Future of the NHS

Geoffrey Clifton-Brown Excerpts

Thursday 23rd February 2023 Commons Chamber

[Matt Hancock]

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.

[Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)]

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.

[Matt Hancock]

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.

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[Matt Hancock]

I wish that I had been able to drive forward the use of technology even more than I did. I pushed it as hard as I could, but if I could have gone further, I would. It is about not just efficiency for the health service, but a better service for patients and the research agenda. Another advantage of a universal service is that, because almost everybody in the country is within the NHS system, we can do amazing research to find out what treatments work better. If we can get high-quality data into the hands of researchers, they can discover new drugs or new procedures to save lives.

Yesterday, for instance, I signed up and had my bloods taken for Our Future Health, which is a wonderful programme run by Sir John Bell that aims to sign up 5 million people—ill and healthy—to give, with consent, their health data and blood to a large-scale research programme to find out what keeps people healthy. That is for 5 million people, but we can use the NHS effectively —with proper consent and privacy—to save future lives, which is yet another benefit of a universal healthcare system.

My second point—I will make three—on what the NHS needs to do more of in the future is about efficiency. The Prime Minister was right in the summer to float the idea that if someone misses too many appointments without good reason, they should be charged for them. One of the problems for efficiency is that many appointments are missed, which wastes clinicians’ time. It was right to consider that idea, but I would be totally against people having to pay for the first appointment.

[Sir Geoffrey Clifton-Brown]

I am grateful to my right hon. Friend for giving way again. I had to have a procedure the other day that I imagine cost the NHS quite a lot of money. When I was talking to the consultant, she told me that some days, she had a 50% no-show rate, which must cost the NHS several thousand pounds.

[Matt Hancock]

I hear such stories all the time. We should separate out free at the point of use from not abusing the service. Of course, people miss appointments for good reasons, but too often they do not have a reason. We should be thoughtful about how we address that.

On the point of the right hon. Member for Islington North about the use of the private sector, the NHS has bought things from the private sector throughout its entire life. Who built those fax machines? It was not the NHS. The NHS buys stuff—everything from basic equipment to external services. GP contracts are not employment contracts but contracts with a private organisation. Most of those private organisations are not for profit; nevertheless, they are private organisations and always have been.

The previous Labour Government expanded the use of the private sector, of course, to deliver a free-at-the-point-of-use service. Patients, in large part, do not care whether they get their service from the local Nuffield or the local NHS—it does not matter. What matters is that they get a high-quality service at the right time and as quickly as possible.

I was delighted that the shadow Secretary of State for Health and Social Care, the hon. Member for Ilford North (Wes Streeting), recently set out that Labour’s policy would return from what I regard as a totally impossible, mad, hard-left agenda of saying that we should not have the private sector in the NHS—even though it has always been there and always will be—to the position that Labour held when it was last in office and used the private sector for the delivery of services where that was in the best interest of taxpayers’ money and patient outcomes. That has been done over and over again, and that contracting is important.

To be in favour of the NHS being free at the point of use, and to be against NHS privatisation, does not rule out the NHS delivering services as effectively as possible whether through employing people or using contracts. The nature of the delivery is secondary to the importance of it being free for us all to use, for the reasons that I have set out.

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[Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)]

I am delighted to catch your eye in this important debate, Madam Deputy Speaker. I commend the hon. Member for Jarrow (Kate Osborne) on having obtained it, and the hon. Member for Blaydon (Liz Twist) on the sincere way in which she made her points. I share one point of absolute agreement with her, which I will make in my speech: the health service cannot function without enough properly trained staff.

I listened to the speech from the former Secretary of State for Health, my right hon. Friend the Member for West Suffolk (Matt Hancock), with great care. I absolutely agree—I doubt a single Member of the House disagrees—that we all want forevermore a universal health service free at the point of delivery. I commend his arguments and agree why that should be.

The health service was dealt a terrible blow during covid and we need to catch up from that. Two-year waiting lists are falling, but we need to improve on 18-month waiting lists. According to data from September 2022, the overall number of people working full-time in the NHS increased by 2.7%, or 36,000 people, compared with the previous year—a point made by my right hon. Friend the Member for West Suffolk. However, there are 130,000 job vacancies, and we need to try to fill those. The latest data published by NHS Digital up to September shows that there are almost 4,000 more doctors and 9,300 more nurses working in the NHS compared with September 2021. But compared with 2015, we have 1,622 fewer fully qualified GPs today. We are seeing the consequences play out in the health service.

Working in healthcare can be very rewarding. However, for many working with staff shortages, it can be incredibly tiring and stressful. The care that they want to provide to all patients is not always possible, and talented individuals are pushed to leave for new opportunities. As well as pay, employment conditions are critical. That is particularly true in the social care sector. In my constituency, double the number of people are in hospital today, clinically fit to be discharged but not able to leave hospital because there are not enough social care workers. We need to look critically at how to bolster that social care system.

The recovery of the NHS is very important to many of my constituents in the Cotswolds, who regularly contact me with concerns about accessing the treatment they require in a timely manner. As I have said, waiting lists in January fell for the first time since the start of the pandemic. Elective care was delivered for 70,000 more patients in November compared with the same month before the pandemic, as the waiting list dropped by almost 30,000 compared with the previous month. However, there were around 7.2 million incomplete treatment pathways as of December 2022, with 406,000 people waiting more than a year for a consultant-led referral to treatment.

There is much work to be done to be caught up from the pandemic. We all know that there are problems in the NHS, but I do not think we have had anything like the pandemic since the second world war. Actually, the health service is to be hugely commended on what it did during the pandemic: the speed with which it was able to administer vaccines, the tremendous care that saved the lives of my constituents and those of every other Member of Parliament. That was to be wholly applauded.

The key to combating waiting times and revitalising the NHS is to recruit more staff, especially filling those frontline positions, and increasing retention. That will enable us to get greater flow through our healthcare system and reduce the waiting time for all treatments, including the critical cancer pathway. We urgently need to invest to train more doctors and nurses, instead of relying on recruiting talented people from poorer countries. It is no good Opposition Members crowing about the training that was provided when they were in office. I seem to remember when Tony Blair was Prime Minister that he shut some of the nurse training centres.

I think it might be of interest to the House that two weeks ago I went on a Public Accounts Committee visit to Denmark, to inform the Committee on the hospital construction programme that we are about to embark on in the UK and ongoing work on the Department of Health and Social Care. Some of the things that we discovered on that visit could be introduced into the health service, and some chime with what my right hon. Friend the Member for West Suffolk said.

Denmark faced many of the same issues as we do now: an ageing population, an ageing workforce within the healthcare system, increased chronic disease, workforce shortages and new needs for educating staff in the latest technology and ways of working. However, it has completely reformed its approach to healthcare in the past 15 years and created a model from which I believe we can learn a great deal. It has closed dozens of old hospitals and is in the process of building 16 brand-new hospitals. Most are completed and the remainder are scheduled to be finished within the next five years. Critically, it has reduced the number of beds by 20%, instead opting for a policy of far greater out-patient treatment and treatment at home. Even quite complicated procedures, such as chemotherapy, are delivered in the home. GPs are absolutely the key to this system, and are described as the gatekeepers for the rest of their entire healthcare system. It was made clear that the policy decision, made in 2007, was not an easy one. They have faced significant cultural resistance from some residents who are now required to drive for up to an hour for care.

The overall vision was for patients to spend as little time in hospital as possible. Today in Denmark people spend an average of 3.5 days in hospital compared to six in the UK. The aim is to discharge people either to their home, or to the municipality nursing or residential homes, as quickly as possible. The system makes great use of telemedicine wherever possible. The increase in care was possible as the number of GPs within the healthcare system was increased by 50%.

Another important change in Denmark, which chimes with what my right hon. Friend the Member for West Suffolk said, was the health digital revolution. Ninety seven per cent of the population now have good broadband connections, and all citizens have a unique reference that covers a number of Government services, including tax and health. The whole healthcare system has been transformed into a digital and paperless system. Access to medical records is strictly controlled, but is available to the relevant physician treating the patient, with their consent. Those physicians update the records in real time. As my right hon. Friend said, appointments are made online through an app, eliminating a vast number of letters and phone calls.

Relevant to our building system for the 40 new hospitals is that the Danes have now produced a standardised hospital design. That was not easy, as different specialties have different requirements. For example, most Danish hospitals have introduced four different-sized but standardised theatres. There are no hospital wards; instead, all rooms are single, with their own bathroom and a bed for a relative to stay overnight or longer. That standardised design will enable hospitals to be built cheaper and more quickly, and it will eliminate the elementary problems that sometimes arise even when our hospitals are newly built.

As I have said, in the UK there is a pledge to build 40 new hospitals at an estimated cost of £1 billion each. While we have many similarities with the Danes—we are fortunate that we both enjoy a universal, equal and free healthcare system—the success of the Danish system comes from its ability to treat many patients outside of hospitals. In the UK, hospitals are often viewed as an inevitability for many people requiring treatment; in Denmark, they are the last resort. I believe there are some real lessons we could learn from the Danes. We need to do so, because it is clear that we cannot continue as we are.

Our health system is limping on, and the cost to the taxpayer is increasing. According to recent figures, £277 billion was spent on healthcare in 2021. That is 11.9% of our total GDP. Some people complain that this is out of kilter with other countries in the world. Certainly, health spending in the United States is 17.8% of GDP, but that is accomplished through both insurance and public finance. Our figure is comparable to the 12.8% of GDP spent in Germany, and the 10.8% spent in Denmark. Both the United Kingdom and Denmark do not have enough doctors, nurses, and, in particular, social care workers. For a health service to run efficiently, it must have sufficient staff who are well motivated and trained.

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[Liz Kendall]

May I gently say to the hon. Gentleman that I know what is best for his constituents and the people of Wales, which is a Labour Government in Westminster as well as a Labour Government in Wales delivering the changes that we are seeing? If he looks at Labour’s record when we were in government in Westminster, he will see the improvements that were made. May I also gently suggest that he focus on the lack of a workforce plan and the lack of a proper social care plan from his own Government, rather than trying to make these petty points?

Our plan will reform health and care services to speed up treatment by harnessing life sciences and technology to reduce preventable illness, and by cutting health inequalities. As a first step, we will carry out the biggest expansion of the workforce in the history of the NHS, doubling the number of medical school places, creating 10,000 more nursing and midwifery training places, recruiting 5,000 more health visitors, and doubling the number of district nurses. We will pay for this by scrapping the non-dom tax status, because we believe that people who come to live in the UK should pay their fair share of tax here. We read today in The Times that the NHS itself backs Labour’s plan, so why do the Government not back it?

[Sir Geoffrey Clifton-Brown]

I listened very carefully to what the leader of the hon. Lady’s party said on the “Today” programme this morning. He said that any proposals he would include in his manifesto for the next general election would be properly costed. Has the hon. Lady properly costed the proposals that she has just outlined, and if so, how much will they cost?

[Liz Kendall]

Yes, we have properly costed these proposals, because we—unlike the hon. Gentleman’s party, which announced huge amounts of borrowing without saying anything about where the money would come from under the former Prime Minister’s plans—will only set out our commitments when we can say where we will get the money from. We will get it by cancelling that non-dom tax status, and I urge the hon. Gentleman to encourage the Chancellor to follow that example in his Budget. I hope that when the Minister responds he will put the House and, more importantly, the public out of our misery. and just adopt Labour’s plan. If he does, he will surely have the backing of the Chancellor, who said only a few months ago that he very much hoped that the Government would adopt our proposals,

“on the basis that smart governments always nick the best ideas of their opponents.”

The truth is that Labour is proposing the solutions to the problems that the country faces because the Conservatives cannot be trusted to fix the mess that they have caused. Instead of introducing the long-term reforms that the country needs, they are constantly lurching from crisis to crisis—always reacting, always behind the curve. Every year there is a winter crisis, with more elderly people ending up stuck in hospital because they cannot get the social care and other local services that they need in the community or at home. Every year, people struggle to get the proper mental health support they need, so they end up reaching crisis point, which is worse for them and more expensive for the taxpayer. Every year, people are left hanging on the phone for hours and hours trying to get a GP appointment until there is no choice but for them to end up in A&E. Every year, there is a sticking plaster and never a cure. In contrast, Labour is calling for a 10-year plan of investment and reform to deal with the root causes of the challenges that we face and to build a care system fit for the future.

We will fix the front door to the NHS in primary care, recruiting more doctors to deliver better access to GPs, ensuring that patients can see the doctor they want in the manner they want—whether that is face to face, over the phone or online. We will fix the exit door out of the NHS and into social care, including by delivering a new deal for care workers so that they get the pay, the training and the terms and conditions that they deserve, which will mean that we can deal with the problem of delayed discharges.

We will recruit 8,500 mental health workers to provide faster treatment and also the support in schools that young people need, which will stop them from getting to crisis point, too. We will enshrine the principle of home first. Ultimately, what we need is a fundamental shift in the focus of care out of hospitals, into the community and more towards prevention. The big challenge that we face is an ageing population, with more people living with one, two, three, four or more long-term conditions. We must get that shift towards prevention. We must enable and support people to take more control over their health and care. We must have one team, with one point of contact, because people do not see their needs in the health or care silos. That is what Labour will deliver. When I first became an MP, I remember seeing in my own constituency people with the telemedicine that they needed to manage long-term conditions, such as chronic obstructive pulmonary disease. I remember visiting Totnes where there was a single, joined-up health and care team. I remember the sexual health and other support services from public health teams that Labour put in place, all of which, in my constituency, have disappeared.

I know from my time working for the last Labour Government that we cannot solve all the problems that the Tories have created overnight, but I also know—and Labour’s record in Government proves this—that with vision, determination and a clear plan, which is drawn up with the staff who provide the services and, crucially, with the users and their families, the NHS and our care system can be transformed. We have done it before. We stand ready to do it again, and Members on the Labour Benches will work day and night to deliver it.