That this House has considered backlogs in the NHS.
Happy new year to you, Madam Deputy Speaker. I thank the Backbench Business Committee for granting the debate. I applied for it because many Members were interested in having the chance to discuss the problems and consult constructively on the potential solutions for the NHS across the country. It has ended up being a particularly timely debate given the Secretary of State’s statement this afternoon, which we broadly welcomed.
The Conservatives have pushed the NHS to breaking point, leaving a legacy that includes the biggest waiting list in history and a healthcare system on the brink of collapse. We have reached a crisis point of backlogs in the NHS system. They affect not only those who are in dire need of medical care, but the wonderful staff who work tirelessly in hospitals, GP surgeries, dental surgeries, pharmacies, social care providers, hospices and so on. The situation in Shropshire right now demonstrates the scale of the crisis.
The pressure is extreme on every aspect of healthcare and reflects the fact that in many cases rural areas are bearing the brunt of a national problem. Shropshire’s NHS has declared a critical incident—one of many across the country, I know—as staff battle to cope with the huge winter spike of viruses. That means that people cannot visit their loved ones on a regular basis, and are required to wear a mask when they go into the hospital. That is just one example of how the system is failing to cope with the pressure.
Understandably, talk about NHS backlogs centres on the 7.5 million cases waiting for treatment. But backlogs also apply to the overflowing A&E waiting rooms and to the long lines of ambulances queuing outside. They apply to the elderly people who have fallen and waited many hours for an ambulance. They apply to possible heart attack and stroke patients being told to make their own way to hospital by West Midlands ambulance service at certain times this year. Outside Shrewsbury and Telford hospitals last Sunday—the latest day we have data for—ambulances waited an average of three hours and 48 minutes to hand over a patient. Across England on the same day, 2,620 patients had to spend more than an hour stuck in an ambulance waiting for space to become available at A&E.
In my constituency, our hospital faces almost 700 sewage leaks, which has an impact on its ability to provide services. That is another pressure. Does my hon. Friend agree that the sooner the Government advise on what investment they will make to enhance services for our hospitals across the UK, the better?
I had not put the crumbling estate into my speech, but my hon. Friend makes a very valid point, because people cannot work efficiently when they are dealing with terrible hygiene and safety issues around them every single day.
I commend the hon. Lady on bringing forward this debate, and on being so consistent and assiduous on this issue. I understand that she will come on to the Lib Dem manifesto, which a lot of us in this Chamber, whether Lib Dem or not, can agree with. In Northern Ireland we have the health and social care board, which has been working on various strategies to reduce the backlog, but the scale is truly significant. Does the hon. Lady agree that, collectively, England, Scotland, Wales and Northern Ireland should look at all the recommendations and bring them together so that this great United Kingdom of Great Britain and Northern Ireland can benefit collectively?
The hon. Gentleman always makes an excellent contribution to our debates. He is right that we should look at best practice in Northern Ireland and the devolved nations, as well as in England, to get the right solutions for the problems that we face. I hope colleagues will forgive me as will not take any more interventions because we are tight on time and a lot of people want to speak.
We have reached a point where patients suffering heart attacks are being advised to find their own way to hospital. How can that be acceptable? Once patients get into A&E, they are confronted with the brutal reality of the backlogs. The reality means that only half of patients arriving at A&E in Shropshire were seen within four hours in November. The statistics are shocking, but individual people with serious problems suffer as a result—people such as my constituent with a pericardial effusion, who was deemed fit to sit and left in a chair for more than 24 hours before finally being taken on blue lights to receive the care she needed.
Staff in this situation are so overworked that the standard of care that they give is below what they would like to provide. The patient’s dignity is compromised, and staff are being driven from the service because they are unable to provide the care that they desperately want to. Until the Government put a plan in place to solve the workforce crisis, there is a risk that these scenes will continue to happen. In my local hospital trust alone, a total of 854,839 hours of nursing shifts went unfilled in the 12 months to October.
Liberal Democrats are calling for a qualified clinician in every A&E waiting room to ensure that anyone whose condition is deteriorating is treated more urgently. We are also calling on the Government to publish accessible localised reports of ambulance response times so that the delays that blight places such as North Shropshire and other rural areas can finally be addressed.
Nuneaton, too, has record high levels of people on NHS waiting lists—over 17,000. Staff tell me that they are burnt out and demoralised. Patients are suffering as a result: long waits on trolleys in corridors, lengthy waits in ambulances, and stagnation at GP surgeries where they simply cannot get the appointments they need. Since 2021, the hospital has seen 1,500 staff absences due to mental health issues, with many leaving the profession. Leaders at our George Eliot hospital really value their staff, but they are struggling to cope with ever-increasing demand and to remain resilient with sudden increases in demand, such as flu outbreaks over Christmas, leading to yearly chaos that costs lives, longer waiting times for patients, cancelled appointments, and a decline in the quality of care.
Nationally, we have fewer hospital beds and scanners per capita than most other European countries. Our buildings are crumbling, and our computer system is outdated. Our hard-working NHS staff deserve better. They deserve a Government who will respect and value them and invest in them.
The failures of the past carry a considerable human cost, but they also impact on family finances and have wider economic impacts on our communities. One particular case, a nurse from Arbury in Nuneaton who works for our brilliant George Eliot hospital, clearly demonstrates the damage that can be done. They were in their mid-40s, fit, active, working and economically stable when they were diagnosed with a spinal condition that compresses the nerves in their legs, causing pain. A simple procedure could solve it very quickly and easily with the right referrals, but they had to wait 12 months for a referral just to speak over the phone to the neurosurgeon. The doctor recommended surgery, but the patient has been left in limbo, unable to get a follow-up appointment or any information about when surgery will actually take place. This is a simple procedure for a condition that has devastated her life over a number of years. Living in constant pain, she can no longer stand for more than five minutes and has been forced to withdraw from her vital role in the NHS—another vacancy, another specialist unit short-staffed.
I thank the hon. Member for North Shropshire (Helen Morgan) for securing this important and timely debate. I must begin by declaring my interests: I am a non-practising NHS consultant psychiatrist and my wife is an NHS doctor.
Christmas and the festive period is always a taxing time for the NHS, especially for those working on call, as indeed it is for all those in the various emergency services and those outside the public sector who are on call. It is important to pay tribute to them for all their hard work over the past couple of weeks.
Much of the correspondence that I have received from constituents over the past few years has concerned the difficulty of obtaining GP appointments. Interestingly, the demand for GP appointments has risen since before the pandemic, following the advent of virtual appointments and different means of contact. Patients are now finding it more difficult to see someone in a general practice, although overall performance in general practices has improved since before the pandemic. It is important that we support our GP practices as much as we can, to ensure that they deliver the high-quality care that our patients expect. Our local practices are fantastic: they are working very hard, in tricky circumstances, to deliver for patients.
My hon. Friend is, of course, absolutely right. Does he agree that part of our duty is to support our general practices? Our constituents often say, “I cannot see my GP”, but if we probe, we find that it is a question of whether they are prepared to accept a telephone consultation, which is probably just as good for most of them. Radiology was mentioned earlier. The issue for the future, surely, is embracing technology rather than outsourcing. In many cases, AI reading of films and scans is probably as good as, if not better than, a reading by a radiologist in India, Shropshire or anywhere else.
I entirely agree with my right hon. Friend about the use of AI to improve productivity in the NHS, and with what he has said about general practices.
I generally take a neutral, honest-broker approach when people raise concerns about general practices. Of course it is important for us to ensure that our practices are performing well, to support them, and to respond to our constituents’ concerns more broadly. However, given that the bulk of care is coming through general practice—and I was interested to hear, in recent days, about the renewed focus on patient choice, particularly in respect of secondary and tertiary care—I think that one of the challenges posed by our current general practice system relates to the absence of patient choice. Effectively, general practices, which, as the Minister will know, are private organisations, have a monopoly in terms of the patients who are in their catchment area. It is very difficult for patients to move to different practices when the ones that they are currently using are not meeting their needs: when seeking an appointment with a GP, they are stuck with their own practice, or else they must go through various mechanisms to obtain care elsewhere.
My hon. Friend is making an excellent point about something that is currently affecting my own constituency. South Green surgery in Billericay has recently been told that it is to be closed down, and the integrated care board is not ensuring that we retain what is essentially competition, so a single surgery will be serving one of the towns in my constituency. Does he agree that the Department of Health and Social Care should be leaning in to ensure that we maintain that competition between GPs’ surgeries, so that standards can be driven up wherever possible?
My right hon. Friend is absolutely right; it is important that patients have information and choice, and that they have the flexibility to move between different practices to suit their needs. My view is that the GP list system does not work. It does not make sense as it currently stands, and it limits the ability of patients to seek the care that they need in a timely manner. As he just mentioned, people get stuck in practices that are not performing or are not working for them, and they have no ability to move out of them.
My right hon. Friend also mentions the role of the ICB/ICS system, which brings me to my final point. As a constituency MP, I find it incredibly frustrating that I have no direct control, power or hard influence, as opposed to soft influence, over the local ICS/ICB system. I can write letters and campaign, and I have spoken in debates in Parliament. I have led a debate on the Weybridge health centre, which is finally going to planning after the drama of multiple consultations. My only ability to direct what is happening on the ICB is through directly asking Ministers questions in Parliament, or by trying to get them to intervene. When the Health and Care Act 2022 was going through in the last Parliament, I raised with the then Minister my concerns about the accountability of our ICSs and ICBs. We have a real problem with what we MPs can do to ensure that our ICBs and ICSs are performing for people locally, because there is a disconnect in the link of accountability.
I believe that the Secretary of State for Health and Social Care and the Ministers on the Front Bench absolutely want to see all our local NHS services performing at their very best. I totally believe that they are in it for the right reasons and want to see better performance, and I want to help them deliver that. But with all the enthusiasm and will in the world, are they going to take the same interest in my local area as I do? We MPs need the ability to cajole and to direct what our local NHS services are doing in order to deliver the best possible care for patients. After all, we are the locally elected representatives and, as we saw in this year’s election and will see in elections going forward, there are always 24 hours to save the NHS.
Addressing backlogs in the NHS, together with changing the current hospital-centric system, will be of central importance in ensuring the long-term sustainability of our health system. Under the Conservatives and the coalition Government, we had more than a decade of under-investment, coupled with a disastrous top-down reorganisation, which caused the high level of backlogs that we currently see across the NHS.
While working in the NHS throughout that period, I saw at first hand the dire impact that the reorganisation had on our health service, and how it led to waiting lists at a record high and patient satisfaction at a record low. That was underlined by the recent analysis from the Institute for Public Policy Research, which shows that 25 times more people waited in A&E departments last summer than in the same period in 2009. In its analysis, the IPPR described long waits for healthcare as the “new normal” for many NHS patients.
I welcome the measures that my right hon. Friend the Health and Social Care Secretary and his team of Ministers have already introduced to address this issue. I also welcome the measures that the Prime Minister announced this morning. Thanks to this Labour Government, the NHS in England will receive a record £25 billion investment, which will support the Government in meeting their target of 40,000 extra elective appointments a week.
I pay tribute to the dedication of my former colleagues across the NHS, who are working hard to treat patients as quickly as possible and cut waiting times. There is evidence of that happening in my area of east Kent. For example, at the William Harvey hospital in Ashford, an average of 84 patients per day were medically able to be discharged in November 2023 but had nowhere to be medically discharged to; in November 2024, the figure was down to an average of 58 patients per day. In the hospitals in east Kent in November 2023, just over 2,000 patients were treated in corridors for more than 30 minutes; in the same month last year, the figure had fallen to just over 1,600 patients.
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A key reason for the emergency backlog is that every day, around 12,000 hospital beds are filled with patients who could leave if they had a care package in place. That is the equivalent of around 26 hospitals being out of action every day. That is why Liberal Democrats have been banging the drum for social care. Without capacity in the care system, beds will remain blocked, A&Es will stay clogged and ambulances will continue queuing outside hospitals.
I am pleased that the Government have finally listened to our call for cross-party talks to fix a broken care system, and I look forward to constructively engaging with them throughout that process, but we cannot afford to wait three more years for this plan to be enacted. I hope that the Government will reconsider their timescale and get the review done as soon as possible, so that the care sector can see the long-term cross-party commitment to reform that it so drastically needs.
Part of solving this issue is supporting preventive measures, which stop people needing secondary care in the first place. I recently visited the North Shropshire charity Energize and saw the work of its Elevate programme, which works to improve fitness, balance and co-ordination in elderly and frail patients. It has had some amazing achievements: I met a gentleman suffering from Parkinson’s who had been falling five times a week before he started his programme, and who is now falling only once a week. Of course, it would be great if he did not fall at all, but I am sure everybody would agree that that is a huge improvement. It is estimated that for every £1 invested in that programme, £26 is saved, so it is an area where we can really make a difference to the crisis in the NHS.
Few backlogs have as much impact as those in cancer diagnosis and care. Nationally, the target of 85% of patients receiving treatment within 62 days has been missed every month since December 2015. At my local hospital trust, fewer than two thirds of patients began treatment within the 62-day target. Improving this situation is integral to increasing survival rates. It is also key to restoring patient faith in the NHS, stopping cases like that of my constituent, whose family felt completely failed by the NHS after he waited almost a year for treatment after first presenting with bowel cancer symptoms. Could the Minister clarify whether the Government remain committed to meeting the cancer waiting time targets this Parliament, as promised in their manifesto, and whether those targets will be included in their new national cancer strategy?
To achieve that improvement, we need to address key workforce issues, notably in radiology, where there is a 31% shortfall of consultants across the country. Again, in rural places such as Shropshire, it is recruitment and retention issues that have caused the sharpest problems. Throughout 2024, it became normal in Shropshire to wait months for cancer test and scan results, with patients in my constituency only receiving their results after their next scan was due to have happened. I am pleased to report that under new management, this backlog is now in the process of being cleared. However, that is happening due to overseas outsourcing, which is not a sustainable long-term solution for this country. We need to retain, recruit, and retrain more radiologists and ensure that enough modern equipment is in place across the country so that no one has to wait too long or travel too far to get the scans that they need. Will the Minister address whether that will also be part of the national cancer strategy?
We cannot talk about backlogs without talking about mental health. According to the Darzi review, 1 million people were waiting for mental health services by last April, over 340,000 of whom were children—children whom we as a nation need to protect, because they are our future. Waiting times for child and adolescent mental health services are shocking in every constituency in the country; from ADHD diagnoses to anxiety, depression and eating disorders, far too many people are not getting the urgent support that they need. A headteacher of a school in north Shropshire told me that in recent years, nine students at his school have lost a parent to suicide, yet there are no community mental health services in the town.
Along with the Government, Liberal Democrats would introduce a mental health professional in every school. However, we are also calling on the Government to improve early access to mental health services, and to cut mental health waits by establishing mental health hubs for young people in every community and introducing regular mental health check-ups at key points in people’s lives when they are accessing the NHS, so that we can pick up those problems and intervene early.
Meanwhile, GP surgeries are also struggling to handle the growing pressure being exerted on them. More than a million patients who tried to contact a GP last year could not get through. If patients cannot access primary care, they seek help elsewhere, or they do not seek help at all; in both cases, this creates further problems down the line. In Shropshire, we have lost 14.3% of fully qualified GPs in the past eight years. A young constituent of mine had to wait seven weeks just for a telephone consultation—a wait that would have been even longer if they had wanted an in-person meeting. Liberal Democrats would give everyone the right to see a GP within seven days, or within 24 hours if it was urgent, using 8,000 more GPs. If we can improve primary care, we can reduce backlogs across the health and care system.
Yet the Government have pledged to increase national insurance charges that could cost GP surgeries the equivalent of 2 million appointments a year. This hike will also hammer pharmacies, with more than a third of pharmacy owners now worried that their business may not survive the winter. If pharmacies close, backlogs will simply increase elsewhere. If we can keep them open and improve services such as Pharmacy First, we can reduce pressure across the system. We would like the Government to commit to removing the increase in employer national insurance contributions to support these crucial community services, so that fewer people end up in hospital and more people are treated in the community, where they will get better and quicker treatment.
Meanwhile, in dentistry, where practices will also be hit by the national insurance rise, there is not so much a backlog of care as an absence of care. Some 6 million adults in the UK are not registered with an NHS dentist and, in places like Shropshire, it is becoming almost impossible to find one, with increasing numbers of practices handing back contracts that have become unsustainable. One of my constituents has been trying to register with an NHS dentist for five years, while another pulled out his own tooth with a pair of pliers.
The Labour Government must show that they understand the problem better than the Conservative Government, whose solution was to introduce golden hello payments. They have been in place in Shropshire for years and they have not achieved the desired outcome. With that in mind, will the Minister outline the Government’s plans in relation to the new patient premium and offer assurances to dentists that any changes will be communicated, so that practices can plan and prepare to best serve their patients? NHS contracts need to be reformed so that we can end the use of the term “dental desert”, end DIY dentistry and guarantee access to people who are in pain.
In conclusion, the Liberal Democrats believe that people should be able to take control of their own lives and their own health. That means everyone should be able to access the care they need, where and when they need it. We welcome much of today’s announcement on elective care, and we welcome today’s announcement on social care, but we are concerned that the decision to hike employer NICs could worsen the crisis in the NHS. Hitting GPs, hospices, dentists and social care providers with higher taxes makes no sense. The Treasury is giving to the NHS with one hand, but taking away with the other. We also want much faster action on social care. As I said, I look forward to engaging constructively with the Minister to come up with the consensus we need, but we cannot afford to wait until 2028 for improvements to be made.
The Conservatives’ legacy on the NHS is that it is on its knees. The Liberal Democrats understand that there is no magic quick fix to change that, but to give people the care they need and deserve we must look at the measures needed for the whole service, giving equal priority to both heart attacks and hip replacements.
That is just one example from the 17,000 among my constituents, many of whom do not make it to the end of those waiting lists. I have stood by the graves of people in my constituency who had been waiting for treatment that could have stopped them ending up there. There are people whose lives are on hold and families who are suffering grief. There is waiting and more suffering. It is a crisis of political failure, a crisis of underfunding and a crisis of neglect. I fully support the Government’s actions to address it.
Although the figures are going in the right direction, they are still far too high, and no one working in our NHS would claim otherwise. The staff in the health service will keep doing their best to clear the backlogs, but it will not happen until we see less of an emphasis on patients being treated in our hospitals. We need to see more focus on and resources for community-based services to help reduce the pressure on overburdened hospitals, as well as changing the system so that people are treated closer to where they live. As a former mental health nurse, I believe this must also include more timely interventions to treat those in need of mental health support. Currently, not only do too many people end up being treated in hospital, but once patients are there, the absence of enough suitable community-based facilities means it is difficult to discharge them. This leads to further blockages and backlogs in the system.
As co-chair of the all-party parliamentary group on adult social care, I welcome the fact that this Government recognise that without addressing the social care crisis, more and more people will be left without the care they need and further pressure will fall on the NHS. I am also pleased that the Government have announced an immediate £86 million boost to the disabled facilities grant for this financial year. That is in addition to the £86 million that was announced at the Budget. Together, this funding means that thousands more people will be able to make the improvements they need to their homes so they can live more independently.