Future of the NHS

[Mark Pritchard in the Chair]

I beg to move,

That this House has considered the future of the NHS.

It is a pleasure to serve with you in the Chair, Mr Pritchard. I am grateful for having been granted this debate, and I thank Members for attending.

The highly respected professor of epidemiology and public health Sir Michael Marmot said earlier this year:

“If you had the hypothesis that the Government was seeking to destroy the national health service—if that were your hypothesis—all the data that we’re seeing are consistent with that hypothesis.”

When asked if we are stumbling or sleepwalking towards a privatised healthcare system, he added:

“I have no special insight into what motivates Ministers, but they are not behaving as if they want to preserve our NHS”.

A few months ago, Professor Philip Banfield, the British Medical Association’s chair of council, said:

“This government has to demonstrate that it is not setting out to destroy the NHS, which it is failing to do at this point in time…It is a very common comment that I hear, from both doctors and patients, that this government is consciously running the NHS down.”

Professor Banfield also commented that the NHS is in a state of “managed decline” because recent Governments have made “a conscious political decision” to deny it adequate resources and not to tackle staff shortages. I think that he is absolutely right.

Legislative change brought in by the Conservative-Liberal Democrat coalition Government in 2012, and by the Conservatives in 2022, fragmented the NHS and increased opportunities for privatisation. The Health and Social Care Act 2012 allowed NHS foundation trusts to, in effect, earn 49% of their income from treating private patients, and the Health and Care Act 2022 allows representatives of private companies to sit on integrated care partnerships and so play a part in preparing the integrated care strategy for an area, influencing where huge sums of public money will be spent.

It is underfunding, however, that is proving to be the Conservatives’ greatest tactic when it comes to undermining the NHS. The report “The Rational Policy-Maker’s Guide to the NHS”, published in July by The 99% Organisation, presents statistics based on research by Appleby and Gainsbury on the average annual change in per capita health spending by UK Governments since 1979, adjusted for population and demographic factors. The stark differences in commitment to the NHS along party lines are clear to see.

Under Labour between 1997 and 2010, there was an average annual increase in per capita health spending of 5.67%. Between 2010 and 2015, the Conservative-Liberal Democrat coalition Government oversaw an average annual reduction of 0.07%. Between 2015 and 2021, under the Conservatives, there was an average annual reduction of 0.03%. This Conservative Government’s committed spend up to 2024 represents an average annual increase of just 2.05%.

The hon. Lady is saying that more money needs to be put into the NHS. It is receiving record investment this year—more than it has in its history. Where does she anticipate that extra money coming from? Does she want to move money from other Departments into the NHS, or to increase taxation, or to increase borrowing?

First, in challenging the hon. Gentleman’s opening remark, I refer him to the point earlier in my speech when I spoke about the Government’s current spending commitment. I also ask him to listen to the rest of my speech, as I will come on to the economy.

It is not the fundamental model of the NHS that is broken; it is the fact that it has been underfunded that has led to us to where we are now. As is clear for all to see, we are at a point of crisis. Waiting lists for routine treatments recently hit a record high of 7.75 million, with more than 9,000 people waiting for more than 18 months. It is truly devastating that last year, more than 120,000 people in England died while on NHS waiting lists for hospital treatment. That is double the number who died in 2017-18. There are over 125,000 staffing vacancies, including more than 43,000 vacancies in nursing and more than 10,000 medical staff vacancies. Many of the staff who are in post are burned out, with not enough colleagues to work alongside them.

The “Fit for the Future” report published by the Royal College of General Practitioners last autumn revealed that the situation in primary care is dire. It found that 42% of GPs in England are either likely or very likely to leave the profession over the next five years. As of August 2023, there were 27,246 fully qualified full-time equivalent GPs in England, 3.1% less than in 2019 and 7.4% less than in 2015. That downward trend simply cannot go on.

Last week, the Care Quality Commission rated almost two thirds of maternity services in England either “inadequate” or “requires improvement” for the safety of care and said:

“The overarching picture is one of a service and staff under huge pressure.”

Cancer Research UK has pointed out that cancer waiting time targets continue to be missed in England, and recent months have seen some of the worst performances on record.

With regard to cancer waiting lists, the Rutherford Cancer Centre, a specialist proton beam centre in my constituency, has been lying idle for almost two years, since Rutherford centres across the country went into liquidation. Does my hon. Friend agree that the NHS should take control of the Rutherford centres, and that that in itself would help to reduce waiting lists for cancer treatment?

I am not familiar with the centre that my hon. Friend speaks of, but I do believe that the NHS should control the assets and make sure that the service is there for people when they need it. I would like to hear more about the centre from him at another time.

By deliberately underfunding the NHS, the Conservatives have undermined it as a comprehensive, universal public service. Their desire to privatise the NHS has been evident for a very long time. It is a shocking agenda to essentially destroy our most cherished institution.

This determination to dismantle the NHS, which has been proven to be a world leader in terms of effectiveness, equity and efficiency, is not only immensely damaging to patients and the staff who work in the service, but damaging to the economy. Last year, an estimated 185.6 million working days were lost because of sickness or injury—a record high. Similarly, the Office for Budget Responsibility reported in July that the 15 to 64-year-old economic inactivity rate

“has increased in the UK by 0.5 percentage points”

since the covid pandemic.

The hon. Lady is being very disparaging about the private sector. Has she ever worked in the private sector?

I have not worked in the health service in the private sector—

Has she worked in the private sector?

I did write a book once, and the publisher was a private organisation. I am not disparaging the private sector. The point I am making is that the national health service is a public service.

She has never worked in the private sector—

Order. If the hon. Gentleman wants to make another intervention, then he can try to do so. If the hon. Lady—

The question is simple: has she ever worked in the private sector?

The answer, clearly, is yes, I have. What I am talking about is the national health service, which was set up as a public service—publicly run and publicly owned. That is what we are talking about here today. I am going to make more progress. [Interruption.] If the Minister wants to intervene, he can.

Order. Let me say something for the orderliness of the debate. Understandably, emotions run high around NHS issues, but there is a convention and there are protocols. If people want to make contributions they can make interventions or speeches, but Members may intervene only if the hon. Lady wants to take their intervention. I just caution everybody that I will not have any unruliness in this debate. The debate has been tabled and the hon. Lady’s constituents have a right to be heard.

Thank you, Mr Pritchard.

I was talking about ill health being a big factor behind inactivity in the labour market, and I will repeat a point. The Office for Budget Responsibility reported in July that the economic inactivity rate for 15 to 64-year-olds has increased in the UK by 0.5 percentage points since the covid pandemic, and ill health has consistently been a bigger factor behind inactivity in the UK than in most other advanced economies. The Government must understand that a Government that fails the NHS fails the wider economy.

As well as focusing on the importance of investing in the NHS for the good of the economy, the Government must focus on tackling poverty and inequality, not only as a matter of social justice but because we know that poverty is a key cause of ill health. As the King’s Fund has noted, poverty

“drives inequality in health outcomes and increases use of health services.”

In its recent research on the state of child poverty, the charity Buttle UK said that it had received some of the most distressing accounts of children in need that it had ever seen. Buttle was keen to stress that it was

“talking not just about significant hardship but life-changing and life-limiting deep poverty.”

Today we read that the Joseph Rowntree Foundation has found that more than 1 million children in the UK experienced destitution last year, meaning that their families could not afford to feed, clothe or clean them adequately, or keep them warm. This extreme hardship will have a profound impact on the individuals concerned and it will lead to greater demands on the NHS. The King’s Fund points out that

“poverty is...expensive, in direct costs to the state and in lost opportunity and productivity.”