offset some of the potential health problems that can flow during a winter period. That is using foresight and planning to try to minimise problems, while at the same time providing funding to back up their actions. That is what a responsible Department of Health should do and has done.

Now, people can demand as much money as they like for the health service, but my argument is this. Yes, the health service does need extra money—year in, year out—but it should not just be thrown at an issue. A far bigger part of the equation is building on the performance, standards and quality of care that the health service will provide to our constituents.

Photo of Tania Mathias Tania Mathias Conservative, Twickenham

I entirely agree with what my right hon. Friend is saying about the increased resources, but does he not agree with me that we now need more resources for integrated health and social care, and that this is the time to stop using the NHS as a political football and engage in a cross-party review?

Photo of Simon Burns Simon Burns Conservative, Chelmsford

I certainly agree that, under the leadership of the Department of Health, we should work with anyone and everyone to come up with a solution.

I was the social care Minister in the late 1990s, before we left office. Integrating health and social care was then at a very early, formative stage, and the ambitions were immense and tremendous. I am afraid that the reality has not matched the ambitious nature of what was being said in the 1990s, which is why I was particularly interested by the comments of my hon. Friend the Member for Totnes. Yes, we must think about that, but what we must also think about—let me push the funding element to one side for the moment—is building on the work of my right hon. Friend the Secretary of State for Health, particularly his investment in patient safety, the raising of standards, dignity for patients in our hospitals and throughout the health system, and the cutting out of waste and inefficiencies.

In 2010, when I was at the Department of Health for the second time, we had the “Nicholson challenge”, which was to save £20 billion over three or four years by cutting out waste and sharing best practice to improve the quality of care. I know from a debate that we had just before Christmas that the NHS achieved £19.4 billion of those savings. The beauty of that was not just that it created greater effectiveness and efficiency in the delivery of healthcare and the sharing of best practice, but that the Treasury did not receive £19.4 billion with which it could do as it wished. The £19.4 billion was reinvested in patient care.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Westminster Group Leader (Health)

Was not a significant proportion of that saving due to wage freezes for NHS medical and nursing staff? That is not something that can easily be repeated.

Photo of Simon Burns Simon Burns Conservative, Chelmsford

The hon. Lady is absolutely right. There was a wage freeze for those who were earning more than £20,000 a year, but that was in keeping with the policy throughout the public sector, which included Ministers and other Members of Parliament.

The important point is that it was possible to achieve that saving by a variety of means. One of them was a pay freeze, but others were improving the delivery of service, cutting out inefficiencies and ineffective ways of operating, and getting rid of nearly 20,000 surplus managers so that the NHS could concentrate on enabling clinicians, nurses, ancillary workers and everyone else to work on patient care. That is the right way forward, and we cannot give up on it. We must continue to think about where we can make savings.

Photo of Simon Burns Simon Burns Conservative, Chelmsford

I am afraid not, because I am about to finish.

Much has been said about the STP programme. We have an STP in Mid and South Essex, and I strongly support it, because it is completely focused on improving and enhancing the quality of accident and emergency care. What annoys me is that people wish to politicise it for grubby political reasons. [Interruption.] Funnily enough, I am not talking about Opposition Members.

Our STP involves three hospitals with three A&E departments. Not one of those departments is to be closed under the proposals, yet as soon as they were published, and on the assumption—correct, I suspect—that most people had not read them, word went out that my local A&E department was to be closed down by the Department of Health because of this nasty Government’s proposals to save money. The exact opposite was the case. If one read the document, one could see that all three A&Es are remaining open. What will happen is building on what happens now. If someone has a heart attack, they are immediately taken to Basildon hospital, because that is the specialist for cardiothoracic treatment. If someone needs treatment for burns or plastic surgery, they come to Broomfield hospital in Chelmsford, because it has one of the finest units in the whole of Europe. If someone has a head injury, they will go down to Romford in the east of London, because that is the specialist area for people with head injuries. If I had any of those conditions, I would want—and I would want for my constituents—the best possible treatment from the best experts available. That is what is happening and that is going to be built on, enhanced and improved. That is an improvement. That is not a cut; that is not taking away services from local communities. Those people who have an agenda and want to play politics will tell people anything in the hope that they believe it, or to frighten them by trying to discredit the work of the NHS.

I am pleased we have had the opportunity to discuss this matter. It is very tricky, and there is no simple answer—what is happening is not unique; we frequently have winter crises, particularly because of the ageing population and the increasing demands on health services in recent years—but we must not lose sight of the fact that we have an NHS and a Government who are determined to improve further and enhance the quality of care, and the safety and standards of care for all our constituents, aided and abetted by a first-class workforce who are often working under very difficult circumstances.

Photo of Louise Ellman Louise Ellman Chair, Transport Committee 3:41 pm, 11th January 2017

It is important to talk more widely about the NHS—about its importance and its funding and perhaps about its organisation, too—but the purpose of today’s debate is to highlight the current crisis in many parts of our national health service and to ask the Government to do something about it.

Our national health service is undoubtedly highly valued, has dedicated staff and provides excellent services. In many parts of the country it is under pressure, however, and today’s debate calls for specific actions to address that crisis. It calls for more funding for social care now, and for an improved settlement for both the NHS and social care in the next Budget. So in our general discussion about how things might be reorganised and changed in the future it is important not to lose focus on the current problems, and those are the reasons for today’s debate.

There has been a lot of discussion about what is happening in hospitals—that will inevitably be the case, as in many areas there is a crisis in A&E and great pressure on hospital services—but reference has also been made to services provided by our NHS outside hospitals, in the community. It is important that we focus on those as well, not just because they are important in their own right, but because if they are working effectively they can prevent hospital admissions from occurring and improve people’s health. Those services include community health services, which involve GP practices, which is the bedrock of our NHS, and the nurses, physios and pharmacists. They also include social care, where the NHS has some responsibility, although local authorities, which are under ever-increasing pressure, are primarily responsible.

I am extremely concerned about the cuts that the Government have imposed on community pharmacists. Pharmacists are essential to our NHS. They are part of the NHS, but in the main are privately run. They offer advice as well as specific services, and where pharmacists can give proper advice and services they can often prevent people from having to go to their GP, let alone to hospital. It is a matter of great concern that the Government’s plan for cuts to community pharmacies will put pharmacies in areas such as mine in Liverpool at risk. I also deplore the reduction in independent pharmacies, which provide an excellent service. I ask the Government to think again about their cuts to community pharmacies, which form a vital part of our health service. Once they are closed, it will be far too late. The Government should act now. They should not go ahead with those cuts, which will have a dramatic effect in Liverpool and elsewhere in the country.

I also ask hon. Members to think a little more about what is happening in social care. In Liverpool, we are facing a major crisis in social care, as local authority funding has been cut severely and is to be cut again. Liverpool City Council’s budget has already been cut by 58%, and £90 million of further savings have been demanded over the next three years—half of that to be achieved in the next year. One result of that has been a severe reduction in social care provision: 40,000 social care packages have been reduced to 9,000, and there are many more cuts in the pipeline.

Providing social care is essential not just to enable people to leave hospital when they are healthy enough to do so—although that is important—but to enable them to live a constructive life. Many people are now fearful of possible cuts to their social care packages. They believe that they will be unable to lead a reasonable life in their own home if their essential services are cut. I ask the Government to think again about what they are doing. They tell us that the better care fund is an answer, but that is simply not the case. In Liverpool, £39 million has been proposed for the social care fund for the coming years, but that will simply scratch the surface of the problem. In poor areas such as Liverpool where it is difficult to raise money, a 1% increase in the council tax fund would raise only £1.4 million. Neither of those measures, either singly or put together, will address the looming and very real crisis in social care. I urge the Government to look again at this, rather than offering platitudes about other funding being available. That funding is not there, and there are no plans for it to be there. A new approach needs to be taken to this urgently; something needs to be done.

The subject of mental health has been raised by a number of Members. I should like to mention two instances from my constituency. The first involves someone who can live a reasonable life at home with some assistance, but that assistance has now been withdrawn. Among other things, it involved helping the person to open letters in order to deal with normal queries, but that has now gone and she is facing great problems.

The second example involves Mr B, who faces very serious mental health conditions. Indeed, he has an incapacitating condition, which means that he cannot work. He was promised specialist help at the Tuke Centre in York, but that offer was withdrawn because it was made in error. That is unforgivable. I have followed this through, and Mr B was promised local treatment, although it was unclear whether that treatment would be appropriate. However, that treatment is not now being offered in the way that was previously suggested. I have followed that up, but 14 months on from the time when Mr B was first offered help for his incapacitating and extremely serious mental health condition, nothing has happened. That is simply not good enough, and I shall be pursuing the matter further.

Those are just two illustrations of how the cruel cuts in mental health services are affecting individuals. I agree that we should perhaps look more generally at funding for our national health service, but the crisis in local services is happening today. The Government are responsible now, and they must act.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean 3:48 pm, 11th January 2017

I am very pleased to follow Mrs Ellman. I am sorry that Dr Whitford is no longer in her place. I particularly enjoyed her remarks, in which she set out a number of constructive policy suggestions, drawing on experience in Scotland, and suggested that we could reflect on them and improve the situation here.

It was disappointing to hear not a single policy suggestion in the shadow Secretary of State’s 33-minute contribution. He might reflect on that because the debate will not move forward otherwise.

The hon. Member for Central Ayrshire drew upon her clinical experience, but I also enjoyed the contribution of Dame Rosie Winterton who, after a period of enforced silence as Opposition Chief Whip, drew upon her ministerial experience, demonstrating the value of ex-Ministers contributing from the Back Benches and bringing something to the debate.

I have reflected on the Labour motion before us today, which specifically talks about the four-hour target and funding issues, which I will touch on in my inevitably brief speech. As I said in an earlier intervention, I was in the House on Monday when the Secretary of State was clear in what he said and I do not understand why Labour Members fail to see that. He did not in any way water down the target. Mr Bradshaw challenged him and the Secretary of State specifically “recommitted the Government” to the target. He was actually generous in paying tribute to the Labour Government for having introduced it, saying that it was

“one of the best things about the NHS”,—[Official Report, 9 January 2017;
Vol. 619, c. 46.]

and in no way resiled from it.

Indeed, I think the shadow Secretary of State said in his remarks that the Secretary of State had somehow talked about ensuring that the target applied only to those with urgent health problems and that he had somehow said that secretly outside the House. However, I have looked carefully at the Secretary of State’s oral statement, given in the House just two days ago, and he was explicit about ensuring that the four-hour standard related to urgent health problems. He specifically referenced Professor Keith Willett, NHS England’s medical director for acute care, and said that

“no country in the world has a”— four-hour—

“standard for all health problems”.—[Official Report, 9 January 2017;
Vol. 619, c. 38.]

The target is for urgent health problems, and if we are to protect vulnerable patients, that is what we need to ensure—it is incredibly valuable.

The motion also relates to social care funding, so I want to talk about the charge that the Opposition keep making about local authority decisions. It is entirely true that the coalition Government had to make savings from local government budgets in the previous Parliament owing to the previous Labour Government’s lack of preparation following the dramatic financial crisis. We inherited a budget deficit of 11% and had to make such savings, but local councils had choices in the decisions they made about where the cuts fell. Gloucestershire County Council prioritised spending on adult social care, stating that it was the single most important service that it delivered. The budget related not only to older people; a third of it went on provision for adults with disabilities, including learning disabilities. The council protected that budget in cash terms, which is one reason why we are one of the best performers in the region and have low delayed patient discharge from the acute sector. While I do not pretend that there are no problems—of course there are challenges—the hard-working health and social care staff do an excellent job.

Photo of Toby Perkins Toby Perkins Labour, Chesterfield

I am grateful to the right hon. Gentleman for giving way, but his comments about local government are ludicrous. The cuts that local government faced were far greater than those to any Government Department. The Government cannot introduce that level of cuts and then say to local government, “You have to decide what you cut.” Of course that was going to lead to social care cuts.

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

The point that I was making is that my local authority also faced significant cuts and had to make choices. It chose to prioritise adult social care as the single most important service that it delivered, and that meant that it had to make difficult cuts in other areas. However, the choice to put adult social care at the top of the list of priorities was the right choice six years ago and remains the right choice today. If councils chose to put adult social care at the bottom of their list, that was not the right decision.

There is no acute A&E department in my constituency, but it is served by A&E departments in Gloucester and Cheltenham. I visited the new chief executive at Gloucestershire Hospitals NHS Foundation Trust and met some of the staff in the A&E department—the hospital has had its challenges—and she is working hard with her management team on turning around the performance of A&E, which has not been up to scratch. I talked to her about the processes they are putting in place, and I am confident that, with the hospital’s hard-working staff and improved leadership, they will be able to hit the targets that the Government have asked them to meet.

Photo of Alex Chalk Alex Chalk Conservative, Cheltenham

I joined Gloucestershire police on a night shift last Saturday, and I went to Gloucestershire Royal hospital A&E, too. I saw professional and compassionate staff offering care in no doubt pressured circumstances. Does my right hon. Friend agree that the current STP process in Gloucestershire must be the occasion to enhance capacity elsewhere in the county and that that must include bolstering and enhancing A&E provision at Cheltenham general hospital?

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

The whole point of the STP process is to ensure that we have capacity across the health sector. One important thing that the Secretary of State talked about is the other changes to the health and social care system—indeed, that is mentioned in the Prime Minister’s amendment, which is why I will support it. In that I agree completely with the Chair of the Select Committee. We have to look at the two things together.

Unlike what Dr Whitford said, in Gloucestershire we are lucky to have a single CCG and a single county council, which work well together with lots of joint working, and they increasingly want to bring health and social care together. That is exactly what the Chair of the Select Committee said, it is the right thing to do and it is what the hon. Member for Central Ayrshire said is being done in Scotland to help deliver a better service.

My hon. Friend Alex Chalk is right that, the more we can improve capacity in the system to ensure that people can access primary care where they need it and can access social care where they need it, we will take pressure off the accident and emergency system. Indeed, when I visited the A&E department, it had a good triage system in place, with general practitioners based in the department to ensure that people with conditions that can be treated by general practice are signposted and treated in an appropriate setting, rather than damaging the service’s ability properly to deliver acute care to those who really need it. We need to consider such steps, going forward.

Photo of Andrew Murrison Andrew Murrison Conservative, South West Wiltshire

Would those people fall within the four-hour target? That lies at the heart of the debate. Should the four-hour target cover both urgent and more elective problems that people present to casualty departments?

Photo of Mark Harper Mark Harper Conservative, Forest of Dean

I do not know the detail of how the statistics are measured, but the important thing is to ensure that people who walk through the front door of an A&E department but who do not need urgent care receive care in the appropriate setting and are properly signposted, whether that is to community pharmacies, general practice or the information services that the NHS provides online or on the telephone. It is about making sure that people go to the right setting. The Government acknowledge that that is not perfect at the moment, and they are doing a lot of work to improve it in the future.

Finally, the Government’s moves to devolve spending power and decision making to local areas, particularly given what will happen in Greater Manchester, to bring health and social care together is the way forward, and I have certainly encouraged my local authority, as it leads the formulation of our devolution proposals, to make an ambitious ask of Government on health. I hope the Government will look at that very seriously in the months ahead.

Photo of Catherine West Catherine West Shadow Minister (Foreign and Commonwealth Affairs) 3:58 pm, 11th January 2017

I do not know the collective noun for Government Chief Whips and Opposition Chief Whips, but I believe it is a crop of Whips. Anyway, it is an honour to follow two esteemed former Chief Whips.

I begin on a slightly less happy note by quoting from an educational psychologist who wrote to me this week:

“I and my colleagues are frequently overwhelmed, frustrated and in disbelief about the amount of work we need to manage, the difficulties in working across services because of cuts and changes to policy. Everyone is perpetually exhausted and burnt out. When we’re not at work because of training, illness or leave we feel simultaneously guilty and relieved.”

Her email went on to describe how she is the only clinical psychologist on duty in the whole of a very busy inner-London constituency.

I wish to comment briefly on the juncture between primary and secondary care, and on acute care. In the past 18 months, many of us have had the experience of fighting for a general practitioner’s service. The Westbury clinic, which lies just between my constituency and that of my right hon. Friend Mr Lammy, has been quite a battleground in the past 12 months. He and I have had to really fight for basic GP services for our constituents. I believe this situation is replicated across the country, and it is obviously what is leading to the build-up of individuals; as the Secretary of State has said, we have so many people turning up to A&E who probably could be seen by a GP but simply cannot get an appointment.

Photo of Rob Flello Rob Flello Labour, Stoke-on-Trent South

One problem we face in Stoke-on-Trent is that we are about half a dozen GPs away from the whole GP system collapsing, because as GPs are retiring or leaving for other reasons, their patients are then going to the ever-smaller number of GPs that there are. Two GPs are due to retire shortly, but if we lose half a dozen the whole GP system in Stoke-on-Trent is liable to collapse completely. What will that do to A&E?

Photo of Catherine West Catherine West Shadow Minister (Foreign and Commonwealth Affairs)

That leads to an individual patient waiting 35 hours on a trolley to be seen, as happened this weekend. I know that a number of Members have made this point, but it bears repeating: it is disgraceful that staff are blamed when this is going wrong, given that the responsibility clearly lies with politicians—with the Government. I was upset to see that today’s front page of The Times blames the senior civil servant at the heart of the NHS, as this is really down to poor Government planning.

Photo of Steve Pound Steve Pound Shadow Minister (Northern Ireland)

On the subject of poor planning, I am sure that my hon. Friend will, like the rest of the House, have heard James O’Brien speaking on LBC yesterday describing his experience of having conjunctivitis over the Christmas holiday and having to go to a community pharmacist because he could not get a doctor’s appointment and did not want to go to A&E. Is this not the maddest time ever to be considering closing thousands of community pharmacies? Is this not the time when we should be supporting them, not closing them?

Photo of Catherine West Catherine West Shadow Minister (Foreign and Commonwealth Affairs)

I do not know whether a Brexit-fever madness took over, but there was a moment when cutting community pharmacies seemed like the right thing to do. Clearly, it was the wrong thing to do at such a crucial time, particularly given the impact of the illnesses to which we all fall prey during the winter months.

In my earlier intervention, I asked the Secretary of State about the flu epidemic. He assured me on the number of vaccinations, and I am pleased that more people have been vaccinated against seasonal flu. However, let me return to the point I was making. I understand that there has been quite an increase in the number of young people getting the flu, so we are not talking about people in the herd group who would have been advised to be inoculated against it. When people, tragically, get the flu they suffer, and doctors do not have time to isolate those individual cases. That creates a real risk, given how busy staff are, that that flu could become an epidemic. Having given us assurances today, I hope the Secretary of State will take that point up further with chief executives of acute trusts.

I want to give colleagues an idea of what is happening on social care. In 2010, I was a council leader and we had a social care budget for children—this is nothing to do with schools, just children—of £102 million. The same local authority now, in a busy London area, has for 2017-18 got a budget of £46 million. If someone is really telling me that the needs are half as much as they were in 2010 or that somehow families need less help and support, which is what children’s social care provides, I would be very surprised. A cut from £102 million to £46 million in 2017-18 is deeply worrying for the children who are in desperate need of social care.

Adult social care is equally worrying. The Secretary of State told us on Monday that we should not worry because £600 million is going into social care. I would not worry, except that I happen to know that, between 2010 and 2015, £4.8 billion was taken out. Anyone who has even key stage 2 maths will know that that does not add up. If £4.8 billion is taken out over a five-year Parliament, putting in £600 million 18 months later is not going to help.

I feel sorry for councils. If they increase tax, that is quite unpopular, but if they do not the Government blame them for not wanting to sort out the social care crisis. Even where the precept does bring the local authority quite a lot of money, the amounts raised do not help in the longer term because they just go towards a short-term fix—we are not actually fixing the problem that we need to be looking at: we need more homes in which older people can live comfortably, have fewer falls and accidents, be warmer so that they are not suffering from fuel poverty, and stay out of A&Es.

It is all about long-term planning, but we have built hardly any new homes, even for older folk. If we did so we could start a chain and enable their families to move into their old homes, thereby solving another problem. We have reached a crisis in which older folk end up in A&E and, on occasion, have to wait on a trolley for 35 hours, which I still cannot quite believe. I am sure that the newspapers are telling the truth, but 35 hours is an awfully long time to be on a trolley and not be seen.

Last year, my right hon. Friend the Member for Tottenham and I had a debate on mental health in this very Chamber, which was followed by a meeting of Members of Parliament from the local sub-region. We were very worried about people suffering from mental health problems, for whom there is currently a perfect storm. First, there have been benefits cuts. We are now in our seventh year of austerity, and there is no doubt that people with mental health problems have been right at the bottom of the pile. Secondly, we have seen cuts to supported housing and all the programmes that helped people suffering with mental health problems to keep their tenancies. That is all being cut, so people have no one to support them, which is part of the reason they fall ill. Thirdly, we have seen cuts to the number of nurses. There are fewer mental health nurses in the system than there were two years ago and, of course, fewer beds.

A constituent came to see me at my surgery in November to say that he had fallen ill with a mental health problem. He was very surprised because he had never suffered in such a way before, and was amazed by the poor care he received, in part because no one was available to diagnose him properly. He spent more than 24 hours in a padded cell, with no explanation and no indication of what sort of service he could expect. There were so few beds that he was sent about 20 miles away to be cared for at another hospital, leading to a great deal of stress and worry for his family.

The whole health system is in crisis and needs our urgent attention. Despite all the demands, political and otherwise, that the Brexit process is going to create, I hope we will not forget not only the most vulnerable—those with mental health problems or in social care and so on—but our basic, universal NHS for all.

Photo of Andrea Jenkyns Andrea Jenkyns Conservative, Morley and Outwood 4:08 pm, 11th January 2017

I begin by objecting to the exaggerated language used over the weekend by Mike Adamson, the chief executive of the British Red Cross. What he said does a huge disservice to our hard-working healthcare professionals in the NHS. Such language was ill-thought-out, sloppy and irresponsible. The Red Cross does some fantastic work, as I am sure both sides of the House agree, but as a registered charity it is legally obliged to be apolitical. If Mike Adamson cannot remain neutral, I suggest that he examines his position carefully.

As a member of the Health Committee and chair and co-founder of the patient safety all-party group, healthcare is extremely important to me, and I am proud to be a Conservative Member of Parliament under this Government. It is thanks to this Government and this Health Secretary that NHS funding is at record levels.

The Government are committed to delivering a seven-day NHS and to expanding access to GP surgeries and hospital-based consultants at evenings and weekends. This winter, the NHS has made more extensive preparations than ever before. As the Secretary of State mentioned earlier, in the run-up to the winter period, there were over 1,600 more doctors and 3,000 more nurses than just a year ago. That is a record of which to be proud, and it would not have been achieved had we had the Opposition party running our national health service.

As chair of the patient safety APPG, I am pleased to say that the Government have introduced a new Ofsted-style inspection regime for the Care Quality Commission to improve patient safety. Hospital infections have been halved since 2010, with the level of MRSA down by virtually 50% and clostridium difficile by more than 50%. It is this Health Secretary who has taken the lead on this issue, and put patients at the heart of the NHS.

Record numbers of people are being treated in our NHS and there are pressures on the service, but it is not this Conservative Government who are a threat to the NHS. If we look at the appalling situation of the NHS in Labour-controlled Wales, we will see that funding is being cut. As the latest statistics show, the NHS in Wales is failing to meet the four-hour A&E targets by a wide margin. It is clear to see who is rarely the defender of our national health service and who would cut investment.

In conclusion, it is this Government who are increasing spending on our NHS, who are focusing on improving patient safety and who are dedicated to providing the best possible service.

Photo of Naseem Shah Naseem Shah Labour, Bradford West 4:11 pm, 11th January 2017

I am grateful for this opportunity to raise some of the serious concerns that have been caused by this Government’s refusal to fully fund our NHS. The Government are running out of places to cut corners to save money on the NHS. They are showing a lack of respect and compassion as they fail to provide the healthcare that people need and deserve. Those who need care at home are having to make do with 15-minute flying visits.

We have seen the pressure in A&E departments building over the past six years and yet every year we reach a “winter crisis” that is somehow a surprise to the Government. We have seen an increase in A&E waiting times, with more than 1.8 million people waiting more than four hours in 2015-16—an increase of over 400% since 2010.

Bed-blocking is increasing as our underfunded social care services struggle to deal with demand. We have seen an increase in the number of patients waiting on trolleys to be treated or admitted, and an increase in the number of hospitals running out of beds. We are also about to see a 12% cut to community pharmacies, which will lead to the closure or reduction in services of our local pharmacies. The time it takes to get a GP appointment is also increasing.

This is not the most complex of problems. If we want a proper functioning full person-centred care system that works with compassion and treats those in need professionally and efficiently, this Government must fund it.

Photo of Alex Chalk Alex Chalk Conservative, Cheltenham

In 2015, the head of the NHS, Sir Simon Stevens, said that the NHS needed £8 billion. It was this party that committed to fund it; the Labour party did not. If the hon. Lady is so keen on funding the NHS, why did the Labour party not pledge to do so back in 2015?

Photo of Naseem Shah Naseem Shah Labour, Bradford West

I thank the hon. Gentleman for his intervention.

Let me turn now to pharmacies. This Government fail to grasp the fact that cuts to one service will have a direct impact on another. Let me be clear: only two months ago, I stood on the Floor of this House to condemn the proposed 12% cut to community pharmacies, which could mean the closure of 25% of the 42 pharmacies in my Bradford West constituency. That highlights the short-sighted approach taken by this Government. They are attacking all forms of primary healthcare and front-line services on which people rely.

If the figures are correct, nearly 30% of people who attended A&E services in Bradford royal infirmary over the past month could have been treated elsewhere for minor ailments. Many of them could go to their local pharmacy, through our local ailments scheme, or see their GP. What is the Government’s long-term approach to these systemic issues if they continue to water down primary care services? All we will see is an increase in the number of visitors unnecessarily attending A&E and an increase in the problems faced by those needing access to services.

The impact of the reduction in GP services is the same. Only a few months ago, I campaigned with the local community to save Manningham health practice. That was temporarily put on hold, although we still have fears. Thankfully, we managed to prevent that centre from being closed down in the short term. However, I know that others in my constituency are at risk. Many other MPs have GP surgeries in their constituencies that face uncertain futures due to the funding restraints. This paints a picture not only of the underfunding of primary care services, but of a strategy that simply does not work together. Even a simple understanding of healthcare provision would allow us to see that if we decrease NHS services in one sector, there is an impact on the rest of it and an increased pressure on other service providers. But this Government continue to underfund and cut funding to all aspects of frontline services, and they expect the quality of care to remain the same. Where is the long-term planning that will ensure that people get access to the care that they deserve and are entitled to?

The Government’s strategy is the same when it comes to local government social care funding. The cuts to local social care funding have been dramatic. As many other hon. Members have highlighted, nearly £4.6 billion has been taken out of the social care sector since 2010, mainly through local government funding cuts. My district of Bradford has just had to announce that it will need to find another £8 million in savings from its social care budget. The authority is trying to be innovative and trying to find ways to ensure that there is no effect on frontline care by putting its resources into prevention. For me, the Government still fail to recognise the impact of deprivation on care needs. In one of the four most deprived constituencies, health issues go hand in hand with deprivation. The cuts to local government funding make that even more evident. It is not the work of our exceptional healthcare staff that has caused this crisis. It is the reduction in funding and the short-term strategy of this Government that are responsible. It is time for them to wake up and provide the healthcare provision people deserve.

Photo of Andrew Selous Andrew Selous Conservative, South West Bedfordshire 4:17 pm, 11th January 2017

Many of my constituents are extremely fortunate to be served by Luton and Dunstable hospital—the hospital that was name-checked twice by the Secretary of State in his statement on Monday. One thing it does extremely well is its excellent streaming process in A&E, with good alternatives when A&E provision is not appropriate. That has helped the hospital to provide very high standards. I am also fortunate that my constituents’ social care is provided by Central Bedfordshire Council, which has been extremely innovative in building extra care court provision for older people. I visited those provisions, which are hugely popular and in central locations. They are much cheaper than residential care and provide a much better living environment for older people. That is exactly the sort of thing that we need a lot more of across the country. Those are two examples of really good individual practice within the NHS and social care. We need to be much better at spreading that good practice across the whole country.

It is worth putting on the record that since this time last year, we have more than 1,600 more doctors and 3,100 more hospital nurses. Since 2010, we have over 11,000 more doctors and 11,000 more nurses. The proportion of patients harmed by the NHS fell by more than a third between 2012 and 2015, and cases of infection are 50% lower than they were one year ago, which is a tremendous achievement. Health spending in England is actually 1% higher than the OECD average and the UK is spending more on long-term care as a percentage of GDP than Germany, Canada and the USA. The King’s Fund has said that STPs are the “best hope” for the future of the NHS in England, and Chris Hopson, the head of NHS Providers, has said that the system as a whole is doing “slightly better” than this time last year.

All of that is dependent on having a strong economy, and I would argue that the Conservative party has demonstrated its competence in running the economy. Of course, I am not complacent, and I recognise that there is, in a sense, an arms race between the extra provision I am proud the Government have put in and the increasing demands on the NHS.

One issue that continually disappoints me is that we do not have enough of a focus on quality in these debates—they are always about funding. However, I draw attention again to the “Getting it Right First Time” initiative brought in by the Government just before Christmas, which is projected to save £1.5 billion that could be redirected back towards front-line patient care across 18 specialties. That will result in fewer infections and fewer revision operations, and we are using the data to shine a spotlight on variability, which is absolutely key for our constituents.

On mental health and the very welcome statement by the Prime Minister on Monday, I was delighted to hear the emphasis on first aid for mental health—something that will take place in our schools. However, as important, if not more important, is the issue of keeping fit for mental health. What do all of us need to do to maintain good mental health? The Mental Health Foundation says we need to talk about our feelings, eat well, keep in touch with family and friends, take a break, accept who we are, keep active, drink sensibly, ask for help, do something we are good at and care for others. I do not think those 10 pointers from the Mental Health Foundation are as well known as they should be, so I am pleased to have put them on the record. It is crucial that all of us look after our mental health, and that will help to reduce the stigma in this area.

Another issue I am passionate about is doing something about obesity, because although we have a national health service, we do not do enough to keep our fellow citizens healthy. I would like to see more emphasis placed on the excellent work of Dr Susan Jebb, an academic at the University of Oxford. She published an article in The Lancet just before Christmas showing that where GPs offered obese patients a referral to 12 weekly one-hour sessions, there was a significant reduction in the patients’ obesity.

Photo of Steve Pound Steve Pound Shadow Minister (Northern Ireland)

I am sure the hon. Gentleman, like me, is a regular reader of the Daily Mail, and he will have noticed the proposal in yesterday’s paper that people who are obese, heavy smokers or even, God forbid, both should be denied medical treatment until they lose weight or stop the filthy habit of smoking. Would he like to recommend to those on his Front Bench the adoption of that policy?

Photo of Andrew Selous Andrew Selous Conservative, South West Bedfordshire

What I am focusing on is what we can do to keep ourselves healthy and to reduce the demands on the NHS by behaving responsibly, and that is what I want to put the emphasis on.

That is important because a quarter of adults are obese, as are 14% of children between the ages of two and 15, and 18% of children in lower income households. Those figures should shame us all, and that is why I intervened on Dr Whitford and mentioned the daily mile, which was brought in by St Ninian’s Primary School in Stirling. We need to see more of that and, frankly, a strengthened obesity policy.

My daily newspaper at the moment is the China Daily—it happens to be delivered free to my office. I was intrigued to see that students at universities in China actually have to take a physical fitness test lasting 50 minutes at the beginning of each new semester or they will not be given a graduation certificate. I am not necessarily suggesting that we introduce that here, but we should look around the world to see what other countries are doing to promote the health of their populations—to keep them fit and healthy—and to reduce the pressure on health services.

At the other end of the age spectrum, we need to do a lot more to keep older people fit and healthy, as many of the issues with social care would be greatly lessened if older people were able to stay healthier into later life. I am proud to be associated with the Buzzards 50+ organisation in my constituency, which helps older people to take regular exercise at our local leisure centres. In Andorra, which I mentioned earlier, that is normal for the whole population. Older people in their 70s and 80s will regularly take part in water aerobics classes and go to the gym. When a BBC correspondent went there a few years ago, women in their 70s taking part in these exercises said, “There’s no point in spending your retirement shut up at home. What’s more important than keeping yourself fit? If you don’t keep your body moving, you won’t keep your mind in shape.” Frankly, we need a lot more of that type of activity in our own country in order to lessen the pressures on our social care system.

Photo of Mark Hendrick Mark Hendrick Labour/Co-operative, Preston 4:25 pm, 11th January 2017

We have heard from Conservative Members about the so-called annual winter crisis, as though the situation we are in at the moment has always existed. Well, there have been crises in the past, but nothing like on the scale that we have seen recently. We are hearing about corridors being used as wards. I saw this in my own local hospital when I had to take my young son there. We went through into the ward and saw queues of trolleys with patients on them before my little son was seen to.

Last December, I wrote to the Department with a question—it was answered by the Minister of State, Mr Dunne, who is in his place—about whether the Government could give the figures for the number of patients left queuing in corridors. I was told that there were no such figures. The Government and the Minister are well aware that this is going on in hospitals up and down the country. If the Government do not collect those figures centrally, but hospitals themselves collect them, the Government should ask for them; and if hospitals do not collect them, they are not carrying out their duty of care to our constituents, because it is important that people know how many patients are being held in corridors.

We hear stories about ambulances being redirected and bed occupancies being well over the 85% recommended level, and in many cases well over 95%. We have heard about the £4.6 billion of cuts in social care funding. Already, while it has not been made explicit, we are hearing talk of downgrading the four-hour A&E wait. In Preston, as I know myself, it is difficult to get GP appointments. If I ring and ask to see the doctor I want to see, I am often told that I will have to wait two to three hours—I mean weeks—to see that doctor. It probably will be two to three hours, at the very least, if I go to the hospital and it is a serious case. It is no wonder A&E is in crisis. A whole cohort of doctors in their mid-to-late 50s are looking forward to retirement. The number of doctors has increased, as we heard from the Health Secretary today, but that increase is nowhere near matching the number of doctors who are leaving the service or going to work elsewhere.

On the social care sector, in Lancashire we have seen tens of millions of pounds of Government cuts forced on Lancashire County Council. That is leaving the elderly vulnerable and more likely to have accidents at home, putting pressure on A&E as well. The mental health services—the Cinderella services—continue not to get the support they deserve. Since the closure of the acute mental health ward in Royal Preston hospital, the Avondale unit, I have seen mental health patients being decanted around Lancashire because they cannot get the care and support that they need in Preston.

Over a five-month period to August last year, we saw a 16% increase in attendance at A&E at Royal Preston hospital. Over the same period, average daily patient attendance increased from 217 per day to 255 per day. A small percentage of that increase was due to the closure of Chorley and South Ribble hospital’s A&E. I am sure that if the Deputy Speaker, my right hon. Friend Mr Hoyle, were here, he would echo what I have said. However, it is not all due to the closure of Chorley’s A&E. Many patients who would have gone to Chorley are now attending the A&E in Wigan, or elsewhere. The Government should not be allowing wards to close when the demand is so high. The daily average for the number of ambulance arrivals has increased from 68 to 91, according to the North West Ambulance Service. In the meantime, a return to a 24-hour accident and emergency service at Chorley hospital has been ruled out. At best, there will be a 12-hour A&E service sometime later this month.

Preston has one of the 134 of 138 A&E departments up and down the country in which 95% of patients are not seen within four hours. I believe it is an absolute disgrace that only four A&Es in the country are meeting the four-hour standard. It is testimony to the cuts and austerity being forced on the NHS and local government social services departments up and down the country. I call on the Government to increase spending on social care and to fund the NHS further in this year’s Budget as a matter of urgency.

Photo of Wendy Morton Wendy Morton Conservative, Aldridge-Brownhills 4:30 pm, 11th January 2017

It is a pleasure to follow Mr Hendrick in this debate. I am very conscious that I am following many Members on both sides of the Chamber who are far more learned about health matters and who bring with them very valuable experience from the frontline in the NHS.

Like all Members in the Chamber, I receive letters and visits from constituents who have concerns about the NHS and issues with their own health. As we all know, some of those issues can be very sad and emotive, and we all do our utmost to help them in what can be very difficult situations. However, let us not forget the many positive stories and experiences that we also hear about. Many of us will have had very positive experiences with the NHS in relation to how it has helped and continues to help us and our own families. It would be very wrong and unfair of us not to recognise those experiences.

I thank all NHS staff and those who work in the health and social care sectors for the work they do not just during the hard times, such as now, when there are winter pressures, but day in and day out throughout the year. In my family—my mother was a home carer for many years, and my sister is currently a practice nurse—I often hear about what it is like to work on the frontline. I also thank our local hospital in Walsall, the Manor hospital, which serves the constituents of Aldridge-Brownhills. Like many other hospitals, it faces many pressures. As we have heard today, A&Es saw the highest number of patients on the Tuesday after Christmas. I believe that all those involved in healthcare are working extremely hard to tackle this problem, and that includes the Secretary of State and his Ministers, with their work to do that and to move us towards a better and more sustainable future.

Hospitals across the country face huge pressures as we enter the winter period, as I have said. We increasingly have an ageing population, but the population is also increasing in numbers and many more treatment options are available than ever before. As we all know, many of those treatments come at a very high cost, but we would like to be able to meet that cost to help those patients. All these factors place challenges and pressures on the NHS, its staff and its resources. The impact of the ageing population has been raised with me by some of my local GPs, and we need to recognise and tackle this issue. I know that GPs in my surgeries would very much welcome the Minister if he were to drop by Aldridge-Brownhills on his way back to Shropshire one Friday for what would be a very useful and constructive roundtable discussion. That is an invitation to the Minister.

It is important to develop effective and integrated health and social care, but although money is an important factor, I do not believe this is just about money. In fact, the Secretary of State said in his speech today that we miss a trick if we say that it is. We forget that it is also about making progress on safety, standards and quality. I recall that a number of years ago, the headlines in the papers were always about really nasty hospital bugs and infections such as MRSA and clostridium difficile, and we have come a long way in working to combat those.

I am proud that the Government are committed to the NHS, and that as we enter the winter period we have nearly 1,800 more doctors and nearly 3,000 more hospital nurses than we had a year ago. We have launched the largest ever flu vaccine programme and allocated £400 million to local health systems for winter preparedness, and we have bolstered support outside A&E with 12,000 additional GP sessions over the festive period. Of course, there is and always will be more to do, but I believe that we are rising to the challenge and will continue to do so. I am sure that the Secretary of State and his team will continue to rise to that challenge as well.

Photo of Owen Smith Owen Smith Labour, Pontypridd 4:35 pm, 11th January 2017

I do not intend to take too long, because I am mindful of the fact that the motion refers largely to NHS England, but I am goaded to speak by the repeated references by the current Secretary of State, the previous Prime Minister and the current Prime Minister to the relative performance of the NHS in Wales. I want to take a few minutes to set the record straight and give a clearer illustration of the relative performance of the two NHS systems.

Before I do that, I want to reflect on the interesting, thoughtful speech that the Prime Minister gave earlier this week about her desire to create a “shared society”, as she put it, in Britain. I read the speech, as many Members did, and felt that it set out precisely what all Governments ought to be doing at all times. In one passage, the Prime Minister said:

“That is why I believe that…the central challenge of our times is to overcome division and bring our country together.”

She said that she wanted to create

“a society that respects the bonds that we share as a union of people and nations.”

I completely agree with her about that, but I find it impossible to reconcile that stated objective and rhetoric with how she and, in particular, her predecessor have sought to divide this country on the issue of the NHS. They have illegitimately demeaned the performance of the NHS in Wales, demoralised its staff and destroyed confidence and faith in it among Welsh citizens. With a few statistics, I hope to illustrate how misleading some of the representations in recent years have been.

The first statistic is that the previous Prime Minister referred to the NHS in Wales in a disparaging fashion 37 times, on every occasion as a political attempt to militate against criticism of the NHS in England. That broke the important bonds between different parts of the UK. I will state a few of the facts. The entire budget for Wales is about £15 billion per annum, and £7.1 billion of that is spent on the NHS. That is 48% of all spending by the Government in Wales. The difference between that and the situation in England is enormous. In England, the NHS budget is £120 billion, and the entire budget of the country is about £750 billion, so 16% of the budget is spent on the NHS in England and 48% in Wales. The Welsh Government’s headroom to expand spending on the NHS instead of other areas is therefore dramatically less than in England. That is the first illegitimate way in which the Government have manipulated statistics on the issue.

Secondly, over the past six years the Government have repeatedly referred to the lesser spending on the NHS in Wales than in England per head or in percentage terms. We have heard that three times today already. The truth is that in 2010 the Welsh Government, with the lower headroom that I have mentioned, chose to reduce spending on the NHS by 1% compared with the previous year. In England, there was flat cash spending. That 1% reduction was made to increase and prioritise spending on education in Wales. Since then, we have seen successive rounds of investment by the Welsh Government: £80 million was announced this week for a new treatment fund; last week, there was £40 million for capital spending. It is now broadly comparable in percentage terms. In fact, last year in Wales we spent £2,026 per head, while England spent £2,028. The difference is negligible. If we add health and social care together, we find that Wales spent 6% more per head than England. These are the realities of the comparative spending.

What has it given us in outputs? There are some things that the Welsh NHS does worse. In Wales, we wait longer for some diagnostic treatment. There is a need to spend more on more MRI scanners and CT scanners. Part of the issue, however, relates to an older and sicker post-industrial population, rural sparsity and a lesser ability to attract people to some of the more far-flung hospitals—all perfectly explicable and reasonable. In England, over the past nine months we have seen the biggest rise in waiting lists for nine years.

In other areas, Wales does well. On the crucial eight-minute ambulance response time, 77% of calls meet it in Wales, against only 67% in England. Most would agree that the 62-day cancer treatment target is vital, but in England it is consistently missed. In England, on average, 81% of people are treated within the target time; in Wales, the figure is currently 86%. There are other areas I could turn to. A&E is the crucial area we are looking at today. In Wales, 83% of patients are currently seen within the four-hour target. In England, the figure is 88%. There are 150 A& E departments in England and only six or seven in Wales, so this is another completely ludicrous and, in many respects, meaningless statistical comparison. Thirty seven of the 150 A&E departments in England are below the Welsh average. Several of the Welsh trusts are up at the 95% or 98% mark. This is a further illustration of how meaningless, misleading and frankly abusive it has been of the Tories to use the Welsh NHS as a stick to score political points.

In conclusion, the truth about the Welsh NHS is that it performs excellently in some areas and that it could be improved in others. As the OECD said, in a 10-year study of all the healthcare systems across the country, no one part of Britain performs demonstrably better or worse than any other. That is the truth about the differences between our NHS in this country. I say to the Minister that he, the Prime Minister and the Secretary of State need to remember that they are Ministers for the whole of the United Kingdom, not just England. Their duty is to increase the bonds of solidary, not destroy them.

Photo of Andrew Murrison Andrew Murrison Conservative, South West Wiltshire 4:42 pm, 11th January 2017

This has been an absolutely first-rate debate, with a number of extremely fine contributions. I was particularly taken, as ever, by the remarks of my hon. Friend Dr Wollaston, the Chairman of the Select Committee. She rightly pointed out that we are all living longer, which is a great thing, but that unfortunately our healthy lives are not expanding. This causes real problems for A&E, which has to deal with that. Although we talk about large numbers of people passing through A&E departments—they are dealing with more people all the time—the truth of the matter is that it is those with chronic long-term and complicated conditions who tend to assume the lion’s share of A&E resources and those of the rest of the secondary care system. As we get older, there will be more and more of such cases. We need to prepare for them.

We also need to militate against those cases. One thing that has not been discussed very much this afternoon is prevention and public health: our need to ensure that we deal with things that are avoidable. The Prime Minister, in her excellent speech on Monday on the shared society, rightly said:

“We live in a country where if you’re born poor, you will die on average 9 years earlier than others.”

That is absolutely appalling and we should all be ashamed. Half of that health inequality is due to tobacco consumption. Someone in a manual occupation is far more likely to be a smoker or to smoke more than a professional or managerial person. We have to be serious about controlling the scourge of tobacco. I encourage Ministers to produce the tobacco control plan, which is now overdue, as soon as possible, as we need to deal with this issue. I hope that the plan will contain some helpful remarks on the tobacco duty escalator and the licensing of retailers and involve serious conversations with supermarkets. The aim must be to reduce the availability of tobacco, reduce consumption and therefore reduce the burden of diseases that are affecting our NHS and having appalling consequences for citizens.

I very much support the Government’s amendment to the motion. I was not present when Dr Whitford, who speaks for the SNP, was speaking about community hospitals. I am sorry about that, because community hospitals are particularly important to me and I would have liked to respond to some of her remarks. I have community hospitals in my area. In particular, there is one serving my constituency at Shaftesbury that is threatened with bed closures under the STP. We need to be very careful about short-term funding cuts that might appear expedient, when we have not properly costed the service. Providing that the case mix is right—and traditionally case mixes have been pretty appalling in the NHS—community hospital beds can provide a cost-effective means of treating people, particularly the elderly, in a setting close to their homes rather than in large acute hospitals, which are the wrong places for elderly sick people. Community hospitals can deal quite effectively with some of the delayed discharge problems currently afflicting our system. As Members of Parliament, we are all sometimes faced with the political choice of whether to oppose, for our own expediency, the closure or reorganisation of services. I have faced that in my constituency. I was pleased to hear my right hon. Friend Sir Simon Burns say that sometimes we need to be brave when approaching such matters.

If we want to drive up standards and outcomes in our NHS, we will have to look increasingly at specialist centres, which will inevitably mean service reconfiguration and probably some closures. That will be disagreeable to many colleagues, but specialist centres certainly improve standards and outcomes for things such as cancer, strokes and heart attacks, and that implies regional and sub-regional services. I would not be one to oppose a closure, reorganisation or reconfiguration for its own sake. We have always to understand that resources are finite and that we need to get the best service and outcomes for the money available.

I say gently to the Minister that we need to look at funding. He will be aware of the campaign by Norman Lamb, which I support, in relation to a commission or convention. It seems a non-partisan way of trying to approach the very difficult conundrum of how we will fund the NHS going forward. I commend it to the Minister. I was pleased to hear the Prime Minister say at lunchtime that she was prepared to meet colleagues concerned about the issue to see whether this proposal could be a productive and helpful way forward. We do not spend as much on the NHS as we need to. That is the bottom line. It is no good people saying we spend 1% above the OECD average. That is not good enough, given that the OECD includes countries with which most people in this country would not wish to be compared. As the Government of the day made clear several years ago now, we need to close the gap with the EU 15, particularly with countries such as Germany, France and the Netherlands, whose outcomes are much better than ours. It is no coincidence that they spend much more on healthcare.

Today, the chief executive of the NHS is being examined by the Public Accounts Committee. I hope he will be examined on the £22 billion efficiency measures that he felt might be achievable in the five year forward view. Two years in and it is clear that those savings will not be met—they never were going to be met. We need to determine how we are going to make up the delta—the difference—between the efficiency measures that the NHS can reasonably achieve and those projected two years ago.

I want to finish by congratulating the Minister and the Government on achieving what they have. We have heard how things have improved in recent years, particularly in relation to such things as activity and hospital infections, but there is much more to do. In particular, I hope he will look closely at the funding issue.

Photo of Toby Perkins Toby Perkins Labour, Chesterfield 4:50 pm, 11th January 2017

This is a vital issue, and I congratulate my hon. Friend Jonathan Ashworth on bringing it before the House. The pressures on our national health service have a multitude of causes. Many of them are societal: whoever was in power would be dealing with an ageing population, limited financial resources and global competition for skills. However, many aspects of the crisis have a political origin, and the Government cannot continue to avert their eyes from that.

In my contribution today, I want to talk about my own experience of the pressures that our NHS staff, and particularly those in A&E, are facing, and ask Members to walk a mile in the shoes of those who are on the frontline, making life-and-death decisions every single day. My exposure to these pressures is both professional and personal. Professionally, in common with many other MPs, I have recently spent time in the A&E department of my local hospital, the Chesterfield royal, shadowing staff on the watch.

I have said that my exposure to these issues was also a personal one. Last year, on Friday 15 July, my father died of an aneurysm. Four days earlier, he had been sent home from the A&E department at Coventry and Warwickshire hospital with what a vascular surgeon described at my father’s inquest as “classical aneurysm symptoms”. With a history of vascular problems and a previous near-fatal aneurysm, he presented at the hospital’s A&E department, suffering extreme pain in his right groin, radiating to side and back. He was described as being confused and uncommunicative. Yet, after five hours in A&E, he was sent home in a taxi. Four days later, he died in my arms.

Although individual mistakes by an experienced and, I believe, respected A&E registrar were clearly made in this case, what was particularly haunting was his response to questions during the inquest about why my father was sent home. He recounted the pressures in the A&E department that day, and said that it was non-stop and particularly busy on that Friday afternoon, so that from one case to another, he was constantly having to decide, as he did most days, which sick patients, all of whom needed to be in a hospital bed, to send home this time. He said:

“There simply aren’t enough beds for those who need to be in them, so every day we have to make these choices. I probably sent home 5 people that day who should have been in a hospital bed, but those are the choices we are left with, when there aren’t enough beds”.

He asked if my father minded going home and when he did not object, he stuck him in a cab.

These pressures and these life-or-death decisions are not unique to that registrar or that hospital. Dr Stephen Hitchin, an out-of-hours doctor and an A&E doctor at Chesterfield royal said:

Chesterfield Royal Hospital have confirmed to the CCG today that they are experiencing SEVERE pressure (RED STATUS) in A&E, Emergency Management Unit, Clinical Decision Unit and critical care beds…This has come from a toxic combination of underinvestment, social care cuts, staff cuts, poor planning and GP surgery shortages. This is a failure of policy from this Government plain &
simple. They are to blame &
must take responsibility &
action to correct this crisis”.

Another consultant said:

“The only thing keeping the wheels even vaguely on is a grim determination and professionalism. Any good will to the system was eroded months ago. The government have thought that Emergency Departments can just soak up exploitation and abuse ad infinitum but we can’t. We have exceeded ‘acceptable tolerances’ long ago.”

If that is the experience of people working within the system, how can we be surprised when it leads to personal catastrophes? How can we be surprised when doctors on whom we have spent tens of thousands of pounds to train, take the expensive training and move to other countries where they feel they are better appreciated? The experiences of those consultants and registrars were echoed by those I met when shadowing the A&E department at Chesterfield royal. Other issues emerged. Certainly there were people in the A&E department who were not urgent cases and should have been at their GP. When I asked one of them why he had come to A&E, he said it was because he had been trying to get a doctor’s appointment for three days at his GP surgery and just could not get one.

The scale of the GP crisis is adding to our A&E crisis, not just because people present who should be seeing a GP, but because problems that could have been sorted out or identified if they were seen early enough escalate without access to primary care. The Government must take responsibility. The cuts in training budgets in 2010-11 and 2011-12 were catastrophic for the provision of the next generation of staff, and we are now reaping the full cost of that decision. Quite apart from the ethics of having to rely on overseas staff to keep our NHS sustainable and the impact that has on health services in developing countries, it is crazy that, at a time of a global shortage of trained medical staff, the Government deliberately cut off the flow of new home-grown recruits.

The story is similar in nursing. In 2010-11, 25,525 students enrolled on a nursing degree course, but owing to budget cuts, that number had been reduced by nearly 15% within two years of a Tory Government, and even now it is more than 10% down. The staff shortages have also led to a ballooning of agency costs: in the past two years, an additional £2 billion has been spent on agency staff. More and more money is being spent on extra staff and not, as it should be, on patient care.

We need to remind ourselves that things were different under a Labour Government. A Labour Government led to record NHS satisfaction levels, achievement of the 98% waiting target, a sustainable GP and A&E system, and, in the words of the King’s Fund, the most efficient health service in the world. The Labour Government led to much higher patient expectations, but under the present Government that progress is being eroded. By 2008, after 11 years of Labour investment, the UK’s health spending had finally caught up with that of leading EU nations, but OECD figures show that, once again, our spending is now “significantly below” theirs.

I am ashamed to say that I am grateful that my father experienced his first life-threatening aneurysm on holiday in Germany. The quality of the emergency care that he received in Munich saved his life and gave us, his family, three more years with him. I regret that the same could not be said of our NHS last year.

We have it in our hands to make our NHS once again a service admired around the world. Although the challenges that it faces are substantial, they are also predictable. If the Government had listened to those who questioned their cuts in training, the impact of pension reforms on GP retention, the impact of GP shortages on A&E departments and the impact of care cuts in the poorest areas on our health service, we would not be facing the crisis that we face today. The call for further action on A&E waiting times and investment in our care system cannot be ignored.

The Government seem to be presiding over the managed decline of our NHS, but the scale of this crisis will engulf them if action is not taken now. It means old people struggling to cope, it means the disabled being left in their homes rather than being able to take advantage of things that we all take for granted, and it means people being sent home from A&E departments to die. We must do better.

Photo of Henry Smith Henry Smith Conservative, Crawley 4:57 pm, 11th January 2017

There is no NHS A & E waiting crisis in my constituency, because there is no A & E unit. It was closed a dozen years ago by the then Labour Government, and people who need to access emergency services must now travel nearly 10 miles on single-carriageway roads to East Surrey hospital. That is the legacy of the Labour Government in my constituency.

I am pleased to say that since 2010 services have been returning to Crawley hospital as a direct consequence of the protection and, indeed, enhancement of the health budget to which the Government have committed themselves, and to which they are still committed. I know that this is often dismissed by the Labour Opposition and by others, but it is quite significant that the NHS asked for an additional £8 billion for the coming period and the Conservative Government are delivering £10 billion of extra investment. That has a very real effect.

I do not deny that there are huge pressures on our health service. As many Members have pointed out today, we have an ageing and a growing population. It is fortunate that people are living longer because new drugs are available to treat conditions that were previously not very treatable, but that puts additional pressure on the health service, although, in a way, those are nice problems to have.

We should not use this issue as some sort of political tit-for-tat. Concern for the health service and our wellbeing is felt by us all, both for ourselves and, of course, for our families and loved ones. I think that, when discussing how to address the increasing health needs of our nation, we should focus on constructive arguments rather than the political point-scoring of which we have heard so much today. I have to say that, as other Members have mentioned, in the 33 minutes of the shadow Health spokesman’s speech we did not hear a single policy suggestion on how under a Labour Administration there would be a different approach to the NHS.

I am delighted to say that Crawley this week celebrates the 70th anniversary of being designated a new town. One of the most disastrous decisions in those 70 years was the loss of the A&E in 2005, although, as I have said, some services are returning. Just yesterday a new clinical assessment unit was opened that seeks to do precisely what we have been discussing: take pressure off A&E whereby those who should not be treated in an emergency environment are triaged and signposted to better support services. That unit is to be welcomed. In recent years, a new 24-hour, seven-day-a-week urgent care centre opened in Crawley hospital as well as an out-of-hours GP surgery. As we strive to achieve that 24/7 NHS, all of these steps are ways we can better serve patients and relieve pressure on emergency care in the whole system, which almost every winter comes under additional strain.

I will support the Government amendment this evening, because we need to recognise the hard work done by our NHS staff and the additional investment. This is not just about funding, however; it is also about the way we deliver healthcare in an acute setting when people present.

Finally, I want to touch on social care, because, of course, health and social care are inextricably interlinked. We have an ageing population, as many Members have mentioned, and it has increasing health needs. One of the areas of increased health need is dementia, and I am pleased to say Crawley was one of the first designated dementia-friendly towns. That is not just a label; it means multi-agency working between health and local authorities, and indeed the voluntary and private sector, to ensure those with dementia are better supported. I am delighted to announce that recently a new ward, the Piper ward, was opened in Crawley hospital. It is a dementia-friendly ward specifically to better treat the health and social care needs of our elderly population.

I could say much more in this debate, which is of importance not just today but throughout this Parliament, but as we have limited time I will let other Members contribute, too.

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Equalities Office) (Women and Equalities) 5:03 pm, 11th January 2017

First, may I pay tribute to my hon. Friend Toby Perkins for his incredibly moving speech?

People are dying—literally. We are no longer saying people will die unnecessarily; we are now in the present tense, and we are hearing horror stories from around the country of people dying on hospital trolleys and at home waiting for ambulances to arrive. These are lives that could have been saved had it not been for this crisis.

People are dying in hospitals undetected by overworked nurses and other members of our amazing medical staff. A constituent of mine went to visit her grandad in hospital and, very sadly, found him dead in his bed on the ward. The overworked nurses had missed the fact that he was at the end of his life and had passed away. He died alone while his relatives were at home, unaware of how seriously ill he was.

I am bemused to hear Member after Member on the Government Benches standing up to defend the Government, when the facts are absolutely clear. They seem to be in severe denial. How can this be normal? How can the Government sit back and say that the solution is to discard the waiting time target? It is not the people who turn up with sore throats who are clogging up the system; it is genuinely sick people who desperately need medical attention.

Another constituent of mine arrived at A&E just last week, only to be told that she would have to wait at least 10 hours to see a doctor. That is not good enough. We are one of the richest nations in the world. It transpired that she had sepsis, a potentially fatal illness, and it is only because an overworked and stressed triage nurse recognised her symptoms and immediately instigated treatment that she is alive today and is able to tell me her horrendous story. Her treatment was started in the hospital corridor, where she sat on a chair while on an intravenous drip, because there were no beds available, not only in that hospital but in any of the neighbouring hospitals in the trust.

The theme is the same from all my constituents who come to me with their horrendous experiences. The doctors, nurses and other healthcare staff are doing absolutely everything they can. They are on their knees. No one wants to blame them, because they can see that what is being asked of them is far beyond what anyone would ever be asked to do in any other profession, but they can all see that the system is at breaking point. Instead of berating the Red Cross for suggesting that our NHS is in the midst of a humanitarian crisis, let us stop for a moment and think about why it had to use that term. Let us talk about what we can do.

We owe our incredible junior doctors so much, and they have been treated appallingly recently. A friend of mine recently attended an outpatient appointment at our local hospital and mentioned to the overworked junior doctor that I was an MP. He pleaded with her to tell me how bad things were, how overworked they were, how the NHS was crumbling around us, and how he and his colleagues could not perform to the best of their abilities due to the horrendous pressure they were under. He talked about working 12 to 14-hour shifts with a 10-minute break. He told her that he loved his job, saying that it was a vocation, never just a job. He said that he was proud of this country and its national health service, and that the only thing that kept him working here instead of fleeing abroad, as many of his friends had done, was that he cared so much for his NHS.

When is the Secretary of State going to stand up and take responsibility for what is going on? People are waiting hours for ambulances and waiting for hours in A&E. They are being treated on trolleys in seminar rooms and in corridors. Where does this end? We are already seeing the creeping privatisation of our NHS, with companies such as the dreadful Virgin Care putting profits before patients. Perhaps the end goal is for us to move to an American-style system where people are literally dying on the streets, and where someone turns up at A&E and the first question is, “Have you got insurance, and can you prove it?”

My constituency is served by two hospitals: Dewsbury and District hospital and Huddersfield royal infirmary. Both are due to be downgraded, losing vital services and beds as their respective trusts struggle to meet the financial pressures that have been placed on them. One of the hospitals that is supposed to pick up the resulting demand from the downgrades, Pinderfields hospital in Wakefield, was last week warning people against attending its A&E, and this is before the downgrades have even taken place. I am in absolutely no doubt that if the downgrades go ahead, lives will be lost. I plead with the Ministers and the Secretary of State to stop those downgrades now and to bring forward the much-needed funds that could save the lives of my constituents. It was interesting to hear the Prime Minister refer to those hospitals today at Prime Minister’s questions. She said that there were two hospitals in the trust. Perhaps someone could pass on to her the fact that there are three.

I have quoted Nye Bevan, the founder of our great national health service, before, but I feel that this is more relevant today than ever. He said:

“The NHS will last as long as there are folk left with the faith to fight for it.”

As those on the Conservative Benches appear to have lost faith and stopped fighting, it is our duty on the Labour Benches, now more than ever, to step up that fight. I would not like to speculate about when a Government Member last set foot in an NHS hospital outside of an official visit—[Interruption.]

Photo of Henry Smith Henry Smith Conservative, Crawley

Between Christmas and new year.

Photo of Paula Sherriff Paula Sherriff Shadow Minister (Equalities Office) (Women and Equalities)

I thank the hon. Gentleman for his intervention. Perhaps he should show some more empathy for the patients who are waiting on trolleys for up to 10 hours just to be seen. One thing I know for sure is that many thousands of my constituents rely on such services every day and the message from them is unequivocal: the NHS needs funds, and needs them now.

I was admonished by Mr Speaker today for berating the Prime Minister during PMQs, but let me be absolutely clear: I will continue to do that while this mismanagement of our national health service is ongoing. I will never, ever stop fighting for our NHS.

Photo of Maria Caulfield Maria Caulfield Conservative, Lewes 5:10 pm, 11th January 2017

I appreciate the opportunity to speak in this debate. For the record, the last time I was in an NHS hospital was when I was working a night shift on Saturday. I declare an interest in that I am a nurse who has worked during this year’s winter crisis, but I have also worked during winter for the past 20 years.

Photo of James Heappey James Heappey Conservative, Wells

I apologise for intervening so early in my hon. Friend’s speech, but Paula Sherriff is too busy congratulating herself on her own speech to note that my hon. Friend was working in an NHS hospital on Saturday night.

Photo of Maria Caulfield Maria Caulfield Conservative, Lewes

I thank my hon. Friend, but that is obviously not of interest to Labour Members. I have been a nurse for over 20 years and have seen 20 years’ worth of winter crises. They are not unusual. There is no doubt that there is more pressure this year than ever before—we have heard about record numbers of people attending A&E—but there have been winter crises under many previous Governments. It was not unusual when I worked in A&E for patients to be treated in corridors or on chairs—wherever there was space. It was not unusual for ambulances to be queued up around the block, waiting for hours to unload patients—[Interruption.] I still work in the NHS and disagree with the chuntering from the Opposition Benches.

Photo of Maria Caulfield Maria Caulfield Conservative, Lewes

I will not. I must make progress and others want to speak.

It was not unusual for my hospital to declare a major incident because we could not take any more patients. It was not unusual for us to take on the extra work when neighbouring hospitals declared major incidents. The truth hurts, but that is what has happened over my 20 years of working in the NHS and what has happened over the past few days of this winter crisis. It outrageous for Labour Members to suggest that it is something new. They are in denial if they believe that it has not been happening for many years.

The Labour Government was so fixated on the four-hour rule that managers used to bully us and tell us which patients would get a bed based not on clinical need, but on the need to meet a target that was about to expire. I want to tell the House a story. One night I was working in a busy A&E when an elderly gentleman was admitted. He had fallen at home and broken his hip and had to be nursed on a trolley in the middle of a busy corridor. The four-hour target was looming, and at three and a half hours he called out to me and said, “Nurse, I desperately need to go to the toilet.” I had no cubicle to put that man in. He could not get off his trolley owing to his broken hip. The best that I could do under that Labour Government was to wheel a curtain around him and he went to the toilet there in the middle of a busy hospital corridor, with his war medals on his chest. Now, he got to a ward within four hours—his target was met—but that was not good care. If Labour Members think that it was and think that this is a new problem, they have buried their heads in the sand.

Photo of Lindsay Hoyle Lindsay Hoyle Chair, Panel of Chairs, Chair, Panel of Chairs, Chairman of Ways and Means

Order. If the hon. Lady wants to give way, she will. Unfortunately, she is not, but Members cannot just stand there—two at once—shouting all the time. It is recognised that if a Member is to give way, they will, but it is up to them.

Photo of Maria Caulfield Maria Caulfield Conservative, Lewes

These problems are not new. I have also worked in out-patient settings where A&E targets have had an impact on patients waiting for elective surgery. The sheer determination to meet those targets due to pressure from the Labour Government led to patients with breast cancer having their elective operations cancelled time after time owing to emergency admissions. I had to tell a young mum, whose mastectomy operation following breast cancer had been cancelled three times while her young family were waiting for Christmas, that the only bed we had left was in a post-natal ward, where she woke up and recovered from her operation next to young mums learning to breastfeed. That was in an attempt to meet four-hour targets, so do not tell me that services have reduced. Targets were met, but staff were put under severe pressure not with quality of care but with targets in mind. I make no apologies in making that clear.

I am a supporter of four-hour targets. I was enthusiastic when they were introduced as a way of monitoring performance and improving the service, but they became the absolute king, above everything else. I congratulate the Secretary of State on introducing the consideration of outcomes. What happens to a patient when they are admitted? If they have to stay for four-and-a-half hours to avoid admission or to get full care, what is the problem with that? If they can leave within two hours because they have been adequately treated, fantastic, but we should not be held to account by an arbitrary four-hour rule that has no clinical significance. I support the four-hour rule, but there are other measures that we also need to be aware of and that should be treated with equal status to the four-hour target.

Of course money is important. As our ageing population, and our ability to treat more patients, grows, we will need more funding for both healthcare and social care. It is worth noting that the trusts either side of my constituency receive the same funding and look after the same types and numbers of people. One is in special measures, is unable to deal with its discharges, has queues and is unable to meet its four-hour targets; the other, five miles along the coast, is rated outstanding, does not have the same pressures or four-hour waits and is able to discharge its patients speedily. There is something about what happens to the money, as well as about how much the money amounts to.

Labour did put huge amounts of money into the NHS over the years, but much of it was squandered—£10 billion on a failed IT project that never saw the light of day, and PFI deals that are still costing the NHS £2 billion a year. How much could be done with that £2 billion?

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

I commend my hon. Friend for making a balanced speech and for rightly saying that meeting targets does not necessarily equate to delivering good healthcare, although they do have their place. Does she agree that one of the biggest challenges is the consistent inability of a number of A&Es across the country to recruit middle-grade doctors? That is one of the biggest problems that has not been addressed to date.

Photo of Maria Caulfield Maria Caulfield Conservative, Lewes

I absolutely agree that there is a problem in recruiting staff, particularly in the south-east—including in my constituency—in all healthcare professions because it is an expensive place to live. I agree that there is an issue with recruitment but, if we are to move forward, we need to work in a more cross-party way. Continually using four-hour targets as a stick to beat the Government with does nothing for cross-party working, so we need to stop the political cheap shots and recognise that money is not always the solution—it is about how the money is spent and the difference it can make. This also has to be clinically led. We can work together as politicians, but if we do not work with healthcare professionals, in both primary care and secondary care, I fear that we will be sitting here again in the years to come to talk about another winter crisis.

Photo of Norman Lamb Norman Lamb Liberal Democrat Spokesperson (Health) 5:18 pm, 11th January 2017

I join many others in commending those who work in our NHS and in our care system, including the hon. Members for Lewes (Maria Caulfield) and for Central Suffolk and North Ipswich (Dr Poulter) both of whom continue to work in the NHS, I think without payment—[Interruption.] Not any longer. It is important that we acknowledge that many people in the NHS are working under incredible strain, and we owe them a debt of real gratitude.

I make it clear that I support the Labour motion, and I recognise the importance of access standards in our health service. After arriving here in 2001, my first Westminster Hall debate was on waiting time standards in Norfolk for orthopaedic cases. People in those days were sometimes waiting three years for treatment. So the waiting time standards that were introduced dramatically changed people’s experience of healthcare, and we should celebrate that. But it is also right to say that sometimes the standards distort behaviour, and those distortions need to be addressed, as the hon. Member for Lewes made clear. Another example to cite is that of the ambulance standards, where I am concerned about a very serious distortion of behaviour, which often causes enormous frustration for paramedics, who are also working under ludicrous amounts of pressure.

The other point I wish to make on access standards is that although I totally applaud the Labour Government for introducing them, they did not introduce them for mental health. That is why we now have to complete the picture. This Government have confirmed that they accept in full the Paul Farmer taskforce report on mental health, but it includes the proposal to roll out comprehensive maximum waiting time standards in mental health, so that someone with mental ill health has exactly the same right as anyone else to get access to good-quality, evidence-based treatment on a timely basis. We put this in an amendment that we tabled for this debate but which was not selected, but I urge the Government, as they have accepted that report, to make sure it is now implemented. The current situation amounts to a discrimination in the health service; how can we possibly justify the fact that someone with mental ill health does not have the right to timely treatment which other people enjoy? We have to end that discrimination.

The final thing I wish to address relates to the question I asked the Prime Minister today. I asked her to meet a group of cross-party MPs who are proposing that the Government should establish what we are calling an “NHS and care convention”. We feel that is an opportunity to engage with the public in a mature debate about the scale of the challenge we all face. We can trade insults across this Chamber, but we all know in our heart of hearts that the system is under unsustainable pressure—that is the truth of it, and we know it. At some point, as the hon. Member for Lewes conceded, we will need extra resources in the future, so let us plan now. Let us get everybody on board and get cross-party support, because sometimes, just as we saw with Adair Turner in the last decade under the Labour Government, we need a process to unlock a problem that ordinary partisan politics has not been able to resolve.

I welcome the fact that the Prime Minister agreed today to meet a group of us who are making this call. We have also set up a petition on the Parliament website so that any member of the public can join this call. I urge hon. Members from across this House who support this call to join in, because not only is it in the Government’s political interest to do this, but it is fundamentally in the interests of the citizens of this country that we in this House collectively address an enormous existential challenge to the NHS and the care system. We surely cannot tolerate more than 1 million older people not getting access to the care and support they need. I do not want to live in a country where someone’s access to care and support in old age depends on whether they can pay for it, but we are at genuine risk of slipping towards that situation. If we all believe that that is not tolerable, we have a duty to act. We must be prepared to act together, not just trade insults at each other. There is a real opportunity now to do what the public are desperately pleading for us to do: bury our differences and work together to achieve a long-term, sustainable settlement for the NHS and the care system.

Photo of Derek Thomas Derek Thomas Conservative, St Ives 5:23 pm, 11th January 2017

There is no doubt in my mind that the meaningful integration of health and social care is the most important issue facing the NHS today. The most productive way to address the issue of bed-blocking is by integrating services, pooling resources, and dramatically raising the profile of and support for community health professionals and care and support providers. We often hear of the problems facing the health services, but I am going to try to concentrate on the solutions.

Last November, I set up a local inquiry, identifying a number of people across the constituency and getting them together to investigate what health and social care could and should look like in west Cornwall—this is all part of the STP process in Cornwall and the Isles of Scilly. Together we are asking that question of representatives of health and social care providers. We are talking to GPs, NHS providers and managers, health campaigners, care providers, day-care managers, pharmacists, mental health clinicians, hospital matrons, Age UK and others—I am even including my predecessor in the discussions. All the clinicians we have met have identified savings that can be made through integration that they believe would improve patient care.

The results of the local inquiry will set out clear recommendations to be considered as part of the sustainability and planning process in Cornwall and the Isles of Scilly; however, it is clear from the evidence we have heard that extra funding will be required to implement the planned transformation. The health services in Cornwall and on the Isles of Scilly already have a deficit that runs into tens of millions of pounds. Delivering rural health services is an expensive and under-funded exercise in Cornwall and the Isles of Scilly, and we in that part of the country long for a fair funding agreement for health and social care. People in my constituency agree that we must integrate health and social care. They also agree that extra funds are urgently needed to fund that integration.

In the autumn statement, the Chancellor confirmed Government plans to continue to increase the tax allowance threshold for workers. I completely agree with efforts to lower the tax burden, but my constituents have asked me to look at how we might raise taxes to help the integration of health and social care. On that basis, would the Government consider pausing the increase announced in the autumn statement and using the revenue generated to fund the transformation of integrated services? That could provide just shy of £6 billion over the rest of the Parliament to help health and social care providers to make the improvements they need and to reduce costs in the long run, while improving patient care.

One example of where extra funding would have dramatic results is if the pay and support for care and support workers was increased. In west Cornwall, some community care workers are paid as little as £7.20 per hour, yet they do incredibly important work in keeping people at home and in safe and good conditions. Because of such low pay and the pressure on care workers, we struggle to recruit and retain such valuable employees. Were we to look at pausing the increase in the tax allowance threshold for just a short time, the money saved could help to integrate the services to which we are all committed, thereby helping to make the savings and improvements in patient care that we all want to see.

Photo of Sue Hayman Sue Hayman Shadow Minister (Environment, Food and Rural Affairs) (Flooding and Coastal Communities) 5:27 pm, 11th January 2017

The Government say that their success regime for the NHS in Cumbria is about transforming health and social care to create a

“centre of excellence for integrated health and social care provision in rural, remote and dispersed communities.”

That sounds fantastic—it sounds like exactly what we need. If that is the case, though, why are local people are so concerned about the actual proposals that there is a petition for a vote of no confidence in the regime? Why did the Secretary of State himself say earlier in the debate that he has profound concerns about the quality of care in Cumbria?

West Cumbria is set to see rapid population growth, owing to the proposed nuclear new build at Moorside, alongside proposed coal mining and tidal energy projects. There are concerns that none of this is being taken into account. Nevertheless, I shall focus on my particular concerns about the proposals for maternity services and community hospitals.

First, on maternity, the highly skilled and experienced midwives in west Cumbria have told me that the success regime’s preferred maternity option is not their preferred option. The idea behind the success regime is to

“bring more care closer to home”, with a model that would

“ensure provision of safe, high quality care and provide a first class experience”.

But the midwives ask how that can be achieved through the proposals to change maternity care at West Cumberland hospital when the success regime’s preferred option sees the choice of birthplace removed from hundreds of women and would potentially see severe delays in women and babies receiving life-saving assistance. The clinical outcomes and satisfaction rates at West Cumberland hospital under the current maternity care system are excellent, and show that safe, high-quality care is being provided. The proposed changes would bring inequality, preventing fair access to maternity services across the county, and discriminate against west Cumbrian women who would no longer have a choice in maternity care, particularly those who are vulnerable owing to deprivation and social isolation.

The proposals will mean that around 700 additional women will deliver their babies at Carlisle every year, but where will they be cared for? The Cumberland infirmary in Carlisle already struggles with its current workload. West Cumbrian mothers need proper answers on this. In addition, a proposed new garden village is to be built south of Carlisle with 12,000 new homes. How on earth is the Cumberland infirmary expected to cope?

I am particularly disappointed that there is no option in the current consultation document to keep beds at Maryport and Wigton community hospitals. All the proposals remove all the beds at those hospitals. This will be particularly difficult for the relatives of patients who are having end-of-life care, because they may be elderly and have their own medical conditions. With no transport of their own, travelling to visit family members can be particularly arduous.

Both hospitals serve areas with considerable deprivation and very poor local transport links. Patients and families in Maryport may have to travel to the community hospitals or the acute hospitals. Journey times would be long with poor bus links, making it difficult for elderly and disabled people.

The people of Maryport feel very strongly about the changes and have run a passionate campaign to show people involved in the success regime just how much the community hospital means to them and how it is an integral part of the local community. They are deeply upset at the removal of the beds.

It is imperative that all services are delivered as close to people’s homes as possible. This must include the retention of beds at all our community hospitals and the retention of consultant-led maternity services at West Cumberland hospital.

I shall finish with a very personal experience, which relates in particular to beds in community hospitals. Not long before Christmas, my father was taken seriously ill. We managed to get him transferred from the acute hospital to his local community hospital, which was within walking distance of his home. He knew the staff at the hospital, and the district nurse was able to call in to see him. When it became clear that he was at the end of his life, we tried very hard to get him moved home—we had a hospital bed set up in the living room. Unfortunately, the move was not possible. However, unlike the experience of my hon. Friend Toby Perkins, my father had a good death in his community hospital. All my constituents should have the same opportunity that my family had. We were able to be with my father at the local community hospital where he knew the staff and the district nurse who came to see him. If we remove palliative care from our community hospitals, we will be making a terrible mistake.

Photo of James Heappey James Heappey Conservative, Wells 5:33 pm, 11th January 2017

The Wells constituency faces some real challenges in healthcare. We have an ageing population, and demand for the local NHS is growing rapidly. There is no doubt that our primary healthcare system is under considerable strain, as is our adult social care system. Our hospitals, too, face record demand. However, to call this a crisis does a disservice to those in the clinical commissioning group and our local hospital trust who have worked so hard to prepare for the incredible challenges that they face this winter.

Demand in the four A&Es that serve my constituency was significantly higher in the week between Christmas and the new year than in the same week the previous year. In two A&Es, demand almost doubled. I know that the A&E staff had to work extraordinarily hard to meet that demand and I know, too, from some constituents who contacted me that some people were not seen within the time that they might expect. However, I have heard from others who arrived at A&E expecting bedlam, only to be seen in well under four hours. Indeed, during last year’s Christmas recess, I spent the early hours of Christmas eve in Weston General hospital’s A&E with my then three-year-old. Like this year, the Labour Front Benchers were claiming crisis, yet I saw some incredible clinicians doing an incredible job well within the required timelines. Moreover, an outpatient appointment needed in the week between Christmas and new year was easily arranged and kept. My personal experience is just one of the millions of experiences within our NHS each year, but I highlight it because if we are to have an honest, factual debate about our health system, we should caution against the emotion of individual experiences, for there will always be at least one that illustrates whatever point we seek to make.

Further into the hospital system, three of the four hospitals that serve the Wells constituency had more beds available in the last week of 2016 and the first week of 2017 than they did in the corresponding period in the previous year. Although occupancy at Taunton and Yeovil was 81% and 82% respectively last week, it is true that occupancy in Bath was 93%, and in Weston-super-Mare 100%. Make no mistake: occupancy levels such as those are a cause for real concern. But it is also important to note that although things are tight, so far the trusts are managing. However, I know that in all four of those hospitals, particularly in Weston, far too many beds are blocked by those who would be discharged if care at home could be arranged.

The Government have made more money available for adult social care and have given councils greater flexibility to increase council tax in the interim, but Somerset County Council and our local NHS organisations are justifiably still very concerned. I encourage the Government to look again at the local government funding settlement and adjust it to ensure that the funding gap between urban and rural areas does not widen, and that funding for adult social care clearly and fully reflects the places in the country where the demographic is most top-heavy and where rurality increases the costs of delivering that support.

Finally there is the challenge that we face locally in primary healthcare. Local practices have assured me that anyone requiring an emergency appointment is seen on the day. However, it is true that my constituents are too often expected to wait a week or more if they ask to see their regular GP. Quite understandably for those with longstanding and complex health issues, they expect to see the doctor they know, so these waits are unacceptable, but it is wrong to connect the waits solely with funding. The greater challenge in Somerset is not the primary healthcare budget, which has risen for each of the past three years, but our ability to recruit new GPs.

The Secretary of State has worked hard to deliver more GPs into the whole system, but now rural CCGs such as Somerset’s will need to look at what initiatives could be developed to encourage new GPs to ply their trade in rural general practice. Furthermore, we must listen to and support those responsible for our STPs. We have called again and again for politicians to keep our noses out of NHS planning. Now that we have and local clinicians are now at the helm, the Opposition dismiss their work as well because it is politically expedient to do so.

The STP in Somerset has been written by people who really know their craft. When I asked them whether they would have written the plan as it is, even if there were no resource constraints, they told me that they would. They say that the demand has changed and that the thinking on public health has changed, and they tell me that the clinical view of how and where people should recover after they have been in hospital has changed too. Things will change still further over the years ahead.

Some of the things that the STP proposes are very challenging to me and some will be very unpopular with the community I serve, but the analysis is based on an expertise that far outstrips mine, so unless I am being implored now to reassert the supremacy of politicians in these matters—we have, after all, apparently had enough of experts—I think we owe it to the clinicians empowered to now design and run our local healthcare systems to scrutinise, of course, and to support them. Moreover, those clinicians deserve to do that work without the partisan hullabaloo being stirred up by the Opposition. Our inboxes give us a great feel for how things are. Our conversations with constituents, clinicians and patient participation groups, such as the one in Cheddar that I will see tomorrow night, shape that view too. To claim that all is perfect right now is not true, but to claim that there is a crisis is not true either. Our population and the practice of medicine are changing. This debate needs to happen—not in a partisan furore, but in an honest, constructive and supportive way.

Photo of Thangam Debbonaire Thangam Debbonaire Opposition Whip (Commons) 5:40 pm, 11th January 2017

I was going to speak about the effects of cuts to health and social care funding on hospitals and healthcare in the south-west, but all the things I wanted to say have been eloquently said by other hon. Members. So, in keeping with other speeches I have made recently, I have decided not to repeat what has already been said, to scrub all of that from my speech and to talk about something completely different: the health consequences of loneliness in older people; the impact of funding cuts to NHS and social care systems on loneliness; and the impact of older people’s loneliness, in turn, on the healthcare system.

In the run-up to Christmas, I was regularly blinking back tears on the underground whenever I saw the advert from Age UK, which I am sure many hon. Members will have seen, which had the slogan, “No one should have no one at Christmas”. For Members who might not remember it, it looked something like the Age UK report “No one should have no one”, which I have here and which I re-read yesterday. It was published in December last year and is about loneliness in old age. Reading that report brought home to me just how much loneliness affects older people and how funding cuts that may appear small and insignificant can have a cumulative effect on older people.

A constituent illustrated that to me recently when she came to talk to me about her worries for the older people she cares for as a very low-paid care assistant. She was not complaining about her pay, by the way—I am just making that observation. She told me that she regularly stays well beyond her low-paid hours because she feels the people she is working with need her. That is partly because they have greater care needs than can be dealt with in the time allowed, and also because they are lonely. As I said, she was not complaining, but if we starve social care of funding, people such as her will be subsidising the health and social care system. She is doing that voluntarily, but things should not be left to chance like that.

The Age UK report mentions the survey that it carried out of 1,000 GP practices as part of its campaign in 2013 to end loneliness, which found that nearly 90% of GP practices felt that some patients were coming in because they were lonely. The report also points out that funding cuts mean that meals on wheels, day centres, libraries, community centres, lunch clubs and public toilets have been cut or closed in recent years. It points out that all of that decreases the opportunities for older people to get out, socialise, take care of their health, eat well and exercise, which increases their loneliness and isolation and damages their health.

What does that have to do with chronic serious illnesses? Age UK carried out an evidence-based review for its loneliness report, and it found that chronic loneliness increases the risk of serious illnesses such as diabetes, stroke, depression and dementia, as well as making it much harder for people to get out and receive help or do things that might prevent those conditions from getting worse, such as exercise or having a good diet.

I pay tribute today to all the people across the country who give their time as volunteers, staff and fundraisers for charities such as Age UK nationally and locally, and in Bristol, for Bristol Ageing Better, which does so much to combat loneliness in older people.

Let me read one example from the Age UK report:

“Arthur’s son was worried that his health was deteriorating because of the many hours he was spending alone in his flat in sheltered accommodation. He was unwilling to participate in group activities because of difficulties hearing. He had had a busy social life, but most of his friends had died...Age UK introduced him to Paul, who had had to retire early after an accident and was feeling increasingly isolated...They play dominoes and cribbage. They dissect the latest football match and reminisce about their time in the building trade—swapping funny stories of mishaps and adventures. Paul has provided Arthur with good company and a ‘link’ back to the job he loved. Arthur has helped restore Paul’s sense of purpose and self-worth.”

That example, and the many others in the report, show just how much work on loneliness can help to improve older people’s health and to reduce the costs on our health and social care system.

It is vital for the Secretary of State to address what the CEOs and staff in NHS hospitals and primary care in my area have told me about the impact that cuts to social care have on delaying discharge from hospital, and I hope that he does so. I also want the Minister to tell us exactly how he and the Secretary of State are going to lead the way in providing us with a fully integrated and fully funded health and social care and mental healthcare service.

I want us all to read Age UK’s report and follow the recommendations that it makes for MPs, among others. It asks Members of Parliament to

“Find out…about loneliness among older people in your constituency…raise awareness…Become an Age Champion”, and to encourage our own political parties to do more. It asks us to

“Take steps to put loneliness in later life on the Government’s agenda”—

I hereby do that—

“and hold them to account for progress”, which I will continue to do. It asks us to

“Make the case for investment in local community resources to support sustainable, long term action to help lonely older people, wherever they may be.”

I urge the Government to take note of that. Finally, it asks us to:

“Support the work of the Jo Cox Commission on Loneliness”, which is launching shortly. I would like us all to take those words to heart.

Photo of Helen Whately Helen Whately Conservative, Faversham and Mid Kent 5:46 pm, 11th January 2017

It is a pleasure to speak in this debate and to follow hon. Members who have made very thoughtful contributions. Thangam Debbonaire spoke about loneliness, which is a problem across the country, and the very important work that is being done on that. It is also a pleasure to follow colleagues who have spoken about their personal and family experiences. My hon. Friend James Heappey, Toby Perkins, who is no longer in his place, and Sue Hayman spoke about their experiences, both good and bad, of the national health service.

I, too, have personal experiences both good and bad. Three years ago, I spent Christmas day night in A&E with my son, who was five at the time, and who had his appendix taken out first thing in the morning on Boxing day. He had absolutely exemplary care and was home within two days, eagerly making up for the quantity of sausages that he had omitted to eat on Christmas day because of his tummy ache. Last Christmas, my grandmother, then aged 100, was in hospital—she was there for several months—and she had a much, much worse experience; it was not the NHS at its best. We all have good and bad experiences to draw on. We hear from our constituents, as well, about these good and bad experiences. It is important to recognise what the NHS does well, and is doing well, but also where the system is failing, and to focus on supporting the good and tackling the bad.

I very much understand why this debate has been called, because there is no question but that the NHS is under extraordinary pressure this winter. We have heard that last week it had the busiest week ever. However, I am quite disappointed by the tone of some of the contributions and more significantly by the lack of proposals from those who just said that that there is no money and made no suggestions as to where the money will come from. That is fundamentally unhelpful.

Photo of Barbara Keeley Barbara Keeley Shadow Minister (Mental Health and Social Care)

It is very clear where the money is to come from—we are asking for £700 million to be brought forward from the better care fund from 2019. It is already allocated.

Photo of Helen Whately Helen Whately Conservative, Faversham and Mid Kent

I appreciate the hon. Lady’s point, but bringing money forward still requires it to be found. This is set against a backdrop of Labour, in 2015—less than two years ago—not committing to fund the NHS with the money that it was asking for, as this Conservative Government are now doing. Labour is in rather a shocking position.

I want to seize this opportunity to say a very heartfelt thank you to all members of NHS staff—nurses, doctors, allied health professionals, porters, care assistants—and those in social services, particularly those in and around my constituency in Kent, who I know are working extremely hard to deal with the pressure on the frontline. I also thank patients and their families who are being thoughtful and taking care to make the best use of the NHS.

We know that there is great variation in how the NHS is coping. I have just been told that the waiting time in Maidstone A&E is—as we speak—only 37 minutes, so Maidstone is coping pretty well right now, but at the nearby William Harvey hospital in Ashford it over four hours, so there is variation. I do not say that so that people listening can divert from where they are going; there may be a case for that and for greater transparency, but that is for another day.

We talked earlier about money. There is no question but that this issue is partly about the need for more funding and more staff, but the Government are doing exactly that: they are giving the NHS more money and investing in significant increases in the workforce. However, money is not the whole answer. If the NHS just continued doing all it does in the way that it does without any change, we would find ourselves with a system that was unaffordable and that used a proportion of GDP for which there would not be public support. We know that we have an ageing population—people are living longer and have multiple complex conditions—and that high-cost treatments are becoming available that people want, so the NHS itself recognises that this is not just about more money but about changing the way in which services are delivered.

Such changes are being worked on and are actually happening at the moment. Earlier today, I spoke to the hospital trust chief executive who is the lead for the Kent and Medway sustainability and transformation plan. STPs have come up several times today. As I have seen, under him and the group around him, there has been a coming together across Kent and Medway of NHS organisations that have not tended to work closely together. The coming together of the NHS and social services is so important, so necessary and so right if we are to work out how to provide a better health service in a more sustainable way. We need to break down the barriers between organisations as it just does not make sense to have a split between the NHS and social care in who provides what. We should look at how we can genuinely move care out of acute hospitals and closer to home, which we know is good for patients. It is exactly what the hon. Member for Workington hoped for her father and what we wanted for my grandmother as she neared the end of her life.

We need to enable people to be looked after closer to home or preferably at home, and to improve prevention and—I feel particularly strongly about this—mental health care. The Prime Minister has taken a personal lead on mental healthcare with her announcements on Monday. In the light of the pressure on A&E, I particularly value the commitment to psychiatric liaison in A&E departments, which we know is helpful in the prevention of suicide, is good for people who go to A&E with mental health problems and helps A&Es look after the people who need to be seen for physical health problems. I welcome the fact that my area of Kent is looking at bringing that forward and having psychiatric liaison in all A&Es by 2018. Really important work is therefore going on at local level.

I encourage Labour Members not to make the knee-jerk or even tear-jerk speeches that some have made, but to take a longer view of the situation. That would help us to have a more mature conversation about what the NHS needs, and to talk about policies and concrete proposals, rather than just about having more money, to solve the problems. It would also enable us to get behind what the NHS is doing at local level, where the NHS and local authorities are coming together to draw up plans across their areas for better care for patients in an affordable and sustainable way.

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Culture, Media and Sport) (Sport) 5:54 pm, 11th January 2017

After four years of having responsibility for the national health service, the Secretary of State for Health has declared:

“We need to have an honest discussion with the public about the purpose of A&E departments”.

We, who have seen his work from this House, and those who have felt the effects of his work on the frontline, know exactly what he means—“Let me tell you why everyone is to blame except for me.”

Earlier this week, the Secretary of State told the UK that nearly one in three visits to accident and emergency do not need to be made. That was his reasoning for weakening the target that every patient should be seen within four hours. That target applies only to people whose condition is serious and urgent enough, so I find staggering the sheer hubris of those comments, the avoidance of accountability in that decision and the danger inherent in both. As an A&E specialist doctor, I have treated patients who arrive in A&E with what seem like minor injuries or illnesses but develop into much more serious and life-threatening issues. The fact that the Secretary of State, both in his words and in that decision, is telling the people of the UK that they should self-diagnose before heading to A&E could have disastrous consequences, for which he would be responsible.

What if, because of the Secretary of State’s words, patients decided to stay at home after a serious bang on the head that turns out to be a life-threatening bleed to the brain? What about a potentially deteriorating case of pneumonia that is not serious enough to warrant being in A&E but eventually results in somebody becoming severely septic and dying?

As a citizen of this country and a patient of the NHS, I find the Secretary of State’s refusal to accept responsibility for the state of A&E departments deplorable. Instead, he blames patients for visits that “do not need to be made”. However, patients do not go to A&E for fun. They go because they are ill and cannot get a doctor’s appointment for two weeks. We have heard today from Members on both sides of the House who have taken their own young children to A&E. Did they do so for fun, or because they felt there was a need for their child to be treated? People go to A&E because their GP does not have resources at their practice, in some cases for something as simple as handing out crutches. They go to A&E because there is something wrong and they are worried sick and simply desperate to speak to somebody professional about their health.

Photo of Lindsay Hoyle Lindsay Hoyle Chair, Panel of Chairs, Chair, Panel of Chairs, Chairman of Ways and Means

Order. Let us just calm it down. Government Members did not give way before, and let us not get into the habit of shouting at each other. Let us have a nice, sensible debate.

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Culture, Media and Sport) (Sport)

Many people who go to A&E know that they should not be there. I have had elderly patients saying to me, “I’m so sorry, doctor, for wasting your time.” But what other option are the Government leaving them? That is what we are debating today. The Secretary of State wants an honest conversation—well, let us have it. Let us talk about the impact that the current state of the national health service, which he has been in charge of for four years, is having on accident and emergency departments and throughout hospitals in this country. Let us talk about rock-bottom staff morale. Let us talk about the breakdown of staff marriages, a rise in depression among staff and the fact that waiting times are not the responsibility of patients. They are not to blame.

Rising waiting times are the Secretary of State’s responsibility, yet he blames them on the number of people going to A&E since the target was set. It is his responsibility to lead a national health service that can meet the needs of its people, but again he pleads innocence. He says that no other countries have such stringent targets, suggesting that it is unfair that we do. The meeting of the A&E target in particular, not watered down but in full, is what establishes the NHS as the best health service in the world, and one that we can, should and would be proud of under a Labour Government. After all, emergency departments’ ability to meet the four-hour target is directly related to the health of the NHS itself. It is simple: more people go to A&E when they have no other options available.

Photo of Sue Hayman Sue Hayman Shadow Minister (Environment, Food and Rural Affairs) (Flooding and Coastal Communities)

On those options, the use of A&E in my area of Cumbria is entirely down to the lack of GPs. With so many GPs reaching retirement age, the situation is only going to become more acute. Does my hon. Friend agree that the Government need to tackle this matter urgently?

Photo of Rosena Allin-Khan Rosena Allin-Khan Shadow Minister (Culture, Media and Sport) (Sport)

I wholeheartedly agree with my hon. Friend. She makes an eloquent point about the lack of GPs and the problems we will face when more retire. Three GPs in my constituency contacted me this week to say that they had been offered jobs that were subsequently retracted due to financial pressures.

The Secretary of State pleads innocence. He says no other countries have such stringent targets. We should not compare ourselves to the worst; we should be leading as the best. The explosion of waiting times is his failure and a sign of the dangerous erosion of one of the country’s greatest institutions. As we saw last week when the British Red Cross had to be drafted in to our hospitals, our NHS is in crisis. Yet instead of listening to doctors and fixing the systemic problems they have created, our Government are repackaging the A&E four-hour target to try to save face and take attention away from the real challenges: the challenge of social care packages not being in place, prohibiting flow through A&E departments; the lack of access to GPs across the country, making A&E the only resort; the chronic underfunding and significant cuts in funding at local authority level; doctors and nurses being forced to miss breaks, as we heard earlier today, and working 14 hours, some without a break, sleep-deprived and unsafe to practise clinical work; and an NHS staff who do not feel supported, encouraged or motivated by the Government. None of these things will be addressed by a watered down four-hour target.

Having spoken to the Royal College of Emergency Medicine, those working on the frontline at all levels, and those who are training our junior doctors, I would like to put forward questions for the Secretary of State to think about. Why has it been decided that the four-hour target will now be downgraded? Who has been consulted on that? Which body said it would be beneficial to patients and A&E staff across the trusts? How will he define major and minor health problems? How are doctors and nurses magically meant to know, at first sight without proper assessment, whether it is a major or minor health problem? Who is responsible if a seemingly minor condition is actually life-threatening? Will it be him? Who will be responsible? How will the Government explain that we will be going back to the days when patients could wait over 12 hours if they were not considered ill enough?

The Secretary of State must recognise the impact of this systemic crisis on A&E rooms across the country in his words and in this decision. To downgrade the target, the Secretary of State does neither, instead placing blame on patients and putting patients at risk. Let me tell it straight: I have been an A&E specialist doctor under a Labour Government and under a Conservative Government. There has been a change under this Government—and for sure it has not been for the better.

Photo of Lucy Allan Lucy Allan Conservative, Telford 6:03 pm, 11th January 2017

There have been very many excellent and constructive contributions to this debate. I welcome the valuable input from those who have real life experience in the NHS. In particular, I congratulate my hon. Friend Maria Caulfield on her excellent speech. It was very disappointing indeed to see an Opposition Member behave with such disrespect for a fellow Member during that speech. We all owe a debt of gratitude to those on the frontline. None of them would thank us for reducing this debate to an ill-tempered party political act of posturing.

I know there are many sensible Opposition Members who fully understand that no complex problem is ever solved by just increasing funding in response to ever-increasing demand. There are some very strong Opposition Members who want to work in a constructive fashion with Members across the House to tackle the challenges our NHS faces. I welcome that. Caroline Flint is one such sensible Member. She made a point earlier this week, on the BBC Radio 4 programme “Westminster Hour”, that it is not even electorally advantageous for the Labour party to treat the NHS in the way it so often does—we have just heard an example of it. It is for the benefit of all our constituents that we must all encourage a more constructive approach.

The four-hour target was introduced for those with urgent health problems. I am sure that all Members agree that those in need should get access to care as soon as possible, and not find their needs eclipsed by someone with a minor ailment just because targets must be met. The Secretary of State has spoken this week about his commitment to protecting the four-hour promise for those who need it, and he is absolutely right to say this, because today, if we talk to those who work in our local A&Es, as all Members do regularly, they often say that there are people going to A&E who do not need to do so, and clinicians will express the desire to be able to prioritise need, rather than simply meeting targets.

As a constituency MP, I fully understand that it can be incredibly difficult to see a GP when one wants to, and it can be equally difficult to navigate the system—ringing at the right moment to get an appointment on the right day—but the answer is not simply to circumnavigate the system and turn up at A&E to get fast-tracked irrespective of need. We should not be encouraging the expectation that whatever the ailment, no matter what the demands on A&E staff, if someone goes to A&E, they will get seen within four hours. If people are going to A&E who do not need to be there, why are we offering them the four-hour service?

I would be grateful if the Minister told us more about what can be done to tackle this issue. Perhaps he could mention what proposals there are for GPs in A&E or different mechanisms for triaging or managing the expectations of our constituents. What matters most is that those in need get access to the appropriate treatment as soon as possible. That is what the target is for. It must be about safety for those with critical and urgent health conditions.

We must never lose sight either of the fact that our health and wellbeing are often dependent on our lifestyle, and with the right help and support we can all make the right choices to help us live healthy and happy lives. Diet, stress management, sleep hygiene, exercise, alcohol use and smoking are all key determinants of our physical and mental health and wellbeing. I would like a much greater emphasis to be placed on self-care and self-help, because we can all play our part and because no amount of funding will ever compensate for a lack of self-care.

Yes, we need to take a grown-up and honest approach to this incredibly important issue, which matters to all of us who have spoken so passionately today—I respect the passion of all Members on both sides of the House—but we must avoid falling into the trap that some have fallen into today of approaching this debate in a way that lets ourselves and the House down and does not benefit those we most wish to assist. So, yes, let us keep on exploring a sensible and collaborative approach, as articulated so eloquently by Norman Lamb and my hon. Friend Dr Wollaston, who has echoed the sentiments of others and is doing excellent work in working together across the House. None of us should ever play politics with the NHS; it matters far too much for simple games.

Photo of Jenny Chapman Jenny Chapman Shadow Minister (Exiting the European Union) 6:08 pm, 11th January 2017

It is a pleasure to follow Lucy Allan. I have not heard her speak before, and I look forward to hearing many more speeches from her in the future, but I completely disagree with her implication that we are letting ourselves, the House and our constituents down by standing up and championing health services in our constituencies. It is an essential part of our work and the reason many of us sought election to this place, particularly those such as my hon. Friend Dr Allin-Khan, who has such relevant experience of this subject and made a tremendous speech. I listened with great interest to what she had to say, and I think that Ministers ought to be doing the same.

We have had a lot of debate about whether the NHS is in crisis, and whether it is a humanitarian crisis, an ordinary crisis or a winter crisis. I looked the word up and found that a crisis is “a period of intense difficulty or danger”, which strikes me as a good description of where the NHS is today. Intense difficulty is what I am seeing in my local hospital, and it is what my constituents are coming to tell me about.

I have been an MP for nearly seven years, and I keep track of the topics people come to talk to me about in my local surgeries. I am sure many of us do that; it is not hard to do. Someone comes to see me every week either about an experience at the hospital or, more often still, because of an experience in adult social care. That is not something that has occurred suddenly over the last few weeks; it has been growing over time. I would say that the crisis we are witnessing today has been long predicted and is something that we have all felt happening over time.

The Government have chosen—they made a decision—not to act to prevent the worsening of the crisis, which is why there is such anger on the Opposition Benches. When a quarter of patients wait longer than four hours in A&E, that is a crisis. I do not really care whether they are there with an minor ailment or a more serious one, because four hours is too long to wait. The fact that people are there with minor ailments is a very clear demonstration of the problems that exist elsewhere in the system.

When people cannot get a GP appointment they sometimes phone 111, and, more often than not, they will be directed to A&E. I think we need a selection of services available at a central point, whereby if people need a GP, they can see a GP; if they need a practice nurse, they can see a practice nurse; and if they need to be admitted, they can be admitted.

Photo of Victoria Atkins Victoria Atkins Conservative, Louth and Horncastle

In an effort to reassure her colleagues, I want to ask a genuine question—one that I would have asked Dr Allin-Khan. What impact does the hon. Lady believe the 2004 GP contract has had on out-of-hours care? This seems to be the nub of many of the issues discussed this afternoon.

Photo of Jenny Chapman Jenny Chapman Shadow Minister (Exiting the European Union)

The GP contract was changed in 2004, but I did not notice the sort of issues that we face today until far more recently. I am not a scientist or a doctor, but I understand cause and effect, and it does not ring true to say that something that happened six years prior to the change in Government can be blamed for something that is happening six years after the change in Government. I am not saying that there were no consequences, but I believe that ample opportunity has been provided to put measures in place that would have prevented us from being where we are now.

The hon. Lady’s intervention leads me nicely to my next point, which is about the Secretary of State. I had not intended to speak today, but I was so frustrated listening to him on the “Today” programme, trying to blame anybody but himself, that I decided to do so. He has a pattern. The first thing he does is blame the Labour Government, who were in government until 2010. His party has been in government since then, but he will blame Labour for anything he possibly can. He will find something that happened, perhaps at a particular trust and say that that is why something has gone wrong today. If that does not work and cannot be evidenced, he will say, “Well, that particular trust is a basket case. It is the trust’s fault or the fault of the local managers and local clinicians who have not organised themselves right”.

If that does not work, he will then blame the public, and tell them that they are going to the wrong place, accessing their care in a way that he does not think they should. He might call them “frequent flyers” or point to a problem that is the public’s fault. He will say, “They do not look after themselves properly; it is clearly their fault”. If that does not work, he will blame the local council, and I think that is the worst thing that I have heard him do—blame the local authority.

Photo of Jenny Chapman Jenny Chapman Shadow Minister (Exiting the European Union)

In a minute.

My local authority has prioritised adult social care, but the pressures are not going away. They are going to get worse and more difficult to manage—and it is running out of things to cut. It is closing our central library in Darlington and making other hideous cuts, and I do not know where the next round will come from.

I will now give way to Robert Courts, if he still wishes to intervene.

Photo of Robert Courts Robert Courts Conservative, Witney

I am sure the hon. Lady agrees that it is incumbent on all of us to discuss the future of our NHS and our healthcare services responsibly. Does she not accept that when the Secretary of State is talking about where people go for their services, it is not a question of blame? We ought to move away from that blame culture. However, there is a benefit in trying to educate people. If their illnesses are not best served by A&E departments and are best served elsewhere, they ought to realise that they should go elsewhere. That would help all of us. It would help the people who are seeking the services, and it would help the people who are providing them.

Photo of Jenny Chapman Jenny Chapman Shadow Minister (Exiting the European Union)

Yes indeed, so why does the hon. Gentleman not say that to his right hon. Friend the Secretary of State? He is the one who is blaming people, not me. I should welcome a programme that involved explaining to people and making it easier for members of the public, including me, to decide where we should go when we need assistance.

One solution that the Government have come up with seems to involve watering down the four-hour target, although, interestingly, not even Conservative Members seem to be able to agree on—or explain—what change will be made, or even whether there will be a change. Their other solution is to close A&E departments, and, as part of the STP, the A&E department at Darlington Memorial hospital is one of those that may be downgraded or closed. I do not think the local community will accept that. Part of our purpose in doing our job is to give a voice to local communities, but, so far, our local community has been completely shut out of the STP process. We would not have even known what was contained in the plan had it not been leaked by Hartlepool borough council on its website. That is a shocking way in which to conduct a dialogue with a local community.

In parallel with the STP process is the Better Health programme, which started about three years ago and which operates in the region that contains my constituency. I was shocked to discover from responses to parliamentary questions that local health managers had spent £4.6 million that could and should have been spent on front-line health services for my constituents on a consultation on whether or not to downgrade A&E. I could have spent that money a great deal better, and I could also have told those health managers what the local population thinks about the proposal. They are very angry and upset about it, and it is right for us to express such anger, disappointment, outrage and fears for safety in the House.

Many Members have spoken about their families and relatives today. My hon. Friends Toby Perkins and for Workington (Sue Hayman) spoke about their fathers. My dad died in 1994. He had had a heart condition. He was 48, and I was 20. Since then, I have taken a keen interest in cardiac health and services for people with heart disease. I was shocked to find that before 1997, it was not uncommon for people to die while waiting for heart treatment, and that people would often wait 18 months. The Labour Government changed that: we made it a matter of weeks, and we saved countless lives as a consequence.

When people say that the Labour party did not do a good job with the NHS, and when Conservative Members try to imply that we have a fake, dewy-eyed, sentimental attachment to the NHS, they are completely wrong to do so. We will fight for the NHS. We created it, but we also did a good job running it in government. We saved lives, cut waiting times and introduced targets, and that made a difference. It made things better for patients. We will never stop making that case, in the House and outside.

Several hon. Members:

rose—

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

Order. I am afraid that this is rather unfair on those who have waited all day and have not yet spoken, but some Members have taken much more than seven minutes, and I must now reduce the time limit to five minutes.

Photo of Jo Churchill Jo Churchill Conservative, Bury St Edmunds 6:19 pm, 11th January 2017

I pay tribute to all who work in our national health service and welcome this important debate. I hear the Secretary of State not blaming, but looking for solutions; that is more what we should be about. I have called for an honest debate about the NHS since I came to this place. The NHS is 70 years old next year, and if it is going to reach 100 we need to look after it.

But I want to start with the positive. My own hospital, West Suffolk, saw a 20% increase between Christmas and new year in the number of patients admitted. Those patients were poorly—very poorly; that point was made earlier. The hospital had prepared a resilience plan for a 5% uplift in patient numbers, but it has coped spectacularly well. To refer to a point made by Dr Allin-Khan, who is no longer present, people come into A&E with ingrowing toenails and dry skin, and it is important that we make sure we see the most poorly people in the most appropriate way and use resources most effectively.

My constituency has the second oldest population in the country. There is an ageing population with comorbidities, and in the next 10 years the number of those aged 85-plus will rise by 45%, so the allocation of resources as we go forward is important.

But my hospital has been one of the most resilient in the east, at 85%, and its resilience is in most part due to its fantastic staff. West Suffolk hospital has been innovative. It pays for 20 beds in Glastonbury court, a facility owned by Care UK to provide a step-down facility. In January it will be doing a bridging care service with the councils. Improvement will come through prevention and integration, and not always by shouting for more money.

My hon. Friend Helen Whately said that what we need is good integration. Good working in Suffolk needs to be copied. As my hon. Friend James Heappey and Dr Whitford said, STPs need to be looked at as a force for good, and I urge Labour not to knock them, but to work with them. They are clinician-led, which is what everybody was asking for.

We cannot have everything we want in life—we never can—and we cannot have everything we want out of the NHS. That is why we need an honest conversation. With rising expectations and an ageing population, the private sector has been in use in the NHS since 1948. If we are going to get more bang for our buck, we should perhaps look at parts of the private sector in order to be able to enhance what we give patients through these critical periods.

Photo of Simon Hoare Simon Hoare Conservative, North Dorset

My hon. Friend is absolutely right about the need for a grown-up debate about integration and about learning from best practice. Does she share my concern that as Labour Members fan the flames of their artificial indignation, all they are doing is proving yet again that they are either unwilling, ill-equipped or ideologically—

Photo of Jo Churchill Jo Churchill Conservative, Bury St Edmunds

I agree in that since we last debated this with the Opposition on 23 November, apart from asking for £700 million to be brought forward, they have put forward very little in the way of tangible plans. We are talking about everybody here, and just slinging bows and arrows across the Chamber will not get us to the solution we need.

If this is about money, why do some areas do better than others? It is actually about the allocation of resources and good leadership. I have received three letters about good healthcare. A resident in my constituency saw the GP on 28 October, the consultant on 8 November, and had their operation on the 29th. That was at my district general hospital that used the private facility locally in order to enhance the patient experience.

We need a long-term solution. I am pleased that the Prime Minister has spoken about tackling the difficulties of mental health. Norman Lamb has championed that, and shares a mental health trust with me. I am pleased to see that another 49,000 people are being treated for cancer—that is something that I came to this place to champion—and another 822,000 people are receiving specialist cancer treatment. We have seen huge increases in demand, and we need to admit that we cannot just carry on. There have been advances in drugs, but we need to take into account comorbidities and an ageing population.

We need to understand what is wrong, and we will do that by having better data throughout the system. The Richmond Group wrote in support of my private Member’s Bill that information held in healthcare records has a huge potential to provide better care and improve health service delivery within the service. Paramedics have asked me for better access to data so that, when they find someone on the floor, they will know what meds they are on and what the most beneficial treatment would be. GPs want their information to flow through the system in order to help social care and the hospital sector. Pharmacies need to be able to read and write, and those working in social care need to be able to look at someone’s pathway. Patient outcomes should be the thing that we are all talking about, but we have to make decisions. At the centre of all this, we need to support those colleagues who are working above and beyond at this time. We need to behave in a grown-up, responsible way, just as they are, in caring for our NHS.

Photo of Margaret Greenwood Margaret Greenwood Shadow Minister (Work and Pensions) 6:26 pm, 11th January 2017

The fact that an organisation as highly respected as the Red Cross should describe our NHS as facing a “humanitarian crisis” is absolutely shocking. It goes to the heart of this Government’s failure to provide a reliable, properly resourced national health service free at the point of need. That should be a source of shame for the Government. Reports last week that two patients died on trolleys in corridors—one having waited 35 hours to be seen—are truly shocking. Can this really be the face of the NHS in England in 2017? Under the Tories, it seems that it is. The Health Secretary responded by suggesting that the four-hour target should apply only to the most urgent cases, and that it was estimated that 30% of patients in A&E did not really need to be there. In other words, he blamed patients and suggested a downgrade of A&E services. He should hang his head in shame.

It is this Tory Government who have decided to cut funding to the health service, asking it to make savings of £22 billion. In Cheshire and Merseyside, the NHS has to find savings of £l billion. Wirral clinical commissioning group calculates that it will have a £12 million deficit for the year 2015-16, nearly a third higher than the original £9 million forecast, but NHS England has asked it to maintain the forecast at £9 million. I would be interested to hear why this curious request has been made. Patients in Wirral West are concerned about the impact that these savings—or cuts—will have at Arrowe Park hospital and in general practice, and they are right to be concerned. The biggest financial squeeze in the history of the NHS is putting services at risk.

Let us be clear: there is nothing inevitable about these Tory cuts. This is a political decision and it is being used to drive through changes including the introduction of accountable care organisations, borrowing a model from America where such organisations are used to deliver private insurance-based healthcare. An NHS manager from my constituency has written to me saying:

“The STPs and national policy are currently pushing for a redesign of services—primary care at scale and a move to make system-wide organisations. The real punch line is there is no funding to make these changes. Locally there is talk about an Accountable Care Organisation for Wirral—meetings of senior managers across health and social care are being held on almost a weekly basis to create a roadmap for this to happen. With no money with which to do it. Having fragmented services and finally recognised the failure and destruction caused by the faux ‘internal market’ in the NHS, they are now making services use what pitiful resources they have to try and put it all back together. I truly despair that there will not be an NHS this time next year.”

That is a stark warning and a damning indictment of the Government’s failure. The Secretary of State should be addressing the crisis by giving the NHS and social care the funding they need, to make up for this crisis of the Government’s own making around access to GP appointments, a failure to train enough nursing staff, a failure to fund social care, and cuts to community pharmacies when communities need them most.

I have long been aware of the Tories’ agenda for the national health service. The Health and Social Care Act 2012 opened it up to the private sector so that profit-hungry companies can cherry-pick the work that they want to deliver and allowed NHS hospitals to give half their beds to private patients. I believe that this Government and previous Tory Governments are seeking to move us to a two-tier system in which those who can afford to do so have private health insurance and the rest are left with a bargain-basement NHS. The arc of NHS history during the Tories’ time in office since the Thatcher period shows this, and we now appear to be reaching the end game.

The Government are cutting the supply of healthcare in the public sector to create demand in the private sector. The Secretary of State may believe in an ideological drive to introduce a system in which the individual pays their own way through individual private insurance—he is of course entitled to that view—but that is an entirely different concept from a national health service, of which Labour Members are so proud. He must be honest about that. In the process of trying to transfer us to a two-tier, insurance-based model, did he not pause to think about the human suffering he would unleash in the process? Patients wait for hours on trolleys while anxious relatives watch on helplessly, and dedicated staff are stressed out day after day.

Now is the time for a decision. It is not too late for the Government to review their approach. They can face the facts and admit to themselves that English people want a state-managed, state-funded national health service that is free at the point of use and paid for through direct taxation—just like the one created after the second world war by a Labour Government with such vision and which became the envy of the world. The Government should swallow their ideological pride and say, “Okay, we get it. We will fund the national health service.” Anything less will be a betrayal of all that the NHS stands for.

Photo of Huw Merriman Huw Merriman Conservative, Bexhill and Battle 6:30 pm, 11th January 2017

We need to look afresh at the entire health and social care pathway, which is why I am delighted to be able to contribute today. From visiting the pharmacist, to attending a GP appointment, to spending time in hospital, whether planned or through A&E, to being able to reside beforehand and afterwards at home or in a care home, we need to find the most efficient and dignified way to treat and look after people. We must avoid using one treatment centre as a default option—that is not the best option either for the individual or for the public purse—because it is the only one available owing to difficulties with individual funding pots, opening hours or lack of access to better forms of provision. We must also be encouraged to speak freely about the pressures in the system and to provide ideas. It has frustrated me for years that anyone who thinks aloud about ideas that could change health and social care for the better is denigrated as seeking to harm it when the opposite is true.

To that end, I listened with interest to the Secretary of State’s interview on Radio 4 on Monday morning. It struck me as measured and thoughtful about new ideas. I was particularly interested in the suggestion as to how we could deliver more capacity in the GP system, because an increasing number of people attending A&E are neither accident victims nor in need of emergency treatment; they do, however, need some form of medical intervention, as the Secretary of State mentioned. It was then thoroughly depressing to read the Secretary of State’s words taken out of context. I hope that he will continue to think outside the box and that all Members will recognise the benefits of his so doing.

Speaking of ideas, I have the following suggestions for each of the treatment centres in the health pathway, starting with pharmacies. In the event that we have too many pharmacy clusters, I completely agree with the need to ensure that they are spread out across the country with the money saved being recycled. At the same time, we should find ways to help pharmacies deliver more interventions in order to free up capacity at GP surgeries. We must do more to signpost patients to pharmacies before they go to their GP. A recent report costed common ailment treatment in community pharmacies at £29 a patient. The cost rises to £82 for GP practices and to £147 for A&E. Treatment results across all three were equally good. The research estimated that 5% of GP consultations for common ailments could be managed by community pharmacies, equating to more than 18 million GP consultations that could be diverted.

I was buoyed by the Secretary of State’s suggestion that more GPs should be placed in A&E departments and in care homes. The new NHS pilot requiring GPs to undertake weekly ward rounds in care homes is the right type of thinking to prevent emergency treatment in our hospitals. I welcome GP surgeries opening on Sundays, but surely only one surgery in each area needs to be open. I do not believe that having all GP surgeries open seven days a week is a good use of scarce resources, in the same way that Government funding of two pharmacies across the road from each other is not a good use of such resources.

Finally, I have long taken the view that we need to find ways to free up our GPs’ time so that they can focus on the patients who need them most. There are too many wasted or cancelled appointments because the service is free. If there was a cost to unjustifiably failing to keep an appointment, it may demonstrate how precious this resource is—just as NHS dentists would charge for a missed appointment when I was younger.

Some of the reforms of pharmacies and GPs are designed to ensure that patients only attend A&E if they have had an accident or in an emergency, which is clearly not the case for some who are now attending. We are also facing demand for hospital places because of a need to reform the way we look after an ageing population.

Time does not allow me to talk about social care, which is so important in my constituency, but the Government’s delivery of more social care funding before Christmas is welcome. However, it is crucial that we question the operating model in social care. The NHS benefits from a national funding programme, but social care is largely the responsibility of local authorities and local rate payers in areas where retirement rates may be high but employment and council tax receipts are not. We have to think radically to ensure that we get the best out of our health and social care system. To do so will not only make resources stretch further but will deliver innovation that improves the lives of the sick and infirm, who are most in need of our care.

Photo of Liz McInnes Liz McInnes Shadow Minister (Foreign and Commonwealth Affairs) 6:35 pm, 11th January 2017

Two days ago, the Health Secretary read out a statement in this Chamber on the crisis in our NHS. His answer to his Government’s failure to meet A&E waiting time targets is to downgrade those targets rather than seeking to take any action to treat the malaise at the heart of our NHS.

The Health Secretary heaped praise on our hard-working and dedicated NHS staff—praise they richly deserve—but it will ring hollow with many of them. I speak from years of experience working in the NHS as a clinical scientist with staff of all grades, skills and experience. The simple truth is that NHS staff are demoralised, and, as I said two days ago, they continue to work with care and compassion in spite of, not because of, his action.

Since that statement, I have been inundated by NHS staff wanting to tell me their stories: of how the service they were once proud to work in is now in perpetual crisis; of the strain of wanting to do their best for their patients but being prevented from doing so because of short staffing, overcrowding, delayed discharges and underfunding; of the emails they get from Ministers demanding to know what they will do about the failure to meet targets; and of their listening to the same Ministers telling the public that the NHS does not have a problem.

Health managers are saying that we have a perfect storm of ageing patients who need more care just at the time when social care has been cut to the bone, leaving hospitals to pick up the pieces. An A&E doctor at Manchester Royal infirmary told me:

“Crisis is the new normal”.

The doctor said that it has become usual to have 10 patients waiting in a corridor.

In my constituency of Heywood and Middleton, the Pennine Acute Hospitals NHS Trust has just been the subject of a damning report revealing appalling neglect in maternity care that led to the avoidable deaths of mothers and babies. The trust had the most 12-hour A&E waits in October and the second most cancelled urgent operations in November. In December it was forced to divert ambulances 14 times in total, one of the highest figures in the country.

Social care across Greater Manchester faces collapse. That is borne out by the delayed discharge figures for Greater Manchester, which doubled in the year to October. Greater Manchester asked for £200 million for social care in the autumn statement, but the issue was not even mentioned. Some see Greater Manchester’s devolved healthcare system as a solution, but even its chief officer, Jon Rouse, says that although devolution can help closer working it is not “magic dust”.

I remind the Health Secretary of the NHS constitution for England, which was updated in October 2015 and establishes the principles and values of the NHS in England. It sets out rights to which patients, the public and staff are entitled, and it sets out pledges that the NHS has committed to achieve. Enshrined in the constitution is the patient’s right to be cared for in a clean, safe, secure and suitable environment and their right to be protected from abuse and neglect—in other words, not to have to wait in an A&E corridor.

Patients and the public have the right to be involved in the planning of healthcare services, in changes to the way that healthcare services are provided and in decisions affecting the operation of those services. For NHS staff, one of the pledges is to engage staff in decisions that affect them and the services they provide, yet I see precious little evidence of staff, patients or the public having any input into the 44 STPs covering the regions of England, which appear to have been drawn up behind closed doors and are shrouded in secrecy. Their impact on healthcare in our regions could be huge, but where is the public involvement?

Patients are being failed on this Government’s watch and their rights to safe care are being neglected. All the Health Secretary has for NHS staff is the occasional flurry of warm words, yet the war he waged over the junior doctors’ contract showed his real attitude towards NHS staff. Nye Bevan said:

“no government that attempts to destroy the Health Service can hope to command the support of the British people.”

That is from Bevan’s book of essays “In place of Fear”. Sadly, the current Health Secretary has managed to achieve “replacing the fear”.

Photo of Barbara Keeley Barbara Keeley Shadow Minister (Mental Health and Social Care) 6:40 pm, 11th January 2017

I want to start by paying tribute to our hard-working staff in the NHS and those in the care sector. The best way to thank those staff would be by giving them the resources they need to do the job we want them to do.

I welcome the contributions made by hon. Members today, particularly the moving contribution from my hon. Friend Toby Perkins, who bravely told us about the personal catastrophe for him and his family when his father was sent home from a pressured A&E, sadly to die from an aneurysm. My hon. Friend Sue Hayman was able to tell us about the happy death her father had with the end-of-life care at the local community hospital.

The hon. Members for Central Ayrshire (Dr Whitford) and for Totnes (Dr Wollaston) both emphasised the complexity and frailty of patients needing care in the winter months. We should remember that in terms of the scale of pressures facing the NHS. Both those Members supported the four-hour target for A&E as a barometer of the wider system pressures in the NHS: a measure of how the system is managing to process those frail and complex patients. My right hon. Friend Dame Rosie Winterton, as a former Minister for emergency care, urged the Government not to give the NHS the impression of giving up on the four-hour target, as that sends the wrong message. At our NHS leaders’ summit yesterday, we heard a real concern that, for instance, parents might be discouraged from taking their children to A&E.

Conservative Members have cited both Simon Stevens and Chris Hopson in support of their claims on NHS funding, but I would like to update them, because in the House this afternoon Simon Stevens said that

“we got less than we asked for” and that the Government are

“stretching it to say the NHS…got more”.

He also said that it does not help anybody to pretend there are not financial gaps. Chris Hopson, of NHS Providers, said:

“No, we don’t believe the NHS has got all the money it needs” and that the NHS is not sustainable on current funding.

I turn now to the pressures on the NHS caused by social care. The crisis in our hospitals has been made much worse by the Government’s continued failure to fund social care properly. The care crisis is caused by insufficient funding in the face of growing demand, and Ministers have ignored warnings from a wide group of doctors, and from leaders and professionals in the health and care sectors. The Government failed to produce a single penny of extra funding for social care in the autumn settlement. Then they told us that extra funding was being made available for social care in the local government funding settlement, but this was not the extra funding so desperately needed from central Government—what Ministers did was to shift the burden on to council tax payers. That was made worse by the fact that the £240 million adult social care grant was actually money recycled within local government budgets, from the new homes bonus. One third of councils will be worse off as a result of this settlement; my own local authority, Salford, will have £2.3 million less in its budgets. This is not a boost to social care.

What health and social care leaders had pleaded for was for Ministers to bring forward funding promised for 2019 to address the current crisis in social care, and that is what today’s motion proposes. That would provide some breathing space, which is needed because the lack of social care means that thousands of older people are stuck in hospital waiting for a care package in their own home. That was the most common cause of delayed discharges caused by social care. More than a third of the record 200,000 delayed days most recently reported were due to lack of social care. Being stuck in hospital not only affects patient morale and mobility; it increases the risk of the patient getting hospital-acquired infections. The major impact, though, is the knock-on effect on people in A&E who are waiting for a bed for an emergency admission.

Health Ministers like to blame local authorities for the lack of social care, but there are problems with that. When NHS chief executive Simon Stevens gave evidence to the Communities and Local Government Committee’s recent inquiry into social care, he was asked by the Chair, my hon. Friend Mr Betts, what extra resources would be needed if every local authority performed as well on delayed discharge as the best local authority. He said:

“Even having sorted that out, if we have a widening gap between the availability of social care and the rising number of frail old people, that is going to show up as extra pressure on them, their families, carers and of course the NHS.”

Of course we want to reach a position where the best practice in tackling delays is spread throughout the country, but Ministers have to start to reflect on what their Government have done through the cuts they have inflicted on local authority budgets. Figures from the Local Government Association show that the hardest hit local authority has had cuts to its budget of 53% over the past five years; the average cut is 39%.

The budget cut for Surrey was at the lower end of the scale, at 29%. Even so, the cabinet member for social care in Surrey, Councillor Mel Few, wrote a letter to The Guardian about the issues faced by his local authority. He said:

“The Care Quality Commission is not the only organisation with worries about inadequate adult social care funding and the impact on already clogged-up hospitals.”

He went on to say that although the social care precept was

“a welcome move, it falls many millions of pounds short of what is needed now—let alone in two decades.”

I suggest that the Health Secretary and the Chancellor talk to social care leaders such as Councillor Few to understand the needs that they see in local communities and the impact of the lack of social care on NHS hospitals. Ministers have been warned and warned about the impact of cuts on social care, but they have ignored those warnings. The Royal College of Emergency Medicine has said that emergency care is

“on its knees…mainly due to a lack of investment in both social and acute health care beds”.

Photo of Nicholas Soames Nicholas Soames Conservative, Mid Sussex

Will the hon. Lady give way on that point?

Photo of Barbara Keeley Barbara Keeley Shadow Minister (Mental Health and Social Care)

No, I will not.

The BBC has reported that last week there were 18,000 trolley waits—that is, people waiting on a trolley in a hospital corridor—of more than four hours, and there were 485 cases of patients waiting more than 12 hours. My hon. Friend Mr Hendrick rightly said that we do not even know the figures for patients waiting in corridors, or being treated and waiting on a chair because of a lack of trolleys.

The figures do not tell us about the misery for patients and their family members waiting with them. Last night, a senior A&E consultant said on “ITV News” that patients can be left with absolutely no dignity during these waits. He said:

“We have got patients with severe illnesses on chairs receiving drips, antibiotics, medications, and patients with cardiac problems on chairs because there are no trolleys for them to go on to.”

The senior doctor talked about patients who were left unable to move off their trolleys or who were stuck on chairs, and about a lack of shutters and blinds, meaning that patients can be left in full view of others while they are being treated. He also reported that some patients were incontinent in front of relatives and strangers because hospital staff could not reach them in time. He said:

“Patients have absolutely no dignity left.”

That is what the lack of social care and acute beds can lead to. How would any of us feel if that was our relative?

The situation may get worse with the expected cold weather, when more major incidents may be declared and more hospitals are put on black alert—the most severe warning level, which means that they cannot cope with the number of patients.

Downgrading the four-hour waiting time target for A&E misses the point that the problems in emergency departments are a symptom of a much wider problem. As has been discussed in the debate, that four-hour target is a proxy for patient safety. It is miserable for a sick patient to lose their dignity through being incontinent during a trolley wait in a hospital corridor. It is also miserable and frightening for a vulnerable patient to be discharged in the middle of the night to a cold home with no care package. That is why we repeat in the motion our call for the Government to bring forward £700 million of the funding promised to social care in 2019 to help the NHS and social care systems to cope with the extra pressures this winter. We are also calling for a new, improved settlement for the NHS and social care to be included in the Budget in March, so that we avoid this sort of crisis in future.

Staff in emergency departments are at the sharp end of saving lives. Many other NHS staff save lives, too, but A&E staff are so directly on the frontline. Whether they are working in people’s homes or in care or nursing homes, care staff make a huge difference to the lives of millions of older and vulnerable people, people with disabilities and people with mental health conditions. Those should be the best jobs in the UK, but without the right investment in the funding they need, the people doing them feel undervalued and overstretched. I urge Members to vote for the motion tonight.

Photo of Philip Dunne Philip Dunne The Minister of State, Department of Health 6:49 pm, 11th January 2017

I am pleased to follow Barbara Keeley and to be able to close this debate. I thank all 34 hon. Members for their contributions, some of whom—mostly those on the Government Benches—managed to rise above party politics and make some constructive comments.

I join my right hon. Friend the Secretary of State in thanking the 2.7 million staff working in our NHS and social care system. As the Prime Minister said earlier, we recognise that they have never worked harder to keep patients safe, with A&Es across the country seeing a record number of patients within four hours in one day last month.

Regrettably, after five and a half hours of debate and criticism from Labour Members, we have heard little, if anything, about how to provide solutions to the challenges that our A&Es face.

Once again, the Opposition have touted more funding as their only answer to solve public sector challenges. In fact, they have pledged to raise corporation tax eight times, promising an unspecified amount from an unspecified source. That will not help our NHS and it will not fool the public. There is much to do to protect the system and ensure a sustainable future, but it is this Government who have plans in place to get through this extremely challenging period and sustain the NHS for the future.

The shadow Secretary of State, Jonathan Ashworth, spoke for about three quarters of an hour without making a single suggestion about how to solve the problems that face the NHS—not one. He should have stayed to listen—he may have done and I apologise if I did not pay enough attention to his presence in the Chamber.

The former Health Minister, Dame Rosie Winterton, asked specifically for community pharmacists to be paid for providing minor ailments services. I am pleased to be able to tell her that that is precisely what we are doing. The Under-Secretary of State for Health, my hon. Friend David Mowat, was discussing that only this morning in Westminster Hall, and I regret to say that not a single Labour Member was present to hear what he had to say. [Interruption.]

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

Order. Surely the House wants to hear the Minister after this long debate—with courtesy.

Photo of Philip Dunne Philip Dunne The Minister of State, Department of Health

We have heard a number of comments from Opposition Members—I am pleased to say that they were outnumbered in this Opposition day debate by Government Members—rehearsing some tired phrases to mislead the public over alleged increasing independent provision in the health service and also misrepresenting what my right hon. Friend the Secretary of State was saying in his remarks about A&E targets. Having said that, I wish to pay tribute to Toby Perkins, who is in his place, and Sue Hayman, both of whom showed considerable personal courage in explaining the circumstances surrounding the death of each of their fathers, and they did so in an entirely honourable and sensible way, and I am grateful to them for sharing that experience.

I congratulate my hon. Friend Helen Whately on managing to get her son into hospital to have his appendix treated on Boxing day. As she said, that showed that that service was working well.

The Opposition sought to take the moral high ground in this debate. Paula Sherriff challenged Government Members on whether they had visited hospitals over the Christmas period other than on an official visit. Her position was completely punctured by my hon. Friend Maria Caulfield who pointed out that she was doing a night shift between Christmas and new year in her role as a nurse—she was not on an official visit.

There have been some impressive contributions. I thank the Chair of the Select Committee on Health, my hon. Friend Dr Wollaston, who was supportive of a more nuanced target for A&E, and for her calm and generally constructive comments, and my right hon. Friend Sir Simon Burns for his support for the success regime in Essex and for pointing out that it is not closing any of the three A&E departments in the hospitals there. I also thank my hon. Friend Henry Smith, who made a very thoughtful speech and welcomed the opening of an assessment unit in Crawley to help to relieve pressure on the A&Es nearby. Finally, I thank my right hon. Friend Mr Harper for another thoughtful contribution from the Back Benches.

Of course, the Conservative party and the Government recognise that our NHS faces the immediate pressures of the colder weather and the wider pressures of an ageing and growing population. There were nearly 9 million more visits last year to our A&Es compared with 2002-03—the year before the four-hour commitment was made. That is more than 2 million A&E attendances every month, and our emergency departments are now seeing, within the four-hour target, 2,500 more people every single day compared with 2010.

Photo of Philip Dunne Philip Dunne The Minister of State, Department of Health

I will not give way. The hon. Lady did not give way and I have a very short time left in which to speak.

Compared to when the Conservative party came into office in May 2010, in 2015-16 there were 2.4 million more A&E attendances. That is in the context of a much busier NHS overall. The NHS is delivering 5.9 million more diagnostic tests. Some 822,000 more people are seen by a specialist for suspected cancer and 49,000 more patients start treatment for cancer every year compared with the year before we came to office. It is therefore the case that a Government of any colour would be faced with the same problems, but it is this Government who have committed to funding the NHS’s own plan for a sustainable future. Had we followed Labour’s plans, the NHS would have £1.3 billion a year less, which is equivalent to 13,000 fewer doctors or 30,000 fewer nurses.

We remain committed to the vital four-hour A&E promise for those patients who need to be there. We are proud to be the only country in the world to commit to all patients that we will sort out any urgent health need within four hours. Only three other countries—New Zealand, Australia and Canada—have similar national standards, but none of those is as stringent as ours.

Today it is the Conservative party that is the party of the NHS. That is why we pledged more than Labour did and why we are delivering more funding with a higher proportion of total Government spending going into health in each year since 2010. Funding for the NHS will rise in real terms by £10 billion by 2020-21 compared with 2014-15. That sum is front-loaded with £6 billion being delivered by the end of this year, as the NHS asked for. It was this Government who established an independent NHS with an independent chief executive. It was this NHS that came up with its own plan and we were the only party to back it. We agree that the NHS and social care face huge pressure and, yes, there is more for us as a Government to do. However, we entered winter with a more comprehensive plan than ever before, and we have confidence that plans are in place to cope with the current pressures we face—winter, A&E and delayed discharges—and to sustain the system for the future.

I conclude by saying a huge thank you to the 1.3 million staff in the NHS and the 1.4 million people who provide social care. They are the ones who continue to make this possible. We are aware of the pressures they are under, especially during winter. We have increased the number of doctors and nurses, as the Secretary of State said earlier, especially in A&E, and we have launched plans to recruit more doctors and nurses. Without them, we would not have a national health service that provides such a high level of care.

Photo of Nick Brown Nick Brown Opposition Chief Whip (Commons)

claimed to move the closure (Standing Order No. 36).

Question put forthwith, That the Question be now put.

Question agreed to.

Question put accordingly (Standing Order No. 31(2)), That the original words stand part of the Question.

The House divided:

Ayes 209, Noes 295.

Division number 122

See full list of votes (From The Public Whip)

Aye

No

Question accordingly negatived.

Question put forthwith (Standing Order No. 31(2)), That the proposed words be there added.

Question agreed to.

The Deputy Speaker declared the main Question, as amended, to be agreed to (Standing Order No. 31(2)).

Resolved,

That this House commends NHS staff for their hard work in ensuring record numbers of patients are being seen in A&E; supports and endorses the target for 95 per cent of patients using A&E to be seen and discharged or admitted within four hours; welcomes the Government’s support for the Five Year Forward View, the NHS’s own plan to reduce pressure on hospitals by expanding community provision; notes that improvements to 111 and ensuring evening and weekend access to GPs, already covering 17 million people, will further help to relieve that pressure; and believes that funding for the NHS and social care is underpinned by the maintenance of a strong economy, which under this administration is now the fastest growing in the G7.

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

Order. If Members wish to have conversations, they should go somewhere else. The hon. Lady is making a point of order.

Photo of Margaret Greenwood Margaret Greenwood Shadow Minister (Work and Pensions)

The Minister told the House that there were no Labour Back Benchers in this morning’s debate on community pharmacies. In fact, he has inadvertently misled the House in that regard, because I was in Westminster Hall and I spoke in the debate, as was my hon. Friend Bill Esterson, who also spoke in the debate. I just wanted to put the record straight.

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

I understand the hon. Lady’s point of order. It is not a matter for the Chair, but I understand why she wished to make the point.

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

It looks as though the Minister would like to say something further to that point of order.

Photo of Philip Dunne Philip Dunne The Minister of State, Department of Health

Further to that point of order, Madam Deputy Speaker. To give the House complete clarity, I understand that two Labour Back Benchers were present and made minor interventions in the Westminster Hall debate, but there were no speeches or substantive contributions by those Labour Members.

Photo of Eleanor Laing Eleanor Laing First Deputy Chairman of Ways and Means

I am sure that the House is grateful to the Minister for clarifying what he said in his speech, and to the hon. Lady for clarifying the position. The matter is now closed.