Defending Public Services

Andrew Murrison Excerpts

Monday 23rd May 2016 Commons Chamber

[Heidi Alexander]

We were very clear at the last election that we would have had an emergency Budget to put every penny that the NHS needs into its funding.

I was talking about the reduction of NHS spending as a proportion of GDP. In terms of real funding, the House of Commons Library has shown that, if spending as a percentage of GDP had been maintained at Labour levels, by 2020, £20 billion more would be being spent on the NHS each year. That demonstrates the scale of underfunding that we have already seen and just how tough the coming years are going to be. That is not to mention the deep cuts to adult social care, which have piled the pressure on to hospitals, and the £22 billion-worth of so-called efficiency savings that this Government have signed up to. I have yet to meet anyone who works in the NHS who thinks that efficiencies on this scale are possible without harming patient care.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I do not disagree with the hon. Lady that there are big pressures on the horizon, but can she say how much, beyond Simon Stevens’ predicted costs, her party is now pledged to spend on the national health service, because so far all we have heard is prevarication?

[Heidi Alexander]

I am not going to be drawn into giving figures here at the Dispatch Box today. Yesterday the Life Sciences Minister was tweeting that we need a big public debate about funding of the NHS.

Three days ago, the scale of this crisis was laid bare. NHS Improvement, the body responsible for overseeing hospitals, published figures showing that NHS trusts ended 2015-16 with a record £2.45 billion deficit—I repeat, £2.45 billion. To give hon. Members some context, that is treble the deficit from last year. What is the key cause? It is the spiralling agency spend because of staff shortages. When this Government talk about more money going in, let us remember that, before that money gets to the frontline, the bulk of it will be spent on paying off the bills from last year.

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[Dr Andrew Murrison (South West Wiltshire) (Con)]

It is always a pleasure to follow the hon. Member for Oldham East and Saddleworth (Debbie Abrahams). It is a privilege to be able to speak in today’s debate.

I start by echoing the comments by my hon. Friends the Members for Harrow East (Bob Blackman) and for High Peak (Andrew Bingham), in particular, and other hon. Members, about the digital economy Bill. I am delighted that the Minister for that business area, my hon. Friend the Minister for Culture and the Digital Economy, has just walked into the Chamber. This Government have done a splendid job in trying to roll out broadband. It is very difficult to make inroads into the last 5%, but the universal service obligation and the commitment to 10 megabits is absolutely right. I look forward, in particular, to my rural constituents and their small businesses being able to access 21st-century technology in the very near future. On behalf of those constituents, I thank the Minister for all his hard work.

I am a doctor, as you know, Mr Deputy Speaker, and I have to declare that interest since most of my contribution will be about healthcare. The Gracious Speech rightly began with the economy, however, and we found out why that might be over the weekend when Simon Stevens, the head of the NHS in England, made it very clear that without a sound economy one cannot have an effective healthcare system. That is absolutely fundamental to the delivery of public services in general, and particularly to the national health service. It is perhaps ironic that Simon Stevens was once a Labour councillor. I wonder what he would make of the financial illiteracy displayed this afternoon by Labour Front Benchers, who must answer the fundamental question about what they would want to spend on our national health service beyond Simon Stevens’ five year forward view. On a number of occasions they have been pressed on this matter and failed to come up with an adequate answer. I say ever so gently that Labour Front Benchers must answer the point being made by me and other hon. Members about precisely what figure they would be prepared to commit to our health service, since at the last general election they opposed the Government’s spending plans, and had they been in government now, enacting their proposals made only a few months ago, our national health service would have little chance of seeing the £30 billion overall extra spend to the end of this decade that it so desperately requires.

I very much welcome the commitment to the so-called seven-day NHS. As it happens, I was visiting a constituent in a busy hospital ward this weekend, and from the activity that I saw, it seemed that the NHS was working at full tilt. However, in some important respects, our health service is different at the weekends from how it is midweek. It is absolutely right that the Government should be attempting to roll out Sir Bruce Keogh’s 10 clinical standards, particularly the four he has identified as most important in this matter. The seven-day working week is essential to being able to do that in a comprehensive fashion. I commend the Government for the efforts that they have put into this for the past several months.

I also welcome the commitment to dealing with sugar. We heard earlier about the perils of obesity and the time bomb, as it were, that this presents to the younger generation. If we are going to be true to our mission on public health and preventive health, it is absolutely right that we should send out the right message to those who sell fizzy drinks—sugary drinks—and ensure that we try to reduce consumption of those things.

The Secretary of State has a very tough job, in my opinion. He has to improve outcomes—which are not good in this country compared with countries with which we can reasonably be compared—and deal with increased public expectations, demographic change, and economic stringency. I am very pleased that I do not have his job. If I may say so, the strain is showing—on the national health service, I hasten to add, not on the Secretary of State—since we know from last week’s data that there is a £2.5 billion deficit that involves two thirds of trusts being in the red. That is set to endure, since we have a real issue in reconciling the money going into the national health service, welcome though it is, with the extra demands being put on the health service all the time through the demographic changes that I mentioned.

We are now 18 months into the five year forward view, and the £22 billion in savings looks challenging, to put it mildly. Those savings are predicated on a number of assumptions—in particular, a continuing input into public health—and yet, necessarily, the local government grant has been squeezed this year. According to the Health Foundation, we also have a £6 billion social care cost funding gap. All this impacts on health generically. Simon Stevens made his prognostications based on continuing spend on public health and on social services, both of which have been squeezed. I make no criticism of the Government on that, since it is absolutely necessary to deal with the economy, as I said in my opening remarks. It has happened, nevertheless, and therefore, I am afraid, undermines much of what Simon Stevens had to say. We need to bear that in mind when we assess how realistic is the £22 billion figure, which, by his own admission at the time, required what he described as a “strong performance” by the national health service.

“Five Year Forward View” talked of a “radical upgrade” of public health and prevention, stating that public health was its first priority. Many of us can remember the Wanless report by the late Derek Wanless, which said that improvements in public health and prevention were absolutely essential if his “fully engaged” scenario was to be enacted. The recent Carter review showed a considerable unwanted variation across our national health service. In this, there is some hope for squaring the budget, since if there is such a wide variation across the national health service, there must surely be capacity to improve practice across the service and thus generate efficiencies. However, it appears that Carter has stalled, and we need to have a proper plan for the future on how the differences may be dealt with and, we hope, erased. Beyond some useful sharing data, it is not clear that Carter has been progressed in the way that we might want. I fear that if we do not give it a bit of oomph, there is a risk that it will go the same way as Wanless, which would be a great pity.

I very much support the seven-day-a-week national health service. As I have said in the past, I am not terribly convinced by the mortality data that underpin it. I am much more persuaded that we need to look at items of clinical service to underpin the argument for a seven-day NHS. I am thinking particularly of things like palliative care services. I am thinking about the fact that there are no routine endoscopy lists on a Saturday and a Sunday. That has huge implications for people who have had an upper gastro-intestinal bleed on a Friday, for example. The upper gastro-intestinal endoscopy example is a good one, since it touches on Bruce Keogh’s standards 5 and 6, which recommended endoscopy within 24 hours of a bleed. That is not happening in many of our acute hospitals. A lot of the remedy has to do with considering how to network hospitals, and perhaps reconfigure our national health service estate, in order to ensure that when people are acutely unwell they go to a unit that is capable of managing their healthcare needs in the most efficient and effective manner and ensuring that they have the very best chances of leaving hospital in good order.

We are faced with the reality of a healthcare system that is working at full tilt, and of which we are enormously proud, but delivers healthcare outcomes that could be better by international standards. Part of the reason is that we do not spend enough on healthcare. The reason I do not envy the Secretary of State for Health is that he is going to have to grip the reality that in this country we spend very much less than countries with which we can reasonably be compared—8.5% of our GDP compared with 11% in the Netherlands, Germany and France. I have no easy solution for that, but I do suggest, ever so gently, that we need to look a little more broadly at potential solutions. We could think, perhaps, of having a non-partisan commission that may grapple with this extraordinarily difficult and complex matter, because one thing is for sure—the institution that is held most closely in the public affection is our national health service, and we must fund it properly.

[Several hon. Members rose—]

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[Huw Merriman (Bexhill and Battle) (Con)]

It is a pleasure to follow the hon. Member for Sheffield Central (Paul Blomfield) in this debate on the Queen’s Speech. In the time afforded to me, I want to focus on the defence of three key public services—the NHS, schools and the BBC.

On the first, 28% of my constituents in Bexhill and Battle are over the age of 65, versus a national average of 17%. There are forecasts that the national average will reach 25% by 2050, which is a cause for great celebration. However, as a result of an ageing population, my constituency has the highest rate of dementia in mainland Britain. East Sussex has the highest percentage of over-90s in the UK, and is predicted to be able to make the same claim for the over-75s and the over-85s in the years to come. Accordingly, the state of the NHS is of particular importance to my constituents—not just those who rely on it in their older age, but those who need to access it across the age spectrum.

I have ruptured, and this week re-ruptured, my Achilles tendon, so I have been something of a drain on NHS resources. It has, however, given me the opportunity to witness, at first hand, the NHS and the first-class people who work in it. I want to say a huge thank you to every clinician and employee for what they do for my constituents. Their clinical expertise, dedication and care make me incredibly proud to be British and equally determined that we should listen to their ideas for and concerns about the NHS.

The decision by our junior doctors to call the first ever all-out strike was a deeply depressing outcome of the breakdown of the contract negotiation. On the day of the strike, I went to the picket line to meet the junior doctors who had looked after me following my first Achilles tendon rupture. I spent an hour listening to the concerns of those junior doctors. Some concerns were linked to their personal circumstances and their feeling that it was unfair, in their position, to have only the same rights as a fixed-term employee when it came to the unilateral imposition of contract terms. Other concerns were about their workplace and their ability to do their best in the face of increased demand from patients.

On that day, I was asked whether I would write to the leader of the BMA and the Secretary of State for Health and pass on those junior doctors’ desire for talks to resume and a negotiated settlement to be reached. I duly did so and was delighted when talks were subsequently held and a resolution was reached. I hope that the junior doctors will consider the settlement negotiated by the BMA a fair compromise that is worthy of acceptance, and I thank the Secretary of State for going the extra mile.

It is clear to me that, once the contract is finally negotiated, we should have a grown-up debate about the future of the NHS. Can we expect it to meet the needs of an ageing population, carry on purchasing ever more expensive drugs, deliver innovative treatment and cope with an increasingly obese population when we as a nation only put 8% of GDP towards health? In the French and German model, it is 11% of GDP. Inflationary patient demands on the NHS equate to a 4% increase per annum, yet the increase in spending, welcome as it is, is running at 2%. This Conservative Government have spent record amounts on the NHS, but does the current situation make it reasonable that those who fail to take individual responsibility, or who waste the time of our doctors or nurses or disrespect them, should pay towards their care or be denied it? I welcome the Government’s decisions to introduce a new Bill to tax sugar content and to strengthen existing rules to ensure that all health tourists from abroad pay for their treatment. However, we could also look closer to home in expecting patient responsibility in return for treatment.

I am intrigued by the requirement for the NHS to deliver £22 billion of savings at the same time as introducing a seven-day NHS. If we are to have a fully functioning NHS on a Sunday, it means absorbing all the costs of running and supporting such a service. I ask myself whether I want to have my physiotherapy on a Sunday, and the answer is that I do not.

[Dr Murrison]

I share my hon. Friend’s confusion, but in fairness, it is only right to point out that weekend working means meeting the four key clinical standards that Sir Bruce Keogh outlined. I fear that my hon. Friend will probably not be getting his physiotherapy at the weekend.

[Huw Merriman]

I thank my hon. Friend for that clarification—it turns out that I will be satisfied, then. However, the point is that when we talk about a truly seven-day NHS, we need to be absolutely clear what services there will be on a Sunday. Those who work in the profession want the flexibility and freedom to work hours that allow them to experience an enriched life and to raise a family. They want to succeed in the workplace and to make a contribution in their field. If they cannot, they will decide to work in another profession. I hope that that will be taken into account when changes are made to Sunday operating practices.

From discussing the pressures on the modern-day NHS with Government, clinicians and managers, it appears to me that there are many shared views on patient safety and individual patient responsibility. Like most of my constituents, I yearn for the day when politicians and clinicians join together and recommend the difficult decisions that both parties know are required. Our NHS would be stronger for it, and our patients would be better served.

I turn to our schools. I was particularly pleased by the introduction of the new White Paper on education. The day after it was announced that schools would be forced to become academies, I spoke in this place about the need to allow good and outstanding schools to make their own choice. I am delighted that the Government have made that alteration, although rightly not for schools for which local education authorities are not fit for purpose or those that are no longer of a viable size.

That is not to say that becoming an academy is not a good idea for a school that wants to. I have just spoken of junior doctors’ desire to take control of their career and their destiny, and it strikes me that we now have a generation of headteachers who are no longer willing to be told what to do by their LEA but want to make their own decisions about how to run their school and whether to expand. It comes down to choice, which drives up standards. I hope that my local schools will consider making their own determination on expansion.