NHS: Long-term Strategy

Aaron Bell Excerpts

Wednesday 11th January 2023 Commons Chamber

[Steve Brine (Winchester) (Con)]

I only have a short time, so I will make a couple of points.

On strikes, since we have a major strike today, I understand that many of the trade unions are saying they will not engage with the independent pay review bodies for the 2023-24 settlement. That is a catastrophic mistake on their part. The shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting), and I were on a well-known evening news programme together the other night. Far from trashing the pay review body, he said that although it may need reform, it is important. I am glad to hear him say that, because it is important, and the alternative is Ministers directly negotiating pay settlements with unions. They have tried to do that in Scotland in recent weeks, and the Royal College of Nursing rejected the offer out of hand. The pay review process may not be perfect and may need reform—our Select Committee hopes to talk to the NHS pay review body soon—but I think that madness lies in pay negotiations around beer and sandwiches in Ministers’ offices. The unions should engage with the pay review process for next year. That would be the smart thing to do on their part.

My second point is about demand. The GMB came before the Select Committee just before Christmas and told us that the number of calls coming into the ambulance service is about 10 times what it was pre-covid. There are 100 times the number of people with flu in the acute setting than at this time last year. Demand is significantly outstripping supply in the health service right now, and I think it is disingenuous not to face that.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

I am grateful to my hon. Friend for his work in chairing the Select Committee, and for the joint session with the Science and Technology Committee, on which I sit, about the lessons learned from covid. We heard that there are lessons for the NHS to learn for the future. Does he not find it a bit strange that there is no mention whatever of covid in the Opposition’s motion? Clearly, covid—combined with flu and everything else that he talks about—is one of the reasons behind the acute pressures that we have experienced this winter.

[Steve Brine]

I said in the House on Monday that covid has put the health service on its knees—it has done so to health services in the UK and around the world. To repeat what I have just said, it is disingenuous to suggest that the problems faced by our health service right now are not caused by our covid experience. The number of people presenting with suspected cancers is through the roof. That is good—many of those cases will turn out not to be cancer, which is even better—but so many people are coming forward because we suppressed demand during that time, and it is adding to the demand outstripping the supply in the health service right now.

--- Later in debate ---

[John Redwood]

Yes, indeed. From my hon. Friend’s own expertise, I am sure she is right. When people talk about productivity, they do not believe that hard-pressed staff have to work harder; they are saying there must be smarter working, making jobs more manageable or enabling them to concentrate on the things they are most skilled at, with more relief for the other necessary record keeping, which may indeed need slimming.

My hon. Friend is right that we could expand our training places further, but as we have heard there has been a big increase in educational provision and it takes seven years for it to flow through. I am glad we are getting to the point where we will see some benefits from that. We need more homegrown talent. Many people are attracted to the privileged career of being a doctor and the more we can allow to do that, the better. However, given the immediate urgency of needing more capacity, and therefore more doctors and nurses, the most obvious place is to look at all those who have already had the training and have left the profession or the NHS for one reason or another. Some may be in early retirement. That is probably not something my hon. Friend wants to change because she enjoys her new job, but there are many others who are not in a very important job like her who might be attracted back. I hope the Treasury will be engaged in the review, because I hear from doctors, as many do, that the quirk in the tax system at just over £100,000 where some of the better paid doctors are resting, producing a more penal 60% rate, is an impediment to extra working. I also hear about the pension problems that have been cited on both sides of the House. The Government need to take those issues more seriously if they wish to accelerate returns.

Ministers have very clearly set out that they want more NHS staff and have obtained much larger budgets in the last three years to help bring that about. They have also said very clearly that the public’s priority—and indeed the Opposition’s priority—is to get more treatments and get those waiting lists and waiting times down for those needing more urgent or emergency care. Those Ministers must translate that through the senior health service managers into ways of spending that extra money. If it needs a bit more extra money, there is always some extra available—every time we meet another additional sum is announced—but it has to be well spent. It has to be spent on motivating and recruiting the medical workforce.

[Aaron Bell]

Will my right hon. Friend give way?

[John Redwood]

I had better not, because we are very short of time for colleagues.

The money has to be well spent and I hope that senior managers, as they give us a published workforce plan, will share more of their thinking. It is not good at the moment that there is such a breakdown in relations with talented and important staff in the health service. There is a complex system of pay reviews, increments, promotions and gradings of activities. All those things have flexibility within them. I look to the senior managers on six-figure salaries to take their responsibilities seriously and get the workforce back on side, using those flexibilities within the system, because we deeply need them to be.

We need more supply because there is excess demand, for understandable reasons. Huge sums of money were tipped into the system to deal with covid. Not all of it was well spent, but that was understandable given the unknown nature of the beast at the beginning, and the obvious pressures in this place and elsewhere to get instant results with personal protective equipment, testing and so forth. That is now behind us, but unfortunately it disrupted normal hospital work and normal GP work and created backlogs.

I urge the Government to understand that part of the answer is having more bed spaces in hospitals, with the staff to back them up. I do not know why so many senior health executives never want to admit that. They always say that there are lots of bottlenecks and other issues. Yes, of course we need to move people on from hospital as soon as it is safe to do so, and of course we need more capacity in social care, but I say to Ministers that it would be great to have a bit more capacity in the main hospitals to give us extra flexibility and take some of the pressure off. Could not some of the extra £20 billion, £30 billion, £40 billion or £50 billion that has been found in recent years be spent on the combination of physical capacity and the staff to support it that we so need?

--- Later in debate ---

[Dr Luke Evans (Bosworth) (Con)]

As a parliamentary candidate, I was once asked by a journalist, “We have 30 seconds left on the panel. How would you solve the NHS?” I said, “If I had that answer, I would not be sitting here with you.” Mr Deputy Speaker, you have given me four minutes to do it, and I will do my best.

My hon. Friend the Member for Erewash (Maggie Throup) made an important point about context, and it goes back to when the NHS was formed in the 1940s and 1950s. We have an ageing population. In the last two decades we have seen a 50% increase in the number of 100-year-olds. Many people over 70 have four, five or six medical conditions and are on multiple medications. Technology has moved far forward, too.

When I started training, a cholecystectomy to remove the gallbladder was open surgery that required a person to be in hospital for a week. It can now be done within 24 hours. When we started people on routine blood pressure medications such as ACE inhibitors—many Members will know ramipril—they had to stay in hospital to have their kidneys checked. We now start it routinely for millions of people across the country.

That is the pace at which we are moving in the west and the developed world, and we have to try to keep up. Throw in a pandemic and workforce shortages, and we can see why every western country with a developed care system is struggling. That is the backdrop of what we are dealing with.

On top of that, demand and supply have gone up, but they have not gone up equally. Services are working hard to provide more tests and more appointments than ever before, yet demand is growing partly because the pandemic led to later and more complex presentations. In the Health and Social Care Committee we have heard that there are 27.5 million GP appointments a month, which is up by 2 million on 2019, yet it is still not enough.

In my area of Leicestershire and Rutland, we have enough GP appointments for everyone to be seen seven times a year, but the problem is that appointment rates are disproportionate. Some young people never need to go, and many older people need routine follow-ups. This is the backdrop we are dealing with. Members on both sides of the House talk a lot about long-term plans, but I would like to focus on day-to-day stuff.

[Aaron Bell]

I am grateful to my hon. Friend for bringing us his experience from before he came into this place, and he is right to look at the long-term demographic challenges. Does he agree that they will require the NHS to become even more efficient and productive? That is not just something we are asking for; it is what the staff in the NHS want, because they are aware that they are still delivering analogue services in a digital age.

[Dr Evans]

My hon. Friend has hit the nail on the head, and that is where I want to focus my remarks, because simple day-to-day changes to make the working clinician’s life better in turn improve productivity, patient care and patient satisfaction.

As with the Sky cycling team, looking for percentage gains brings big outcomes. So let us go through a quick list of some things we could do. We could have a root-and-branch review of prescribing. How much time is spent with patients waiting for prescriptions in hospitals to be dispensed? How much time is wasted by GPs signing prescriptions on paper? We have electronic prescribing but the prescriptions still get printed out to be signed. A root-and-branch review of prescribing all the way through would solve that problem, making this system more streamlined and fit for the 21st century. It would also save wastage, because there is an estimated £1 billion-worth of medication in Mr and Mrs Jones’s back cupboard just in case.

What about the IT? I am talking not about singing and dancing robots, but simply about making the IT for the day-to-day clinician work like their mobile phone does. That is not too much to ask. We could address the interface between primary and secondary care, allowing secondary care to be able to book blood tests into primary care and vice versa. This stuff does not happen. We no longer send faxes but we still send letters instead, and we pay someone to scan them so that a doctor can have a look at them and sign them off. We could cap list sizes, on a graded time for GPs. We are recruiting more GPs and it is going to take time, but that is a way of ensuring demand and at the same time continuity of care.

What about all the other stuff associated with the administrative time of looking after doctors to make sure they are fit for purpose? There is so much red tape when someone tries to join a performers list or come off one, or start an induction in a hospital. This is simple stuff we can change now, today. We can further do that by enabling the new ICBs, because my biggest worry with them is that they are going to ask for permission not for forgiveness. These 42 regional areas will be able to design the difference that can stick for the future.

I was hoping we might be able to spend these few hours today talking about the wider picture, because this all comes from context. The biggest question this House has to answer is what is the purpose of the NHS and what should it do? We all agree with the principles of clinical need and not to have to pay, but how do we deliver that for the 21st century?

--- Later in debate ---

[Aaron Bell (Newcastle-under-Lyme) (Con)]

In line with the wording of the amendment, which I rise to support, I thank all NHS staff, particularly those in Newcastle-under-Lyme and in north Staffordshire at the Royal Stoke University Hospital, which, as the Secretary of State acknowledged both on Monday and today, has been under the severe pressures we have seen throughout the health service over the last month. As he acknowledged, many people have had unacceptable experiences. I have seen examples of that in my inbox and I have fought for my constituents in those cases.

I also thank the local leadership, the integrated care board and, in particular, Tracy Bullock, the chief executive of the University Hospitals of North Midlands NHS Trust, for their time in briefing MPs about what has been going on. We have suffered the fourth highest level of flu in the United Kingdom at the Royal Stoke; it is the fourth worst-hit trust. We were running up to 30 flu admissions per day in December. I am pleased to say that that is now back down to a more normal level; it is about 10% of that. Of course, a lot of those flu admissions were people aged 85-plus who needed critical care.

As I said in an intervention, there is absolutely no acknowledgment of covid in the Opposition’s motion, despite the fact that there are still covid cases in hospitals and the backlog has had an effect on all our NHS services. That needs to be acknowledged.

To say a little more about the Royal Stoke, we are pleased that a new ward of 28 beds will be open next week thanks to Government investment last year. I know that Tracy will want me to request from the Minister even more capacity for next winter. The Royal Stoke is still in a very difficult position because of Labour’s private finance initiative—it is one of the most indebted hospitals in the country. That has been raised with multiple Secretaries of State. I know that it is an expensive thing to sort out because Labour wasted so much money on PFI, but we need to address it.

The Government have a long-term plan, as many on the Conservative Benches have said. It is about doctors and nurses and more GP appointments. We have record numbers of people in training as undergraduates and on nursing and midwifery courses. It is also about the long-term strategy, new surgical hubs, community diagnostic centres—my hon. Friend the Member for Peterborough (Paul Bristow) talked about his one—and our elected recovery taskforce, putting more spare capacity in the independent sector to use.

We know about elective recovery because we had to recover in 2010, when we inherited 20,000 people waiting more than a year for elective surgery. We got that down before the pandemic to under 1,000. Forgive me if I say that all the lectures from Opposition Members about how marvellous things were under the Labour Government ring a little bit hollow, especially as a Staffordshire MP. We experienced the absolute scandal of Mid Staffs under the previous Labour Government. I applaud the work that the current Chancellor, the former Health Secretary, did to get avoidable deaths down. That did not happen under the previous Labour Government.

I am very short of time, but I commend in particular the speech of my hon. Friend the Member for Bosworth (Dr Evans) who brought his experience to bear. There is so much that needs to be achieved through productivity and innovation in the NHS, and that is how we will get a long-term NHS fit for the future.