I beg to move,
That this House
condemns the Government for failing to recognise the current crisis in the National Health Service;
regrets that, as a result of Government mismanagement, hundreds of lives may be being lost every week due to the collapse of emergency care while patients are finding it impossible to get a GP appointment, ambulance or operation when they need one;
calls on the Prime Minister to acknowledge the crisis and act with the necessary urgency to mitigate the impact on patients;
and further calls on the Secretary of State for Health and Social Care to ensure the NHS is never in this situation again by bringing forward a long-term strategy which will end delayed hospital discharges, provide the NHS with the necessary staff to treat every patient in good time, and reform primary and community care to reduce the number of people needing hospital treatment.
I rise to support the national health service, which is going through the biggest crisis in its history, and most importantly, to defend the patients who are suffering as a direct result of 13 years of Conservative mismanagement of the NHS. This winter has shown just how high a price patients are paying: NHS staff are walking out on strike—in the case of nurses, for the first time in their history—patients are waiting entire days for an ambulance to arrive, and then days on end in A&E before they are admitted; there were 50,000 needless, preventable deaths last year, which experts have blamed on unacceptably long waiting times; and there have been hundreds of avoidable deaths every week this winter, because emergency care has collapsed.
The Secretary of State for Health and Social Care says that he disputes those figures from the Royal College of Emergency Medicine and the Office for National Statistics, but I invite him to listen to some of the stories behind the numbers. An 89-year-old fell in the bathroom and waited nine hours for an ambulance. The sepsis that caused him to fall killed him. His consultant said:
“Had I seen him within a couple of hours it could have been avoided. Maybe.”
Teresa Simpson, a 54-year-old woman from Hull, suffered a cardiac arrest and lost oxygen supply to the brain. She waited 16 hours for an ambulance, which arrived only when her husband phoned 999 a second time, after she had become lifeless. She passed away. A consultant in the north of England described a scene in a hospital waiting room this winter when a patient collapsed:
“They get CPR on the floor. I am forced to declare his time of death in front of frightened, horrified members of the public and his wife. On the floor of the waiting room. He was elderly and frail and hadn’t wanted to bother us. We had run out of trolleys and beds. In the whole hospital. This was by 10am.”
The Prime Minister refuses to describe this as a crisis.
Our motion before the House calls for a long-term plan to end delayed discharges, give the NHS the staff it needs to treat patients on time, and reform primary and community care, so that fewer people end up in hospital.
The Government do not have a plan, but perhaps the right hon. Gentleman will surprise me by telling me, against all hope and expectation, that they do.
Clearly, some of the statistics and cases that the hon. Member highlights are distressing and no doubt need to be investigated. The Prime Minister has rightly prioritised waiting times as one of his key commitments this year. How does the hon. Member account for the performance in Wales, which is worse than in England on all the statistics that we highlight, in spite of the Labour party having been in charge of the NHS there for more than 20 years?
I am grateful for the right hon. Gentleman’s intervention, because it brings me directly to the Government’s amendment to the motion, which is not a plan but a litany of excuses for the situation across the United Kingdom, including in Wales. I will run through them. By way of excuse, they say that the situation is challenging across the United Kingdom, and they are right: in Wales, the NHS is struggling; in Scotland, the NHS is struggling; and in Northern Ireland, the NHS is struggling. What do all parts of the United Kingdom have in common? Thirteen years of Conservative underfunding.
I will tell the right hon. Gentleman that, as he knows perfectly well as a Welsh Member, the reason why the Welsh NHS struggles more than England overall is the age profile of the population, the number of disabled people in Wales and the level of deprivation. The same disparities between Wales and England overall also explain the enormous health inequalities within England, which is why health outcomes in my city—in London—are so much better than in so many parts of the north or south-west of England. And you know the way to deal with that? It is genuine levelling up. But if people want a Government who tackle health inequalities so that every person in every part of the United Kingdom gets good-quality healthcare, they need to elect a Labour Government here in Westminster. That is the truth that the right hon. Gentleman does not want to admit.
I know that SNP Members will not be here today, because we are talking about England, but here is another truth that Nicola Sturgeon does not want to admit either: people in Scotland will be better off under a Labour Government too. She knows that just as well as anyone else.
When Conservative Members are not talking about other parts of the United Kingdom, they say that health pressures exist right across the world, but international pressures do not explain why the average wait for an ambulance is 14 minutes in France, while heart attack victims and stroke victims routinely wait an hour for an ambulance here in England. International pressures do not explain why it is that, over the past year, one in six UK adults had a pressing need for medical examination or treatment but could not get access. They do not explain why this is the highest figure out of 36 European countries and almost triple the EU average. Their excuses about international pressures do not explain why cancer outcomes in England are behind other comparable countries. None of that explains why the state of the NHS is as bad as it is today, but perhaps Dr Evans, who was trying to intervene, wants to stand up and justify why it is that, after 13 years of Conservative Government, his constituents are waiting an average of an hour for a heart attack or stroke case.
I am grateful to the hon. Member for giving way, and there are two points that I would like to pick up, seeing as he has come back to me on the second one. The first one, about comparable data, is really important. Does Labour have a position on sharing data between Wales, for example, and England, because the data is not comparable, which makes it very difficult to work out what is going on? Secondly, a plan was brought forward by the Government. It is called the NHS White Paper, which was brought forward by the NHS to transform the NHS with the integrated care boards, which are now in place. The people on those boards—42 of them—are the best people to make that change.
I find it astonishing. The hon. Gentleman’s position seems to be this: the Government have a plan, after 13 years, and apparently that plan is in progress. So why is it that so many Conservative Members just this week have stood up to talk about the fact that their constituents cannot see a GP, they cannot get an ambulance when they dial 999, and they are waiting hours on end in A&E departments? I know they like three-word slogans, but is the latest Conservative slogan on the NHS really “Crisis, what crisis?”?
I have received several emails from Labour party members in Ashfield asking me to back the Labour party’s fully costed NHS plan. Could the hon. Member please send me a copy?
I would be delighted. I can barely believe it. Honestly, I can barely believe it. This is the second time this week that Conservative MPs have said, “We need to see Labour’s plan, because we haven’t got one.” I would be absolutely delighted. The hon. Member can even sign it and put it in one of his party’s fundraisers—God knows he is going to need it at the next general election. I will tell him what the plan is: it is a fully funded, fully costed plan to deliver the biggest expansion of NHS staff in history—doubling the number of medical school places; 10,000 more nursing and midwifery clinical training places; 5,000 more health visitors; and doubling the number of district nurses. That is my plan. Where is their plan?
The Government amendment refers to funding and states that they are putting in an extra £14.1 billion. I wonder how much of that will be swallowed up by the inflation caused by their catastrophic mismanagement of the economy. People are not just paying the Truss and Kwarteng premium; this is the price of 13 years of low growth, low productivity, high taxes and stagnation. Every penny will be swallowed up by higher inflation. That is the truth. Why do people talk about 13 years of underfunding? It is because they know it did not need to be like this, and because they saw what the last Labour Government did. With Labour, per capita spending on health increased by 5% each year, and we were able to do that because we grew the economy. Under the Conservatives, spending per capita fell during the coalition years, fell in the following two Parliaments, and even the increases that the Government promise today will not match the investment that Labour put in. That is the price of Tory economic failure.
My hon. Friend is making an outstanding opening speech. My constituent told me last week about his relative who has multiple myeloma and had a stem cell transplant last year. She had a bad viral infection for three weeks, which is a serious issue after chemotherapy and a transplant. My constituent was asked by her consultant to take his relative to another hospital, because no beds were available at the hospital where she was being treated. She was treated in the corridor and waited 24 hours for a bed. Does my hon. Friend agree with my constituent that that hospital and its staff were not to blame and that, with underfunding and no strategy for the NHS now or in the future, the fault lies squarely with this Government?
I wholeheartedly agree. We hear this time and again. When patients are struggling to get access, and experiencing appalling delays in accident and emergency, they do not blame the staff. They know that the staff of the NHS are busting a gut, but those staff are suffering in the same way as patients because of 13 years of Conservative mismanagement. The only part of the Government’s amendment that I agree with is the part that praises NHS staff. Why is the Secretary of State’s Prime Minister bringing in his “sack the nurses” Bill next week? How many nurses will he sack? How many paramedics or junior doctors will he sack? The only people who need the sack are this Government—[Interruption.] Perhaps Tim Loughton agrees.
The hon. Gentleman has got some brass neck. I have already given him figures showing that per capita funding increased by 5% under the last Labour Government—[Interruption.] And as for GDP, perhaps he should look at growth figures and ask why the economy is so much smaller than it would have been if we had had a Labour Government managing the economy well. That is the truth; it is a simple fact. If not, perhaps he wants to explain how his Government will put more money into the NHS, but I did not hear that commitment.
I thank my hon. Friend for his excellent speech. I do not quite know why I have intervened, because I am very much enjoying watching him flay the bowling to the boundary when he gets questions from Conservative Members. He is absolutely on to something in relation to the money that has been wasted in our NHS by the failure to plan for NHS staffing. Is not the reality that far too much money is being spent on agency workers because there is no long-term strategic plan for NHS staffing?
My hon. Friend is absolutely right. We are spending £3 billion on agency costs that would surely be better spent on ensuring that we have a serious workforce plan, and on hospital departments that are staffed by regulars who get to know their shift, get to know their colleagues, and get to know their patients and communities.
Let me turn to what the Secretary of State for Department for Business, Energy and Industrial Strategy said about ambulance staff, because I think he irresponsibly suggested that ambulance staff have not committed to minimum service levels for category 2 calls today, which is just not true. I think he ought to apologise to ambulance workers.
On minimum service guarantees, does my hon. Friend think that the Conservative party has a brass neck to try to enforce minimum service guarantees, which are always made by agreement on any strike anyway, but says nothing at all about the catastrophic loss of service guarantees because of their mismanagement and underfunding on every other day?
My hon. Friend brings me neatly to the argument that I want to make about minimum service levels. Let me tell the Health Secretary who they are talking about when the Government attack ambulance crews. Donna Wilkins called an ambulance when she became concerned that her disabled son James may have been having a stroke, which is a listed side-effect of the medication that he takes. She and James waited in an ambulance for nine hours outside the Royal Bournemouth Hospital because there were no beds. Paramedics waited with them for the full nine hours. They chatted with James, loaded his favourite TV shows on their phone for him to watch and ran into the hospital to bring tea for Donna and soft food for James, who has problems with swallowing, which they spoon fed him. This is who NHS staff are. This is who ambulance crews are. These are the very staff the Government would have sacked with the legislation that they are bringing forward next week. As my hon. Friend said, what brass neck from this Government to talk about minimum standards on strike days when they cannot deliver basic minimum standards on any other day of the year.
The two-month target from GP referral to cancer treatment has not been met since 2015. Four in 10 people are waiting more than four hours in A&E. The four-hour target for A&E waits has not been met since 2015. The 18-week treatment target for elective care has not been met since 2016. One in seven people cannot get a GP appointment when they try. More than 1.3 million waited more than a month to get a GP appointment in November. How much more evidence do the Government want that they are incapable of delivering the minimum basic standards that patients deserve every single day of the year?
This has to be seen to be believed: the Government are planning an advertising campaign to urge patients to stay away from the NHS with the tagline “Help us help you.” Do they not see the risk in patients not coming forward for help when they need it? Can they not understand that people are fed up with being told that they have to protect the NHS, rather than the other way round? Instead of asking the public to help the NHS, the public want the Government to help the NHS to help them.
I do not know whether my hon. Friend is as horrified as I am by the juvenile and facile comments from the Conservative Benches, or whether he heard today on Radio 4 about the 600,000 people who every single month are waiting for four hours or more to get into A&E and be treated. As a direct result, horrifyingly, each and every month, hundreds and hundreds of people are dying needlessly in our country. That is on this Government’s watch. Should they not be hanging their heads in shame?
I wholeheartedly agree with my hon. Friend—avoidable and preventable. The Chancellor wrote an entire book about getting the number of preventable deaths down to zero, because that is where the figure should be, so to have 50,000 preventable, avoidable deaths reported is a badge of shame for the Government.
Worst of all, the height of the Prime Minister’s ambition is to stop making things worse. If we have 7.1 million people waiting for treatment, rather than 7.2 million people, apparently that is a job well done in the Prime Minister’s book. Our NHS needs to be rebuilt and renewed, but all he offers is managed decline. His five pledges have the bar set so low that even his predecessor could meet those promises.
If hon. Members want to know what real ambition and action look like, it is this: 89,000 more nurses; 44,000 more doctors; waiting times cut from 18 months to 18 weeks; 3 million more operations carried out each year; banning smoking in pubs; the largest hospital building programme in history promised and delivered; 100 new walk-in centres; GP appointments guaranteed within two days; free prescriptions for cancer patients; appointments with a cancer specialist within two weeks of referral; waiting lists cut to their lowest point in history; and patient satisfaction at its highest levels in history. That is the difference that a Labour Government make.
On delivery by Labour, over the many years of a Labour Government, Dover and Deal saw its health service absolutely decimated, service by service. What has happened under a Conservative Government? There has been a new hospital built for Dover, the first dementia village in the country, built for Dover and Deal, one of the first 40 diagnostic covid hubs, delivered for Dover and Deal, and a new GP training centre, delivered for east Kent. Of course, there is more to do on health, but we have the plan—
I cannot believe that the Member for Dover and Deal seems to be standing up and telling her constituents that when it comes to the NHS they have never had it so good. I know she is desperate and scraping the barrel because Prime Minister after Prime Minister have broken their promises on immigration and the Prime Minister is not dealing with small boat crossings, but I am afraid that pretending the NHS is working will not save her at the next general election.
To govern is to choose and the last Labour Government showed that investment plus reform equals better standards for patients. You do not need to do A-level maths to get to that equation. Sir Edward Leigh asked his Health Secretary:
“What is our long-term plan? We cannot leave the Labour party to have a long-term plan while we do not. How are we going to reform this centrally controlled construct?...What is the Secretary of State’s plan?”—[Official Report,
What indeed is the Secretary of State’s plan? He has been in power for 13 years. His Government have presided over this record and still, after 13 years, they have no plan. Conservative Members asked what my plan was and I outlined it: a fully costed, fully funded plan to deliver the biggest expansion of NHS staffing—[Interruption.] They are saying, “Where is it?” I will repeat it for them again: double the number of medical school places; 10,000 more nursing and midwifery clinical training places; 5,000 more health visitors; and doubling the number of district nurses qualifying, paid for by abolishing non-dom tax status, because we believe that people who make Britain their home should pay their taxes here, too.
I understand that, in their partisan fury, because they cannot bear the fact that Labour has a plan and they do not, Conservative Members cannot swallow humble pie enough to take our plan and run with it. If they do not believe me, they should at least believe their own Chancellor, because this is what he said about Labour’s plan:
“I very much hope the government adopts this on the basis that smart governments always nick the best ideas of their opponents.”
If we were in any doubt already, this is not a smart Government and it will take a Labour Government to deliver Labour’s plan. That is why we end up with these sticking plasters, as we saw on Monday, to deal with this crisis.
Why did the Government choose to leave 230,000 patients languishing on NHS waiting lists when the spare capacity was there for them to be treated in the private sector? We know what our priority is: get patients treated as quickly as possible, pull every lever available to make it happen and make sure that patients do not have to pay a penny. The Government could act on doctors’ pensions to stop doctors retiring early for no reason other than that there is a financial disincentive to stay, but they still have not done it. They could bring strikes to an end by negotiating with the unions instead of threatening to sack the staff, but they still have not done it.
I want to give the hon. Member an idea to nick. He mentioned earlier the chronic situation with cancer waiting times, with 40%-plus of people diagnosed with cancer waiting two months to be seen. I wonder if he is aware of the work of the all-party parliamentary group on radiotherapy; I chair the group and his hon. Friend, Grahame Morris, is a vice-chair. Fifty per cent. of people with cancer need radiotherapy. We spend 5% of the cancer budget on it. The average across developed nations is about 9%. Will he agree to give a bit of time to come to the group’s inquiry on
Unlike the Government, we are happy to look at good ideas wherever they come from. I do not know whether I can make
I have to make progress. I know that Conservative MPs were not interested in speaking in this debate, but many Labour Members were.
We cannot continue pouring money into 20th-century healthcare that is not fit for the future. We do not focus nearly enough on prevention, early intervention and care in the community. Because people cannot see a GP, they end up in A&E, which is worse for them and more expensive for the taxpayer. Because people cannot get the mental health support they need, they reach a crisis point, which is worse for them and more expensive for the taxpayer. Because people cannot get the social care they need, they are left stuck in hospital, which is worse for them and more expensive for the taxpayer. That is why the next Labour Government will agree a 10-year plan with the NHS to shift the focus of healthcare out of the hospital, into the community and closer to patients, which is where it should be.
My hon. Friend makes an excellent case, showing that Labour is the only party with a plan to deliver for the NHS. He will know that prevention and early intervention are key for people who are losing their sight. More than 650,000 people are currently on waiting lists. We know that 50% of all sight loss is avoidable, but many people are completely losing their sight because they are not getting early intervention and appointments. Does he agree that the Government need to get on with having a plan to tackle the eye health crisis in our NHS?
My hon. Friend has campaigned so determinedly on the issue, and she is absolutely right. When I spoke about self-referral in an interview with The Times, it was partly with ophthalmology in mind. In the vast majority of cases and for the vast majority of conditions, self-referral will not be appropriate and it is right that people see a GP before being referred to specialist services. But when people go and see someone who is trained and qualified to investigate their eyes, and that person makes a clinical judgment that they need to see a specialist, how can it be that, rather than being referred straight to the specialist, they are sent off to a GP first? That is absolutely crazy. It is wasting valuable doctors’ appointments and is lengthening waiting times for patients.
Labour is willing to look with an open mind at how we improve the patient journey. It is that fresh thinking that the NHS needs and is so badly missing from this Government. That touches on what I have been saying about the need to fix the front door to the NHS in primary care, with more care in the community. Our plan to recruit more doctors will deliver better access to GPs and ease pressure on accident and emergency departments.
We have to take a look at the GP partnership model, which under this Government is withering on the vine. By 2026, a majority of GPs will be salaried. There are three routes: let it wither on the vine, as the Conservatives are doing; accept that it is in decline and have something better to follow as it phases out over time, which is how we would approach it; or accept that GP partnership is valuable, in which case we should rebuild it. I am open-minded about whether we phase out GP partnerships or whether we rebuild general practice, but what we cannot do is what the Conservatives are doing, which is allowing general practice to wither on the vine. That is exactly what they have done.
Do you know what I found most remarkable today, Mr Deputy Speaker? In advance of this debate, I received a letter from the Minister, no less—Neil O’Brien, who is unfortunately not in his place—telling me that the current system of general practice is working. Bad news for you guys sat opposite, who are facing the patients and the voters at the next general election: your Ministers think that general practice is working. Your Ministers are therefore not looking at plans to fix it. Your Ministers are leaving you hanging out to dry at the next general election, because patients can see that only Labour is thinking about how to fix the front door to the NHS and rebuild general practice.
Our plan to recruit 8,500 mental health workers and provide community mental health clubs in every community—a plan championed by my hon. Friend Dr Allin-Khan—will deliver faster treatment, supporting schools and easing pressure on hospitals, as well as general practice.
Then there is the exit door of the hospitals to social care. Labour’s commitment to deliver better pay and better terms and conditions for care workers will reduce the 400,000 delayed discharges every month and provide a better quality of care for not just older people but working-age disabled people. There are so many people in hospital who would not need to be there if we could provide quality care in their homes, which is why our commitment to double the number of district nurses qualifying every year is central to our policy. We will also give every child a healthy start to life, with 5,000 more health visitors. [Interruption.]
The Under-Secretary of State for Health and Social Care, Maria Caulfield has just said, from a sedentary position, “We need more GPs.” I know we need more GPs. Patients know we need more GPs. So why have the Government cut more than 5,000 GPs in the last decade?
We have seen 13 years of failure in social care, with promises made and nothing ever delivered. There are now 165,000 social care vacancies, which is why the NHS is logjammed. Does my hon. Friend agree that it is time to pay our social workers a fair wage? Agenda for Change is a framework already built; let us give social workers a decent wage for the excellent work that they do.
My hon. Friend has consistently made the powerful case that pay and terms and conditions are directly linked to retention. No wonder we are losing so many people, not just from the NHS but from social care, to other employers in sectors such as retail. Earlier today, in this Chamber, I heard the Prime Minister say that as the minimum wage increased care workers would benefit, which tells us that care professionals are on the minimum wage while doing a really difficult job. No wonder they are going off to other jobs that cause less stress and anxiety and are better paid. This is not the way to run a social care system. We understand that, but the Government do not.
No, because I must conclude my speech now. So many other Members want to speak that it would be unfair to take up more of their time.
This year marks the 75th anniversary of the NHS. For 75 years it has been there for us when we need it, founded by Labour but built by the British people, a public service, publicly funded, free at the point of need. Those are the values that are written into the DNA of the NHS. They are British values, they are Labour values, and it now falls to us, the party that created the NHS, to make sure that it is fit for the future.
I know, and the Opposition know, that the biggest obstacle to that change is no longer a busted, discredited Conservative Government on their way out, but the belief among too many people in our country that voting does not change anything, that politics does not matter, and that things cannot get better. I urge people throughout the country to ask themselves this simple question: are you better off than you were 13 years ago? Are your NHS services better off than they were 13 years ago? Are your public services better off than they were 13 years ago?
Labour has a plan; the Conservatives do not. Labour has a proud record of 13 years in government; the Conservatives do not. Only Labour can offer Britain the fresh start that it needs.
Order. As Members can see, there is a great deal of interest in this debate. Before I call the Secretary of State to move the amendment, let me advise Back Benchers that we will start with a speaking limit of five minutes, but that will rapidly be reduced so that we can get as many people in as we possibly can.
I beg to move an amendment, to leave out from “House” to end and add:
“pays tribute to the work done by the National Health Service and recognises that there are pressures on health systems around the world;
recognises that all parts of the UK are facing pressures;
welcomes that the Government has committed to reduce waiting times in England as part of its strategy to strengthen the NHS and care system with up to £14.1 billion additional funding being made available by government over the next two years to improve urgent and emergency care and tackle the backlog—the highest spend on health and care in any government’s history;
and regrets that the Scottish and Welsh governments have refused to make similar such commitments.”
I am grateful for the opportunity to update the House further to my statement on Monday, in which I recognised the very real pressures faced by the NHS, particularly in emergency departments and with ambulance handovers, and the fact that the experience had not been acceptable for some patients and staff in recent weeks. I set out a range of actions that we are taking in response to those pressures—pressures that are being experienced by healthcare systems throughout the United Kingdom, and in Europe and beyond.
Before I turn to the honourable Opposition’s flawed motion, I want to reflect on a few points that Wes Streeting did not cover. For a start, he hardly mentioned social care, although that was an issue raised on his own Benches. We have made £2.8 billion and £4.7 billion available for social care in each of the next two years, recognising that what happens in one part of the system impacts the other. He also failed to mention any of our life sciences success stories, such as our 10-year partnership with Moderna, our deal with BioNTech to give 10,000 people early access to cancer therapies, and how we were the first country in the world to have the bivalent vaccines. That kind of work will shift the dial on prevention.
I speak for the people of Bristol South. Let me talk about social care: can the Secretary of State explain why he will not publish information about the trailblazers on social care? The Government made a huge commitment to people in this country that they would fix social care, but they have reneged on that promise. They spent £2.9 million on trailblazers. I have asked written parliamentary questions of the Secretary of State and have been told that they are not publishing information. We do not know what has happened to that money. We do not know the outcome of that trailblazers report. If we are to learn from the disaster of the last year in which the Government marched us up the hill and back down again, we need to understand the outcomes. Will he commit to publish the evidence that we have had thus far?
I support transparency, so I will take away the issue of trailblazers that she raises. [Interruption.] Dame Angela Eagle chunters from a sedentary position, but I am agreeing to look at the point that Karin Smyth raises. She and I have debated in the past, not least when I was a Minister of State and she raised the issue of NHS property. She knows that I was a supporter then of transparency. She raises an interesting point that has not been raised with me previously.
I am very happy to take that away and look at how we get some transparency on that, because it is important that the House is able to see the evaluation of innovation and where pilots are done. Secondly, one of the challenges that the NHS faces is that it does not adopt that innovation at scale. The substance of the hon. Lady’s point is fair and I will happily take it away. On why I mentioned Welsh MPs, given Bristol’s proximity I thought she may be able to shine a light on the strange absence of any Welsh MPs, unlike the Secretary of State for Wales who is taking a keen interest in this debate.
I turn to the motion moved by the shadow Secretary of State, which seems, incidentally, to have been written before my statement on Monday. I might have thought that he would change it. We set out a further £250 million to support emergency departments and to get those patients out of hospital who are medically fit to be discharged. Across the House, people recognise that the pandemic has had a significant impact on that. It effects flow in hospitals and it is an area of common ground between the shadow Secretary of State and me: the issue of delayed discharge is a big factor in the compression in emergency departments.
My right hon. Friend’s visit to Watford just last week highlighted the incredible innovation there in virtual hospitals and the power of people being looked after at home. I know the work area that he looked at; I would like his opinion on that fantastic visit and on how we can roll that out across the country.
My hon. Friend highlights an extremely important area of innovation that speaks to the point about how to adopt that at scale. I will come on to the issue of virtual wards. At Watford, they told me that it was saving the equivalent of another ward of the hospital by enabling people to be discharged to recover in their homes where it was more comfortable. Patient satisfaction was extremely high—over 90% in the programme in Watford. Not only that; the clinical wraparound support means that if they need to return to hospital, they are able to do so.
I, too, have seen the virtual ward at Watford General Hospital, which serves my constituents. We are very proud in west Hertfordshire that we were the first hospital trust to have that virtual ward, but he will know from his visit that the No. 1 priority of every member of clinical staff in that hospital is to have funding from the new hospitals programme to improve our hospitals in Watford, Hemel and St Albans. Could the Secretary of State please pledge to write to me within the next seven days to report on his meeting with the hospital trust and tell us whether and when we will finally get some funding, after being overlooked for decades?
It was extremely helpful to discuss the priorities for the new hospital build with the clinical team and the leadership team at Watford. I could see that for myself, and we are committed to it. This is an issue that my hon. Friend Dean Russell champions assiduously on behalf of the people of Watford, but I know that it matters to a wider cohort there and I am happy to write further to the hon. Lady as she requests.
The virtual ward at Watford—it is great to have cross-party support for that innovation—is further facilitated by the funding we announced in the autumn statement: the further £500 million this year, £600 million next year and £1 billion the year after. The Opposition say we are “failing to recognise” the scale of the current challenges in the NHS, yet when I set out in the statement the additional actions that we are taking, it was both to respond to the pressures from flu—the sevenfold increase we have seen, with 100 times the number of patients in hospital with flu compared with last year—and to facilitate the innovation that they highlight in programmes such as virtual wards.
The Health Secretary will be aware that our hospital bed numbers are approximately half the OECD average, at fewer than 2.5 per 1,000 compared with 5 per 1,000 in the OECD. He will also have read reports in The Observer about the facility that was made available in the Health and Social Care Act 2012 that allows hospitals to allocate up to 49% of their hospital beds to private patients. Does he regret that?
The issue of bed capacity does indeed matter. I made the point a few moments ago that flow in hospitals is obviously constrained when bed numbers are high. That is exactly why, in the statement on Monday, I highlighted the importance of discharge, and of things like discharge lounges so that we can better facilitate those patients that are free to leave. But this is not simply about hospital bed capacity; it is about step-down intermediate care capacity and also, as we heard a moment ago, about the innovation that means we are better able to facilitate those patients who want to recover at home but want the safety net of some clinical support when they are doing so. It is about looking at the capacity in the whole of the system, not simply in the hospital; otherwise, the hospital itself becomes a magnet.
The crisis this winter was predictable and building long before we arrived here. Normally, the NHS and the Department plan for winter crises in the summer months, but this year something else was going on in the summer months, wasn’t it? The Tory leadership election. Does the Secretary of State regret what the distraction of the Tories’ internal faction fighting has led to, which is the inability of this Government to plan ahead and do the day job, and the fall below minimum standards of the Government service?
I do not think those are factors that affected what happened in Scotland, where the First Minister warned on Monday that the hospitals were almost completely full. Indeed, the Scottish Government are taking emergency measures, including cancelling some non-essential operations. I do not think that was a factor in France, where the French Health Ministry is saying that intensive care beds are at saturation point. I do not think that was a factor in Wales, where more than 54,000 patients are waiting more than two years for an operation. I am glad that the hon. Lady highlights the summer, because it was in the summer that we hit the first of our elective recovery targets in terms of the two-year wait, getting those below 2,000, in stark contrast to what we saw in Wales. The surge in flu has happened across the United Kingdom, not just in England, and it has also affected France, Germany and other countries in Europe.
I am very conscious that this Government have put a lot of extra money into the health service, and that Ministers have consistently wanted to get waiting lists down so that we have the extra capacity we need. Will the Secretary of State share a little of the thinking of senior management, who run the NHS day to day, in not using more of that resource for extra beds and extra staff to back them up?
As so often, my right hon. Friend raises an extremely important point about how we best use the resources and significant investment being put into the NHS. He will recognise that a key part of delivering value for money is looking at the interfaces on the patient pathway through the healthcare system. Handover points are often when we have the most difficulty.
I am sure my right hon. Friend will welcome that I recently visited Maidstone to see how we track the patient journey through a hospital and into care—residential care or domiciliary care. We are putting control centres in place through the 42 ICBs, and our reforms are bringing health and social care closer together. An area of common ground across the House is on the need to bring social care and healthcare closer together, and the ICBs, which were operationalised from July 2022, are a key part of that.
I suspect that one issue on which my right hon. Friend and I strongly agree is that it has to be underscored by data, so that we can see where the blockages are and prioritise the use of technology, such as machine learning, artificial intelligence, virtual wards and other innovations.
The Association of Directors of Adult Social Services surveyed English local authorities back in 2019, and it found that they had endured cuts of £6.3 billion in adult social care, resulting in a drop since 2014 of 425,000 beds. How much does the Secretary of State think that has contributed to today’s crisis?
I am delighted that the hon. Gentleman raises the additional funding that the Government are putting into social care. In his autumn statement, the Chancellor made the biggest social care spending increase of any Government in history: an extra £2.8 billion next year and £4.7 billion the year after. That is £7.5 billion over two years, on top of the £6.6 billion he put into the NHS over two years. At a time when, as a consequence of the pandemic and the war in Ukraine, inflation is extremely high and there are acute cost of living pressures for constituents across the country, the Chancellor prioritised spending not just on health but, as Clive Efford helpfully highlighted, on social care. Bringing health and social care together is exactly what I set out in my statement to the House on Monday.
The Secretary of State refers to significant challenges, as though this crisis started a few weeks ago. This crisis has been ongoing for more than a decade, and it is worsening year on year, but Ministers come here blaming it on anything other than, frankly, their incompetence and negligence over the last decade. When will they wake up, move away from their ivory tower and accept that it is on their watch that their incompetence and negligence have resulted in our constituents suffering today?
The data shows very clearly the profound impact of the pandemic, and the data shows that the impact is not constrained to England. It is acute in—[Interruption.] Imran Hussain has just had his intervention. If he wants to hear the answer, the reality is that the pandemic has had a profound impact on the NHS in Wales and Scotland, just as it has across Europe. That is what he is ignoring. He does not like the facts, but the facts are clear.
I will answer the hon. Gentleman’s first question. I will then give him a second go, as he is chuntering. Hospital flu admissions went up sevenfold in a month. The figure is 100 times higher this year than last year, and that comes on top of the severe pressure from the pandemic—9,000 cases. Perhaps he wants to explain the situation in Wales and why he feels the pandemic has not had an effect.
Of course, the Minister did not answer my question. I ask him about two things. First, every time this Government are put on the spot, they refer to what has become the Welsh defence; they would much rather not talk about their own incompetence. Secondly, how does he explain that in at least seven of the past 12 years they have missed their target overwhelmingly? That suggests we were in a crisis a long time ago.
I am grateful to the Health Secretary for that. On the point about relative performance, I want to touch on cancer treatment capacity. Our performance as a nation is lamentable on the seven most common forms of cancer. If the buzzword is innovation, surely we have a tremendous opportunity to roll out advanced radiotherapy. About one fifth of the machines we have in our hospitals are more than the recommended limit of 10 years old. Surely that is a perfect example of a cost-effective means by which we could apply artificial intelligence and diagnostics in parallel, and we could treat many more patients and improve outcomes. Is he open to that idea?
I am very open to that idea. For all the sound and fury that there sometimes is within the political debate, I know that there are certain topics within health on which people across the House are keen to work. Cancer is one issue that affects all families and all constituencies, and there is often scope to work extremely closely together on it. Knowing the hon. Gentleman well, I am happy to work with him moving forward.
May I just answer the last point, as Grahame Morris raised an important issue, and one that matters to many families? On the substance of his point about equipment, tech and innovation, we are looking at how we innovate. GP direct access is part of that, as it provides direct access to diagnostics. More patients are having their first cancer consultation following an urgent GP appointment. If we take the cohort of more than 810,000 who have started treatment for cancer since March 2020, the statistics show that 94% did so within their first month.
I wanted to seize the moment, based on the excellent question from Grahame Morris. The inquiry by the all-party group for radiotherapy is on
Let me check the diaries with the Department. These things are always dangerous because we need to know what the travel plans and various commitments are, but I hear the hon. Gentleman and the hon. Member for Easington, and we will absolutely look at what can be done.
As a declaration of interest, let me say that I am the daughter of two NHS doctors, the sister of a geriatrician and the wife of an oncologist. I hope that the shadow Secretary of State shows a bit more respect in the future for those of us who come from medical families. I thank my right hon. Friend the Secretary of State for giving way, given that the Opposition were not allowing me to ask my question.
We know that it takes a long time to train doctors. Before the last interventions, the Secretary of State mentioned the Chancellor. One excellent thing the Chancellor did when he was Health Secretary was to announce 10 new medical schools. We have always had a shortage of doctors in Essex and difficulty recruiting them, because we had never trained doctors there. The medical school in Chelmsford is brilliant. Its attrition rate is less than half the national average. The first students will qualify this year, and it is fantastic. Those students want to stay locally. This is a symbol of the Conservative party investing in the long-term future of the NHS where it is needed. Will the Secretary of State consider expanding these excellent medical schools?
My right hon. Friend raises an extremely important matter. I was in the Department when the current Chancellor was Secretary of State and when we made that commitment to a 25% expansion in medical undergraduate places. She is absolutely right in saying that it takes time for those cohorts to come through. She is also right that Chelmsford has been a huge success. I am sure that, in the context of the workforce strategy that NHS England colleagues are bringing forward, she will make the case for where any additional capacity should go, but we will, of course, look to that workforce strategy to map out what is needed.
Let me turn to elective care backlogs. A number of Members across the House have raised the issue of the 7.2 million people on the waiting list. I think that it is worth breaking that figure down between the 1 million who require surgery and the 6 million who are waiting for outpatient appointments—either for their first appointment or for their follow-up. The NHS is doing more than 94 million outpatient appointments a year, of which 30 million are for new patients and 64 million are follow-ups. The “did not attend” rate is about 6.5%. This relates to the question of my right hon. Friend John Redwood about value for money and how we deliver the reform of which he spoke. If we halved the “did not attend” rate of about 6.5%, it would free up almost 4 million slots. I am very interested in looking at the data and at how we prioritise within that data the wider challenge around the elective care backlog. I hope that that provides him with some reassurance.
Before the intervention is taken, I advise Members that there is a lot of interest in this debate, and each intervention is cutting into the contributions that can be made. We will be down to a three-minute limit very quickly, and some people still may not get in.
I wish to bring the Secretary of State back to the point raised by my hon. Friend Debbie Abrahams, who pointed out that in the Health and Social Care Act 2012, the coalition Government legislated to allow NHS hospitals to make up to 49% of their money from private patients. She asked whether he regretted that, but we did not get a response, so I would like to hear the Secretary of State’s response. Will he also tell us what assessment he has made of the impact on waiting lists of non-NHS patients taking the place of NHS patients in our hospitals?
It is a good thing to be bringing more funding into healthcare rather than turning it away. However, conscious of your edict, Mr Deputy Speaker, I will truncate some of the areas that I was going to cover, because I am sure that right hon. and hon. Members will bring out some of those points in the wider debate.
Labour’s motion ignores the statement that I gave to the House on Monday. It ignores the extra funding that we provided in the autumn statement and the commitment reflected in the Downing Street summit on Saturday to publish recovery plans for urgent and emergency care and for primary care, which we will do in the weeks ahead. The motion ignores the very real health challenges being experienced across the United Kingdom in Wales, Scotland and Northern Ireland, which all face pressures. It ignores the fact that France, Germany and elsewhere in Europe also face significant pressure.
The Government recognise, as I set out to the House on Monday, that there are real challenges in the NHS and social care. That is why we set out a three-phase approach: first, taking immediate steps to reintroduce flow to relieve pressure in the emergency department and across the hospital estate; secondly, putting in more capacity to build greater resilience over the course of the year, mindful of the fact that summer is increasingly a busy period—more so than was traditionally the case; and thirdly, making investments in our life science industry, such as the deals with Moderna and BioNTech, to ensure that patients in the UK get the most innovative drugs at the earliest date. That shows the Government’s commitment to backing the NHS now and in the future, which is why I commend the amendment to the motion to the House.
Before I call Barbara Keeley, I remind everybody again that interventions eat into the time of those at the end of the speaking list, so please have a little bit of care and consideration for your colleagues.
First, I want to share with the Health and Social Care Secretary my constituent’s recent battle to get medicine for his son, who had a high fever and symptoms that could be strep A. Unable to get a GP appointment, my constituent and his son had to travel out of the area to a local walk-in centre. They were then sent to the hospital, where they endured a six-hour wait. When the child was eventually examined, he was prescribed amoxicillin, but it was another long battle to find a pharmacist who stocked the antibiotics needed. My constituent said:
“Even I am shocked with what I have experienced over the last 24 hours.”
More and more people are finding out that the health service is no longer there for them when they need it. When someone has a child with serious symptoms and a temperature over 40°C, they should be able to access care quickly and not be forced to drive around for miles in desperation. My constituent also told me that he ran into several other parents that day who were experiencing the same issues in trying to get appointments and medicine for their children, who were very ill.
Nurses, doctors, ambulance workers, pharmacists, administration support staff and all those who, as part of our national health service, pour their energy into helping people when they are sick are worthy of our deepest respect and our thanks. The NHS crisis is not of their making. It is caused by the inability of the Conservative Government to plan or to support our health services adequately.
Many clinicians and commentators looking at the NHS crisis this week have raised the question of social care. Every year we revisit the pressures on social care and the desperate need for reform. Every year we see the consequences of Government inaction. We have had promise after promise of reform, but that reform is always dropped in favour of sticking-plaster solutions.
This week’s sticking-plaster solution gave the NHS some extra money, apparently to buy care beds. The deeper issue in social care is not beds, but the crisis in the social care workforce, with 165,000 posts vacant, representing one in 10 of the workforce. The NHS can buy beds in care and nursing homes, but that home may not have the appropriate staff available for the needs of the person being discharged. Unsuitable care will only lead to readmissions to hospital, so the cycle carries on. We know that in some parts of the country there are care deserts where there are no care home places. Does that mean that hospitals will start buying care home places tens or even hundreds of miles away?
The scandal of out-of-area placements is already a reality for many autistic people and people with learning disabilities. Chronic underfunding of social care and the lack of appropriate community services have entrenched a reliance on expensive in-patient care for autistic people and people with learning disabilities—care that is often far from home and not suited to the person’s needs. There is no extra funding to solve that problem. Indeed, the budget for those community services has been reduced this year from £62 million to £51 million.
We know that 2,000 autistic people and people with learning disabilities are trapped in that inappropriate in-patient care, which is often found to rely on the overuse of punitive seclusion and restraint. The fact that many placements are hundreds of miles away from family and friends makes the problem worse. Despite the steady stream of scandals, from Winterbourne View 11 years ago to the Edenfield Centre more recently, it is an issue that the Conservative Government choose to forget, even though it is destroying the lives of many of those detained and their families.
Our Opposition motion rightly ends with a call on the Government to
“end delayed hospital discharges…and reform primary and community care”.
Thirteen years of Conservative failure have led to this crisis. It will take a Labour Government to make the NHS fit for the future.
I only have a short time, so I will make a couple of points.
On strikes, since we have a major strike today, I understand that many of the trade unions are saying they will not engage with the independent pay review bodies for the 2023-24 settlement. That is a catastrophic mistake on their part. The shadow Secretary of State, Wes Streeting, and I were on a well-known evening news programme together the other night. Far from trashing the pay review body, he said that although it may need reform, it is important. I am glad to hear him say that, because it is important, and the alternative is Ministers directly negotiating pay settlements with unions. They have tried to do that in Scotland in recent weeks, and the Royal College of Nursing rejected the offer out of hand. The pay review process may not be perfect and may need reform—our Select Committee hopes to talk to the NHS pay review body soon—but I think that madness lies in pay negotiations around beer and sandwiches in Ministers’ offices. The unions should engage with the pay review process for next year. That would be the smart thing to do on their part.
My second point is about demand. The GMB came before the Select Committee just before Christmas and told us that the number of calls coming into the ambulance service is about 10 times what it was pre-covid. There are 100 times the number of people with flu in the acute setting than at this time last year. Demand is significantly outstripping supply in the health service right now, and I think it is disingenuous not to face that.
I am grateful to my hon. Friend for his work in chairing the Select Committee, and for the joint session with the Science and Technology Committee, on which I sit, about the lessons learned from covid. We heard that there are lessons for the NHS to learn for the future. Does he not find it a bit strange that there is no mention whatever of covid in the Opposition’s motion? Clearly, covid—combined with flu and everything else that he talks about—is one of the reasons behind the acute pressures that we have experienced this winter.
I said in the House on Monday that covid has put the health service on its knees—it has done so to health services in the UK and around the world. To repeat what I have just said, it is disingenuous to suggest that the problems faced by our health service right now are not caused by our covid experience. The number of people presenting with suspected cancers is through the roof. That is good—many of those cases will turn out not to be cancer, which is even better—but so many people are coming forward because we suppressed demand during that time, and it is adding to the demand outstripping the supply in the health service right now.
The hon. Gentleman chairs the Select Committee, so it is really important that he is clear about this. The Government ran the health service at 96% capacity well through the 2010s, well before the pandemic. They were consistently warned that 96% capacity is too much; we should be running at about 85% capacity for staffing and so on. Capacity in the system has been our problem for a long time. Demand is outstripping capacity—supply is about capacity—and he, as Chair of the Health and Social Care Committee, needs to be clear about that point.
I will choose my words and the hon. Lady can choose hers. I will come to capacity in the conclusion of my remarks—I promise her that.
I will touch on patient flow. Any acute sector that I speak to or visit at the moment is saying clearly that patient flow is hampering everything happening at the front door and the back door. One of the reasons why those in the ambulance service are striking is that they are so heartbroken about not being able to deliver the service that they want to deliver and cannot get out on the road because they are waiting to dispatch their patients.
I said it on Monday and I will say it again now: I welcome the £250 million that the Government have put forward to buy beds. I repeat that two thirds of social care is domiciliary care—care in people’s homes—and we must not forget that, because it is important to getting people through the acute system. The modular work that the Secretary of State talked about—modular units in and around emergency departments—to add extra capacity and meet some of the extra demand coming through the front door, is also very welcome.
I said that we have to separate the now from the long term, so let me address the long term. The elective recovery taskforce is important; the 15 new elective hubs are important. At Prime Minister’s questions today, the Prime Minister talked about eliminating the two-year wait, and that is good—it is not, of course, the extent of his ambition, and to say so is facile. We do not yet have an elective hub in Winchester. The Secretary of State knows that I am on his case about it, but may I just land that point with him again? The Prime Minister’s primary emergency care plan, which we eagerly expect later this month, will be important. It is also part of a long-term strategy and plan, and I think many people in the ambulance service will be pleased with what they see there. I hope that it will be as ambitious as what we hear in some of the rumours.
Some of the things the Select Committee is looking at feed into what the Secretary of State and the Government are doing. Integrated care systems are a creation of this Government. They are about flattening services across the NHS and breaking down those barriers between health and social care. We are in the middle of a big inquiry into integrated care systems, and we are liaising with the Hewitt review, which is a good thing. We were talking to the Care Quality Commission this week, and the Government have not yet laid the regulations on how the CQC will look at ICSs. Will the Minister please look at that?
This morning we talked about the digital transformation of the NHS. There are huge dividends in digital for the NHS, including simple things, such as the amount of money that the NHS spends on sending letters to patients—not least given that they never get there due to Royal Mail strikes. There are clinical dangers to that. Let us pursue our digital transformation, and I know that the Secretary of State is up for that. In terms of the stuff we will be doing this year, we eagerly await the workforce plan.
I cannot give way, because I do not have any more time. We eagerly await the workforce plan. When the Minister sums up, will she update us on where we are with the workplace plan and its independent verification, which the Chancellor announced in the autumn statement?
The Select Committee will be looking significantly at prevention this year. I know that the Secretary of State is passionate about some of the upstream prevention measures we will be talking about, and I look forward to him coming before the Select Committee on
Finally, we need to be very careful about the language we use and how we talk about the NHS. Are we honest about the reform we need? Do we believe in the independent pay process? Is primary care really fit for purpose as it is? Do the British people want to spend more than the £159 billion that we will spend this year, and how will we pay for it? I think we do need a bigger NHS, and we clearly need more people in the NHS—that is not a point of debate—but we need to be careful about the language we use around the NHS, because otherwise the long-term strategy is nothing more than a moot point of debate in this House.
It is a pleasure to follow my friend Steve Brine, the new Chair of the Select Committee. My hon. Friend Wes Streeting, the shadow Secretary of State, is right about Government mismanagement of the NHS since 2010. As a member of the Health Committee from 2010 to 2015, when it was chaired by the right hon. Stephen Dorrell, the former Health Secretary, I want to set out why this crisis has been brewing since 2010. Incidentally, Stephen Dorrell has noted five mistakes that the Government have made and should look at.
The Health and Social Care Act 2012 prevented integration. It made the NHS not the first and default option, and it was opened up to privatisation, fragmented and destabilised. The reorganisation was described as so big that it could be seen from space, and it was opposed by so many that it had to be paused. Despite the pressures of the pandemic, we had a further reorganisation with the Health and Care Act 2022, under which we will not have CCGs any more, but integrated care boards.
His Majesty’s Opposition have been pushing integrated care since before 2010. Our Select Committee visited Torbay in 2009, during the last Labour Government. We saw the single-point entry of Mrs Smith, who could be tracked from the start—from a single phone call—to hospital and out again, with any of her needs met by an upscaled, co-located team. However, the 2012 Act stopped that pooling of resources. Integrated care can only work if there are adequate resources for local authorities. Austerity measures since 2010 have starved local authorities and other public services of funding. Clinicians should be at the heart of the NHS. People who use it or work in it do not get a say.
In 2016 the then Secretary of State, now Chancellor, picked a fight with the junior doctors. I met them outside Richmond House. We have had more mismanagement, with £347 million for a covid testing contract to Randox, which then had to be recalled because of concerns about contamination. Now we have PPE Medpro, and today the Public Accounts Committee said the Government have mismanaged the economy by losing £42 billion in uncollected taxes. There is money, but not the will to find it.
Nurses went on strike in December, yet in the first statement the Secretary of State has made since—he is not in the Chamber, but he said that we did not mention his statement—he did not mention the workforce at all. In fact, he gave an understatement of the figures for people with delayed discharge. He said that there were just 6,000 cases in June 2020. Last year, there were 12,000 to 13,000 a day. The Government knew the figures, but they did nothing—they had no plan.
Not talking to a workforce who stepped up into the unknown during the pandemic is mismanagement. Stopping nurses’ bursaries was mismanagement. Not holding cross-party talks to solve the care crisis when we urged them to—the Health Committee report was in 2012—was mismanagement. The Government dismantling a health service that had its highest satisfaction levels in 2010, when Labour left office, is mismanagement.
On the workforce, existing nurses are underpaid, but the serious number of vacancies that existed in September—47,000, as reported by Nursing Times—must also be addressed adequately and immediately. Those vacancies are putting pressure on nurses, on top of the pay awards they are after.
My hon. Friend is absolutely right and puts the point perfectly. I have questions to ask the Minister. Are the recommendations on safe staffing levels made by Sir Robert Francis being followed now? Will the Secretary of State consider a patient discharge dashboard so we can see the figures on a weekly basis? Where is the accountability for the £500 million in the discharge fund? Are the 42 NHS system control centres mentioned in the statement just the ICBs by a different name? Our shadow Secretary of State for Health has outlined a plan for training more doctors, paid for by abolishing non-doms, and I am with him on salaried GPs as a step in the right direction.
Nye Bevan heard the cries of his community in the valleys. He said:
“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”
He turned his dream into a wonderful service that is free for all of us. We will not let this flailing and failing Government destroy our NHS.
I must admit that I was surprised by the audacity and tone that Wes Streeting took when introducing such an important debate. Not one Welsh Member of Parliament from the Labour party is present. I think they may share my disappointment in the tone the Labour party is taking over this serious issue, bearing in mind the performance of the Labour party and Government in Wales in failing to deliver on the NHS. Who knows, those Members might be embarrassed or angry; maybe they are angry and embarrassed at the hon. Member for Ilford North. I hope they are certainly disappointed by the performance, waiting times and outcomes for our constituents in Wales.
Tone really does matter. This is a really important debate, and we need to consider it in the way the Secretary of State recognised the issues facing every part of the United Kingdom. The Chairman of the Health and Social Care Committee, my hon. Friend Steve Brine, also recognised that and urged the use of responsible language. This needs to be followed through. When I have highlighted deficiencies in the NHS in Wales in the past, I have been accused of undermining the NHS or attacking NHS staff. I hope I will not be accused of that now, as that is not my objective. I am instead frustrated with the Labour Government in Wales and the outcomes my constituents are experiencing. I make this contribution in support of the NHS staff, clinicians and all the apparatus that delivers an effective and efficient health service.
Much has been said about data and waiting times, and I could go on and on about that. No matter what statistic the hon. Member for Ilford North highlights, I could trump him every time with worse performance in Wales. I am not celebrating that, because my constituents and my family experience that performance. I am disappointed by the political tone the hon. Gentleman is taking in seeking to exploit the challenges facing the NHS and its staff having come out of a global pandemic. That is something we absolutely need to recognise.
I will highlight some statistics to encapsulate the experiences of my constituents and others in Wales. After 25 years of a Labour Administration in Wales, accident and emergency times, primary care delays, cancer treatment times and waiting lists are much longer than they are in England, or than they were previously. In England, 5% of patients are waiting longer than 12 months; in Wales, 23% of patients are waiting longer than 12 months. I will not bore everyone with lots of numbers, but I will take that to the next level of statistics: 7.9% of patients in Wales are waiting longer than two years for treatment. That is why Opposition Members have to accept and recognise that this a serious debate that affects every part of the United Kingdom, Europe and beyond.
Does my right hon. Friend agree not only that the statistics for Wales are markedly worse than for England, but that in Wales the expenditure per head on health is 15% higher than in England?
My hon. Friend makes an important point. The hon. Member for Ilford North pointed to the lack of funding for the NHS in Wales, but since 2010, only the Labour Government in Wales have ever cut NHS funding—no other Government in the UK have done that. When I was the Secretary of State for Wales, we renegotiated a funding formula that the First Minister, who was the Finance Minister at the time, said was a very fair deal. That formula means that Wales receives £120 for every £100 that is spent in England, and there is a funding floor attached to it. That highlights the generosity and fairness of the settlement, bearing in mind the inequality that the hon. Member for Ilford North highlighted earlier.
In my final minute, I will comment on the strike action. Every point that the Leader of the Opposition has made about the challenges of strikes, and every criticism that has been made of the Prime Minister and Secretary of State for Health and Social Care, could equally apply to the First Minister and Health Minister in the Welsh Government. That demonstrates the complexity of the situation. The Welsh Government say that they cannot act until they have more money, but they need to remember that they are getting £120 for every £100 that is made available in England, and they have tax-varying powers. Are they saying that they want to tax the English more in order to spend more in Wales? They can vary taxes however they want—[Interruption.] They can vary taxes and that is the choice that they have to make. They decide where they spend their money. In closing—
Through neglect, ideological hostility and incompetence, the Tory Government are presiding over the worst crisis the NHS has ever seen. Some 7.3 million people are on the waiting list; there has been a virtual collapse of emergency response; and people cannot see a GP or get follow-up treatment without unacceptably long waits. Today, there have been reports of more than 1,000 excess deaths a week—the highest total, excluding the pandemic, since 1951. There have been many, many preventable deaths on the Government’s watch, and each and every one is a tragedy.
Our NHS is in crisis from top to bottom. There are patients in hospital beds who cannot be discharged because there is no domiciliary care and nowhere for them to safely go. Ambulances are queuing for hours, unable to admit critically ill patients. There are inhumane waits in A&E before anyone can be admitted to beds they desperately need. Staff, who are already burnt out from the stresses of the pandemic, are unable to care properly for patients and are barely able to get through a shift because of the emotional exhaustion of having to deal with those failures.
“never worked in such an unsafe environment”.
“Staff are literally on their knees, leaving shifts late in tears, and leaving in their droves”.
My constituent went on to detail a case in another local hospital in which a patient had a cardiac arrest in a hospital corridor. Frankly, a hospital should be the best place to have a cardiac arrest if somebody is going to have one, but it is now not so in Tory Britain. The individual collapsed and died.
With 132,000 NHS vacancies in England—over 17,800 in the north-west alone—our NHS is dangerously understaffed, under-resourced and under-respected. That is why NHS staff at the end of their tether have taken the desperate decision to go on strike. That is why any Government worth their salt would have decided to negotiate properly with them, to listen to them and to try to deal with and recognise that, in the last 13 years, a real-terms cut of 20% in nurses’ remuneration is simply not acceptable, but what did they do? They chose to have a divide-and-rule strategy, and they chose to try to scapegoat and blame NHS staff for the terrible conditions I have been talking about.
Perhaps the Government should consider legislating for a minimum service outside of strike days, because we are going to be in the absurd position of having, by law, guarantees on strike days—they could be negotiated anyway and always have been—that do not apply on non-strike days. It is an insult when the Secretary of State meets the health unions and says they have to increase their productivity. They are working beyond any amount of time that any human being should be asked to work.
I confess to being a bit confused by the Labour party’s position on minimum service levels. We all want to ensure that our constituents are as safe as possible. The ambulance workers want to ensure that people are as safe as possible. The hon. Lady has said herself that these things would be negotiated anyway. But the challenge people face on the ground is not knowing who is going to come in, the fact that people do not have a say on whether they are going to come in and the fact that a negotiated settlement might be different in different areas of the country, which makes messaging and public health messaging very difficult and puts people at risk. So why is Labour so against minimum service guarantees?
I think the hon. Lady, and I know that she is a doctor, needs to recognise that these agreements have always been made when there have been strike days in the NHS—always. I think she also needs to recognise that any Government who were being responsible would have negotiated to put an end to these strikes, recognised the fantastic service that nurses have given and dealt with the issue, instead of going for confrontation.
I am not giving way again.
I am going to leave the last parts of my speech to another constituent of mine, an 83-year-old who fell alone in his home and was left. The ambulance was called at 4.15 in the afternoon—it was thought he had a fractured hip—and he was warned of a potential 14-hour wait. My constituent said he
“naively thought this must be the worst case scenario and thought it was very unlikely to be that long”.
He could not move, he could not sleep and he could not go to the toilet. Eighteen hours later, the ambulance arrived—18 hours later—at 10.15 the following morning. At the hospital, things got no better. There were patients on trolleys lining the corridors. For nearly another 24 hours, this 83-year-old man immobilised with pain was to lie on a trolley in a hospital corridor after 18 hours of waiting for an ambulance.
This is in no way acceptable. This should not be accepted by any Government worth their salt. They should hang their head in shame at what they have done to our NHS. We need to have a Government finally, which we will after the next election, who will solve these problems, instead of seeking to blame everybody else—the weather, the pandemic, the staff and any number of other things. It is about time we had a Government who have the guts to take responsibility for the decisions they have made and put it right. We are going to have such a Government soon. Shamefully, we have not now.
I begin by paying tribute to the hardworking staff of our NHS, including those working across Erewash, whether at Ilkeston Community Hospital, in our GP practices or pharmacies, and those who work in the care sector.
On the creation of the national health service in 1948, the public information leaflet sent to every household in the country stated:
“Everyone—rich or poor, man, woman or child—can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a “charity”. You are all paying for it, mainly as tax payers, and it will relieve your money worries in time of illness.”
At that time, average life expectancy for men and women was 66 and 70 respectively. Alongside heart disease and cancer, people were still dying in large numbers from what today are preventable diseases such as tuberculosis, polio, measles and diphtheria—all now preventable through vaccines.
Countless lives have been saved by the NHS since its inception, which is in no small part thanks to the increasing use of diagnostic testing. Often overlooked as the less sexy side of medicine, the field of diagnostics is so much more than a blood pressure check, X-ray or computerised tomography scan. A simple blood test provides a multitude of clinical information, leading to the diagnosis of complex medical conditions. More and more in-vitro diagnostic tests are available in a rapid format, giving almost instant results close to the patient. I am sure all Members in the Chamber today will have used a diagnostic test recently in the form of a lateral flow test for covid. Indeed, we will all have seen the benefits of such devices, which are a useful and invaluable tool that help to prevent serious illness and disease by diagnosing conditions at an early stage, allowing for timely treatment and helping to prevent more serious illnesses.
We are, however, yet to capitalise on the full potential of diagnostics as a way of relieving pressure in the NHS system, and helping to reduce the backlog—one of the Prime Minister’s top priorities. For example, the British In Vitro Diagnostics Association estimates that at least 3% of Accident and Emergency admissions are for chest pain symptoms. A simple but sensitive blood test for cardiac troponin can be used to rapidly diagnose or rule out a heart attack in patients attending A&E with chest pains, allowing for either early discharge or admission for further treatment. That could potentially save billions of pounds and is better for the patient, but it requires changes to well established protocols within the department, and links with the hospital laboratory. I am sure that is the type of change the Secretary of State was referring to when he spoke about productivity. This is about the productivity of procedures and processes that fully match the technology available today, rather than that available 74 years ago. I therefore seek the Minister’s assurance that in-vitro and in-vivo diagnostics will be given the recognition they justifiably deserve in all forward planning by her Department, as an effective way of reducing pressures on our NHS and social care services.
I believe this debate should be framed within a wider global context, and not localised just to issues affecting the NHS in the UK. The Guardian newspaper—a favourite of the Labour party—recently highlighted that in France more than 6 million people, including 600,000 with chronic illnesses, do not have a regular GP, and 30% of the population does not have adequate access to health services. There are similar pictures in Germany, Spain—I could go on. This is a Europe-wide problem, and not a unique crisis in the NHS as Opposition Members would like the public to believe.
I believe the onus is also on us as individuals to use our precious resources appropriately. I hear from my local GPs that people are seeing them who have had a cough for just four hours, as opposed to four weeks, and that people phone 111 instead of 999, or 999 instead of 111. People turn up at A&E when they could have got great advice from their local pharmacy, and others do not appreciate that some of their lifestyle choices will have a huge negative impact on their health. There is still a lot of work to be done on simple and effective public messaging. We must all make our own contribution—both financial and from the perspective of personal responsibility—to ensure that the NHS remains viable because, like any form of insurance, although we may not need it today, we might well need it tomorrow.
My constituent Lynne O’Sullivan emailed me at 4.30 am last Sunday from the A&E department at Aintree University Hospital. She said:
“Good morning Maria. I email you in a last bid for help. I’ve been sat in Aintree hospital A&E since Friday…with my father who was sent here by his GP. We arrived at 10.30 on Friday with my father, who they think suffered a stroke. They admitted my dad…saying he needs an MRI scan and some other tests. We are still sat in A&E awaiting a bed on hard seats having slept here since Friday…It’s now our 42nd hour sat in A&E. I am at my wits’ end trying to get help. A doctor on Friday evening prescribed high blood pressure medication for my father. He has only received one dose.
I beg for your help. I don’t want to lose my dad due to poor hospital care”.
Well, who would?
Lynne’s father finally got a bed after 54 hours sat on a hard seat in A&E at Aintree hospital. He eventually got an MRI scan 78 hours after he attended the hospital—that was without him needing an ambulance. I am glad to say that Lynne’s father had not had a stroke and that he is in hospital now.
That is not one isolated example; there have been many other examples in Liverpool. On
That is not only appalling for patients; it is terrible for staff. Right hon. and hon. Members may have seen the letter that top doctors at the new Royal Liverpool wrote to their management saying that they were “ashamed” of the “dreadful conditions” in the “chaotic” emergency department—that is in a brand-new hospital. They described the new Royal’s accident and emergency as “overcrowded, chaotic and unpleasant”, with an “unacceptable and unsafe” reliance on corridor care. The letter stated:
“The need to utilise the waiting room and X-ray waiting area chairs to house patients awaiting admission is completely unacceptable.”
They also said that they were
“embarrassed, ashamed and demoralised by the standard of care” that they were able to provide. Yet what have we heard from the Government?
I am sorry that the Secretary of State is no longer in his place, but I am afraid that today he has come across as complacent, as he did on Monday when he gave a statement to the House. He disappeared over Christmas. There is no point in talking about winter pressures in January—it is too little and too late if one is having to talk about it in January. There needs to be planning well in advance. He has come across as simply seeking to blame anybody else but him and his Government. Everything else is to blame: the pandemic, flu and unexpected pressures.
I am afraid that the Government are complacent. They are in charge of the system. I am appalled by the Secretary of State’s indifference. I actually find it quite shocking, because one cannot fix a problem if one does not accept that it is serious, that it is one’s responsibility to do so and that hard, hard work is necessary to get these things right. I am afraid that what we have from the Government is complete indifference and complacency, and I am very sorry to say that it comes across as a lack of care.
No one can deny that the health service is under extreme pressure. No one can look at it and not realise that there has been a big surge in extra demand, that there are problems from the hangover of covid when a large waiting list for less urgent treatments built up, and that we are short of doctors and nurses, not because Ministers will not authorise their appointment but because there are vacancies to be filled. As one of those who has been urging for some time to see a published workforce plan, I welcome the decision of Ministers to insist on that, and the sooner we get it the better. However, I am quite sure that there are a whole series of workforce plans already in the many dozens and hundreds of working trusts and quangos that constitute the NHS. It is about aggregating and making sense of those plans.
We often talk about the shortage of doctors. We know we cannot create a doctor overnight. It takes a substantial amount of time to train them. The Chancellor, a former Health Secretary, invested in five new medical schools to increase the number of doctors in training. Does my right hon. Friend agree that the Chancellor, with the Health Secretary, needs to invest more money in more medical schools and medical school places, but also look at how we increase the number of doctors by reducing the amount of bureaucracy and paperwork they have to fill in, so that they can spend more time doctoring and less time filling in forms?
Yes, indeed. From my hon. Friend’s own expertise, I am sure she is right. When people talk about productivity, they do not believe that hard-pressed staff have to work harder; they are saying there must be smarter working, making jobs more manageable or enabling them to concentrate on the things they are most skilled at, with more relief for the other necessary record keeping, which may indeed need slimming.
My hon. Friend is right that we could expand our training places further, but as we have heard there has been a big increase in educational provision and it takes seven years for it to flow through. I am glad we are getting to the point where we will see some benefits from that. We need more homegrown talent. Many people are attracted to the privileged career of being a doctor and the more we can allow to do that, the better. However, given the immediate urgency of needing more capacity, and therefore more doctors and nurses, the most obvious place is to look at all those who have already had the training and have left the profession or the NHS for one reason or another. Some may be in early retirement. That is probably not something my hon. Friend wants to change because she enjoys her new job, but there are many others who are not in a very important job like her who might be attracted back. I hope the Treasury will be engaged in the review, because I hear from doctors, as many do, that the quirk in the tax system at just over £100,000 where some of the better paid doctors are resting, producing a more penal 60% rate, is an impediment to extra working. I also hear about the pension problems that have been cited on both sides of the House. The Government need to take those issues more seriously if they wish to accelerate returns.
Ministers have very clearly set out that they want more NHS staff and have obtained much larger budgets in the last three years to help bring that about. They have also said very clearly that the public’s priority—and indeed the Opposition’s priority—is to get more treatments and get those waiting lists and waiting times down for those needing more urgent or emergency care. Those Ministers must translate that through the senior health service managers into ways of spending that extra money. If it needs a bit more extra money, there is always some extra available—every time we meet another additional sum is announced—but it has to be well spent. It has to be spent on motivating and recruiting the medical workforce.
I had better not, because we are very short of time for colleagues.
The money has to be well spent and I hope that senior managers, as they give us a published workforce plan, will share more of their thinking. It is not good at the moment that there is such a breakdown in relations with talented and important staff in the health service. There is a complex system of pay reviews, increments, promotions and gradings of activities. All those things have flexibility within them. I look to the senior managers on six-figure salaries to take their responsibilities seriously and get the workforce back on side, using those flexibilities within the system, because we deeply need them to be.
We need more supply because there is excess demand, for understandable reasons. Huge sums of money were tipped into the system to deal with covid. Not all of it was well spent, but that was understandable given the unknown nature of the beast at the beginning, and the obvious pressures in this place and elsewhere to get instant results with personal protective equipment, testing and so forth. That is now behind us, but unfortunately it disrupted normal hospital work and normal GP work and created backlogs.
I urge the Government to understand that part of the answer is having more bed spaces in hospitals, with the staff to back them up. I do not know why so many senior health executives never want to admit that. They always say that there are lots of bottlenecks and other issues. Yes, of course we need to move people on from hospital as soon as it is safe to do so, and of course we need more capacity in social care, but I say to Ministers that it would be great to have a bit more capacity in the main hospitals to give us extra flexibility and take some of the pressure off. Could not some of the extra £20 billion, £30 billion, £40 billion or £50 billion that has been found in recent years be spent on the combination of physical capacity and the staff to support it that we so need?
I start, as many hon. Members have done, by thanking our NHS and social care staff. They go above and beyond every day and have sacrificed so much, especially over the past few years. However, it is no secret that they are struggling to cope. In fact, the NHS is not only on its knees but on its face, as the shadow Secretary of State has said in his recent powerful contributions in this place.
The NHS is facing the worst crisis in its history. Urgent action is needed to make our beloved health system work again, but the Government have failed yet again. They are failing millions of patients and NHS staff across the country, as has been evident from all the contributions to this debate—even those from Government Members who have championed the cause of their constituents. Waiting lists are out of control, staff are burned out and people are literally losing their lives, despite some of the denials from the Government Benches. Look at the stats published today by the Office for National Statistics: 50,000 additional people lost their lives last year. It is shameful.
Nationally, 7.1 million people are waiting months and even years for treatment. Mid Cheshire Hospitals NHS Foundation Trust serves the Northwich part of my constituency; more than 33,000 of its patients were waiting for care in October. Just 59% are seen within 18 weeks, which is well short of the NHS target of 92%. I have been told by people working on the frontline and certainly by my constituents that many of them are waiting, not only at A&E but in corridors and car parks, for hours on end—12 hours in some cases. I will take the House on a bit of a journey to Warrington and Halton, and then we will go on to the Countess of Chester and to Whiston, where it is the same. People are waiting 20 hours—it is simply unacceptable. People’s lives are on the line, and that is a direct result of 13 years of Tory mismanagement. It is nothing new.
I will not give way. We do not have much time.
We have heard about covid and about flu. Those are facts, but let us take a journey through history to 2010, when waiting lists were substantially lower. In March 2020, when this shower of a Government were in place, the figure was more than 4 million. Now it is 7.1 million. It is shameful.
We must remember that these are not just statistics; these are real people. My constituent Tracey from Runcorn contacted me because her husband required life-saving surgery and it was postponed, as has happened for many constituents who have been spoken about today. Jonpaul was sadly diagnosed with prostate cancer, and was told that the cancer was trying to break free from his prostate. Thankfully, following an intervention from my office, he was able to have his surgery owing to a cancellation, but in many of the stories we have heard in the Chamber today, that has not been the case.
It is not just patients who are suffering; hard-working, dedicated NHS staff simply cannot cope with the current pressures, and now—as the Royal College of Nursing says, for the “first time in history”—they have resorted to strike action, with a very heavy heart. The clapping is long forgotten, and now they are threatened with the sack. That is not just unacceptable but absolutely disgraceful, and any Conservative Members who vote for it should be ashamed of themselves. They are culpable.
As the shadow Secretary of State pointed out, we do have a plan. There is a great big pot of money available from non-doms. I know that the Prime Minister is rather keen on non-dom status—I am not sure what the interest is there—but that money could be used to create not only health but resources, the frontline resources that we need to get waiting lists down. I say to the Government, “Step aside: it is time for Labour. It is time to save and rebuild the NHS.”
Order. I am afraid I have to drop the limit to four minutes, and it may be necessary to drop it down further to three minutes later. That depends entirely on colleagues, and how generous or otherwise they are to their friends.
When I heard the big announcement recently that Peterborough would have a new NHS community diagnostic centre, I described it in my local newspaper as a great Christmas present for our city. This is a good NHS news story. The new centre will include MRI, CT and ultrasound scanning, as well as phlebotomy and cardiology testing. I am so pleased about the benefits that the centre will bring: it will mean that more than 67,000 extra scans and tests can be conducted in Peterborough every year. Along with many other centres opening across the country, it will do just what the Prime Minister has pledged to do: cut NHS waiting times and detect conditions earlier. I am talking about it today because this is precisely what we need to do: we need to get on with the job and have a long-term plan for our NHS. I am delighted that Peterborough is getting this state-of-the-art facility, because it is fantastic news for my city.
Like the Prime Minister, I have huge admiration for NHS workers. Both my parents worked for the NHS as nurses for most of their lives, and I understand the sacrifice and the long hours that are involved. Let me tell a story about something that happened in my constituency only recently, which is an example of the amazing work of NHS staff. I was told this story by my constituent Ivelina Banyalieva.
After five minutes of CPR the first ambulance arrived, and its staff confirmed that the man was still not breathing and had no pulse. They immediately started defibrillation, and within two or three minutes two more ambulances arrived. For an hour and half, those staff fought for the man’s life. They took it in turns to give CPR as they became exhausted, but did not stop for a second. After those one and a half hours, they were able to detect a very weak pulse. They transferred the man to one of the ambulances, where they spent another hour putting him into an artificial coma, and then successfully transferred him to a Cambridge hospital. He was given surgery with the placing of three stents, and 12 hours later he woke up.
That story shows that amazing things are happening in our NHS in places such as Peterborough. Saving someone’s life—essentially, bringing someone back to life—is one of the most amazing things that anyone can do. Such stories give me great pride in our national health service. Getting a new diagnostic centre makes me incredibly excited for the future. Yes, the NHS is facing challenges—no one will deny that—but I look forward with confidence, given my experience as the son of two nurses and experiences such as the one I have described. I am confident that this Government’s long-term plan for the NHS will succeed. I am confident that it is the right plan for the people of Peterborough.
I rise to support the motion on behalf of not only the Labour party but every person in Chesterfield who has contacted me in recent times in despair about the state of our national health service.
I first came to this place in 2010. Over the first year or two that I was a Member of Parliament, I had virtually no casework about the health service. Very occasionally someone might have got in touch with me, but now in every single surgery, someone comes to see me about being unable to access a doctor’s appointment, or about how long they have been waiting for a hospital appointment or an operation. Tragically, far too often I meet the families of people who are deceased but would be alive today if they had got the treatment that they should have had. It is for them that we are having this debate. It is for them that we need a long-term plan.
One of my first duties in the new year was my regular monthly catch-up with Hal Spencer, the chief executive of the Chesterfield Royal Hospital. I was expecting it to be a difficult meeting, and my goodness it was. The strain put on the senior management in our national health service, due to the failures under this Government, was etched all over his face. Chesterfield Royal Hospital had a critical incident over the Christmas period. It is a very good hospital, staffed by wonderful people who are professional, committed and passionate about the service that they provide. But imagine being a caring, dedicated, passionate, committed person and meeting patients who have been waiting 24 hours on a trolley before you get to see them. Imagine being an A&E registrar and knowing that people are arriving in agony, but that all you can give them is paracetamol to get them through the next 12 or 18 hours before they are seen. Imagine being a professional and seeing people with cancer who have been waiting, knowing that their cancer has got worse because you have not been able to see them soon enough.
The constant sticking-plaster approach of this Government is letting those people down. It is, as the motion says, costing hundreds of lives every week due to the collapse of emergency care. As my hon. Friend Wes Streeting said, we need that long-term plan to address the staffing crisis in our national health service, which has 160,000 vacancies. We need it to address the failure in general practice where the poorer you are, the more likely it is that your GP service will be unable to see you. We need it to address the failure in care that means 100 people in Chesterfield Royal Hospital over Christmas were fit to leave but did not have a care package to support them.
If we can get that long-term plan to address the failure in general practice and social care, we will save money. One of the maddest things about the failure in our NHS is that we are spending far, far more treating people in hospital beds than if we were able to treat them at home with a social care package, or in a general practice if they were able to get in there. I support the motion and I thank my hon. Friend for introducing it. The people of Chesterfield will demand that we deliver when we get a Labour Government.
Time is short, so I want to put on the record straightaway my thanks to all the hard-working hospital and ambulance staff at Southend Hospital and everyone working in the NHS across the city of Southend and picturesque Leigh-on-Sea, because none of them is on strike and all of them are treating patients with huge care and dedication. They are also innovating at high speed to tackle the unprecedented demand on their services. Two modular ambulance units have already been installed at Southend Hospital, providing 12 extra beds; an enhanced discharge service pilot was started last year; an active discharge ward has been opened with 12 beds and 12 comfy chairs; and yesterday 12 major treatment spaces were added, with more to come. I know this because I am in regular contact with my hospital and the local NHS and I have been visiting the hospital and seeing and supporting what it is doing on a regular basis. It is very impressive and it deserves all of our praise and recognition.
That is not to say that my inbox is not also full of people’s problems with accessing the NHS, and of course there is more to do. However, we have to look at this in context. We have to look at the international context, because these challenges are not unique to the UK. Countries around the world are facing an unprecedented double whammy from the combined upswings of covid and flu leading to hospitalisations. France currently has 22,500 people in hospital with covid, and Italy has more than 8,000. When it comes to flu, cases in Italy have hit their highest level in 15 years. Even Sweden, always held up as a great exemplar for the NHS, has a huge burden on its healthcare systems due to respiratory viruses.
Obviously the UK is not immune to these twin pressures, and obviously we are facing much higher rates of hospital bed occupancy than is normal at this time of year. We have 8.6% of our beds occupied by covid patients. Four years ago, there were none. Last year there were only 50 people in hospital with flu. This year there are more than 5,000—a hundredfold increase. As I have said, in Southend we are seeing identical figures on a local level. However, to suggest that we are not committed to our NHS is frankly outrageous.
In addition to the billions of pounds—I will come on to funding in just a minute—we delivered 9 million flu shots and 7 million autumn boosters into people’s arms last year. This was to prepare for what we knew was coming. We are putting in an additional 7,000 beds, and £500 million into delayed discharge before Christmas and another £250 million now. Over the last 12 months we have recruited 4,700 new doctors and more than 10,500 new nurses. Of course there is more to do, but to suggest that nothing has been done—which is what one might think, sitting here and listening to Opposition Members—is plainly not true. We have heard the PM’s plan to tackle the backlogs and waiting lists. If they think that is not much of a plan, they should consider what the Nuffield Trust said last week about Labour’s plans. It said that they would
“cost a fortune and stem from a failure of understanding and an out-of-date view”.
We are in the middle of the greatest NHS crisis for a generation. Hospital beds are full, hospital corridors are full, patients are waiting hours, even days, in ambulances outside A&E, GP and the dentist appointments are almost impossible to get, medicines are running out, waiting lists continue to grow, and doctors, nurses and care staff are exhausted. We all know this, and I think we also know where the blame lies. It lies at the door of the Government, not only for their inaction over the last few weeks and months, but for the years of mismanagement that have left the NHS under-resourced, underfunded and understaffed.
With the greatest of respect to Conservative Members, people in Batley and Spen and elsewhere are not interested in international comparisons; they are interested in solutions. After 13 years in power, the Conservatives have to take responsibility for the current crisis in the national health service. There is quite simply nowhere for them to hide, and I think they know it.
Every hon. Member has stories of constituents who have faced an absolute nightmare in recent weeks and months. I would be extremely surprised if Conservative Members have not received the same kinds of emails that every Labour Member receives every day about the current state of the NHS. I have a list of constituents, friends and family members who have not received the care they deserve due to the huge pressures within the system.
Of course we understand the impact of the pandemic, but the NHS would be in a far better position to cope with the demand it now faces if there had not been a lost decade, and more, of underfunding and staff shortages. The public and our incredible, tireless NHS staff are now paying the devastating price for this Government’s failings.
Last week I visited Cleckheaton group practice, a GP surgery in my constituency. I spoke at length with the practice manager about the pressures it is facing, its struggle to recruit and retain staff, the dramatic increase in case load, the increasing level of abuse and the real pain of not being resourced to provide the service that the practice wants to provide.
When patients ring for an appointment, receptionists desperately want to book them in to see a GP. They understand patients’ desperation, but the capacity is simply not there. The practice received 690 phone calls in just two hours. Staff are doing their very best, but they are struggling on a professional level and a human level. We often talk about the NHS as an organisation, as a thing, but we must never forget that it is full of real people who feel the daily impact of this crisis and longer-term Government mismanagement. The impact on their physical and mental health must not be ignored.
Where is the serious work needed to prevent the next crisis or to introduce longer-term preventative health measures to free up capacity in the years and decades to come? The Government have a role to play, but this type of forward thinking, solving problems before they arise, has been sorely lacking for the last 13 years. I am enormously reassured that, as a Government in waiting, we in the Labour party have begun that work, setting out the long-term plans and fixes our country needs. The next Labour Government will make the decisions needed to ensure that our country is fit for the next generation.
However, in the short term, I plead with the Government to treat the NHS crisis with the seriousness and leadership it needs, and to work collaboratively with healthcare staff and the unions. We all rely on the NHS being there in our time of need, and I know that I speak for many constituents who are deeply concerned that, if they become ill in the next few weeks, an ambulance will not be there for them, the hospital bed they need will not be free and the doctors and nurses will not be there to care for them. The Government are failing in their primary duty to keep us safe, and what we are seeing under their watch is simply not good enough. Our constituents deserve better, our NHS deserves better, and Britain needs and deserves better.
As a parliamentary candidate, I was once asked by a journalist, “We have 30 seconds left on the panel. How would you solve the NHS?” I said, “If I had that answer, I would not be sitting here with you.” Mr Deputy Speaker, you have given me four minutes to do it, and I will do my best.
My hon. Friend Maggie Throup made an important point about context, and it goes back to when the NHS was formed in the 1940s and 1950s. We have an ageing population. In the last two decades we have seen a 50% increase in the number of 100-year-olds. Many people over 70 have four, five or six medical conditions and are on multiple medications. Technology has moved far forward, too.
When I started training, a cholecystectomy to remove the gallbladder was open surgery that required a person to be in hospital for a week. It can now be done within 24 hours. When we started people on routine blood pressure medications such as ACE inhibitors—many Members will know ramipril—they had to stay in hospital to have their kidneys checked. We now start it routinely for millions of people across the country.
That is the pace at which we are moving in the west and the developed world, and we have to try to keep up. Throw in a pandemic and workforce shortages, and we can see why every western country with a developed care system is struggling. That is the backdrop of what we are dealing with.
On top of that, demand and supply have gone up, but they have not gone up equally. Services are working hard to provide more tests and more appointments than ever before, yet demand is growing partly because the pandemic led to later and more complex presentations. In the Health and Social Care Committee we have heard that there are 27.5 million GP appointments a month, which is up by 2 million on 2019, yet it is still not enough.
In my area of Leicestershire and Rutland, we have enough GP appointments for everyone to be seen seven times a year, but the problem is that appointment rates are disproportionate. Some young people never need to go, and many older people need routine follow-ups. This is the backdrop we are dealing with. Members on both sides of the House talk a lot about long-term plans, but I would like to focus on day-to-day stuff.
I am grateful to my hon. Friend for bringing us his experience from before he came into this place, and he is right to look at the long-term demographic challenges. Does he agree that they will require the NHS to become even more efficient and productive? That is not just something we are asking for; it is what the staff in the NHS want, because they are aware that they are still delivering analogue services in a digital age.
My hon. Friend has hit the nail on the head, and that is where I want to focus my remarks, because simple day-to-day changes to make the working clinician’s life better in turn improve productivity, patient care and patient satisfaction.
As with the Sky cycling team, looking for percentage gains brings big outcomes. So let us go through a quick list of some things we could do. We could have a root-and-branch review of prescribing. How much time is spent with patients waiting for prescriptions in hospitals to be dispensed? How much time is wasted by GPs signing prescriptions on paper? We have electronic prescribing but the prescriptions still get printed out to be signed. A root-and-branch review of prescribing all the way through would solve that problem, making this system more streamlined and fit for the 21st century. It would also save wastage, because there is an estimated £1 billion-worth of medication in Mr and Mrs Jones’s back cupboard just in case.
What about the IT? I am talking not about singing and dancing robots, but simply about making the IT for the day-to-day clinician work like their mobile phone does. That is not too much to ask. We could address the interface between primary and secondary care, allowing secondary care to be able to book blood tests into primary care and vice versa. This stuff does not happen. We no longer send faxes but we still send letters instead, and we pay someone to scan them so that a doctor can have a look at them and sign them off. We could cap list sizes, on a graded time for GPs. We are recruiting more GPs and it is going to take time, but that is a way of ensuring demand and at the same time continuity of care.
What about all the other stuff associated with the administrative time of looking after doctors to make sure they are fit for purpose? There is so much red tape when someone tries to join a performers list or come off one, or start an induction in a hospital. This is simple stuff we can change now, today. We can further do that by enabling the new ICBs, because my biggest worry with them is that they are going to ask for permission not for forgiveness. These 42 regional areas will be able to design the difference that can stick for the future.
I was hoping we might be able to spend these few hours today talking about the wider picture, because this all comes from context. The biggest question this House has to answer is what is the purpose of the NHS and what should it do? We all agree with the principles of clinical need and not to have to pay, but how do we deliver that for the 21st century?
Order. I regret to say that I must now take the time limit down to three minutes. I am desperately trying to get everybody in, but we are trying to get a pint into a half-pint pot. I call Claudia Webbe.
The first thing that needs to be said in this debate is that its title gives a false impression: “mismanagement” creates an impression that the Government have been doing their best to manage the NHS well but have failed to do so, whereas in fact the emergency in our NHS is the result of 13 years of deliberate policy decisions by the Conservatives. A staff shortage of 133,000 that has only grown in recent years is not “mismanagement”. A shortage of almost 40,000 NHS nurses is not “mismanagement”, especially not when the Government knew there was a huge shortfall and decided anyway to end the nurses’ bursary and make already-underpaid nurses pay a fortune to train while inflicting annual real-terms pay cuts on staff across the NHS.
Consistently allowing staffing numbers to remain far below safe levels is a decision, not something that was just badly managed, as was the intentional fragmentation of the NHS and the Health Secretary’s decision, along with the Government in 2012, to end statutory responsibility to provide a safe and fit health service. Cutting thousands of beds and millions of annual bed days in the NHS is a wrecking strategy—even more clearly so when it continued during the pandemic. It is part of an ideological push towards a rationed system that is more profitable for private providers and in which the NHS is in perpetual crisis not because of demand, but because beds, staff, hospitals and services have been intentionally slashed below the demand that was there. Even the current push to a so-called “integrated care system” is acknowledged by the King’s Fund and others to be, in reality, based on a US accountable care system that is designed to withhold treatment in order to cut costs and share the profits with private providers.
It is vital to be clear that the NHS is not merely collapsing; it is in a state of induced coma. There is not enough time in this debate to properly list all the damage that Conservative Governments have done to our health service in the past 13 years—and all in the full knowledge of what the consequences would be for those who need the NHS and who work in it and the deaths that it would cause.
The scale of this intentional damage is so great that playing around the edges with a little more cash that will end up in private company accounts—let alone talk of one-off payments to NHS staff who now rely on food banks—is just PR. The solution to all this is not better management; the only solution to 13 years of fragmentation and hollowing out is a return to the NHS’s original principles: a publicly owned, properly funded national healthcare service free to all.
Order. I must ask hon. Members to keep one eye on the clock. I know that it is difficult when you are reading notes, but you really must watch the clock.
We have heard much negativity from the Opposition, which I need to address. First, I wish to thank all the nurses at Doncaster Royal Infirmary who did not go on strike. I hope the doctors will follow suit. Secondly, I wish to read out this redacted letter from one of my constituents:
I recently had occasion to consult my doctor over an ongoing medical condition. The GP who examined me was courteous, clear and informative and referred me to Doncaster Royal Infirmary. I expected a long wait to be seen, but within a week I was asked to visit DRI. Again, expecting a long wait, I was surprised to be attended to by the consultant straight away. He was good humoured, explanatory and took the time to explain the condition. The following week, I received the results of the examination I had undergone.
At a time when the news is dominated by the failings of the NHS, I have to state that I found my treatment of the very best and my GP, the consultant and the staff at DRI deserve the greatest praise for their outstanding work.
I do hope that you will convey my appreciation to those concerned.”
I know that not everybody receives that kind of service, but let us give credit where credit is due. Perhaps the Minister will reward Doncaster staff by giving them a new hospital—I just thought I would get that in there.
We all know that many of the issues that we face are down to covid, but I am hopeful that, with the introduction of the integrated care boards, the additional staff and the additional funds to help with bed blocking, we can achieve the goals that our Prime Minister has stated and that soon all our constituents will receive the service that they deserve.
While I have the opportunity, I wish to take a few seconds to thank Anthony Fitzgerald and Richard Parker, who both work tirelessly in the health sector in Doncaster. Their work is unsurpassed by anybody else I know. I want to say one thing to the unions. We understand that this is a tough time, but these strikes will not help. The best thing that they can do is work with everybody—work with staff, work with MPs, and work with the NHS as an employer. Let us all come together and put the NHS where it needs to be and the country where it needs to be—the pride of Europe. Let us all get back to work and let us start doing that now.
Thirteen years of Conservative Government have led to crises in every part of our health and social care system. Our infrastructure is breaking down, patient experience is at rock bottom and the consequences of the mismanagement of our health staff is all too clear. Of course covid has played a part, but most of those things were dangerously clear before the pandemic struck. Up and down the country, the condition of repair of our hospitals is declining. Despite all the bluster of the former Prime Minister and his successors, in Warrington, we are still waiting for a decision on a new hospital—if the Minister wants to announce it today, we will be very grateful. We just do not have the capacity to deal with the number of people requiring care in a town our size with the dated, far too small hospital that we have, despite the best efforts of our incredible staff.
In June last year, ITV’s “Tonight” spent a couple of days filming with the North West Ambulance Service and Warrington Hospital. It reported horrific conditions, with patients forced to sleep on trolleys for days on end outside A&E departments, and that was back in the summer. Since then, we have only seen matters get worse. Over the winter, I have heard horror story after horror story from constituents, and I will read just one: “My dad, aged 72, arrived at Warrington Hospital on Christmas morning by ambulance after being unable to walk and being confused at around 3 am. I was shocked to see a number of trolleys with patients winding around in the corridor in the A&E department, with paramedics attending to patients and nurses rushed off their feet treating multiple patients. He was in a trolley in the corridor for 26 hours before being admitted and kept trying to get off the trolley, as he was very distressed and confused. I spent three days going in and out of the hospitals and walking through the corridors and A&E department and I honestly feel traumatised by the experience.”
Those failures are unprecedented and a total collapse from the achievements that the last Labour Government left. It is all too easy to make a debate such as this about statistics, but the reality is unnecessary pain, distress and death. When Nye Bevan wrote “In Place of Fear”, he proposed a healthcare system that would remove the anxiety of illness and injury and make us a more secure, contented and productive society. This Government have overseen the return of fear. The degradation of our national health service since 2010 is a national tragedy, and I warn Government Members that, if they do not address it seriously, that will be their shameful legacy.
I am not particularly surprised by the absence of Labour Welsh MPs from the Opposition Benches, because they have a health service with inferior outcomes compared with England. There has been a lot of talk about 13 years of Conservative Government, but in Wales it is almost double that, at 25 years of Labour Government, yet we have poorer outcomes.
There are many statistics, so I will focus on one. In terms of waiting more than 52 weeks, figures are worse in Wales, at one in four, compared with one in 20 in England. That sums up the problem that we have. If the plan of Wes Streeting is so great, why do the Welsh Government not implement it? They are in power and capable of doing so.
Dame Angela Eagle, who is no longer in her place, talked at length about the issues of the strikes by healthcare workers in England, but exactly the same situation exists in Wales, and the attitude of the First Minister in Wales is very similar to the attitude of the Government here in dealing with those strikes. Yet again, we have a situation where the Opposition Members are not admitting that the problems in Wales reflect the fact that their Government are ensuring poor performance.
Of course, in my Clwyd South constituency, those are not dry statistics, but the day-to-day problems that people face: problems in getting to see a GP or receiving timely hospital treatment, as well as with often excessively long ambulance waiting times. Mine is a border constituency. We look across the border to see what is going on in England and share healthcare across the border, so the comparison between Wales and England is all the more acute.
My right hon. Friend Alun Cairns spoke about the fact that the Welsh health service’s level of funding is superior to that of England. He also mentioned the cut of £800 million in 2012 by the Labour Government in Wales—the only Government in Britain to cut NHS spending in modern times—which has meant that, while the increase in health spending in England since 2010-11 has been 29%, it has been inferior in Wales, at only 22.6%. In conclusion, I urge the Labour Opposition to focus on improving their stewardship in Wales.
I would like to begin by placing on record my personal thanks to the thousands of NHS staff across Manchester: nurses, doctors, paramedics, healthcare assistants and sports staff. I remain grateful for the care they showed my mother and both my parents-in-law in their last days at the height of the covid-19 pandemic. I am proud that so many members of my own family have chosen to dedicate their working lives to the NHS. They deserve not empty platitudes but respect. These are not crises of their own making.
This disaster is the direct result of decisions made by Government over the last 13 years. Nearly 10% of the UK’s population is on the NHS waiting list, and there are three times as many patients on NHS waiting lists as there were 13 years ago. In November, 37,000 waited more than 12 hours to be seen in accident and emergency departments across the country. When Labour was in power, it was just one hour.
Over the last few weeks, the NHS in Greater Manchester has experienced some of its busiest days ever. Over 98% of beds in our hospitals are occupied. Thankfully, we have not faced critical incidents in Manchester’s hospitals. That is in no small part thanks to the hard work of local clinicians and staff, and because the devolution of NHS decision making to Greater Manchester allows greater flexibility and collaboration between hospitals, primary care structures, local councils and the combined authorities. That reflects the findings of the Griffiths report—it marks its 40th anniversary this year—which found not only that effective management is the backbone of a high-quality health system, but that there must be devolution of power from the political centre to the operational frontline.
We cannot fix the crisis in the NHS without fixing the crisis in social care. There are 165,000 vacancies in social care. Carers leave the profession every day because they can get a better deal working in a supermarket than they can working in care. Despite the crisis, the Government still have no plan. The truth is that our NHS heroes and their patients have been let down by the Prime Minister, the Secretary of State and their predecessors. Members on the Government Benches know it, too. After 13 years of Tory failures, only the Labour party now has a plan to fix our NHS.
In line with the wording of the amendment, which I rise to support, I thank all NHS staff, particularly those in Newcastle-under-Lyme and in north Staffordshire at the Royal Stoke University Hospital, which, as the Secretary of State acknowledged both on Monday and today, has been under the severe pressures we have seen throughout the health service over the last month. As he acknowledged, many people have had unacceptable experiences. I have seen examples of that in my inbox and I have fought for my constituents in those cases.
I also thank the local leadership, the integrated care board and, in particular, Tracy Bullock, the chief executive of the University Hospitals of North Midlands NHS Trust, for their time in briefing MPs about what has been going on. We have suffered the fourth highest level of flu in the United Kingdom at the Royal Stoke; it is the fourth worst-hit trust. We were running up to 30 flu admissions per day in December. I am pleased to say that that is now back down to a more normal level; it is about 10% of that. Of course, a lot of those flu admissions were people aged 85-plus who needed critical care.
As I said in an intervention, there is absolutely no acknowledgment of covid in the Opposition’s motion, despite the fact that there are still covid cases in hospitals and the backlog has had an effect on all our NHS services. That needs to be acknowledged.
To say a little more about the Royal Stoke, we are pleased that a new ward of 28 beds will be open next week thanks to Government investment last year. I know that Tracy will want me to request from the Minister even more capacity for next winter. The Royal Stoke is still in a very difficult position because of Labour’s private finance initiative—it is one of the most indebted hospitals in the country. That has been raised with multiple Secretaries of State. I know that it is an expensive thing to sort out because Labour wasted so much money on PFI, but we need to address it.
The Government have a long-term plan, as many on the Conservative Benches have said. It is about doctors and nurses and more GP appointments. We have record numbers of people in training as undergraduates and on nursing and midwifery courses. It is also about the long-term strategy, new surgical hubs, community diagnostic centres—my hon. Friend Paul Bristow talked about his one—and our elected recovery taskforce, putting more spare capacity in the independent sector to use.
We know about elective recovery because we had to recover in 2010, when we inherited 20,000 people waiting more than a year for elective surgery. We got that down before the pandemic to under 1,000. Forgive me if I say that all the lectures from Opposition Members about how marvellous things were under the Labour Government ring a little bit hollow, especially as a Staffordshire MP. We experienced the absolute scandal of Mid Staffs under the previous Labour Government. I applaud the work that the current Chancellor, the former Health Secretary, did to get avoidable deaths down. That did not happen under the previous Labour Government.
I am very short of time, but I commend in particular the speech of my hon. Friend Dr Evans who brought his experience to bear. There is so much that needs to be achieved through productivity and innovation in the NHS, and that is how we will get a long-term NHS fit for the future.
Today I would like to cover two matters that are deeply important to my constituents and where the Government have consistently failed to show vision or leadership and have left the country in a state of emergency.
The first is the issue of pharmacies and GP waiting times. As a pharmacist and the newly elected chair of the all-party parliamentary pharmacy group, I urge the Government to look again at utilising the key resource of community pharmacy. The sector is crying out for more responsibility to reduce pressures on the rest of the health service. Community pharmacists must become the first port of call for patients who need advice and treatment, as they are in almost every other European country. That will help to rebalance workload across primary care, bring healthcare back into the community, reduce pressures on GPs and waiting times and deliver healthcare that is much more prevention-focused.
Yesterday, I launched a survey for my constituents on the situation in our NHS, and I quickly received more than 200 responses by this morning. I was appalled that 70% of my constituents told me that they were putting off dealing with health worries because of the terrible situation in the NHS. That is incredibly dangerous, and it is exactly why we have to empower community pharmacies and reduce GP waiting times. Until the Government fully mobilise pharmacies, we will struggle to reduce waiting times, clear the NHS backlog or improve patient access to GPs.
Secondly, I will speak about the ongoing ambulance crisis that is having a disastrous impact on many of my constituents. Ambulance drivers in Coventry tell me that they are unable to support their families, that they are overworked, underpaid and that extra support is simply not available. My constituents are frequently having to wait hours on end for an ambulance to arrive during an emergency. This is all because the Government have failed in their duty to demonstrate leadership.
In my survey of constituents conducted just this week, one in five told me that either they or a family member had suffered delays when waiting for an ambulance in the past six months. One older constituent had to wait 10 and a half hours for an ambulance to take him to A&E after having a bad fall over the Christmas period. That is simply unacceptable, and it is putting people’s lives needlessly at risk. Lastly, I thank all the NHS staff at my local hospital, University Hospital Coventry and Warwickshire, for all their dedication and hard work and everything they do to provide excellent patient care.
Bedford Hospital, its partners in the Bedfordshire, Luton and Milton Keynes trust and ambulance services are currently experiencing an extreme level of pressure, with record numbers of people using services. The NHS is trying to cope with this level of demand with record waiting lists and a depleted and burnt-out workforce. Desperate times call for desperate measures, which is no doubt why The Sunday Times recently reported that Bedfordshire patients could find themselves being treated in field hospitals. Although the trust board said that the use of field hospitals was not imminent, the fact that it is being discussed at all should worry the Government. The Prime Minister and other Ministers will not even admit that there is a crisis. If they did, perhaps they would take some meaningful action.
The latest Care Quality Commission inspection report on Bedfordshire Hospitals NHS Foundation Trust in December found an overall rating of good, which is testament to the hard work of staff and hospital leaders. However, the trust was found to require improvements around safety, particularly in relation to urgent and emergency care, medicine and maternity services. Much of the concern relates to waiting times and staff not having completed training in line with the levels required for their role. Workforce shortages are at the heart of these problems. If staff are unable to take the time to complete training or are spread too thinly to do their jobs properly, it is inevitable that the service they are able to provide will not be as it should. Staff and patients deserve better.
The most pressing issue in Bedford is the serious delays in funding for capital expenditure. The primary care estate is not fit for purpose and is a threat to patient care and the ability to attract GPs to the area.
Despite six years of waiting, the Government are still stalling on their promise to return in-patient mental health beds to Bedford. More children are seeking mental health support than ever before. Plans and funding are in place for a new mental health facility with specialist places for children, yet the East London NHS Foundation Trust is still waiting to hear from the DHSC if its expression of interest in the new hospitals programme, announced a year and a half ago, has been successful.
The Conservatives have been in power for 13 years. It is clear that the NHS has been broken apart piece by piece, despite the best efforts of staff. To go from record NHS satisfaction levels under a Labour Government to patients dying waiting in A&E under this Government is a dereliction of duty and a shame on our nation.
Order. This is a test of your ingenuity—whether you can sell a bar of soap in 30 seconds—because you are going to have to go down to two minutes if I am going to get everybody in. Do your best. I call Robin Millar.
I acknowledge the hard-working staff of Betsi Cadwaladr University Health Board, who serve us to the best of their ability and make terrific efforts to give us the care that we need and deserve in north Wales.
I want to mention Welsh colleagues from across the House, many of whom share my concern over the state of the health service in Wales. I know that some who are not present today will share that concern, even on the Opposition Benches, although it does raise the question of why they are not present. My right hon. Friend Alun Cairns and my hon. Friend Simon Baynes make the case for Wales as a case study of healthcare under Labour. I add to their observations that healthcare spending now accounts for some 55% of the Welsh Government budget.
I want to look briefly at the effects of the Labour prescription for healthcare in Wales. Our treatable mortality rate is 20% higher than in England. Last year, five out of seven of our health boards were in some form of special measures. My health board, the Betsi Cadwaladr University Health Board, was in special measures for six years. It got so bad that the BBC reported on a patient from Swansea who was forced to go to Lithuania for a hip operation when she discovered that she was on year four of a seven-year waiting list for treatment. Kim Leadbeater, who is not in her place, was absolutely correct when she said that the Government have to take responsibility—the Welsh Government must take responsibility for their 25 years of stewardship of healthcare in Wales.
On the defence of Wes Streeting for the inequalities in Wales, I would say this: in 2015, the Nuffield Trust reported that the Welsh Government had used their powers to set different priorities and a different tone from their London counterpart. It has emphasised prevention—
I was a nurse for 25 years and I returned to the frontline during the pandemic. I know at first hand that after 13 years of Tory mismanagement, our NHS is in crisis. Many health workers who have dedicated their lives to caring for others day in, day out are still living with the after effects of having worked flat out during and before the pandemic, all while trying to do the work of three or four people due to staff shortages. It is soul destroying for people to go on duty knowing that there will be inadequate staffing levels for nine or 12-hour shifts. Tory cuts have reduced A&E departments to shells of what they were under the last Labour Government—they are now so busy that staff feel that they can seem, at times, like a zoo.
Social care needs fundamental reform that truly brings together health and social care. People in Erdington, Kingstanding, Castle Vale and across the UK are finding it almost impossible to get a GP appointment, an ambulance or an operation when they need one, but the implications of stress on the health of staff can be tragic. The ongoing failure of the Government to address staffing levels can be a matter of life or death for patients. It breaks my heart to say that I just could not face the prospect of working in nursing right now.
In November, 140,000 people had to wait more than four hours to be admitted to A&E, and unfortunately my husband was one of them. If we add all that time together, collectively, the British public waited almost 65 years for emergency treatment, but the real question is: how much longer will they have to wait for a competent Government—
I put on record my appreciation and thanks for the NHS staff who serve my constituents in Devizes in Wiltshire, particularly those at the Great Western Hospital in Swindon and the Salisbury District Hospital, our local doctors and pharmacists, and care workers.
I accept the reasons that the Secretary of State gave earlier for the pressures that the NHS is under, which are largely immediate and covid-related. There was a recent policy that led to many of those problems, of which Labour was the principal cheerleader, and we are now seeing the reckoning of those lockdowns. It is no surprise that we have 10 times the usual number of flu admissions to hospital and double the number of delayed discharges.
It is also true, however, that there were problems in the NHS before covid. Although we talk about the crisis in the NHS, it is a perennial crisis. When we are in Government, Labour Members talk about the crisis in the NHS, but when they are in Government, we talk about the crisis in the NHS. There has been a significant crisis throughout the history of the NHS.
The shadow Secretary of State is right to say that we need fundamental reform, but I am not sure that that is what we are hearing from him. He listed a lot of outputs that he wants to achieve, such as more staff, and a whole bunch of inputs, such as more money from the inexhaustible pot of non-dom taxation. More important than spending and inputs, however, is the value for money that the NHS needs to generate, and we have not heard a proper plan to change the systems to achieve those improvements.
The Government have a plan, which is the integration of health and social care. I support that integration and localisation. We should go further and integrate the non-specialist services that exist in our communities. Much of the demand on health and social care is driven by lifestyle and relationships, so we need to harness the immense resources of civil society to support families and communities. I end by paying tribute to the social prescribing project that the Government have introduced, which is achieving such good results.
“Demand for hospital treatment was outstripping capacity even before the pandemic. In recent years, patients have been waiting longer for emergency, routine and cancer treatment.”
It is clear that our national health service is not safe under this Government, because our ambulance service is in crisis; our A&E departments are at breaking point and in crisis; operations are being delayed and cancelled; there are long waiting lists to see consultants and GPs; and patients cannot be discharged. The Government are failing to overcome the challenges that the health service has faced since we left the EU, especially in terms of the NHS workforce and medicines. Staff are experiencing burnout and NHS hospitals are understaffed. The NHS is in crisis.
As ambulance staff go on strike today, the Government must remember that people go on strike only because they are experiencing hardship—nobody takes the decision lightly. The Government should feel ashamed and disgraced that nurses have had to go on strike for the first time in their history. NHS workers in my constituency have said that, because of their current rate of pay, they have been forced to sell their car and they are thinking of leaving the NHS altogether. The health service has been run into the ground for both patients and staff. The Conservative Government must fix these systemic problems and end this crisis. If they do not, it will inevitably be left to a Labour Government to clean up this mess when we do get into government.
A Salford health worker said to me recently:
“We visited a seriously ill man who was frightened of being taken to hospital and made it clear he was at risk of death and that he needed urgent treatment. He and his wife told us that when he was in last, he was left on a corridor for hours, he was not offered food, he is diabetic and could have died.”
He had waited hours. They went on:
“I found it heart breaking that this man would rather die than put himself in that situation again as he could not face the way he had been treated.”
Our constituents are frightened, and many are choosing not even to attempt to access vital treatment for fear of what will happen to them. Our health workers’ mental and physical health is deteriorating with the stress and pressures they are facing.
Of course, the Government claim they have given the NHS the funding it needs, but this just is not true. Of the half a billion pounds of so-called early discharge funding announced by the Prime Minster recently, only £200 million—40%—has actually made it to the NHS and local authorities. The BBC reports that, to help the health service cope with winter demand as well as pay for advances in medicine, the NHS budget has traditionally risen by an average of 4%, but since 2010—since this Government have been in charge—the average annual rate of increase has been half that. The King’s Fund calls this a “decade of neglect”, and it is right.
This Government are destroying our NHS. They are destroying our constituents’ faith in our NHS, and now they are destroying the very workforce who try to hold it together. The Government can solve this crisis: they can fund the NHS, scrap the Strikes (Minimum Service Levels) Bill and actually listen to our NHS key workers when they ring this alarm.
The root cause of this problem is capacity. In my area of Bristol, north Somerset and south Gloucestershire, we are short of roughly 300 beds. Commitments made in the 2004 plan, when we rightly closed one hospital and consolidated services in another, have not delivered community-based beds—mainly in south Gloucestershire, which is largely represented by Conservative MPs who do not want to admit that problem. Added to the low base of funding, in a growing city we have a real capacity problem, and the solution now is 30 temporary hotel beds. That will not cut it. It is short term and, frankly, a very poor use of money.
In the short time I have, I want to highlight some issues with the social care promise. We were promised so much, and people were led up the garden path. A lot of money has been allocated and, frankly, it has just disappeared. Some £3.6 billion was allocated for the social care charging system between 2022 and 2025. That has now been postponed. There was over £70 million for local authorities to look at market-shaping and commissioning capabilities—gone. As I said earlier, there was £2.9 million on trailblazers, but what have we learned from them, and how is that being used?
I have asked a lot of questions about where our money has been allocated, where has it gone and what we have got for it. In written answers, I have been told that we might get something on trailblazers soon—that was in October 2022—but in December, the Minister who is in her place said there were “no current plans” to publish an independent assessment of the fair funding trials by selected local authorities. It is our taxpayers’ money, but it has now been wasted and we need to know what has happened to it.
In conclusion, matching capacity to demand in all ICB areas, so that we understand in our own patches what is really happening, is the way forward. To help the system, we need to start paying carers a decent wage, with a career structure and decent employment rights, to reduce the 165,000 vacancies. That would give people the care they need where they need it, it would help women in communities increase their economic power, and it would rebuild primary and community-based services from the cradle to the grave.
I want to start by sharing the experiences of my own office manager. He has two children who are one and four. They both became increasingly unwell on a weekend. They had temperatures just below 40°C and were becoming lethargic, with the four-year-old complaining of a sore throat and the younger having spots on her tongue.
Concerned as all parents are about the tragic fatal cases of children with strep A, and with the GP closed, they decided to call 111. They waited one and a half hours for someone to answer the call, and were told that the symptoms were such that they required a call back from a GP within six hours. Shortly after ending the call, my office manager received a text:
“Dear Parent/Guardian, due to unprecedented numbers of calls, we are unable to provide a call back at this time, and your case has been closed.”
As the children’s condition worsened, into the evening and on a weekend, the parents became increasingly concerned for their children and felt that they had no choice other than to take them to A&E. After an eight-hour wait in A&E, into the early hours, an exhausted doctor came to the waiting room and told patients that he was incredibly sorry but there was no way they could see everyone, and that anyone who could possibly leave should do so. My office manager was faced with the decision reluctantly to take his children home.
In his speech to the nation, the Prime Minister asked people to judge him on his results, saying,
“judge us on the effort we put in and the results we achieve.”
He is not seeking to be in government; he is the Prime Minister from a party that has been in government for 13 years. We are judging him by the results. During his interview at the weekend, he repeatedly refused to say whether he uses private healthcare, insisting it is not really relevant. I know he clarified that point at Prime Minister’s questions today, but the Government’s response to the crisis so far has not reflected the sheer panic and hopelessness that people, and parents in particular, feel if their loved ones and children are seriously unwell, and the NHS is so broken that they cannot get any help.
Let us be clear: the NHS crisis did not begin with covid. It is the culmination of 13 years of failure and neglect by the Conservative party. Nye Bevan described the creation of the NHS as
“the most civilised step any country has ever taken”.
After hearing the horrifying testimonies today of delayed ambulances and operations, it is clear that we have taken a giant and shameful step backwards. Our overworked and underpaid healthcare staff are telling us that with more than 100,000 vacancies in the NHS, safe and timely care can no longer be guaranteed. Underfunding is causing delays, and delays have real-life consequences on people’s lives, as I know only too well.
In 1989, a decade into an earlier Conservative Administration, my daughter was born 10 weeks premature. She needed a ventilator before she could breathe on her own. The local hospital did not have one, and neither did any of the surrounding hospitals. Eventually, one was found 30 miles away, and Maria was born three hours later by emergency C-section. As a consequence she suffered brain damage, and lived her life with severe cerebral palsy. No parent should face such an agonising delay today, but the harsh reality is that there are no guarantees.
Decisions made in this place have life-changing impacts on the people we represent, and under the watch of the Tories, the words “NHS” and “crisis” have again become synonymous. Today, ambulance workers from the Unison and GMB unions have been forced to strike in order to protest against the underfunding of the service, and the dangerous disfunction it has created. People are dying needlessly. Labour has a clear plan to train a new generation of doctors, nurses and midwives, and to have meaningful negotiations to end the strikes.
In the time available I will focus, laser-like, on the issue I wish to raise, which is the mismanagement of cancer care. I declare my interest as vice-chair of the all-party groups on cancer and for radiotherapy. Covid has undoubtedly compounded the pressures on our NHS, but the problems in areas such as cancer care predate the pandemic—there is no doubt about that. Radiotherapy is a vital treatment option, which already plays a part in the treatment of about four out of every 10 cancers. It is highly cost-effective—a cure typically costs between £3,000 and £7,000—but its potential is being systematically overlooked, and there has been chronic underinvestment.
Ten months ago, the previous Secretary of State for Health and Social Care declared war on cancer, but we are still waiting for the weapons to fight that war effectively. We urgently need to improve treatment capacity in radiotherapy. As I have stated, a fifth of all radiotherapy machines are more than 10 years old and will need replacing before the end of the year.
We need a better approach to funding IT, technology and networking, as that could dramatically speed up treatment processes. New immunotherapy cancer treatments often work far better in combination with radiotherapy. I ask the Minister to commit to engaging with the all-party parliamentary group for radiotherapy and with leading clinicians to develop the potential of advanced radiotherapy treatment capacity and to bring about a step change in cancer outcomes.
“This crisis has been a decade or more in the making and we are now paying the high price for years of inaction and managed decline.”
He is right. The crisis has not emerged overnight. It was evident before covid, and it is a crisis of the Conservative Government’s own making.
That managed decline is a political choice. One needs to look only at the Health and Social Care Act 2012 to see the sheer ruthlessness of the Conservative party’s determination to run down the national health service. In that Act, the Conservatives and the Liberal Democrats legislated to allow NHS hospitals to generate up to 49% of their income from private patients. By 2015-16, nearly £600 million a year was being generated by the NHS treating private patients. How many operations for the general public have been delayed while private patients were treated? How much shorter would those waiting lists be had those resources not been siphoned off to private patients? Why did the Conservatives and Liberal Democrats think it was acceptable to hand over about half of our hospital resources to private patients? To argue that it is about making money for the NHS is a sleight of hand; it is taking resources and capacity away from the NHS and it is morally indefensible. The NHS belongs to all of us; it is not the Conservative party’s to give away.
I have met people who, in desperation and pain, have paid for treatment and been angry at being put in the position where they felt the need to do so, not just because it is expensive but because they believe in the NHS as a public service. It felt terrible to them to be put in that position. The Government have chosen to reduce capacity in the NHS by handing it over to private patients, and they have failed to provide the staffing and resources that the service needs.
We need to reinstate the NHS as a comprehensive and universal service, publicly run and free at the point of need. It has served us incredibly well for well over 70 years. The public will not forgive those who undermine it so ruthlessly and cause so much suffering for patients and staff.
I am worried and angry about the complacency that I have seen from the Secretary of State towards the NHS. Look, I knew that the situation was bad, but I did not realise how bad until I visited St George’s A&E last week. That hospital, which serves my constituency, had to declare a critical incident because of the situation in its A&E. All the doctors and nurses I spoke to agreed that it was the worst time that they had experienced in their whole careers. The winter ward was opened last year but had to stay open for the whole year, so there is no more space for the extra winter surge. Sixty nurses have resigned from that department because of the stress of the workload and being underpaid.
The additional winter payments that came from the Government were paid only in December and must be spent by March, giving them hardly any real impact. The situation is chaotic. The doctors and nurses are having to practise corridor care for patients for the first time in the hospital, and they are broken-hearted that they have to do so. They have had to stop elective heart surgery since the beginning of December. Mental health patients are being treated in A&E for five days. We need a long-term plan, not to be surprised by winter every year.
Four areas are seen as having critical community care shortages: eating disorders; Korsakoff dementia patients; frail patients who have a stroke after a fall; and functional neurological disorder. Those huge gaps in community care were raised by the staff. I am glad that the Secretary of State is in his place to hear me raise them.
The Conservatives are failing the people of Putney, Southfields and Roehampton. The Conservatives are failing the British people. Labour has a plan to fix this, but they do not. Pain, suffering and preventable deaths are up, GP waiting times are up, A&E waiting times are up, and mental health and cancer assessment times are up. There is only one conclusion: the Conservatives’ time is up.
Today’s debate has laid bare the dire state of our health and care system after 13 long years of this Conservative Government: more than 7 million people waiting for hospital treatment, 400,000 for more than a year; the worst ever waits for A&E, with 50,000 patients a week now waiting more than 12 hours in A&E; excess deaths this winter at their worst level since 1951, except for the pandemic years; ambulance response times plummeting; cancer targets missed; and waits for mental health care so bad that thousands of patients end up forced to go to A&E or even attempting to take their own lives. In social care, the situation is even worse: 165,000 staff vacancies, 30,000 more than in the NHS; more than half a million older and disabled people waiting to have their needs assessed in the first place, not even on a waiting list; and millions—millions—of families pushed to breaking point because they cannot get the help they need to look after their loved ones.
The question I want to focus on today is why we have ended up here. Labour Members have never claimed that everything was perfect in the NHS when Labour last left government, but Conservative Members squandered a golden inheritance of the lowest ever waiting lists and the highest ever patient satisfaction, with access to services we can only dream of now. Ministers want to blame all of the current crisis on covid and this year’s winter flu, but the truth is that waiting times were at record levels and staff shortages were soaring long before the pandemic struck.
The most glaring reason for the problems we face is the sheer incompetence of this Government. To take just one example, effective winter planning in the NHS is a non-negotiable and a key test for any Secretary of State. When Labour was in Government, winter plans were done and dusted well in advance. I know that from my time working in the Department of Health. So, it beggars belief that not a single penny of the original winter hospital discharge funding was out of the door by the end of November. Some £300 million of it still has not reached the frontline. Their latest flawed plan to buy up care home beds, when what most people need is care in the community or their own homes, was not even announced until
There are even more fundamental reasons for the current crisis than the Government’s sheer incompetence. The root cause is a decade of Conservative economic failure trapping Britain in a vicious cycle of low growth, low pay and high taxes, which in turn has failed to provide sufficient or sustainable funding for our public services, including decent pay for frontline staff. Einstein’s definition of madness was to keep doing the same thing over and over again but expecting a different result. Yet that is precisely what we saw in the Chancellor’s autumn statement, so Britain is once again set for, at best, anaemic growth by the end of the Parliament. Britain deserves so much better than this. Labour’s green prosperity plan, our industrial strategy and our plan to fix business rates set out a different path for the future. No wonder the chairman of Tesco says that in terms of a growth plan Labour is the
“only team on the field”.
Economic growth that delivers proper investment in the NHS and social care is vital, as Labour’s record in Government shows, but on its own it will not secure a care system fit for the modern world. It also requires reform. On that, Ministers have again utterly failed to deliver. Mr Deputy Speaker, you will forgive me if I take the House on a brief trip down memory lane. Remember the Lansley reforms? I am sure Conservative Members would rather forget. That legislation so large it could be seen from outer space, but no one understood what it was for. Years of time and effort were squandered on a disastrous internal NHS reorganisation that failed either to integrate care or to deliver the improvements in patient care that the Conservatives claimed. There was the Conservatives’ cap on care costs—[Interruption]—and their solemn promise that no one would have to sell their home to pay for their care. Remember that? [Interruption.] It was first promised in 2012, postponed in 2015 and 2017, and re-promised by Boris Johnson on the steps of Downing Street. [Interruption.]
Thank you, Mr Deputy Speaker.
The promise was buried once and for all by the Chancellor in his autumn statement last year—a Chancellor, I remind the House, who said that his biggest regret as Health Secretary was failing to put in place a long-term plan for social care.
In contrast—[Interruption.] I am sure Alun Cairns will be interested to hear this. In contrast, Labour has a 10-year plan for investment and reform in our NHS and social care. It includes the biggest ever expansion of the NHS workforce, funded by scrapping non-dom tax status; ensuring that patients can see the doctor they want in the manner they want, whether that is face to face, over the phone or online; a new deal for care workers—[Interruption.] Maybe Lee Anderson would like to listen to our plan and suggest it to his Ministers. We will have a new deal for care workers to tackle staff shortages and give older and disabled people the support they need. Above all, we will have a relentless focus on prevention and early intervention. There will be a new principle of home first, shifting the focus of care out of hospitals and into the community, with more people being cared for in their own home, which is where they want to be.
Using new technology, providing genuinely joined-up care and support, putting people first, giving staff the support they deserve, providing investment with fundamental reform: that is Labour’s plan, not the failed sticking-plaster approach that we have seen from the Conservatives over the past decade. Britain deserves a fresh start. We deserve a better future. That is what Labour will deliver. I commend the motion to the House.
I welcome this chance to come to the House and speak about everything that we are doing right now, in the months ahead and for the longer term, so that people can get the healthcare they need from our health and social care system at a time when it is under huge pressure—when we face the worst year for flu for a decade, with 100 times as many patients in hospital with flu as there were a year ago; when the NHS is working through the backlogs caused by our fight with covid; and when we know that the NHS is struggling with the high number of people coming to emergency departments and the difficulty of discharging people to be cared for at home.
These issues are mirrored in health systems across Europe, and indeed across the rest of the United Kingdom. Despite what Opposition Members are saying, the honest truth is that there are no silver bullets. I know that NHS and social care staff are working incredibly hard in the face of these challenges; I want to assure them, and everyone, that the Government are working flat out on short and long-term solutions to these great challenges. That work is supported with record NHS funding, rising further to £165 billion by 2025, and with more funding for social care, with the record increase of up to £7.5 billion over the next two years that we announced at the autumn statement. We have committed to getting waiting lists down and getting people the care they need more quickly, and we will do so.
I thank hon. Members for their contributions to the debate. I particularly thank those who have been constructive and thoughtful this afternoon. The Chair of the Health and Social Care Committee, my hon. Friend Steve Brine, spoke about increased demand for care and the importance of prevention. My hon. Friend Maggie Throup brought in her expertise as a biomedical scientist when she talked about the potential for innovative diagnostic tests to improve care and productivity. My hon. Friend Paul Bristow shared the story of how the life of a constituent was saved through first aid and brilliant NHS care.
We heard from my hon. Friend Anna Firth, who works incredibly hard to support her hospital and who often comes to me with suggestions. My hon. Friend Dr Evans, who brings expertise as a doctor, spoke about the 50% increase in the number of people over 100 in the last decades. He talked about the increased demand for healthcare and brought in many ideas for what more we can do to increase healthcare supply. My hon. Friend Nick Fletcher reminded us of some of the excellent care that the NHS is providing in his area. He also asked for a new hospital.
My right hon. Friend John Redwood spoke about workforce and bed capacity. My hon. Friend Aaron Bell spoke about the context of what we face, the extra flu admissions at Royal Stoke University Hospital and covid. My hon. Friend Danny Kruger spoke about the importance of integration in health and social care.
There are three more hon. Members I want to mention—I am sure they know who they are—because they represent constituents in Wales. They are all Conservatives; nobody is on the Opposition Benches representing Welsh constituencies today. Nobody here is standing up for Labour’s record in Wales. My right hon. Friend Alun Cairns, my hon. Friend Simon Baynes and my hon. Friend the Member for Aberconwy (Robin Millar) all reminded us of Labour’s shocking record of running the NHS in Wales. They spoke about more patients waiting over two years for treatment in Wales than in England, about a higher treatable mortality rate, and about the fact that it was not the Conservatives but a Labour Government in Wales who cut health spending. That is a record that no Labour Member has proved willing to defend.
Let me now respond to some of the criticisms from Opposition Members, starting with the way in which the NHS prepared for this winter. Back in August the NHS published its winter plan, which included proposals to increase capacity by 7,000 beds and increase the use of virtual wards, to ramp the number of staff to handle calls, and to establish system control centres in each of the 42 integrated care systems: that was delivered in December. We gave more than 17 million people a covid booster vaccine, and gave more than 19 million their flu jabs. The shadow Secretary of State is talking over me, but I recommend that he listen to what we have been doing.
We set up a national discharge taskforce to work with hospitals and the wider health and care system to improve flow in the system. We published “Our plan for patients”, which included a £500 million adult social care discharge fund that is being spent on more home and residential care packages and boosting the social care workforce to help get patients out of hospital—that is happening right now.
However, as we feared, the combined pressures of flu and covid, alongside unprecedented demand, have indeed left our health system facing enormous challenges this winter. That is precisely why, as my right hon. Friend the Secretary of State said in his statement on Monday, we are taking immediate further action to support the NHS and local authorities. We are providing £200 million of additional funding for short-term care placements to help patients to be discharged more quickly and safely from hospitals, and an extra £50 million in capital funding to expand hospital discharge lounges and ambulance hubs as a matter of urgency.
As we come out of this winter, we know that these problems will not suddenly disappear, and that is why we are already making plans for the future. For instance, we have six national “discharge frontrunners” leading the way in exploring new long-term initiatives to free up hospital beds. As was announced in the autumn statement, we will marry those new ideas with a further £600 million next year and £1 billion the year after in order to transform the way in which we handle discharges.
At the same time as putting in money here and now, we have plans in place which will transform our health and social care system over the next decade. Our integrated care systems are bringing together health and social care in a way that has never been seen before. Our NHS workforce plan will provide a long-term staffing plan for the next 15 years. We are bringing forward ambitious social care reforms, including workforce reforms to develop social care as a career. Our reforms are timely, ambitious and deliverable, developed in partnership with health and social care organisations, unlike Labour’s new plan for primary care, an expensive top-down reorganisation, uncosted and unfunded, and described by the chief executive of the Nuffield Trust as costing “a fortune” and “out of date”—like the Labour party.
Our health system, like others across Europe, is facing a multitude of pressures. We are taking action, in the short, medium and long term, to tackle each and every one of those pressures, and I am determined to ensure that the work we are doing will make things better not only in the here and now, but next winter, next year, and every year thereafter.
Question put (
The House divided: Ayes 289, Noes 0.
Question accordingly agreed to.
The Deputy Speaker declared the main Question, as amended, to be agreed to (
That this House pays tribute to the work done by the National Health Service and recognises that there are pressures on health systems around the world; recognises that all parts of the UK are facing pressures; welcomes that the Government has committed to reduce waiting times in England as part of its strategy to strengthen the NHS and care system with up to £14.1 billion additional funding being made available by government over the next two years to improve urgent and emergency care and tackle the backlog—the highest spend on health and care in any government’s history; and regrets that the Scottish and Welsh governments have refused to make similar such commitments.