NHS Capital Spend and Health Inequalities

– in the House of Commons at 8:25 pm on 22nd March 2022.

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Motion made, and Question proposed, That this House do now adjourn.—(David T. C. Davies.)

Photo of Lucy Allan Lucy Allan Conservative, Telford 8:27 pm, 22nd March 2022

It is a great privilege to secure this debate and to have the excellent Minister responsible for hospitals, my hon. Friend Edward Argar, on the Front Bench for it. I wish to speak about an issue that has been uppermost in the minds of my constituents for the past nine years, causing much anxiety and uncertainty. All MPs want better health for their constituents and better access to healthcare. That is all the more true for MPs who represent communities that experience the highest levels of deprivation.

As the Secretary of State for Health and Social Care set out earlier this month in an important speech at the Royal College of Physicians, the poorer a person is, the greater the proportion of their life spent in poor health will be. He referred to the 20-year difference in healthy life expectancy between the richest and poorest communities. If someone lives in an area in the bottom decile for deprivation, they can expect to have 20 fewer years of healthy life than someone who lives in an area in the most affluent decile. If someone is poor, not only is their life expectancy lower, but more of their life is spent in ill health.

Telford has some of the poorest communities in England. In our area, 30,000 people live in the bottom decile for deprivation, and the impact is seen in health outcomes across every measure. The Secretary of State was therefore right to say that

“poor health is economically destructive and socially unjust.”

I applaud him for focusing attention on this issue.

If Members look at a map of areas of deprivation in the whole of Shropshire, they will see in Telford, splashed in red, a cluster of 18 lower super output areas in the bottom decile for deprivation. That compares with only two such areas in the whole of the rest of the county. On every health measure, people in Telford have worse outcomes than people in Shropshire. For example, cancer incidence, cancer mortality and later-stage diagnosis are all much higher in Telford than they are in Shropshire. In Shropshire, the mortality rate is 8% below the national average, whereas in Telford it is 15% above the national average.

The problem in Telford is getting worse, not better. This is what we should be talking about in Telford, but we do not. Instead, for the last nine years, the health bodies in Shropshire—the clinical commissioning group, the hospital trust, the sustainability and transformation plan, the integrated care system—have all being talking about a capital spending plan that was once called “Future Fit” but is now referred to as a hospital transformation plan. This plan is expensive and controversial.

The Government made £312 million available to Shropshire health bodies to improve Shropshire’s healthcare, which was great news. The local health bodies set about coming up with a plan. The plan they devised involved a brand-new, state-of-the-art, cutting-edge critical care centre, which was to be built in the west of the county, in Shrewsbury. The plan was controversial because it proposed that Telford’s A&E, in the poorer, urban east of the county, become an urgent care centre, and that Telford’s women’s and children’s specialist centre relocate to Shrewsbury. In effect, the greater part of this significant sum of taxpayers’ money would be invested in Shrewsbury, and specialist services would be removed from Telford, a rapidly growing new town to which people come in their thousands every year to build a better life.

Among the reasons given for choosing Shrewsbury as the location for this new specialist centre was that the consultants and management would rather live and work there than in Telford, and that it would make recruitment easier. Perhaps the initial decision makers, who are long gone, thought they could ride out the criticism. They talked of twisting the arm of local clinicians, but they overlooked something fundamental. Telford has a unique identity and demographic. It is a rapidly growing new town in an area that has historically been perceived as the poor relation to the affluent shires. Telford is made to feel like a town of incomers, surrounded by a rural hinterland to which it does not belong.

Given Telford’s history, identity, and demographics, concerns should have sounded loud and clear about the plan, under which an area with significant deprivation lost out in NHS healthcare investment to its more affluent neighbour. But nobody wanted to listen. No one wanted to hear. My greatest frustration as Telford’s MP was that I could not get the voice of the communities that I represent—the communities with the fewest years of healthy life—heard. I was talked at, talked over, dismissed and disregarded. The plan was going ahead, and that was that.

I know that all politicians will want shiny new hospitals in their constituency, and that this desire may trump proper concern for improving the health of disadvantaged communities in neighbouring constituencies. I also know that the Labour leader of Telford and Wrekin Council, Councillor Shaun Davies, exploited the situation politically and deliberately misled local people by claiming that all A&E services would be closed in Telford thanks to a Tory Government. I therefore understand health bodies’ scepticism when politicians try to make a case. However, the partisan behaviour of some local politicians does not mean that all reasonable objections to the plan should be ignored; but that is what happened here. Nobody would listen to a contrary view.

The data is clear. If local decision makers had been driven by considerations of healthcare need and health inequality, as they should be, the plan would not have been formulated or proposed in the way that it was. What followed was predictable: there were protests, petitions, angry public meetings, endless futile private meetings and marches. There was legal action, and there were pages of newsprint at every election and by-election—at parish council elections, borough council elections, and three general elections. On every leaflet that came through every door, anger and rage was whipped up against the Government by those who sought to profit electorally, as year after year, ordinary people were told that they would lose all their A&E services to their better-off neighbours.

The decision makers could not, or would not, distinguish between confected political outrage and genuine concerns about their plan. They ploughed on regardless, but they did not get far. Nine years on, nothing has been built, and costs have spiralled. As of July 2020, the plan was £221 million over budget—and that was when inflation was below 1%; no one knows what the price tag would be today.

Last month, local health bodies were still talking about how they were

“continuing to work closely and collaboratively with NHSE and our local health system partners…continuing to explore the outputs of the public consultation”— which had been held four years ago, back in 2018—

“continuing to develop more detailed plans and continuing to develop business cases.”

Nine years on, this is where we are: continuing on the same path, immune to changing circumstances and continuing to ignore the underlying health inequality across our area. So much management time, so many consultants, so many accountants, and so many highly paid staff tied up year after year, involved in a massive distraction project. They were not able to articulate how my constituents would benefit or to focus on what really matters—patient care, patient safety, and improving the health of people in the poorest areas.

I am very grateful to the former Secretary of State who, in 2019, made it clear that Telford would have a local A&E 24/7 with same-day emergency care. I am grateful, too, to the current Secretary of State for his help in getting confirmation of that position earlier in the year. This is a significant win and I am grateful for it. Ministers have always been willing to listen, including my hon. Friend the Minister for Health, who is on the Front Bench tonight.

It is now clear that the project cannot happen anywhere close to budget, and given all the other significant challenges that we face in delivering healthcare in Shropshire, this costly plan from a different era has run out of road. My plea to NHS England now is to call time. After nine years, all organisations are doing things differently. The NHS is doing things differently; it has evolved and moved on. It is no longer about increasing hospital capacity, but about tackling the causes of poor health.

This plan does not address increasing demand for healthcare. It does not address improving access to healthcare for those who need it. The plan is treating the symptoms, not the causes. It is time to tackle the causes of poor health. The NHS recognises this and the Health Secretary is prioritising this, so local health bodies in Shropshire cannot go on ignoring this.

The NHS website says it very clearly. It says that health inequalities are

“the preventable, unfair and unjust differences in health…that arise from the unequal distribution of social…and economic conditions…which determine the risk of people getting ill…and impact on their ability to prevent illness and their ability to access treatment when ill.”

The NHS today cares about prevention. It cares about keeping people out of hospital and delivering more care and more services close to those with the greatest need. It is not about pumping more and more money into shiny new buildings in areas miles away from the county’s most deprived communities.

The overall health ecosystem in Shropshire faces many challenges. Plans for its future need to be considered in that context. The hospital trust has been in special measures since 2018. Senior management have come and gone at record rates. Repeated critical incidents are declared—three in the past months—because A&E is overwhelmed.

This is the same trust that, in one day last week, had waiting times to unload ambulances that added up to the equivalent of 25 ambulances and paramedic teams being off the road for a day. This is the same trust that has the Ockenden maternity review, reporting next week, into poor and negligent care resulting in death, injury and trauma to women and their children, and it is the same trust that did not listen to them.

In spite of these challenges, our health leaders devoted their time to the unaffordable business cases and strategic outline plans for this undeliverable project. I do not blame the current postholders, who are trying their best, but there is someone, somewhere in NHS England who needs to take stock. This is an Alice in Wonderland plan—more and more money being funnelled into a capital project that does not solve the healthcare challenges and does not deliver on NHS objectives.

I take this opportunity to ask NHS England to think again; maybe the Minister can kindly help to get that message through. I understand that sunk costs and time will be written off, but this plan is at least £221 million over budget and does not address the health needs of those whose health is poorest. It must be time to focus on patient care, patient safety, prevention, diagnostics, access to primary care and tackling preventable conditions early so that people can live more healthily for longer.

As an MP, how am I to ask my constituents to pay more for the NHS, if all they see is more and more of their cash being shovelled into a state-of-the-art building the other side of the county? It is those same constituents who experience the worst health outcomes, the lowest life expectancy and the most years in poor health, not just in Shropshire, but nationally. How can we plan to spend more than a billion pounds and make no mention of how we are improving their health and their access to healthcare?

I have two asks of the Minister. First, I ask him to stand firm on the agreed £312 million budget for this transformation plan and, if there is an extra £221 million down the back of the sofa—I am assured by Treasury that there is not—to use the additional capital spend, if available to Shropshire, to improve health and access to healthcare where it is needed most, on local diagnostics, screening and prevention services, so that we can narrow the gap of healthy life expectancy. Secondly, I ask him to confirm for the record that, whatever the outcome of this nine-year saga, Telford, with its cluster of 18 areas in the bottom decile for deprivation, will have a local, 24/7 A&E, capable of same-day emergency care.

This Government are rightly committed to prevention and tackling health inequalities, and I welcome that. Local health bodies should focus on that too, particularly when embarking on significant capital spend projects. They must be able to say how the poorest communities with the poorest health will benefit before just expecting more and more of taxpayers’ cash.

Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care) 8:42 pm, 22nd March 2022

As ever, it is a pleasure to be here at the end of the day for the Adjournment with you in the Chair, Madam Deputy Speaker—I may jest slightly, but these Adjournment debates are hugely important, as you know, because they give an opportunity to raise matters of genuine local importance to Members of this House, as my hon. Friend Lucy Allan has done.

With that in mind, I congratulate my hon. Friend on securing this debate, and on her passion and commitment to her constituents. She has raised these issues consistently in this House, both in the Chamber and in Westminster Hall debates, and I pay tribute to her for that. She is a strong and passionate campaigner on behalf of her Telford constituents, and they are extremely lucky to have her as their Member of Parliament.

Occasionally, as a Minister, one may catch one’s breath slightly when one sees an Adjournment debate in my hon. Friend’s name on this subject in the Chamber, because one knows she will press her constituents’ points hard, which is exactly what she is here to do. That is why they have wisely elected her three times now to this place. I know her determination on behalf of her local hospital and her constituents, and I gently say to her local trust that it ignores or dismisses that at its peril—something I have learned doing this job for two and a half years. I hope she will feel that I have never ignored or dismissed the points she has raised.

I will turn to the national picture on capital spend before turning to my hon. Friend’s specific points. This Government are prioritising capital spend in the NHS to transform and improve healthcare outcomes for people and to put health financing on a sustainable footing. We are building new hospitals, upgrading those that have reached or are reaching the end of their life and tackling backlog maintenance and RAAC—reinforced autoclaved aerated concrete—challenges in hospitals. We are also improving the mental health estate, investing in technology, the digitisation of the NHS, elective recovery and research and development.

It is our firm belief that health services will need to do things more efficiently and differently from before, and for that reason the DHSC’s capital budget is set to reach its highest real-terms level since 2010: £32.2 billion for the period 2022-23 to 2024-25. My hon. Friend mentioned the importance of improving our diagnostics facilities. This Government are proud to have invested £2.3 billion in the community diagnostic centres programme. Some £5.9 billion of capital investment will be provided for the NHS to tackle the backlog of non-emergency procedures and to modernise digital technology to tackle waiting lists, including £2.1 billion for the innovative use of digital technology, and £1.5 billion for new surgical hubs, increased bed capacity and equipment to help elective services to recover, including surgeries and other medical procedures, as well as the community diagnostic centres that I have referred to previously. Based on increasing demand and patient convenience, the CDCs aim to carry out the range of diagnostic tests required for a patient in as few visits and in as few locations as possible, and they genuinely have the potential to improve health outcomes.

My hon. Friend talked about health disparities particularly in the context of her own constituency, sitting within our country but also within the county of Shropshire. She is right to say that health disparities across the country are stark and have been further highlighted and exacerbated by the pandemic. We are determined to address the long-standing health disparities that exist in many areas, be they in access to services, health outcomes or people’s experience of their local health service. To that end, later this year we will publish a health disparities White Paper setting out actions to reduce the gap in health outcomes between different places and communities across the country so that people’s backgrounds do not dictate their prospects for a healthy life ahead of them. This will mean looking at the figures for preventable killers such as tobacco and obesity as well as wider causes of ill health and access to the services needed to diagnose and treat ill health in a timely, accessible way. This will be a cross-system endeavour relying on close working with the NHS, wider health and care services, and across local and central Government. I welcome any thoughts my hon. Friend has in her local context as we develop that White Paper.

Let me turn to my hon. Friend’s two specific points relating to her health and care system. She highlighted her campaign to retain a 24/7 A&E local in Telford. As she said, in 2019 my right hon. Friend Matt Hancock made his decision, which still stands, for the Future Fit programme to proceed, but also, crucially, for an A&E local to be in place in Telford. It is very important that I put this on the record. The success of my hon. Friend’s call—the fact that that was agreed to—is down to her campaigning work on behalf of her constituents. I suspect that without her, it may not have happened. The fact that it has, as I believe was confirmed by my right hon. Friend the current Secretary of State in a letter to her recently, is testament to the success of her campaign, regardless of some of the more misleading views that have been spread around in the course of this process. She has succeeded. She has campaigned for her constituents and she has won on this point, and I pay tribute to her.

On my hon. Friend’s second key point about the Future Fit programme more broadly, and the budget available to it, she will be aware that as of this month £1.1 million has been made available to the trust to continue the development of that programme as part of the £6 million-worth of early funding agreed in late 2020. NHS England and NHS Improvement continue to work with her local trust to develop the business case for that programme, and we still wish them to go ahead with it. We want them to work to come up with the right solution for the local community, and we remain committed to that. My hon. Friend asked a very specific point about that. It will have to follow the usual business case approvals process.

We are clear that the £312 million that my hon. Friend alluded to remains, as it was at the outset, the maximum amount currently allocated to that programme. It reflects the original allocation and continues to be the allocation, so I encourage her trust to continue working with NHS England and NHS Improvement to develop a scheme and a programme that matches that budget for the benefit of everyone’s constituents in Shropshire and in Wales, who this hospital also serves.

I look forward to continuing to work with my hon. Friend and other hon. and right hon. Members from Shropshire and Wales on the future of services at Shrewsbury and Telford. I conclude by once again paying tribute to my hon. Friend for her passion, her determination and her perseverance on behalf of her constituents.

Question put and agreed to.

House adjourned.