I inform the House that Mr Speaker has selected the amendment in the name of the Leader of the Opposition, which will be moved at the start of the debate, and amendments (j) and (g), which will be moved at the end.
No. I can assure the hon. Gentleman that his amendment was not selected.
2:41 pm
Jonathan Ashworth (Leicester South) (Lab/Co-op)
I beg to move an amendment, at the end of the Question to add:
“but respectfully regret that the Government has provided insufficient information for its proposals properly to be scrutinised; and therefore beg leave that she will be graciously pleased to give directions that the following papers be laid before Parliament: the DHSC internal review of their operation during the pandemic as referenced by the Prime Minister’s official spokesman on 12 May.”
May I take this opportunity to note that although amendment (e) in the name of my hon. Friend the Member for Rhondda (Chris Bryant) has not been selected, its contents, which relate to brain injury, are important and welcome? I hope that Ministers take on board its recommendations.
It is all too tempting to intervene; I have never objected to temptation. On brain injury, I just want to say that I really want us to think about legislation now. The United States of America has made dramatic changes—it has introduced legislation four times now—and I think it is time we went down that route.
Jonathan Ashworth
I completely agree. I hope that Ministers on the Treasury Bench have listened carefully. If they are prepared to bring forward legislation, we would work constructively across the House to ensure its speedy passage. May I thank my hon. Friend for the reference in his amendment to the impact of alcohol abuse on children? He knows that it is a subject very close to my heart; on behalf of the children of alcoholics community, I am grateful that he referred to it in his amendment.
Although we have often said this in the House, I still think that the whole House will want to remember today the 127,691 people so far who have lost their lives to covid-19, this awful disease, including the 850 health and care workers. Although repeating the numbers has become almost routine in this House, that does not make the scale or gravity of the loss any less shocking. We grieve as a nation and we all pay tribute to our healthcare workers, our social care workers and our public sector workers.
I am sure that the whole House will want to dedicate itself in good faith to learning lessons for the future. Sadly, we are in an era when, according to the experts, pandemics are becoming more predictable and will become more regular because of climate change and biodiversity loss, so learning lessons is about preparing better for the future rather than settling scores.
We know that the B1617.2 variant is spreading. From the data that I have seen, it appears to have a growth rate advantage of about 13% over the B1117 variant. It could well become the dominant strain in the United Kingdom. Although vaccination should mean that many are much safer and ought to avoid hospitalisation, the Government still have a responsibility to do all they can to contain its spread, minimise sickness and ensure that the 21 June target is not disrupted, if at all possible.
That is why I said on Monday that we need more surge vaccination in hotspot areas. We know that with vaccination there are always pockets where rates are lower than necessary, and we need to drive those rates that up. We have seen that throughout history—with measles, for example. So we urge the Government again to do all they can to drive up vaccination rates in Bolton, Bedford, Blackburn and other areas where we know there is an issue. We also need the Government to do more to contain the virus through test, trace and isolate. We need more surge testing. We need more enhanced contact tracing locally, with local authorities given the resources to carry it out. We need sick pay and isolation support fixed as well.
For those who are going in to work, or for those who are now socialising in premises, those buildings and premises need proper air filtration systems. There are experts now who can easily fix filtration systems in buildings to make them much more covid secure, and we should be inspecting workplaces in all these areas to ensure that every workplace is covid secure.
The shadow Minister and I, and many others in this House, shared that wonderful victory on Saturday. After 139 years of Leicester City, we won the FA cup; it is great news.
I chair the all-party parliamentary group for respiratory health. This morning, we were given some very worrying figures. They indicated that the halting of the lung cancer screening pilots restricted access to diagnostic tests, contributing to a 75% drop in urgent lung cancer referrals. Does the shadow Minister agree with me, and share my concern, that the outcomes for patients with the fastest-progressing cancers, such as lung cancer, are indeed very worrying?
Jonathan Ashworth
The hon. Gentleman is spot-on. I will come on to cancer in a few moments. He is a great champion for improving cancer care, and I thank him for reminding the House that Leicester City won the FA cup on Saturday. It is a reminder that even when the odds are stacked against them, a small team can still beat a well-funded, complacent opposition.
I will now move on to elective waiting lists. Where is the plan in this Queen’s Speech to bring down the rocketing waiting lists for treatment and surgery? Where is the plan to roll out technology such as in ophthalmology, for the thousands in our constituencies awaiting cataract operations? There are already 81,762 of our constituents waiting over 12 months for orthopaedic surgery. Where is the plan to get on with the hip replacements and knee replacements that many of our constituents will be raising with us in our surgeries, and how much longer will they have to wait? Where is the plan for the 24,407 of our constituents who are now waiting over 12 months for gynaecological surgery? How much longer will they have to wait?
Everyone understands that there has been a pandemic and that that has meant a disruption in care pathways, but the NHS was forced into this unprecedented position because we went into the crisis on the back of 10 years of Tory underfunding and cutbacks. We went into this crisis on the back of a 6% reduction in bed numbers between 2010 and 2019. That is why, at the beginning of 2020 when we debated the last Gracious Speech, 4.5 million people were on the waiting list for treatment. The target of 92% of patients beginning treatment within 18 weeks of referral from their GP had not been met for five years. We need a resourced plan now because the queues are set to lengthen further, as those who may have delayed seeking treatment for fear of covid infection will begin to emerge once again. Even though the NHS is dealing with significantly fewer covid patients, it is still operating at a much-reduced capacity and is unable to treat everyone in need of care.
Infection control measures meant that the number of beds fell by 9% in the first quarter of last year. It has only partially recovered in the past three months, but the number is still 6% lower than the previous year. What that means when we look at the most recent figures is that, on average, there are almost 4,000 fewer patients in NHS general and acute beds than the equivalent pre-covid period.
The Prime Minister has delayed the review of social distancing for entirely understandable reasons, but we must have a plan to drive up this capacity in the NHS. The solution to these capacity issues in the NHS cannot be a multi-billion pound deal with the private sector. The loss of capacity in terms of beds in the NHS is actually far larger than the whole capacity offered by the private sector. In order to reopen those closed and empty general and acute beds in the NHS, we need more capital investment. This investment needs to be built up now, so that the NHS can get on with the routine surgery that it will clearly have to confront in the coming years. I am afraid that, both the Queen’s Speech and, indeed, the Budget from a few weeks ago, failed to deliver that.
Is the hon. Gentleman saying that under no circumstances would he use the independent sector to reduce the pressure on elective surgery waiting lists?
Jonathan Ashworth
If the hon. Gentleman thinks that the answer to driving up capacity is just a four-year £10 billion deal with the private sector, then we will not be in a position to reopen the beds over the coming years in the NHS. That is the issue. It undermines capacity in the NHS. We need capital investment in the NHS, so that we can drive up capacity.
Let me repeat the question: is the hon. Gentleman explicitly ruling out using the independent sector at all to drive down that backlog?
Jonathan Ashworth
The independent sector is not the answer to this. The answer is investing in capital in the NHS. In the hon. Gentleman’s local area, there are 8,485 patients waiting for diagnostic tests—that is 25% when the operational standard is supposed to be 1% or less. He should be arguing for capital investment in the NHS, but he is not, and he is not sticking up for his constituents.
I want to make a bit of progress. If the hon. Gentleman wanted more beds in the NHS and greater diagnostic capacity, he would have been arguing for capital investment in the NHS, which we did not get in the Budget and we did not get in the Queen’s Speech.
That brings me to diagnostic capacity—I have just given the hon. Gentleman his local diagnostic figures. [Interruption.] This is not about new hospitals; this is about diagnostic capacity. The Secretary of State knows that we still have some of the lowest numbers of computerised tomography scanners and magnetic resonance imaging scanners per capita in the OECD. We still have only average amounts of RTE radiotherapy machines. We need investment in this technology, which we are not getting in sufficient amounts. That is why, in the past year or so, we have seen 4.6 million fewer diagnostic tests for cancer. Some 46,000 fewer people are starting cancer treatment. We should not have to choose between covid care and cancer care, but, for too many, that has been the reality of the past year, and it means that 4,500 additional avoidable cancer deaths are expected in the next 12 months. It means that progress in survival rates for colorectal cancer, breast cancer and lung cancer is expected to be undone. The proportion of cancers diagnosed while still highly curable has dropped from 44% to 41%.
The long-term plan, on which the Secretary of State fought the election, promised rapid action on cardiovascular disease. Experts now predict the highest cardiovascular mortality in a decade, and they predict 12,000 additional heart attacks and strokes over the next five years. The Queen’s Speech needed to include proposals to expand access to the appropriate cardiovascular healthcare facilities, but it also needed to include real interventions to tackle smoking and alcohol rates, and to reduce salt intake. Yes, there is a commitment to a tobacco control plan, but will there be a reversal of the 17% cuts to smoking cessation services? Given that 7,400 people died last year from alcohol abuse—a record number—will the Secretary of State reverse the cuts to drug and alcohol addiction services, with budgets being cut by 15% over the past three years?
We have been promised action, again, on banning junk food advertising, but when? I have heard the Secretary of State—and, to be fair, his predecessor—make that promise at the Dispatch Box many, many times, but when will we have the ban? When will he reverse the cuts to public health weight-management services?
Narrowing health inequalities should be at the heart of every Government policy, but there can be no levelling up while life expectancy advances stall for the poorest in society. Levelling up and tackling inequalities apply to mental health outcomes as well. More people suffer from depression in the poorest areas of the country than the richest. We know that the mental health problems are prevalent among certain minority ethnic communities —black men, in particular, are more likely to be detained under the Mental Health Act 1983, more likely to be subjected to seclusion or restraint, and less likely to access psychological therapies. We therefore welcome the commitment to reform the Mental Health Act, as we welcomed it last year, and I look forward to working constructively with the Secretary of State on reforming the Act. I would like to put on record my thanks to Sir Simon Wessely for his pioneering work on this front. Simon is a committed Chelsea fan, so I dare say that he will be more responsive to my felicitations this morning than he might have been on Saturday evening.
Order. At the beginning of this debate, I fear it was not quite clear which other amendments had been selected by Mr Speaker. I have now had an opportunity to look at my notes on my Order Paper. For the sake of clarity, let me tell the House that Mr Speaker has not selected amendment (e) in the name of Mr Bryant, as I predicted earlier. He has selected amendment (g) in the name of the hon. Member for Walthamstow (Stella Creasy), the right hon. Member for Haltemprice and Howden (Mr Davis) and others. He has also selected amendment (i) in the name of the leader of the Scottish National party.
I remind hon. Members that, although their contributions should address the terms of these amendments, it is in order for them also to refer to other matters relevant to the Gracious Speech.
I start by thanking the right hon. Member for Leicester South (Jonathan Ashworth) for his comradely advice, and I just correct the record because, thanks to his steadfast support for the Government’s action through the pandemic and the very grown-up approach he takes to these exchanges, Her Majesty the Queen was pleased to invite him to join the Privy Council, which we on the Government Benches welcome.
I am grateful to the right hon. Gentleman for describing the bond that has grown between us. It is true that, even while challenging each other from time to time in times of pandemic, sometimes relationships are strengthened in the heat of responding to something so serious. That is absolutely true. I think he is a wonderful man. I know that occasionally he has to criticise, because he has to please his Back Benchers, but I know he does not really mean it.
Throughout these great challenges and these difficult months, we have protected the NHS and protected and supported the amazing people who work in it, and we are determined to give the NHS all it needs as we emerge from this pandemic. The Queen’s Speech underlines that commitment, first, with a total focus on beating covid through our unprecedented vaccination programme, and then through an ambitious programme of support for our whole health and care system to tackle the backlogs caused by the pandemic, which the right hon. Gentleman rightly described, and a health and care Bill to set the NHS fair for the future—a Bill whose ideas and central propositions come from the NHS itself—alongside social care reforms to tackle injustices that have remained for far too long, public health reforms to learn the lessons of the pandemic and to promote the health of the nation, mental health reforms to bring that legislation into the 21st century and digital health reforms to harness all the opportunities that modern technology provides. That is our mission, a mission to ensure that, in support of all this, we also turn our nation into a life sciences superpower.
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We need transparency in decision making as well. For the first time in my life, I think, I find myself agreeing with Mr Dominic Cummings.I know the Secretary of State does not often agree with Mr Dominic Cummings, but I find myself agreeing with Mr Dominic Cummings, who tweeted yesterday:
“With something as critical as variants escaping vaccines, there is *no* justification for secrecy, public interest unarguably is *open scrutiny of the plans*”.
Mr Cummings, on this occasion, is correct. [Interruption.] A wry laugh from the Secretary of State. Mr Cummings may well have been saying something different when he was in government; I do not know, but at least his public statement yesterday is correct. That is why our amendment calls for the publication of a Government lessons-learned review; not so that we can try to undermine the Government or find some hole to use across the Dispatch Box, but so that we can learn the lessons in our efforts to contain variants, and ensure that we are better prepared for the future. I hope the Secretary of State looks sympathetically upon that request, and perhaps joins us in the Division Lobby this evening.
I now turn to the contents of the Gracious Speech more generally. This should have been the Queen’s Speech that unveiled a new NHS plan to bring down the elective waiting list, which now stands at 5 million. This should have been a Queen’s Speech that outlined proposals to tackle the backlog of 436,000 people waiting over 12 months for treatment—many of them waiting in pain and anxiety, many of them facing permanent disability as a consequence of those waits.
We face a crisis in mental health now, and we need action now. Two hundred and thirty five thousand fewer people have been referred for psychological therapies; eating disorder referrals for children have doubled; and the pandemic—again, because of infection control measures —has meant a reduction of almost 11% in beds occupied, which is equivalent to 1,700 fewer patients over the past three months compared with a year earlier. When will the Government implement their promise of significant increases in staff and resources for mental health, to ensure that mental healthcare is genuinely given parity of esteem with acute services?
That brings me to staffing more generally. Given that we are short of 200,000 staff across the health and social care sector, why was there nothing new in the Queen’s Speech to recruit more doctors, nurses and social care staff? Why was there no plan to give our NHS staff the pay rise that they deserve? NHS staff, including nurses who have cared for those with covid on wards, and district nurses who, in the first wave, cared for those who were discharged from hospital earlier than planned so that they could stay at home safely, have gone above and beyond, yet they feel that the 1% pay rise, which could well turn out to be a real-terms cut because of inflation, is a kick in the teeth. Is it any wonder that nurses are leaving the profession, including the nurse who cared for the Prime Minister, blasting Ministers for treating NHS workers with a total lack of respect? It is simply not fair. Our NHS staff deserve better.
The gaping hole in the Queen’s Speech is the plan for social care. Two years ago, the Prime Minister stood on the steps of Downing Street and said he had a plan to fix social care. He said:
“we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve.”
It was not a plan to be developed, or work in progress; no, this was a plan that was already done—oven-ready, you might say, Madam Deputy Speaker. But two years on, where is it? Has the Health Secretary seen it? What do we need to do to see it—perhaps we could pay for some cushions in the Downing Street flat? The Government promised us cross-party talks. They now brief that cross-party talks have taken place, but when—did they forget to send the Zoom link?
However, there is a consensus on social care, isn’t there? Care workers should be paid the living wage and proper sick pay. There should be a cap on costs, as this House legislated for. When the Institute for Public Policy Research, social care and older people’s charities and a House of Lords Committee, which, at the time, consisted of true-blue Thatcherites such as the noble Lords Lamont and Forsyth, have all called for reform of free personal care, why is the Secretary of State not engaging in that debate with us? To be frank, though, lack of cross-party talks is not an excuse for not getting on with reform. A Prime Minister with an 80-seat majority should be able to show some leadership and get on and fix social care.
If the Health Secretary wants to talk social care reform, I am free this afternoon. He knows where I am. I am happy to sit down with him at any time and discuss it. I think we would have very constructive conversations on this one, because it is true to say, as Members have detected, that we have developed something of a bond these past 12 months. The Health Secretary has been so friendly to me across the Dispatch Box that I am half expecting to win a lucrative PPE contract by the end of the day.
Because we have this new friendship, I have, as we say on the Labour Benches, some comradely advice for the Health Secretary. I know he is bringing forward a Bill to neuter the independence of the NHS chief executive and bring powers back to the Secretary of State. I have been around a long time and I remember when Tory MPs used to complain that the NHS needed independence, but we will leave that to one side. I just suggest that he ought to be careful what he wishes for, because I have been reading the Evening Standard, where Mr Tom Newton Dunn reveals not only that Simon Stevens, whom the Secretary of State is trying to neuter, was best man at the Prime Minister’s wedding, but that the Prime Minister is said to be about to appoint Simon Stevens—I beg your pardon, Lord Simon Stevens—to, yes, you guessed it, the newly empowered post of Secretary of State for Health and Social Care. It brings a whole new meaning to the phrase, “the best man for the job”, doesn’t it? But this is a Secretary of State who set up Test and Trace, who was responsible for PPE procurement and who failed to protect care homes. Dominic Cummings said the Department under his leadership was a “smoking ruin”—and now he wants more control.
The Queen’s Speech was remarkably unspecific in its description of the contents of the coming health and social care Bill, so perhaps the Secretary of State can reassure us today. Can he commit to ensuring that neither the NHS nor the partnership force to be set up in each integrated care system will permit the inclusion of private sector participants? Will he rule that out? Can he guarantee that as statutory bodies ICSs will meet in public, publish board papers and be subject to the Freedom of Information Act 2000? What guarantees can he give this House that the establishment of integrated care systems will not lead to more private corporations taking over GP practices, as has happened recently with Centene, or services currently delivered by NHS providers? I hope he can give us those very simple reassurances today.
With nearly 5 million people on the waiting lists and rising, ever-lengthening queues in our constituencies waiting for hip replacements and cataract removals, cancer survival rates worsening, mental healthcare in crisis, social care reform kicked into the long grass, and a costly, morale-sapping reorganisation on the way, we needed a fully resourced 10-year rescue plan for our NHS. I commend our amendment to the House.
The last year has proved beyond measure the value of the NHS across Britain, the importance of social care and the strength of feeling that people rightly have for these cherished institutions. Our task in this Parliament is to help them further strengthen and build back better, and that is what this Queen’s Speech will allow us to do.
I turn first to the immediate task of tackling covid. With more than 70% of adults now having had a first dose and almost two fifths already double vaccinated, we have much to celebrate. Vaccination underpins our road map, which means we can now have pints in pubs and hugs in homes. Yet, as I updated the House on Monday, the race between the virus and the vaccine has got a whole lot closer. I can tell the House that 2,967 cases of covid-19 with the B1617.2 variant have now been identified. We are protecting the progress we have made and the progress that everybody has worked so hard to achieve, with the biggest surge in local resources of this pandemic so far. That means surging vaccines and testing. In the last week across Bolton and Blackburn with Darwen, we have given 26,094 jabs, as well as delivering 75,000 extra tests.
But this challenge is not restricted to Bolton and Blackburn. We have used the extensive biosecurity surveillance system that we have built and new techniques to identify the areas we are most concerned about, where we will now surge testing and vaccinations further. We, of course, look at the data on cases, variants and hospitalisations, all of which we publish, but we are now able to use further tools. Mobility data shows how often people travel from one area to another, and we look at that in deciding where the virus is likely to spread. We now analyse waste water in 70% of the country, and we can spot the virus and the variants in the water to identify communities where there is spread.
As a result of all that analysis, I can tell the House that we will now surge testing and vaccinations in Bedford, Burnley, Hounslow, Kirklees, Leicester and North Tyneside, and we are supporting the Scottish Government, who are taking similar action in Glasgow and Moray. In practice, this means that we are putting in place more testing and more testing sites, and we are making more vaccinations available to everyone who is eligible. We are not yet opening up vaccinations to those who are 35 and younger, because across the whole country, the message is crystal clear. This episode shows just how important it is that every single person who is vulnerable to covid-19 gets not just one but two doses, because the vaccine offers the best possible protection against this disease.
Turning to our programme for the future, we must learn from the success of this vaccine roll-out, which shows how we can deliver huge projects with huge flexibility at huge pace. We must apply these lessons to how we tackle the backlog, and I want to set out clearly to the House the sheer scale of the challenge left by the pandemic. I agree very much with the analysis that the right hon. Member for Leicester South set out in respect of the scale of the challenge.
We now have 4.7 million people in England waiting for care and more in Scotland, Wales and Northern Ireland. Before the pandemic, we had succeeded in getting the 12-month waiting list down from 18,700 in 2010 to just 1,600 in the months leading up to the pandemic. Now, 380,000 have waited more than a year for care, but these figures do not yet include the returning demand of those people who have a problem but have not yet come forward during the pandemic, often because they have been trying to reduce the burden on the NHS, but are now rightly regaining the confidence to approach the NHS. So the real waiting list is far larger than those figures, and as people re-present with problems that they might not have wanted to bother the NHS with in the past year, we will see the waiting lists go up.
We know that, during the pandemic, 6.9 million fewer patients were added to the waiting list for diagnosis and treatment. The scale of the pent-up demand that will come forward is unknowable, but to give the House a sense of the scale of the challenge, since the start of the pandemic, the NHS performed 70% fewer electives than in a normal year. Some of those will have been resolved without the need for hospital treatment, and that is fine, but some will return. We do not yet know how many will present themselves and add to the waiting lists, but we do know that the NHS needs to operate at a scale never seen before across the whole United Kingdom to clear the backlog, so we are working hard to support the NHS to accelerate the recovery of services.