NHS 70th Anniversary — [Stewart Hosie in the Chair]

– in Westminster Hall at 9:30 am on 16th May 2018.

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Photo of Nick Smith Nick Smith Opposition Whip (Commons) 9:30 am, 16th May 2018

I beg to move,

That this House
has considered the 70th anniversary of the NHS and public health.

It is a pleasure to serve under your chairmanship, Mr Hosie. The 70th anniversary of the NHS is an important time for the country, but it is also a special time for Blaenau Gwent. Aneurin Bevan, and the health service he created, was born and bred in Blaenau Gwent—in Tredegar. Since Nye’s death in the 1960s, Blaenau Gwent MPs have followed in the footsteps of a colossus. We in the borough are immensely proud and fiercely protective of his legacy. When he said he wanted to “Tredegar-ise” the NHS, he was basing his plans on the Tredegar Medical Aid Society, a mutual and an organisation established for all, supported and funded by the people of Tredegar, whether they be miners at the Ty Trist colliery, like my grandfather George, quarry workers at Trefil or nurses at the St James Hospital. If Bevan established an NHS for the 20th century, at this anniversary it is important that we ask ourselves what sort of NHS we need for the 21st century.

Photo of Nick Thomas-Symonds Nick Thomas-Symonds Shadow Solicitor General, Shadow Minister (Home Office) (Security)

I should declare an interest as a biographer of Aneurin Bevan. Before my hon. Friend moves on to talk more generally about the future, does he agree that the decision to nationalise the hospitals, and the painstaking work that Bevan did in negotiations with the British Medical Association, mean that he truly is the architect of the national health service?

Photo of Nick Smith Nick Smith Opposition Whip (Commons)

My hon. Friend has written a terrific biography of Aneurin Bevan. He absolutely captured what Nye did for us all.

On 5 July it will not be good enough just to celebrate the past, the history of this brilliant institution and its architect; we must also look to its future and the challenges it now faces. Many of those challenges have been created by eight years of Tory austerity, which has left our national health service underfunded, understaffed and underprepared. Labour would provide more doctors and nurses and provide a funding level to support the service for years to come. Other challenges cannot be put down to politics. The epidemics of old—diseases once fatal that we have almost eradicated—are being replaced with new health problems that are putting massive strains on our NHS. It is wonderful that people are now living longer, but that also means our population is an ageing one that needs support. As our society gets to grips with caring for our mental health, more people need access to these services than ever before.

Today I want to concentrate on another big challenge: rising levels of obesity, particularly among children. In this case, it is a challenge where an ounce of prevention can be better than a pound of cure. Back in Blaenau Gwent, surveys estimate that 70% of adults are overweight or obese and 11% are being treated for diabetes. Most troublingly, the latest figures from the child measurement programme reveal that last year 15% of four and five-year-olds in my constituency were classed as obese. We should all be worried by that trend, which is being replicated across our country.

Photo of Jessica Morden Jessica Morden Opposition Whip (Commons)

My hon. Friend is making some important points. Does he agree that we should urge Ministers to take more of a lead in restricting junk food advertising and to provide extra money and the consequentials to the Welsh health service for such things as earlier intervention by GPs and practice nurses?

Photo of Nick Smith Nick Smith Opposition Whip (Commons)

My hon. Friend makes an important point. As always, she is ahead of the game—I will come on to that point shortly.

Obesity is the second biggest preventable cause of cancer. Diabetes leads to significant complications, including, in extreme cases, amputation. The consequences for our society are massive. NHS England has said that around £16 billion a year is spent on the direct medical costs of diabetes and conditions related to being overweight or obese. That is more than the cost of delivering all our countries’ police and fire services combined. The Government cannot shirk their responsibility to tackle the issue head on. When the next chapter of their childhood obesity plan comes into effect, it needs an effective UK-wide public health drive. It needs to do more to deal with that priority. The 2015 Conservative manifesto pledge to clamp down on advertising unhealthy brands vanished into thin air by the time of the first childhood obesity plan.

It now looks like junk food ads may be banned from programmes where three quarters of the viewers are children. That is to be applauded. It is a good thing, but it fails to tackle the big primetime shows that families gather around the sofa for: shows such as “The X Factors” and the aptly named “Saturday Night Takeaway”. That is without mentioning, with the World cup on the horizon, the premium advertising space around sport. There is a real contradiction when fantastic displays of athletic prowess are bookended by burgers and packaged with pizzas.

Alongside others, Cancer Research UK is pushing for a 9 o’clock watershed for junk food adverts, and the Government must consider that proposal seriously. It is not only me who thinks that; the head of the NHS, Simon Stevens, thinks it would be a good way to tackle this scourge. He believes that even the likes of Facebook must be roped into any plans that limit junk food advertising. The Jamie Oliver Food Foundation suggests having mandatory training for GPs and health professionals to talk about weight in a helpful way and to refer patients to nutritional experts. Whatever the Government decide, they will need to be bold in the face of pressure from the industry heavyweights and their lobbying teams. When plans emerge from this Government, every organisation should be doing their bit.

I was pleased to see the Mayor of London, Sadiq Khan, take real steps to address junk food advertising last week with his announcement that such adverts are to be banned from the tube and bus networks. Almost 40% of London’s 10 and 11-year-olds are obese or overweight. The Mayor is taking a positive step to tackle what he has rightly called “a ticking time bomb”, and that must be supported. However, it is up to all public bodies, including devolved Administrations, councils and housing associations, to weigh in. Primary schools should promote walking every day to their pupils. It is about using soft power and nudge, as well as improved regulation to make legislative and cultural change.

Photo of Neil Gray Neil Gray Shadow SNP Spokesperson (Social Justice)

The hon. Gentleman is talking about action to tackle childhood obesity and junk food adverts, and also about Jamie Oliver. He will perhaps be aware that Jamie Oliver met the First Minister of Scotland on Monday and welcomed and supported the Scottish Government’s plan to halve childhood obesity by 2030. Would he care to welcome that, as Jamie Oliver did?

Photo of Nick Smith Nick Smith Opposition Whip (Commons)

I am pleased to welcome that support for a UK issue that we all need to work on.

With further support, we could achieve the healthy lifestyles that so many people want by using influence and our voices. I want to round this speech off with one initiative that I think deserves real backing. It will help our society get on track to healthier lifestyles. To return to Bevan, the initiative is about harnessing community support to deliver improved health for all. Dame Kelly Holmes teamed up with the NHS and parkrun last weekend to encourage people to “take care of yourself” in the build-up to a special parkrun for the NHS on 9 June. My local parkrun group is the Parc Bryn Bach running club, and I can report what a difference such initiatives can make. After a year of running every week, my blood pressure is down and I have tightened my belt a few notches.

I am grateful for the esprit de corps of my local running club. Parc Bryn Bach has Saturday parkruns, special Sunday sessions for parkrun juniors and is a backer of the brilliant NHS Couch to 5k scheme. Just a few Mondays ago, it had 150 people running through a wet, windy April evening to get their fitness up. Over three months, many of those local people will gain confidence and a level of fitness to help them change their lifestyle. The camaraderie and support on offer is fantastic, and that is what makes these schemes fun to join and easy to keep up. Unsurprisingly, the club membership has doubled in recent years, and the coaches and volunteers include many health professionals. They are a great team. I am pleased that the Welsh Labour Government have seen the value of that. Welsh Athletics is supporting clubs with regional Couch to 5k programmes.

Photo of Gerald Jones Gerald Jones Shadow Minister (Defence)

I thank my hon. Friend for giving way and congratulate him on his passionate speech that marks this historic anniversary and the part that his constituency and the wider south Wales region played in the formation of the NHS. Does he agree that in order to tackle our modern health challenges it is important that we have further investment and that the UK Government match the Welsh Government’s passion and commitment to this most cherished national institution?

Photo of Nick Smith Nick Smith Opposition Whip (Commons)

As usual, my hon. Friend and neighbour makes a very good point. I went on his Merthyr parkrun a few months ago and had a good time.

Photo of Nick Smith Nick Smith Opposition Whip (Commons)

I am pleased to give way to my other neighbour.

Photo of Nick Thomas-Symonds Nick Thomas-Symonds Shadow Solicitor General, Shadow Minister (Home Office) (Security)

I join my hon. Friend in congratulating all those involved in parkrun. Will he join me in congratulating the volunteers who make parkrun possible in his constituency and in mine in Pontypool and Cwmbran, where I too have taken part in parkruns, but I have not quite reached my hon. Friend’s running level yet?

Photo of Nick Smith Nick Smith Opposition Whip (Commons)

I thank my hon. Friend for supporting parkrun. Perhaps we should have a south Wales eastern region parkrun championship at some point in the coming months. He is absolutely right about volunteers and the running club supporters who are out there at 9 o’clock on a Saturday morning, or sometimes on a Sunday morning for the junior parkrun, in parks all across the country. They do a great job in all weather. It is brilliant to see. More than 30,000 runners took part in parkruns in Wales alone last year. It is that sort of activity with cross-body support and backing from our community role models that can make a big difference to making such schemes stick.

When Nye wanted to Tredegar-ise the national health service, he wanted a service built on community where we all bought in and all had a stake. In that spirit the public health challenges we face 70 years on should not be tackled alone. To truly take care of ourselves, we need a society that sets us up for success, a system that has our backs, a public service that recognises what needs to be changed and how to do it. The Government have a real chance to honour the anniversary of the national health service in the months ahead, not with pomp and ceremony, but with the sort of action that people will celebrate another 70 years from now.

Photo of Stewart Hosie Stewart Hosie Scottish National Party, Dundee East

Numerous Members wish to speak and I intend to start the summing-up speeches at about 10.30. Members are not particularly time limited, but speeches of six or seven minutes will get everybody in.

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock 9:42 am, 16th May 2018

It is a pleasure to serve under your chairmanship this morning, Mr Hosie. I congratulate Nick Smith on securing this important celebratory debate.

On 5 July this year we will mark 70 years of the NHS across the whole of the United Kingdom. Although now a devolved matter, the same core principle of safe, effective, person-centred care applies and it remains free at the point of delivery throughout the United Kingdom. I have no doubt that, no matter where we live on these islands, the NHS is the British institution most loved and valued by the public.

For the past seven decades, millions in the United Kingdom have known that they can rely on the NHS in their hour of need, to treat them when they are sick or injured and help them keep fit and healthy—most importantly, without discrimination. That principle has worked well for 70 years because of the dedication of generations of hard-working NHS staff. In this anniversary year, it is only right that we should thank all NHS staff, past and present, in Scotland and across the United Kingdom for their dedication and service. Mr Hosie, I should have declared an interest. I have two daughters who are nursing professionals in NHS Ayrshire and Arran.

This is indeed a time to reflect on the progress that the NHS has made since 1948 and consider what steps we should take over the next seven decades to ensure that the national health service continues to provide the best possible service to the British public, who very much rely on it.

In 1948, the newly created NHS was more concerned with childhood malnutrition than with obesity. Penicillin, discovered by Sir Alexander Fleming, physician and Nobel prize winner, who was born in Ayrshire in Scotland in 1881, was a relatively new and revolutionary treatment. Polio, tuberculosis and rickets were of major concern as opposed to dementia, the diabetes that was mentioned earlier, and the cancer conditions experienced today.

It is worth noting the progress that the NHS and society in general have made in recent years in recognising the need for improved mental health provision. Health is health, whether we categorise it as mental or physical. The UK Government’s introduction of parity between mental and physical health was a vital and important step forward, and I am glad that the Scottish Government have followed suit.

As our population ages—I fall into that category—and our society changes, the challenges that the NHS faces in health promotion and health and wellbeing will continue to evolve. We need an NHS that is adaptable and committed to embracing new technologies such as genomics wherever possible, and it must be well resourced to meet the increase in demand. I mentioned earlier the dedication of the staff, but it is crucial that there are enough skilled staff to meet today’s demanding and changing workload. Sadly, today’s national health service as a whole has vacancies and challenges in recruiting across the spectrum, whether nurses, allied health professionals or medics. There are too many gaps in the system, which has led to significant funds being paid on overtime and expensive agency nurses. We need to resolve the long-standing UK-wide conundrum of delayed discharges from acute care beds by ensuring that patients are cared for safely in the most appropriate, supported environment.

Over the past 70 years the NHS has been a great success based on a great principle. We are living longer and healthier lives as a result. May I commend the Labour Government who, 70 years ago, in the dark days of a post-war Britain, had the courage and foresight to create the national health service, and also successive Governments, including, dare I say, Conservative Governments, who have supported the service that we all continue to value so much?

Photo of Peter Bottomley Peter Bottomley Conservative, Worthing West

If I were able to make a speech, which I cannot, I would talk about public health even before the health service. However, let me remind everyone that on the creation of the national health service, in January 1944, Henry Willink, a Conservative Minister in the coalition Government, held up the first White Paper that said, “national health service”.

Photo of Bill Grant Bill Grant Conservative, Ayr, Carrick and Cumnock

I thank my hon. Friend for that intervention. I was being extremely kind today to my colleagues in the Labour party. The war prevented the launch at that time, but the general principle and the welcoming of a national health service has been good for the United Kingdom.

Finally, a line from a Robert Burns poem that was penned more than two centuries ago in 1780. It is four verses long but I will recite only one line. It is called, “Here’s to Thy Health”, and it reads as follows:

“I’ll count my health my greatest wealth

Sae lang as I’ll enjoy it”.

Photo of Hugh Gaffney Hugh Gaffney Labour, Coatbridge, Chryston and Bellshill 9:47 am, 16th May 2018

It is a pleasure to serve under your chairmanship this morning, Mr Hosie. I pay tribute to my hon. Friend Nick Smith for securing this debate.

If we look back over almost a century, so much change has happened and so many developments have taken place, but one thing has remained constant: our world-leading, history-making and much loved national health service. Let us think about the founding principles of the national health service. It is comprehensive, universal and free at the point of delivery; millions of lives have been saved and millions of people treated and restored to good health; and it has tens of thousands of decent, hard-working and much-loved public sector workers.

As we approach the 70th birthday of the national health service, to those workers I say thank you for your compassion and sacrifices, for always going the extra mile and for standing firm in the wake of the millions of Tory cuts that we have seen since 2010 and the Scottish National party cuts in Holyrood since 2007. Decisions taken by politicians of all political parties have had an impact on our national health service. I was proud of the previous Labour Government’s record investment in our NHS. We delivered lower waiting times, faster operation times, a GP in local communities and vital investment in infrastructure and facilities. Sadly, it is not all good, and we cannot take our NHS, its workers or its mission for granted.

My local hospital, Monklands, serves many of my constituents in Coatbridge, Chryston and Bellshill. It is one of the busiest hospitals, and just a few months ago there were reports that it needed more than £30 million worth of repairs. There are leaks, and wards are closing. We will look at Monklands hospital. Sadly, on a personal note, one day when I was in Parliament my mother, who is 85 and has dementia, was sent home from Wishaw hospital in a taxi after waiting two hours, with no food and no toilet facilities. My father is 88 years old. They both saw the NHS born. They have been taxpayers all their lives. My father cannot understand why his wife, at her age and with her illness, was treated that way. All that in the 21st century. Thankfully, my mother is now back at her care home, and has settled down a little bit.

Sadly, thanks to the Scottish Government’s failure to invest, more than £3 million was spent on agency staff—that would have paid for more than 100 nurses. Across Lanarkshire in the year 2016-17, more than £10 million was spent on agency staff in three hospitals: Wishaw, Monklands and Hairmyres. To quote the leader of the Scottish Labour party—my leader—Richard Leonard, we need to stop these private companies

“sucking money out of the NHS”.

I do not want to sound too negative. I am proud of the NHS, and I am proud of its workers. I will work with anyone and everyone who wants to see it funded, supported, protected, defended and enhanced. That is why I am here: to defend and fight for public services, to champion public sector workers, and to fight for the right to a hospital bed, an appointment with a GP and an operation in good time.

As Bevan said in 1948, the national health service must meet everyone’s needs, be free at the point of delivery, and be based on clinical need, not the ability to pay. That is our mission; that is my focus. As we come together to acknowledge and celebrate the 70th anniversary of the foundation of the national health service, we must recommit ourselves to delivering that noble aim and objective. Happy birthday, NHS.

Photo of John Howell John Howell Conservative, Henley 9:51 am, 16th May 2018

It is a great pleasure to serve under your chairmanship, Mr Hosie. Let me begin by reassuring the Minister that I am not going to give a list of all my medical complaints—I seem to have a tendency to do that at these debates. I will just say that they are very few in number. As one of the officers for the all-party parliamentary group for diabetes, I agree with what Nick Smith said about diabetes, and the way we need to tackle it by fighting obesity and waiting for the effects of that to come through.

If there were one birthday present that I would like to give the NHS, the Prime Minister has already given it: a long-term plan for the NHS and a multi-year funding settlement in support of it. That is very important for a number of reasons. We all know that the NHS has suffered its most challenging winter for many years. We also know, as Opposition Members have pointed out, that we are living in an ageing society. By 2020, there will be more 70-year-olds than there were five years earlier. I am not sure whether my hon. Friend Bill Grant and I will be in that category—I have not done the maths yet—but we will go there jointly and with good humour, I am sure. The number of over-85s will nearly double by 2035. We have to focus our services on dealing with the requirements of that group of people, who are living in a modern age where the NHS has introduced many improvements over the past few years.

For the NHS to plan and manage budgets effectively in the long term we need to move away from annual top-ups of its budget, and towards a sustainable long-term plan. Whatever plan we introduce, it has to be sustainable. We have the five year forward view as a basis on which to work towards that. I was very pleased that the Prime Minister announced to the Liaison Committee that the Government would introduce a long-term plan for the NHS and, most importantly, do so in conjunction with the leaders of the NHS, clinicians and health experts. We cannot introduce that long-term plan simply as politicians. I look forward to that with a great deal of anticipation.

We all know that care is not properly integrated—we have seen that in our constituencies—and we all know that we need to integrate health and social care more quickly than we can really manage. I fully support that process. All those things came up at a public meeting in my constituency just a few days ago. Somebody asked why we still fund the NHS on an annual basis, and I was able to point out that we are moving away from that system.

I will finish with this point: putting public health at the heart of what we are doing with the NHS is crucial. We cannot stand here and speak about the future of the NHS unless we put public health at the centre of everything we do. I recommend that course of action to the Minister.

Photo of Rachael Maskell Rachael Maskell Shadow Minister (Transport) 9:56 am, 16th May 2018

Thank you, Mr Hosie, for chairing this morning’s important debate, and I thank my hon. Friend Nick Smith for introducing it in the way that he did.

The incredible tributes that we have heard this past week to Dame Tessa Jowell have reminded us what a formidable politician she was, and how she centred her work around the important agenda of public health, backed up by the epidemiological evidence. We have had so many fantastic evidence-based reports, not least the work done by Michael Marmot in identifying the importance of the social determinants of our health outcomes. We know that various agendas meet around public health—social, economic, health and education agendas, and many more. That is why it is really important that we put our focus on the whole person and the impact that life has on people.

We have seen severe cuts, not least to our Sure Start centres, hundreds of which have closed. From the evidence that they produce, we know about the real impact that they have, particularly on our young people. Health visitors are an initiative that the Government took up in 2010, following Labour’s urging that we must increase the number of health visitors. That number has now fallen, from the 4,200 additional health visitors that David Cameron put right at the heart of his Government, back to the numbers before that Government. There is a real crisis among that vital workforce, with ever-increasing workloads.

We have had workforce cuts, financial cuts and service cuts in public health. Public health is about long-term outcomes, and when we are dealing with austerity and cuts, we are looking at having to support tomorrow, not the future. Public health has been a very poor relative in the austerity programme, and I can witness that in my city. In Acomb in York, since 2011 I have seen childhood obesity more than double among my community. I have also seen health checks cut; those are vital at the age of 40 to ensure that we put people’s health back on track.

Long-term contraception has been cut, and smoking cessation services demolished—unless, of course, people pay for them. We have seen a 90% fall in the number of people able to access smoking cessation services, in an area where the number of people who smoke is higher than the national average. Those are the real consequences of cuts. In York, the clinical commissioning group denies surgery to people who have a high body mass index or who smoke, yet the support services to help people change their lifestyle and behaviours are not there any more—a complete nonsense. That is why it is really important to put the focus back on public health.

Over the past week, I was most shocked by a letter I received about substance misuse services in York. York is now 148th out of 148 authorities when it comes to drug-related deaths of people in treatment and across the community as a whole. Most people will be shocked to hear that about York, but when I look at what our local council have done in absolutely slashing funding to those vital services, I am not really surprised—and, of course, the most severe cuts are still to come. What will that mean to the people in my community whose life chances are being taken away from them?

Across mental health services, the sustained lack of investment over such a long period is having a real impact on health outcomes. People have been hurt by cuts and hurt by political decisions. It need not be that way. We all know it is the most vulnerable, the poorest, the people who really need the state’s help who fall down when the state stands back.

We have heard so much about young people in the debate, for whom interventions are even lower than for older people. For people in their latter years, public health virtually does not feature. Yet, in the health service that Bevan created, everyone from cradle to grave could access the necessary good public health services. Such interventions save the NHS so much money—it is a no-brainer—so why cut those services? That question comes not just from me, but from directors of public health I meet regularly in my constituency, and across the board. They want to understand what will happen when the public health grant is withdrawn. I hope the Minister can reassure them today that he will ensure that they will receive the funding needed to sustain services into the future. They also want to know how the Department of Health and Social Care will work with directors of public health to ensure that their long-term goals for improving the community’s public health will be funded.

We need to look seriously at the workforce in public health, which has been decimated. We have to look at funding to sustain that for the future health of our nation. We need to look at outcomes, not just inputs. Let me take the child measurement programme as an example. It is a nonsense that we know now how obese children are, but we cannot afford the interventions to change the trajectory of those children’s lives. That means that the programme does not work. We need to examine how we change the life chances of so many people across the country.

I want to touch on the 70th birthday of the NHS, which is so important for so many of us, and draw the Minister’s attention to what we are doing in York. When I heard what his Department was rolling out, I thought it quite lacklustre—it lacked ambition—so I pulled together the health leaders in York to drive forward a public health initiative to mark the 70th birthday. It includes the clinical commissioning group, the acute trust, the mental health trust and the local authority. We are working together to launch in July, as part of that fantastic celebration, a whole programme intended to transform the health of our whole community.

I have a meeting with businesses to talk about how employers can change the life chances of people who work for them. We are meeting faith and community groups to talk to them about people that they engage with. We are going to have a touring pop-up event across the city over the NHS birthday to provide advice, health checks and services, and simple programmes, because we do not have a lot of money. I know from Health questions that the Minister will meet with me, as the Secretary of State said, to talk about this initiative. We are going to have health walks at lunchtimes. We are going to have basic tests to understand health measures, as well as advice, information, encouragement and the promotion of better understanding, looking at diet, exercise, behaviour and the choices that people made. We are determined to touch the thousands of lives of people in York on this 70th birthday, because we want to celebrate the future with everyone.

We know that so many people are being failed, and the most vulnerable are being failed the most, but we can change things around. Public health does not actually cost a lot of money compared with acute services. So, I trust that from today, we will take the spirit of Nye Bevan and ensure that we invest in the very people who will depend on our NHS in the future.

Photo of Jamie Stone Jamie Stone Liberal Democrat Spokesperson (Armed Forces) 10:04 am, 16th May 2018

It is a pleasure to serve under your chairmanship, Mr Hosie. I am grateful to Nick Smith for securing this important debate. I wish the NHS a very happy birthday. I cannot understand—I get angry—when I hear politicians on the other side of the Atlantic rubbishing the NHS as a service. It is one of the greatest achievements of this country and, as has been said, credit is due to Clement Attlee’s Government for doing what they did.

Being born when I was, and being brought up in the Highlands, as a child I was part of the nascent NHS service. My late father told me what it was like before I was born. He spoke of the inequalities—how, if someone did not have enough money, their life would be shorter, because they could not pay for the doctor. That is how unfair it was. The NHS is about fairness, and that is why it is such a great achievement for this country.

I extol the virtues of the staff. Through my wife’s illness, I know how dedicated the neurosurgery team in Aberdeen Royal Infirmary is, and how fantastic the nurses were at a critical time in my wife’s life. She recovered, thank God. If there are angels on this earth, they wear nurses’ and doctors’ uniforms, believe you me.

The issue for Scottish Members is that the NHS is of course devolved, but I want to touch on something I mentioned in the summer when I questioned the Prime Minister. Within my vast and scattered constituency, we face really big challenges owing to remoteness and distance. There was a story in the national press recently about a mother who lived in Wick who had to make a 520-mile round trip to Livingston to give birth. That was due to an accidental coincidence of unavailability of services more locally. I do not want to give the staff a hard time—staff morale is crucial—and, for the record, I am not getting at the staff, but the fact that it happened should worry us all.

What we see in remote parts of Scotland, including my own constituency, is that there seems to be an impression that our network of local hospitals is not being used to the maximum it could be, in terms of treating people locally. I believe it is an issue of funding, which other hon. Members have also highlighted. What bothers me about what I think is happening in my constituency is that it seems to be taking us rather worryingly near to the sort of inequalities that my father spoke of. In other words, a person who lives in a very remote area of Caithness or Sutherland might not get the same deal as someone who lives in Glasgow, Edinburgh or Aberdeen, because it is harder to access services. That is the challenge for the Scottish Government, and for us all. Surely to goodness a person should not be disadvantaged because of where they live. That is what lay behind the Beveridge report, which in a way was influential on Nye Bevan bringing into being the NHS: the idea that no matter who someone was, or where they lived, they had an equal right to the service.

I do not know the answer. Health is devolved to Scotland, which I accept. It is rightly the property of Members of the Scottish Parliament and Ministers in the Scottish Government, who I am sure do their level best, but if there is a perception in Westminster that one part of the UK—it may be Wales, Northern Ireland or Scotland—is perhaps not functioning quite as it should, and on something as fundamental to our lives as the NHS, at the very least there has to be a conversation between UK Ministers and Scottish Government Ministers to say, “Is it going okay for you? Is there something we could do better? Is there something that can be co-ordinated better throughout the UK to make sure that whether someone lives in Scotland, Wales, England or Northern Ireland, they have the same access to health services?”

I give notice that this is an issue to which I will return, while of course always recognising the difficulty of the fact that health is a devolved matter and there are therefore limits on what I can say. I do not intend to be silent on the issue.

Photo of Karin Smyth Karin Smyth Labour, Bristol South 10:09 am, 16th May 2018

It is a pleasure to serve under your chairmanship, Mr Hosie. As my hon. Friend Nick Smith said, the antecedents of the NHS are to be found in Tredegar and in the Beveridge report, which preceded it. Disease was one of Beveridge’s five great evils. Infectious diseases such as polio, diphtheria and tuberculosis caused people to die in their early and mid-50s on average. The need for a sufficient and healthy labour force to rebuild the economy necessitated combating those diseases, which also caused a high rate of infant mortality. The need for a better, longer-living workforce drove much of what Beveridge looked at.

There was in fact a good deal of state funding provision before 1948 to cope with the devastation of disease, but what Bevan did, against tremendous opposition within the service and politically, was to centralise the system, nationalise hospital provision, create standards across the country and, crucially, give people the assurance that they would always be seen and treated, based on their need, not their ability to pay.

The health service was built on a tripartite structure of hospital, GP and community services. In return for good terms and conditions, clinical freedom and autonomy in the system, the doctors finally agreed and the NHS was born. It was a wonderful achievement, but it was also a wonderful compromise. Over the past 70 years, the tensions in that compromise—the local versus the national, the role of clinical autonomy, priorities and the quality of the service—have regularly surfaced. There are always crises—astonishingly, every year there is a winter.

We now treat 1 million people every 36 hours, and employ nearly 2 million people. We are very grateful for everything they do, and we celebrate them today on this 70th year. However, the challenges are different today, and the service should therefore be different in the next 70 years. This anniversary is an opportunity to celebrate the achievement, revisit the compromise and set a course that is as resilient for the next 70 years. The diseases that are with us today—cancer, and cardiovascular, respiratory and liver disease—are very different. Depending on a person’s social class, dietary risks, tobacco and obesity are the biggest contributors to early death and disability. Alcohol and drug misuse, and lack of physical activity, are also key. We are finally starting to appreciate the impact of mental health and social isolation on physical health.

Life expectancy has increased, but the prevalence of people living with one or more limiting long-term illnesses has changed the picture of healthcare demand, and that requires the system to change. In Bristol, women live an average of 64 years in good health, but a further 19 years in poor health. For men, the figures are 63 and 15 years, but that average masks a huge range in social class. Several areas of my Bristol South constituency are in the bottom 5% in England for male life expectancy. In 2010 the Marmot review told us that such health inequalities cost us approximately £36 billion to £40 billion in lost taxes and costs in welfare and to the NHS—that is a huge amount of money. We must prevent and manage life-limiting diseases and address the silent misery of families who support and cope with people living with them.

Accountability is a major issue for the service in the next 70 years. We need to start treating patients and the public as assets to the health service, not as nuisances. We need somehow to introduce democratic accountability into decision making. The complex fragmentation of the health service makes it wholly unclear where responsibility, and hence accountability, lies. From the bottom up, hundreds of bodies are involved. The 200-odd clinical commissioning groups are members’ clubs with no element of either direct or representative democracy, and they are plagued with conflicts of interest. At the top, there is not just the Department and Ministers, but a raft of arm’s length bodies, which Members of Parliament find it impossible to navigate. I worked in the system for a CCG, and I still find it really difficult—it is an absolute mess.

One reason for the mess is the disaster of the Health and Social Care Act 2012, but the NHS has been poor on accountability since the early centralisation. It has always been fragmented in a way that makes accountability harder, and it has always seen itself as separate from the rest of the local system, which has democratic accountability. That is a problem. It has always been riven by powerful vested interests that distort the general accountability. That is a key part of Bevan’s compromise, and I think we need to revisit it.

Presented with a well-made case that is supported by, dare I say it, experts or informed leaders, the public will make difficult decisions. I know local politics can make things difficult when tough issues such as service changes are necessary, but excluding people does not make that any easier. Making a hard case to local people and their MPs is challenging work, but if that does not happen decisions gain no legitimacy. We can keep the “N” in the NHS, but we need to give local people far more control to make it more resilient for the next 70 years.

It looks like we are going that way. We have heard about the experience in Scotland, and this is also a devolved matter in Wales. Very interesting things are happening in Manchester, but we need a much better debate about what local looks like. We must recognise that the key issues for now are the money and the workforce. Technology gives us huge opportunities, including on some of the workforce issues.

I want to finish by talking about leadership. I joined the health service as a manager in the late 1980s, and I am very proud of the role that managers play in the services. General management, which was introduced in the 1980s, has few friends, partly because it was associated with the Thatcher era of reforms, and partly because it threatens clinical autonomy and freedom, which were fundamental to Bevan’s compromise. We should use this anniversary to celebrate managers and leadership in the NHS. We need good clinical and non-clinical managers to make the changes we want to see, deliver the efficiencies we need and keep making the system safer. I hope that they can also help leaders make the NHS more open and accountable. We need that for the next 70 years.

Photo of Neil Gray Neil Gray Shadow SNP Spokesperson (Social Justice) 10:16 am, 16th May 2018

It is a sincere and genuine pleasure to serve under your chairmanship, Mr Hosie. I pay tribute to Nick Smith for securing this debate and for his thorough and measured speech. He talked about the challenges we face in the NHS, about austerity—obviously, across these isles, we all face the challenge of dealing with austerity constraints—and about obesity. I mentioned earlier that on Monday, Jamie Oliver met the First Minister of Scotland, Nicola Sturgeon, here in London. He backed the Scottish Government’s target to halve childhood obesity rates by 2030 with a new healthy weight and diet plan, which is due to be published this summer. It will include action to restrict promotions that advertise junk food, including multi-buy deals on unhealthy products.

The hon. Gentleman mentioned the fantastic parkrun, which is one of the best lifestyle movements—if you will pardon the pun, Mr Hosie—that we have. It is free, run by volunteers and accessible. It is 5 km—anyone of any ability can manage that. This morning, I managed to get some miles in the bank before this debate, alongside my Scottish National party running club colleagues. The hon. Gentleman is more than welcome to join us any time he wishes. The invitation is open to all: we are ecumenical.

Bill Grant gave us a very good history lesson about how far the NHS has come. He was very comradely in his cross-party acknowledgment that Labour founded the NHS, and rightly so. In his comradeliness, he neglected to mention any of the NHS measures in Scotland, which are no doubt helped in no small part by the intervention and support of his daughters. It is right that we pay tribute to NHS workers. The NHS in Scotland is the best performing in the UK.

My constituency neighbour, Hugh Gaffney, perhaps missed the tone a wee bit, but I understand his anxiety. He talked about Monklands Hospital, which is in my constituency. Of course, the SNP Scottish Government have committed funding to build a new Monklands Hospital. We are all aware of the challenges previous Scottish Governments faced with the accident and emergency service at Monklands Hospital. There was potential for a downgrade, but the hospital’s future is secure and we are going to get a new service. The hon. Gentleman talked about funding, and of course the NHS in Scotland is supported by record funding levels. However, the hon. Gentleman is right that, like all NHS services, we are not without our challenges in Scotland. In that regard, I hope that he pursues the case that he mentioned, involving his mother. It is right that where there are problems they are called out and we learn from them.

John Howell talked about the need for a long-term plan for the NHS. We all agree with that. He also talked about care not being properly integrated, but in Scotland we have legislated to integrate health and social care, so we are further down the road to seeing it realised. He was right to mention that public health must be central—we must all remember that, and remind ourselves of it.

Rachael Maskell was right to pay tribute to Dame Tessa Jowell, who personified dignity, passion and eruditeness in her final months of campaigning on health issues. We all pay tribute to her work and pass on our sincere condolences to her family.

Jamie Stone gave a very measured speech based on experience and personal testimony. He is right that the NHS is fundamentally about fairness, and he was right to pay tribute to our NHS staff, as we should all do—it should be something to unify us all. He talked about rurality and distance, and I benefit from experience in that regard because I am originally from Orkney, so I well appreciate the challenges of local service delivery, which are not too dissimilar from the ones that he faces in his constituency. I know, however, that the Scottish Government are aware of that and that the door is open to him should he seek to make representations or come up with ideas.

The hon. Gentleman also spoke about the potential for UK conversations, but as I have said, the Scottish health service is performing well according to any number of measures. The issues and conversations that we are having are about funding, and about breaking the austerity stranglehold that affects all our local public services. Perhaps he will join us in continuing to challenge UK Ministers to end austerity.

Karin Smyth, too, gave a very good speech based on experience. She spoke about the new challenges that we face and how they have changed over time. She mentioned obesity, as I have, and alcohol abuse. The Scottish Government have intervened to legislate for and bring in, after much challenge, a minimum unit price for alcohol in Scotland. UK Ministers are following developments to see how progress is made. When discussing NHS staff, it is right to mention frontline staff—our nurses and doctors—but we should also mention the decision makers, leaders and management level. I have a good working relationship with my local decision makers and managers, and the hon. Lady was right to mention them.

I want to touch a wee bit on my personal experience of the NHS. In many ways, it has shaped where I am, and I am personally indebted to it. First, when I was a young boy, not that much older than my son is now, I pulled a kettle of boiling water down on myself. The scars are still there on my arm and chest, a physical reminder of what happened. Had it not been for swift and expert intervention at the time I would not have the full use of my right arm, so I am personally indebted to the staff in Kirkwall and Aberdeen for what they did for me.

Those who know me and my slightly accident-prone nature will be surprised to learn that my next major intervention from the NHS was not for 20 years, when I dislocated my knee running on a running track, ending what little there was of my athletics career. However, it could have been far worse. Had it not been for the swift intervention of the surgeon at Ninewells Hospital, John Dearing, who operated within the week, because of the nerve damage I sustained when I dislocated my knee I would not have the full range of mobility in my legs that I have now. As I have said, I can still run, and play football and rugby equally badly, but I would not have been able to had it not been for his swift and timely intervention, so I am very grateful.

I am sure that many of us in the House are indebted to the NHS in one area that we have not really talked about, other than the hon. Member for Caithness, Sutherland and Easter Ross. I am certainly grateful to the NHS for the wonderful experience of the birth of my two children. Sometimes we take such services for granted, in particular when we hear about the experience of friends in America, for example. Anecdotally, if we make an analogy with the recent delivery of the royal baby in the Lindo wing, American patients could travel first-class the whole way to the Lindo wing for the same price that it would cost to have their baby delivered in America. We should all remind ourselves of how fortunate we are in many regards in this country.

I know that we do not all have positive experiences when we interact with the NHS. I deal with complaints about the NHS, just as any MP, any Member of the Scottish Parliament up the road, or any colleagues of the hon. Member for Blaenau Gwent in Wales do. However, as I mull over developments in my area, such as the new Monklands Hospital, and the medical advances that have been made over the past 70 years, we should be incredibly proud of our NHS and protect its integrity with every political and moral fibre available to us. I thank all those who work in our NHS, past and present, in Scotland and across these isles, and I wish the institution that we are so proud of a very happy 70th birthday.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health) 10:26 am, 16th May 2018

Mr Hosie, it is a pleasure to serve under your chairmanship this morning in this very important debate.

I start by thanking my hon. Friend Nick Smith for securing the debate and for his excellent speech. He is rightly proud of his roots in his wonderful constituency and the connection that it holds with Nye Bevan and the founding of the NHS. I am sure that he and his constituents will enjoy the 70th anniversary celebrations, and I look forward to hearing all about them.

I would also like to thank the other hon. Members who spoke this morning for their thoughtful contributions to the debate—the hon. Members for Ayr, Carrick and Cumnock (Bill Grant), for Henley (John Howell), for Caithness, Sutherland and Easter Ross (Jamie Stone) and for Airdrie and Shotts (Neil Gray), who speaks for the Scottish National party, and my hon. Friends the Members for Coatbridge, Chryston and Bellshill (Hugh Gaffney), for York Central (Rachael Maskell) and for Bristol South (Karin Smyth).

This is the first speech that I am giving on the 70th birthday celebrations of the NHS, and it is a genuine honour and privilege to be able to do so here today as the shadow Minister for public health. On 5 July, 70 years ago, the Health Secretary, Aneurin Bevan, was handed the keys to Park Hospital in Manchester, now known as Trafford General Hospital, and launched our national health service. I have my own little photocopied memento of a leaflet distributed before that launch—I wish I had a better copy, but I treasure this one. It says:

“Your new National Health Service begins on 5th July. What is it? How do you get it?

It will provide you with all medical, dental, and nursing care. Everyone—rich or poor, man, woman or child—can use it or any part of it.”

It went on to say:

“But it is not a ‘charity’. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness.”

The crux of it for our citizens was that they would no longer have to make that awful decision—the choice between debt or, in some unfortunate cases, death. Everyone would now receive healthcare publicly provided and free at the point of use.

I have got my own family anecdote which, as we have the time, I am going to share with you all this morning. I am sure we have all got these family anecdotes. Mine involves my Aunty Ella and my mam. My Aunty Ella was born before the start of world war two and my mam was born in 1945—so you can see straightaway that there is going to be a great anecdote here.

Now, I do not know why—they must just have been unlucky—but in both of their childhoods they suffered from pneumonia. Pre the NHS, when it was my Aunty Ella who had pneumonia, my nana had to go to the doctor’s surgery every morning, where he would hold out his hand, and into his hand she would place a coin—a shilling or whatever. Then she would hold out her hand and into her hand he would place a tablet—obviously, penicillin or some form of medicine. Then she would go home and give it to my Aunty Ella. This went on nearly a week.

My nana was very poor, working class, and she says that in those days, in order to get the money to get that tablet, she would pay a visit to the pawn shop on her way, and pawn whatever was valuable to her at that moment. It tended to be sheets, or a son’s suit or her husband’s suit. She did that in order to get the tablet.

Now fast forward to when my mam, who was born in ’45, got pneumonia, after the health service came in in ’48. My nana did not have to pawn anything; she did not have to go to the doctor’s surgery at all, because a district nurse knocked on the door every day and went upstairs to where my mam was lying in bed with pneumonia, gave her an injection and left. No pawning of sheets, no handing over of money, no stress—that was the difference. Therefore, all of us—I do believe that it is all of us—are committed to those founding principles. We on the Opposition side of the House especially, will continue to fight against the privatisation of our NHS for those reasons.

To quote a phrase often falsely attributed, I now understand, to Bevan, but one I repeat because it rings true no matter who said it:

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

I am pleased to say that 70 years on, there are still plenty of people with the faith left to fight for it. I hope that we will all—though maybe not us personally—be celebrating our NHS for 70 years more, and 70 years after that, and so on. It changed the lives of people then and it is still changing the lives of people today.

Bevan had huge ambitions, but he never would have imagined all those years ago the successes we have had in medicine because of the development of the NHS. I will talk about a few of them now. In 1952, Francis Crick, a British scientist, and James Watson, an American student, made one of the most important scientific breakthroughs of the 20th century, when they discovered the molecular structure of DNA. The discovery helped revolutionise medical treatments in the NHS and elsewhere, improving prevention and treatment of disease. For example, we know now that a BRCA gene mutation can cause a number of cancers in both men and women, who now have the option to have preventive surgery in order to reduce their risk of developing cancer.

In 1954, Sir Richard Doll, a British scientist, published a study in The British Medical Journal co-written with Sir Austin Bradford Hill, which established the link between smoking and lung cancer. That very important study has since led to increased smoking cessation policies from successive Governments, including the ban on smoking in public spaces by the Labour Government in 2006 and the current Government’s—and the Minister’s—tobacco control plan. Smoking prevalence is decreasing across the country, and I am pleased to say that smoking rates in the north-east are declining faster than the national average, thanks in no small part to support from programmes such as Fresh North East, which has seen around 165,000 people quit smoking since 2005.

In 1958, vaccinations for polio and diphtheria were launched, to reduce deaths from both diseases. I am pleased to say both those terrible diseases have now been eradicated from the UK. Others, such as TB and MMR vaccinations, have now become a key part of NHS prevention work. We were in this Chamber just two weeks ago debating the extension of the HPV vaccination to boys after its successful roll-out to girls in order to prevent cancers caused by that virus. Bevan could never have imagined such developments—or maybe he did, such was his vision.

In 1960, doctors at the Royal Infirmary of Edinburgh completed the UK’s first kidney transplant, using a set of 49-year-old twins. Incidentally—perhaps it was the pneumonia—my Aunty Ella, who I have mentioned once already, went on to have kidney failure; and just a decade after the first transplant in Edinburgh, she became one of the first to receive a kidney transplant in Newcastle Freeman Hospital. That helped her live long enough not only to see her own children grow up, but to see her first grandchildren born. In 1968, a team of 18 doctors and nurses at the National Heart Hospital in London, led by surgeon Donald Ross, carried out the first heart transplant in this country. There are now more than 50,000 people living with a functioning transplant thanks to organ donation and transplantation in the UK, giving them more time to spend and treasure with their families.

In 1988, breast cancer screening was introduced, offering mammograms to women over 50. We have now increased the number of women who are eligible for breast screening. That helps with early diagnosis and survival rates, which are now at 78% for 10 years or more—excellent figures. None of this would have happened if it were not for our NHS and the everyday heroes that work within it. The NHS is the UK’s largest employer, with over 1.5 million staff from all over the world and more than 350 different careers. Those people are kind, caring and passionate about their patients. They just want to get on and do their job, but sadly, they are finding this more and more difficult, with funding cuts and thousands of unfilled vacancies, when more and more is expected of them.

We on the Opposition side of the House do not take our NHS or the workforce for granted, and neither should the Government. It has to be said that for the last eight years, the NHS has been in crisis. We have ever-growing waiting lists, patients waiting on trolleys in overcrowded hospitals, and people being told not to go to A&E unless it is an absolute emergency. Earlier this year, the Prime Minister announced a funding plan to mark the 70th anniversary of the NHS. I hope the Minister will inform the House how much of that funding will go to improving and establishing public health services. There is a huge funding gap within the NHS, but with the right public health services we can help people to live healthier lives and support them in their endeavour to do so, which, in turn, will save money.

It is estimated by the King’s Fund that since local authorities became responsible for public health budgets in 2015, on a like-for-like basis, public health spending has fallen by 5.2%. That follows a £200 million in-year cut to public health spending in 2015-16 and there are further real-term cuts to come, averaging 3.9% each year between 2016-17 and 2020-21. On the ground, that means cuts to spending on tackling drug misuse in adults—cut by more than £22 million compared with just last year—and smoking cessation services—cut by almost £16 million. Spending to tackle obesity has also fallen, by 18.5% between 2015-16 and 2016-17, again with further cuts in the pipeline in the years to come. These are vital services for local communities, which would benefit their health and life expectancy, but sadly, they continue to be cut due to lack of funding.

As my hon. Friend the Member for Blaenau Gwent said in his excellent opening speech, an ounce of prevention is better than a pound of cure—a line that I will certainly be stealing for future speeches—and that is why, 70 years on, we must focus on public health initiatives. That is why I am so pleased that he made today’s debate about public health, rather than its just being on the 70th anniversary generally. Not only can such initiatives help people live healthier lives, but they will save the NHS—and, in turn, the Treasury—money. I think the technical term for that is a no-brainer.

In closing, I will return to Bevan’s wise words. He said:

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

This Government have the means to make people in this country some of the healthiest in the world. I hope that they will take those means and ensure that vital public health services are provided to society to do just that.

Photo of Karin Smyth Karin Smyth Labour, Bristol South

My hon. Friend is making an excellent speech, as usual. Does she agree that one of the issues with devolution, and some of the experimentation we have seen, is the separation of knowledge between the health service and providers of our public services, particularly in England? We can learn from the experience that has been gained, particularly in Wales, where there is much more integration between those areas, and transfer the learning about public health that has come into local authorities, so that they understand the need to work better with local health services.

Photo of Sharon Hodgson Sharon Hodgson Shadow Minister (Public Health)

Absolutely. That point had not been covered, so I am pleased that my hon. Friend has made it. There is best practice in Wales, and even in Scotland—we are always hearing in these debates about some of the wonderful things going on in Scotland, aren’t we, Minister? We should learn from where there is best practice. Where good things are happening, that knowledge should be spread across the NHS, especially if it will lead to better public health and, in turn, save money.

I was just coming to the end of my contribution. I just wanted to say that we want to go on to see more successes, such as the ones I listed earlier, over the next 70 years. I am sure we will. With medical technology and science the way they are, we probably cannot even imagine the sorts of advances that we will see. I hope those will all be within the publicly funded national health service that we are all so proud of, for many years to come.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care 10:41 am, 16th May 2018

What an interesting debate. I echo the view of the shadow Minister, Mrs Hodgson, that it is a privilege to be in this position at this time in the NHS’s history. I feel like I know her Aunty Ella personally—what a lovely family anecdote that was. That real example was a good reminder of what the NHS has brought to families.

I congratulate Nick Smith on securing the debate. Those who know me know that I certainly share his passion for this topic. Winchester cannot claim ownership of Mr Bevan, but Florence Nightingale established a hospital in my city on the hill—the Royal Hampshire County Hospital, which is much loved and is still there doing great things. It has very committed and caring staff. Karin Smyth said that the NHS was a great achievement but that there were also a number of compromises. If I may say so, she was very astute to put it that way. As many Members have said, we live with that achievement but there are many compromises.

The NHS is of course 70 years old this year. Much has changed in our society and our health since 1948. Our health needs are very different, and we have better drugs and diagnostic tools. When the NHS was born, life expectancy was 66 for men and 71 for women; today it is 79 and 83 respectively. That is incredible. In 1948 there were more than 34 deaths for every 1,000 live births; today there are just five, although that is still too many.

I will start where every Health Minister should, by thanking our NHS staff for all they do, day in, day out, to make our NHS something that we are incredibly proud of. There was a great awards event this week in London, at which the Duke of Cambridge spoke, which showcased so many wonderful examples. Indeed, Mr Bevan would be amazed at the work that goes on today across the NHS.

We want to use the NHS70 moment to reflect on the last 70 years of patient care, to celebrate the innovations in the NHS, to raise awareness of the many ways we can support the system and, probably most importantly, to promote the public’s role in the future of the NHS and the importance of taking care of our own health and using the NHS wisely—and, yes, accountability, which the hon. Member for Bristol South wisely raised. I am giving her a lot of credit. [Interruption.] “Keep going,” she says.

So much of this debate is about our changing society, but the NHS has consistently been a universal service that is free at the point of need. That will continue. However, as several Members said, we are facing many different challenges from those we faced back in the ’40s, such as the prevalence of type 2 diabetes, which my hon. Friend John Howell mentioned. He sits on the all-party parliamentary group on diabetes. I was bitterly disappointed that he did not give us any of his medical updates, but I know that those will come another time. In fact, we heard a couple of medical examples from the SNP spokesman, Neil Gray. The rising prevalence of type 2 diabetes is a great challenge for us, as is cancer. Both can be reduced if we tackle obesity and encourage more people to lead healthier lifestyles, so that is where I will focus.

The Government take the public health challenge we face incredibly seriously. We have responded by putting prevention at the heart of public policy making. We have taken quite stringent steps. As the shadow Minister said, we are a global leader on tobacco control. We were the first country in Europe to introduce legislation to bring in plain packaging for cigarettes, off the back of the smoking ban in public places. She rightly mentioned Fresh North East, which is a very good example—it is in many ways the apple of my eye in this policy area. I hope at some point, if the arithmetic in this place ever allows, to go and see it for myself. I will let her know if I do—perhaps we can do that together. In April we introduced the soft drinks industry levy, which is a big public health measure. In recent years we have vaccinated more than 1 million infants against meningitis and an additional 2 million children against flu.

We have run award-winning public health campaigns, including Be Clear on Cancer, which I am very invested in, and Act FAST, the public health stroke campaign. They all sit with the inheritance of the landmark Don’t Die of Ignorance campaign about the AIDS challenge we faced in the late 1980s—I am surprised that was not mentioned. That campaign still makes the hair on the back of the neck stand up, does it not? It was an incredibly impactful and powerful piece of work that came out of the public health movement.

I want to cover a lot of things, but let me return to diabetes, which is a major challenge. Preventing diabetes is a huge priority for the Government. According to Diabetes UK, which I saw just last week, about 5 million people in our country are currently at high risk of developing type 2 diabetes. If the current trend persists, one in three people will be obese by 2034 and one in 10 will develop type 2 diabetes. Some of the risk factors for type 2 diabetes, such as poor diet and a sedentary lifestyle, which can lead to obesity, can be changed. We know that 61.4% of adults are either overweight or obese; and 26% of adults and 20% of children aged 10 to 11 are obese. The obesity crisis has been decades in the making, and tackling it is a real challenge. It will not be turned around overnight, and no one pretends that it can be. That is why tackling obesity is absolutely a Government priority. I will come back to that point in a moment.

I mentioned the NHS diabetes prevention programme, which is aimed at providing people aged 40 to 60 who are at risk of diabetes with personalised help with healthy eating and lifestyle, and bespoke physical activity. So far, as I said at Health questions last week, more than 170,000 people have been referred to that programme. Those who are referred get tailored, personalised help, and that is really making an impact.

Photo of Neil Gray Neil Gray Shadow SNP Spokesperson (Social Justice)

It was remiss of me when talking about childhood obesity and lifestyle changes not to commend those who started and spread the daily mile challenge in our schools. Perhaps the Minister will touch on that, and on its roots in Scotland.

Photo of Steve Brine Steve Brine The Parliamentary Under-Secretary for Health and Social Care

I thank the hon. Gentleman for that point. I touched on child obesity, which is one of the top public health challenges, if not the top challenge, for this generation. Overweight and obesity-related ill health is estimated to cost the NHS in England about £5.1 billion each year. The estimated total cost to society is between £27 billion and £46 billion per year. Our child obesity plan, which was published back in 2016, is informed by the latest evidence and research in the area. At its heart is a desire to change the nature of the food that children eat and make it easier for families to make healthier choices. Since we published the plan, real progress has been made on sugar production. Since the introduction of the soft drinks industry levy, which I mentioned, sugar has been drastically reduced in around half of all soft drinks products that fall under the levy. I recognise the daily mile, which was rightly raised by the hon. Gentleman, which he said started in Scotland. It is in England as well, though not as much as I would like to see it—we have an ambition for it to do much better.

Many Members mentioned child obesity, and we have always been clear that the child obesity strategy is the start of a conversation and not the final word—we call it chapter 1 for a reason. We continue to monitor the progress we have made since the publication of the strategy a couple of years ago, and if further measures are needed we will take them.

Let me touch on physical activity, which the hon. Member for Blaenau Gwent rightly spoke about. People know that being active is good for their health and they want to do more, but the truth is that many of us are simply not active enough to benefit our health. Only 66% of men and 58% of women in England meet the chief medical officer’s recommendation to be active for at least 150 minutes a week. Children are no better, with only 23% of boys and 20% of girls being active for at least 60 minutes a day. As we get older, we become less active. It is recommended that we do muscle strengthening and balance exercises on at least two days a week, but the most recent health survey shows that only 1% of the adult population in England meet that guideline.

Why is that important? We are facing an ageing population and there is good evidence that being active reduces the chance of falls, depression and dementia by up to 30%. That will help people stay healthy and independent for longer, and we need that to happen if the NHS is to be sustainable for its next 70 years. People need to understand why being active is important and have a clear understanding of how much activity they should do and the impact that can have on their health. I was pleased to hear parkruns mentioned by a number of Members, including the hon. Member for Blaenau Gwent, because they are incredibly important. I have them in my constituency at the River Park leisure centre.

It is vital that we acknowledge the importance of good mental health, which was mentioned a couple of times in the debate. Everybody’s mental health is on a point on the spectrum and, as my hon. Friend Bill Grant said, mental health is just the other side of the coin of physical health. Good mental health is so important to leading positive and productive lives and to the NHS. This is Mental Health Awareness Week, but really every day should be a mental health awareness day. Mental health is a key priority for the Secretary of State and the Prime Minister, which is why last December we published the Green Paper on children and young people’s mental health, backed by more than £300 million of funding to improve access to services and, crucially, mental health support in schools.

Just yesterday I was at the Maudsley Hospital in London, looking at the incredible work it has done in bringing us to a smoke-free NHS. We identified mental health in-patients as a key target in the tobacco control plan. I saw the important work being done, which I would recommend to any Members who think they could inspire their local areas to follow that lead.

My hon. Friend the Member for Ayr, Carrick and Cumnock was dead right to mention delayed transfers of care—delayed discharges—which are a key component and in many ways the magic key to the NHS. It is also always nice to hear Robert Burns quoted in the Chamber, but I am sorry that he did not sing it—maybe next time.

I understand why Hugh Gaffney made the speech he did. He certainly put down a marker for the Scottish Government, who govern his constituents.

I thank my hon. Friend the Member for Henley for mentioning the long-term economic plan—I have not said that for a while—and the multi-year funding plan that the Prime Minister talked about at the Liaison Committee. He is dead right. That is exactly what we should be doing, and it is exactly what we will do.

As always, Rachael Maskell spoke from the heart about health matters. She mentioned the integrated public health plan for her city, which sounds great. Local application of what is good for local areas is right, and I look forward to hearing more about her local area when we meet.

Jamie Stone raised questions about the devolution settlement. Of course, we talk across England and the devolved nations, but the settled will of this Parliament and of the people in this country is that we have a devolution settlement. Devolution can bring difference, and that can be good or bad. Yes, we do talk and share best practice, and I know that NHS England and Public Health England talk to their counterparts in the devolved nations all the time.

On good and bad difference—this is not political knockabout; it is just some facts—it would be remiss of me, as a Conservative Health Minister, not to put on the record that since 2010 we have increased NHS spending each and every year, even as we have had to take some very difficult financial decisions, given the state of the public finances we inherited. The NHS now has £14 billion more to spend on caring for people than it did in 2010. To give that some context, over the past five years funding for the NHS increased in Wales by 7.2%, in Scotland by 11.5%, and in England by 17.3%. I say that not to make a political point; it is a simple fact that should be put on the record.

Let me take this opportunity once again to congratulate the hon. Member for Blaenau Gwent on introducing this timely and important debate. As we have seen, the challenges that the NHS faces are radically different from those it faced in 1948. The debate has shown us why we, the Government, the NHS and the people we all represent, wherever they live in this United Kingdom, are all part of the solution to the deep and significant public health challenges we face as a nation. They are also all part of the inheritance of that health service that we are all so proud of.

In the short time available I have tried to show how seriously the Government and the NHS take those challenges. We must use all the opportunities we have at our disposal and that long-term health economic plan—I like saying that—to address the big public health challenges facing our nation. Only through the combined efforts of the Government, the NHS and the people in our country who are taking responsibility for their own healthcare, as technology increasingly allows them to do, which was another good point made in the debate, can we truly tackle the public health challenges we face and make sure that the NHS does not just survive for another 70 years—we are not interested in that—but thrives and goes from strength to strength, being a preventive health service as much as a treatment health service. That will truly honour Nye Bevan and everyone else involved in its establishment back in the ’40s.

Photo of Nick Smith Nick Smith Opposition Whip (Commons) 10:56 am, 16th May 2018

I thank my comrades and other colleagues for their contributions. I agree with the Minister that it was good to hear a Rabbie Burns poem emphasising good health. My hon. Friend Hugh Gaffney praised health service workers, and I was pleased to hear that his mum is better and at home now.

My hon. Friend Rachael Maskell emphasised the enormous contribution that Tessa Jowell made to her career. I too would like to support and emphasise that. From Jamie Stone we heard about the huge difficulties of getting healthcare on the Scottish islands before 1948. He supported the then Attlee Government’s legislative jewel in the crown: the establishment of the NHS. I thank him for that.

My hon. Friend Karin Smyth emphasised the importance of William Beveridge and the thinking he did to address the five “giant evils” in 1942. That was important for our Labour Government after the second world war. I was pleased to hear from Neil Gray about the Scottish Government’s plans to halve child obesity. I support that, and of course it should be done everywhere. I was also pleased to hear that our parliamentary running group is getting stronger weekly.

I was glad to hear the Minister emphasise the importance of addressing child obesity, but we really must do better. I will not accept his political barbs about the NHS across our country. I remind him that Churchill and the Conservatives voted against the establishment of the NHS in 1948, and that crucial fact is never forgotten—certainly not in my constituency. I want to praise Nye and the people of my constituency for helping to establish the national health service. We on the Opposition side will guard it with every muscle in our bodies.

Question put and agreed to.

Resolved,

That this House
has considered the 70th anniversary of the NHS and public health.