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NHS Funding Bill

Part of the debate – in the House of Commons at 6:38 pm on 27th January 2020.

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Photo of Lilian Greenwood Lilian Greenwood Labour, Nottingham South 6:38 pm, 27th January 2020

In the recent election, the issue of the NHS was frequently debated in the media. Our constituents often say things like, “Can’t you take the party politics out of it?” I completely understand why they feel that way, but the truth is that our parties do not always agree about NHS funding, and there is good reason for that.

I obviously welcome the extra funding set out in the Bill for the national health service, but I worry that it is rather more about presentation than dealing with the very real needs of our constituents and the health service that they rely on. I cannot help wondering whether the cash increase of £33.9 billion is preferred to the real-terms increase of £20.5 billion just because it sounds like more, when actually it is potentially exactly the same, but not necessarily.

My constituents just want to be sure that high-quality services will be there when they and their family need them. For many of them, their experience of using the health service in recent years tells them that it is under real and rising pressure. They tell me that it is increasingly difficult to get an appointment to see their GP, that they have been waiting a long time to see a specialist or that their much-needed operation has been cancelled. They ask for my help when they cannot access the mental health support they need or when an elderly parent is not getting the social care they need to enable them to stay in their own home. NHS staff tell me that they are working under intolerable pressure, that there are too many vacancies and that too many colleagues are off sick or leaving the service altogether as a result of workplace stress. My conversations with my constituents are no doubt similar to those of other Members across the House, and my concerns echo many of those already described in the debate.

Of course, the funding in the Bill is welcome, but it is simply not enough, and my hon. Friend Jonathan Ashworth set out precisely why. One of the reasons why funding is so badly needed and why this is not enough is that the system has been allowed to get into a state of crisis. My hon. Friend has been tireless in challenging the Government on these issues, and unfortunately the symptoms of recent under-investment are there for everyone to see.

Health Ministers may not believe my hon. Friend, but here is what doctors in the NHS say. The British Medical Association’s briefing for today’s debate tells us:

“A decade of underfunding…
has led to a serious deterioration in the NHS’s ability to provide safe and effective care to patients”.

It notes that the A&E waiting time target has been missed for 53 months in a row, having not been met since July 2015; that the proportion of A&E patients seen within four hours is the lowest on record; that there are over 4.42 million people waiting for elective treatment; that in November 2019 there were 145,800 delayed days due to delayed transfers of care; and that 78% of doctors say that NHS resources are inadequate, which “significantly affects” the “quality and safety” of patient services. If Ministers will not listen to Opposition Members, I hope they will listen to the doctors working in our national health service.

This is also not enough money because we have a growing population, and people are living longer. The development of medical science means that new procedures and treatments are becoming possible, and those developments generate additional pressures on the system. The national health service needs real-term funding increases every year just to stand still, and the lack of sufficient extra resources in recent years has added to those pressures. There is a gap to fill.

The problem has already been made worse by wider changes to Government policy, and a number of Members have made reference to this. The policy of austerity has led to deep cuts in funding for a whole range of local services, and in particular social care, which puts additional pressure on the national health service. That investment in social care needs to be not only forthcoming but properly and fairly distributed on the basis of need, and it must be sustainable. I heard from Nottingham City Council about the fact that so much of the funding is provided on a single-year basis, and it is non-recurrent grant funding. Unless that changes, the council cannot make the best use of the money available. Adding a precept on to council tax means that places with a lower tax base—those with the greatest levels of deprivation and need—receive the least available funding.

I am concerned that this extra funding is not sufficient and will not allow us to catch up, particularly if there is not investment in social care. I am also concerned that it is expressed in cash terms, because that leaves the NHS with a lack of certainty about what funding will be available in real terms and therefore what can actually be delivered. I am disappointed that the Secretary of State would not commit to providing additional funds to ensure that the £20.5 billion in real terms will definitely be delivered.

I want to briefly touch on mental health. I welcome the commitment that mental health funding will grow at a faster rate than the overall NHS budget, but how will the Secretary of State ensure that the funding set out in the Bill goes where it is required and leads to increased investment in mental health in every local area? How will he address the urgent shortages in the mental health workforce? Workforce issues are the largest risk to the delivery of the NHS long-term plan, and the challenges are especially acute in mental health.

Finally, I want to turn to the issue of capital funding, which many Members have mentioned. Many parts of the NHS estate need extra investment. I remember visiting the Meadows Health Centre in my constituency and hearing from patients, GPs and staff how a relatively small amount invested in their building had made a big difference to the services they are able to provide. I want to focus on the needs of Nottingham University Hospitals NHS Trust, which is one of the biggest and busiest acute teaching trusts in the country and a big centre for specialist services in the east midlands. It has a leading university teaching hospital, a regional trauma centre, cancer centre and heart centre and is one of the most research-active trusts outside of London, Oxford and Cambridge. We are really proud of our hospitals and grateful to our dedicated and caring staff, but there is huge concern about the fabric of our three hospital sites.

NUH was included in the list of 21 trusts that will be allocated a share of £100 million seed funding, but that was announced in September, and the trust still does not know how much it will receive. There is no certainty, even once it has drawn up those plans, that they will be funded and delivered. That future funding may help us, but £1 billion of capital funding is needed to provide new and refurbished facilities, and our trust has the highest critical infrastructure risk in the entire NHS outside of London, adding up to £104 million. I have previously raised with Ministers the concerns that the city hospital still has coal-fired boilers, which are both polluting and totally inadequate. Some £24 million over two years is needed to replace those boilers—when will that funding come forward? I raise that yet again and hope to get an answer.

The hospital trust has made a number of priority requests for funding needed to ensure the quality of patient care, including £10 million, or £22 million over two years, for the redesign and partial consolidation of the maternity and neonatal service, since many Nottinghamshire mums and premature babies are currently sent to other places to be treated; increased paediatric intensive care capacity; ward renewals; and funding for backlog maintenance. We need that capital investment, and we need certainty, not just in this year but in future years.