Future of the NHS

I beg to move,

That this House has considered the future of the NHS, its staffing and funding.

The national health service is a beloved national institution. Everyone in the country and in this House will have interacted with the NHS and have their own personal connections and stories that they can reflect on, from the birth of their children to the death of a loved one or seeing a general practitioner about a health condition. It is undeniable to most of us that the NHS is in crisis. It is being pushed into an avoidable and unprecedented collapse after 13 years of Conservative mismanagement.

All our constituents will have been impacted in some way by the crisis, a crisis so bad that nurses have taken strike action for the first time in NHS history. Ambulance workers and other NHS staff have also taken action, and this week British Medical Association junior doctors voted with a 98% majority to do the same. I thank all my constituents who work in the NHS, particularly those who got in touch about this debate, including paramedics from the North East Ambulance Service who tell me that on a daily basis they are unable to hand over patients because of delays in A&E and lack of beds, and how frustrating it is that many of the calls are for people who need social care or cannot get a GP appointment, rather than the acute calls that they are best placed to deal with.

That highlights the impact the crisis in social care is having on the NHS. Half of all people arriving in A&E by ambulance are over 65 and one third are over 75. The lack of adequate social care for basic daily needs is storing up problems and leaving older people less able to care for themselves, or arriving in hospital with preventable health problems, adding to the pressures in A&E and bed provision. People who work in the NHS have had enough of being failed by this Government’s mismanagement. The country deserves better.

NHS dentistry is on its knees, with patients facing a growing crisis of access and resorting to DIY dentistry. The NHS was in crisis pre-pandemic and the Government’s failures and mismanagement have made the situation far worse. For Ministers to dismiss the crisis as winter pressures, or even to flat-out deny that there is a crisis, is frankly absurd.

The crisis in dental and mental health is affecting our children at the moment. In some of our constituencies, it is a direct result of the lack of local provision. We are feeding a generation of problems as a result of that failure.

I absolutely agree with my right hon. Friend. The problems for our children further down the line are worrying, but of course, they are preventable if the right action is taken.

The Conservatives blame everything else—the weather, the pandemic and even NHS staff—but their 13 years of failure have left the health service in crisis. At Prime Minister’s questions yesterday, the Prime Minister boasted about

“record sums into the NHS…and…a clear path to getting people the treatment they need in the time they need it.”—[Official Report, 22 February 2023; Vol. 728, c. 222.]

He is not living in the real world. Every briefing and communication that we have received has cited delays in treatment and the devastating impact that they have, as well as the decade of underfunding. It is hard not to agree with the British Medical Association, which called the Prime Minister “delusional”.

The last Labour Governments allocated, on average, a 6% rise in the NHS budget every year. Successive Conservative and coalition Governments have since allocated a rise of only 1% a year. The Prime Minister can talk about “record sums” all he wants, but he is fooling no one. In reality, the settlement is not enough, and it is nowhere near what previous Labour Governments invested. This crisis can be laid firmly at the Government’s door.

There are so many awful headlines and statistics, and I will delve into some of them, but let me say from the outset that we must all remember, when we talk about the 7 million people on waiting lists, or the 500 avoidable deaths every week, that we are talking about people. There are faces behind those statistics: the faces of women who cannot get urgent gynaecological treatment, the faces of children who cannot access mental health support, the faces of families whose loved ones have died—lives that could, should and would have been saved if this Government cared about communities and invested in our NHS.

I congratulate my hon. Friend on securing the debate. This will come as a surprise to her, but I have visited a private health provider in my constituency in the last fortnight. People there told me that they are recruiting staff directly from university, so people are trained at the state’s expense but are then used for private profit. That means that the health service, which cannot afford to pay the same wages, loses out. Does she have any ideas about how that might be sorted out?

I will address my hon. Friend’s point in my remarks. This Government’s ideological commitment to the free market has led them to force through more and more privatisation of our national health service. Some Government Back Benchers are talking openly about moving to an Americanised healthcare system in which people are priced out of healthcare, and they have even mentioned it in this Chamber. We have seen corrupt contracts for cronies, and friends of the Government making millions while people suffer. The Government have allowed the private sector to run rampant, taking hundreds of billions out of the NHS budget over the last 10 years.

It is as if the Government are on a mission to destroy the NHS as we know it. They have even performed smash-and-grab raids on hospital repair budgets, taking £4.3 billion away and leaving hospitals crumbling, leaking and falling apart at the seams. Fifty per cent. of trusts now have structural issues with leaks, collapsing floors, raw sewage and unsafe wards.

American news agency CNN said last week:

“Britain’s NHS was once idolized. Now its worst-ever crisis is fueling a boom in private health care.”

The number of people paying privately for operations is up 34% in 2022. If that trend continues, it will embed a two-tier service in our NHS and price many people out of healthcare. My constituent Christine was referred to a private health company by her GP, while another constituent, Ray, was told that he could no longer get a service from the NHS and that he would need to pay privately, at a cost of £50. Ray said to me:

“As I am 74 years old and rely on my state pension it makes it very difficult for me in the current economic climate to pay this amount. Having paid national insurance contributions for 50 years, I don’t understand. Why do I have to pay again?”

I thank my hon. Friend for making such a powerful speech on a really important issue. A fantastic GP surgery in my constituency, the Waterloo Health Centre, is closing because the landlord is selling to a private developer. Many people who have used that GP service for decades are now worried about where they will register. A number of people across the country are waiting to register with NHS GPs, and waiting lists continue to grow. Does she agree that that is another example of the private sector coming in and making it really difficult for our NHS system?

Yes. We have all seen for ourselves and heard from our constituents how difficult it is to get an appointment, and the private profiteers are driving that.

I congratulate my hon. Friend on securing this important debate and making such a powerful case. On the subject of privatisation, does she share my concern that, as we have heard in recent speeches in the Chamber by Conservative Back-Bench MPs, this is entirely deliberate? They want to manufacture consent among the public for a move to an insurance-based, American-style system by more and more people feeling forced to take out health insurance or pay for healthcare, so that over a number of years, we see healthcare provision go down the same path as council houses, which went from mass provision to minority provision.

I agree that if things do not change, that is exactly the route we are going down.

I congratulate my hon. Friend on securing the debate. Does she acknowledge that this has already happened in dentistry, with families taking out dental plans because they cannot access an NHS dentist?

We are seeing this across the whole NHS, including dentistry, as my hon. Friend rightly says.

As with any crisis, we see companies step in to exploit the situation and make money. US group Cleveland Clinic plans to open its third UK facility in London later this year, adding to the 184-bed hospital and six-floor clinic that it opened in 2021 and 2022 respectively. HCA Healthcare, another American group, which has over 30 facilities in London and Manchester, will be opening a £100 million private hospital in Birmingham later this year. Some 40% of private mental health companies need safety improvement, and we are handing over billions to companies that are failing our constituents.

Too much of what is happening is hidden from Parliament and from the public. Where is the accountability for these private companies? Labour’s plan for the NHS includes working with partners to ensure patient safety and to bring down waiting lists. What it does not include is the rampant corrupt profiteering, with contracts for cronies and profit put above patients, that this Government are presiding over.

In England, we have a 20-year gap in life expectancy between the most and least affluent areas of the country. Less than a year ago, the Government promised to tackle the causes and symptoms of these underlying health inequalities and publish a White Paper on health inequalities. Last month, the Department of Health and Social Care confirmed that no White Paper would be published. I am pleased that today, Labour announced that we will build an NHS fit for the future and cut health inequalities.

The cost of living crisis has pushed over two thirds of UK households into fuel poverty, which will exacerbate health inequalities that were already widened during the pandemic. In September 2022, one in four households with children experienced food insecurity, and in my constituency of Jarrow, 39% of children are living in food poverty. Malnutrition costs the NHS an estimated £19.6 billion each year. Investment in greater support, particularly targeted at the most vulnerable, would lead to returns in reduced NHS demand. As well as a strategy for the NHS, this Government need to start prioritising much more support to get the most vulnerable through the cost of living crisis. I hope Ministers will listen closely to the contributions in the debate and take on board what is needed for a workforce strategy and funding to secure the future of our NHS.

I rise to set out in this debate on the future of the NHS, with the experience of three years as Health Secretary, how we can build on the promise of healthcare that is free at the point of delivery for every single person in the United Kingdom. This is a promise that I hold dear in my heart and that my party has supported with enthusiasm throughout the NHS’s over 70-year history. In fact, the NHS has been run by Conservative-led Administrations for the majority of its time.

It is a joy to follow the hon. Member for Jarrow (Kate Osborne). A few of her comments were not quite right, but I can tell from what she said that she, like me and like the vast majority in this House, supports the principle of an NHS that is free at the point of use. As a Conservative, there are many reasons why I believe in that so strongly. I will set aside and not make the straight- forward political argument that no party in this country would ever get elected to power without steadfast support for the NHS. As Nigel Lawson put it, the NHS is the closest thing we have to a national religion, and that captures it about as well as we can. Over 75% of the public believe that the NHS is crucial to British society.

However, there are substantive reasons, as well as those purely political ones. The first is the importance of the efficiency and effectiveness of the delivery of healthcare—the nuts and bolts of why it is good to have a free-at-the-point-of-use healthcare system. According to 2019 figures, just before the pandemic, the proportion of GDP that we spent on healthcare in this country was just over 10%. In the United States, it is over 16%. In Germany and France, it is higher too, yet life expectancy is higher in the United Kingdom, showing that we deliver more effective healthcare, and a lot of that is because it is a universal service delivered free at the point of use.

The second argument, which is quite an unusual one that is not often made but is important especially to those whose heart beats to the right, is a pro-enterprise, pro-business one. Enterprise is the source of prosperity for any nation; a quick look at the history books demonstrates that that is where our prosperity comes from. We can start a business in the UK and employ somebody in the private sector without having to pay for healthcare, whereas in many countries around the world, one of the first costs for a new or growing business is healthcare for its employees. That is not necessary here. There is a pro-trade, pro-business argument for having an NHS free at the point of use.

I absolutely agree that there is a moral case for healthcare free at the point of need in our country—I absolutely support that. Does the right hon. Gentleman not think, though, that there is something immoral about the huge profits that are being made out of the NHS by private contractors that have been brought into it, when those profits that are paid to shareholders all over the world in the form of dividends would be better invested in the healthcare of people in this country?

I am very grateful to the right hon. Member for that intervention. I am not surprised that he agrees with what I said about the moral case for a universal healthcare system, nor that he makes the case against any use of profit in the NHS. I was going to come on to exactly that point, because it is bunkum to suggest that the NHS has ever in its history provided services without the use of private companies. That has happened throughout the long and proud history of the NHS, and it is absolutely vital to its functioning—always has been, always will be, under Governments of all stripes. I will come on to explain why.

My right hon. Friend is being generous with his time. Is there not a fourth argument for a universal healthcare system, which my right hon. Friend was very keen on when he was Secretary of State: the ability to introduce new technologies, new procedures and new drugs? All of those things are much easier when one has a big bulk of patients to draw data from.

Two of my arguments for what the NHS needs to do better in the future are responses to precisely the two points that have just been made. I cannot decide which order to go in, but both are absolutely vital. I agree with my hon. Friend, and disagree with the right hon. Member for Islington North (Jeremy Corbyn).

Given the pressures on the NHS, in order for it to succeed in the future, all of us who care about the NHS must have a hard-headed view of what needs to happen for it to function long into the future. One of those things, which I think is absolutely central, is the use of technology, so I will come to that point first. Today, the NHS has more clinicians in it than ever before. Contrary to what the hon. Member for Jarrow said, it has a higher budget than ever before. It has more nurses and more doctors than ever before, it is delivering more service than ever before, and it takes up a higher proportion of our national income than ever before. That has all happened under a Conservative Government that believes in the NHS. Those are the facts.

I am sure the right hon. Member will acknowledge that a lot of the doctors who are now working in the NHS were trained under a Labour Government, with the Conservative Government now getting the credit for them. Since then, we have seen a reduction in the number of doctors trained.

No, that is not right. There are record numbers in training, and the opening of the new medical schools that were put in place by my right hon. Friend who is now Chancellor of the Exchequer is another Conservative achievement in that space.

However, given the record numbers of nurses and doctors, the record numbers of training places, the record numbers of GPs coming out of training places and the record funds going into the NHS, there is still a record-scale problem. I do not at all deny the scale of the challenge, but that challenge demonstrates to me the vital importance of reform of the NHS—we cannot support its long-term future without supporting reform. My experience of the NHS and of being Health Secretary tells me that the single most important thing that has to happen for the NHS to be as effective as possible in the future is the widespread and effective adoption of the use of technology and data, so that the NHS can be more efficient, giving clinicians back—as Eric Topol put it when he launched his review in 2019—“the gift of time”.

The inefficiency of the NHS because of poor use of data leads to appointment letters being sent out that arrive after the appointment date has passed. Who gets a letter these days for an appointment, anyway? We all use modern technology instead.