Thank you for giving me the opportunity to speak in this debate, Madam Deputy Speaker. I have worked in the NHS since 1996, as a doctor, in hospitals, as a GP and as a commissioner of services, and I must say that it feels as though we are going back to the ’90s at the moment, with long waiting times. Even before this unprecedented decision to suspend operations for a month, we were already breaching 18-week targets in many trusts. From a patient point of view, it feels as though the standards are deteriorating, particularly in my constituency, with the difficulty people face in accessing an ambulance when they need it.
I wish to share two insights into the problem and two potential solutions. My first insight is that, no matter what Ministers say, some of this is about the money. We have seen an anaemic level of growth in NHS funding in the past eight years. As we have heard from others in this debate, we have also seen cuts to social care funding and to public health budgets. We have also had a long-standing underinvestment in prevention, general practice and out-of-hospital care, although I appreciate that that is being reversed now. The money that came in the Budget was too little, too late. It is hard for commissioners and providers to spend that money when they get it at the last minute, because they have to get people to come in to do the work to spend that money. Had the money come earlier, we would have been able to put in place much better contingencies.
As well as this situation being about money, it is also about having the wrong strategy. There has been planning for reactive services, but at the same time we have been cutting prevention. We have been doing planning for healthcare services, but not enough planning for social care services. We have also been planning by giving this emergency injection of cash into acute hospital services, but while we have been cutting, prioritising and fragmenting community services. We have seen 5,000 fewer community nurses and a 45% reduction in the number of district nurses since 2010.
What do I suggest should happen now? We need to change the strategy. We cannot just respond by providing more and more acute hospital beds. We need to focus on prevention; on having good-quality community services, community nursing, social care; on having better palliative care, because most people want to be able to die in their own home, not in hospital; and on having more emphasis on screening. We also need to focus on poverty reduction and tackling deprivation, as people living in poverty are much less likely to access prevention and much more likely to be acutely admitted to hospital. I include in that people with mental health problems—the most vulnerable people.
Integration is the right direction of travel, but we have to change some things about how it is being achieved, the first of which is the name. Calling these organisations “accountable care organisations” lends people to think that this is an idea captured from the United States. We might call them “public health boards”—something that puts the needs of populations at the centre of healthcare and of healthcare planning. We need to make sure that the leadership teams of these organisations are focused on out-of-hospital care and not on just providing more and more acute hospital services.
There is also a fundamental contradiction to address, because we still have section 75 of the Health and Social Care Act 2012, which mandates competition, yet we are trying to get organisations to collaborate.
So it does not have to be like this—it is not inevitable. Huge praise must go to the staff, and I myself have done shifts over the short recess. With the right type of investment, the right preventive strategy and proper collaboration, uninhibited by competition, we can do better.