A Plan for the NHS and Social Care

Eleanor Laing Excerpts

Wednesday 19th May 2021 Commons Chamber

[Madam Deputy Speaker (Dame Eleanor Laing)]

I inform the House that Mr Speaker has selected the amendment in the name of the Leader of the Opposition, which will be moved at the start of the debate, and amendments (j) and (g), which will be moved at the end.

[Chris Bryant (Rhondda) (Lab)]

Not amendment (e)?

[Madam Deputy Speaker]

No. I can assure the hon. Gentleman that his amendment was not selected.

--- Later in debate ---

[Jonathan Ashworth]

I want to make a bit of progress. If the hon. Gentleman wanted more beds in the NHS and greater diagnostic capacity, he would have been arguing for capital investment in the NHS, which we did not get in the Budget and we did not get in the Queen’s Speech.

That brings me to diagnostic capacity—I have just given the hon. Gentleman his local diagnostic figures. [Interruption.] This is not about new hospitals; this is about diagnostic capacity. The Secretary of State knows that we still have some of the lowest numbers of computerised tomography scanners and magnetic resonance imaging scanners per capita in the OECD. We still have only average amounts of RTE radiotherapy machines. We need investment in this technology, which we are not getting in sufficient amounts. That is why, in the past year or so, we have seen 4.6 million fewer diagnostic tests for cancer. Some 46,000 fewer people are starting cancer treatment. We should not have to choose between covid care and cancer care, but, for too many, that has been the reality of the past year, and it means that 4,500 additional avoidable cancer deaths are expected in the next 12 months. It means that progress in survival rates for colorectal cancer, breast cancer and lung cancer is expected to be undone. The proportion of cancers diagnosed while still highly curable has dropped from 44% to 41%.

The long-term plan, on which the Secretary of State fought the election, promised rapid action on cardiovascular disease. Experts now predict the highest cardiovascular mortality in a decade, and they predict 12,000 additional heart attacks and strokes over the next five years. The Queen’s Speech needed to include proposals to expand access to the appropriate cardiovascular healthcare facilities, but it also needed to include real interventions to tackle smoking and alcohol rates, and to reduce salt intake. Yes, there is a commitment to a tobacco control plan, but will there be a reversal of the 17% cuts to smoking cessation services? Given that 7,400 people died last year from alcohol abuse—a record number—will the Secretary of State reverse the cuts to drug and alcohol addiction services, with budgets being cut by 15% over the past three years?

We have been promised action, again, on banning junk food advertising, but when? I have heard the Secretary of State—and, to be fair, his predecessor—make that promise at the Dispatch Box many, many times, but when will we have the ban? When will he reverse the cuts to public health weight-management services?

Narrowing health inequalities should be at the heart of every Government policy, but there can be no levelling up while life expectancy advances stall for the poorest in society. Levelling up and tackling inequalities apply to mental health outcomes as well. More people suffer from depression in the poorest areas of the country than the richest. We know that the mental health problems are prevalent among certain minority ethnic communities —black men, in particular, are more likely to be detained under the Mental Health Act 1983, more likely to be subjected to seclusion or restraint, and less likely to access psychological therapies. We therefore welcome the commitment to reform the Mental Health Act, as we welcomed it last year, and I look forward to working constructively with the Secretary of State on reforming the Act. I would like to put on record my thanks to Sir Simon Wessely for his pioneering work on this front. Simon is a committed Chelsea fan, so I dare say that he will be more responsive to my felicitations this morning than he might have been on Saturday evening.

We face a crisis in mental health now, and we need action now. Two hundred and thirty five thousand fewer people have been referred for psychological therapies; eating disorder referrals for children have doubled; and the pandemic—again, because of infection control measures —has meant a reduction of almost 11% in beds occupied, which is equivalent to 1,700 fewer patients over the past three months compared with a year earlier. When will the Government implement their promise of significant increases in staff and resources for mental health, to ensure that mental healthcare is genuinely given parity of esteem with acute services?

That brings me to staffing more generally. Given that we are short of 200,000 staff across the health and social care sector, why was there nothing new in the Queen’s Speech to recruit more doctors, nurses and social care staff? Why was there no plan to give our NHS staff the pay rise that they deserve? NHS staff, including nurses who have cared for those with covid on wards, and district nurses who, in the first wave, cared for those who were discharged from hospital earlier than planned so that they could stay at home safely, have gone above and beyond, yet they feel that the 1% pay rise, which could well turn out to be a real-terms cut because of inflation, is a kick in the teeth. Is it any wonder that nurses are leaving the profession, including the nurse who cared for the Prime Minister, blasting Ministers for treating NHS workers with a total lack of respect? It is simply not fair. Our NHS staff deserve better.

The gaping hole in the Queen’s Speech is the plan for social care. Two years ago, the Prime Minister stood on the steps of Downing Street and said he had a plan to fix social care. He said:

“we will fix the crisis in social care once and for all with a clear plan we have prepared to give every older person the dignity and security they deserve.”

It was not a plan to be developed, or work in progress; no, this was a plan that was already done—oven-ready, you might say, Madam Deputy Speaker. But two years on, where is it? Has the Health Secretary seen it? What do we need to do to see it—perhaps we could pay for some cushions in the Downing Street flat? The Government promised us cross-party talks. They now brief that cross-party talks have taken place, but when—did they forget to send the Zoom link?

However, there is a consensus on social care, isn’t there? Care workers should be paid the living wage and proper sick pay. There should be a cap on costs, as this House legislated for. When the Institute for Public Policy Research, social care and older people’s charities and a House of Lords Committee, which, at the time, consisted of true-blue Thatcherites such as the noble Lords Lamont and Forsyth, have all called for reform of free personal care, why is the Secretary of State not engaging in that debate with us? To be frank, though, lack of cross-party talks is not an excuse for not getting on with reform. A Prime Minister with an 80-seat majority should be able to show some leadership and get on and fix social care.

If the Health Secretary wants to talk social care reform, I am free this afternoon. He knows where I am. I am happy to sit down with him at any time and discuss it. I think we would have very constructive conversations on this one, because it is true to say, as Members have detected, that we have developed something of a bond these past 12 months. The Health Secretary has been so friendly to me across the Dispatch Box that I am half expecting to win a lucrative PPE contract by the end of the day.

Because we have this new friendship, I have, as we say on the Labour Benches, some comradely advice for the Health Secretary. I know he is bringing forward a Bill to neuter the independence of the NHS chief executive and bring powers back to the Secretary of State. I have been around a long time and I remember when Tory MPs used to complain that the NHS needed independence, but we will leave that to one side. I just suggest that he ought to be careful what he wishes for, because I have been reading the Evening Standard, where Mr Tom Newton Dunn reveals not only that Simon Stevens, whom the Secretary of State is trying to neuter, was best man at the Prime Minister’s wedding, but that the Prime Minister is said to be about to appoint Simon Stevens—I beg your pardon, Lord Simon Stevens—to, yes, you guessed it, the newly empowered post of Secretary of State for Health and Social Care. It brings a whole new meaning to the phrase, “the best man for the job”, doesn’t it? But this is a Secretary of State who set up Test and Trace, who was responsible for PPE procurement and who failed to protect care homes. Dominic Cummings said the Department under his leadership was a “smoking ruin”—and now he wants more control.

The Queen’s Speech was remarkably unspecific in its description of the contents of the coming health and social care Bill, so perhaps the Secretary of State can reassure us today. Can he commit to ensuring that neither the NHS nor the partnership force to be set up in each integrated care system will permit the inclusion of private sector participants? Will he rule that out? Can he guarantee that as statutory bodies ICSs will meet in public, publish board papers and be subject to the Freedom of Information Act 2000? What guarantees can he give this House that the establishment of integrated care systems will not lead to more private corporations taking over GP practices, as has happened recently with Centene, or services currently delivered by NHS providers? I hope he can give us those very simple reassurances today.

With nearly 5 million people on the waiting lists and rising, ever-lengthening queues in our constituencies waiting for hip replacements and cataract removals, cancer survival rates worsening, mental healthcare in crisis, social care reform kicked into the long grass, and a costly, morale-sapping reorganisation on the way, we needed a fully resourced 10-year rescue plan for our NHS. I commend our amendment to the House.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. At the beginning of this debate, I fear it was not quite clear which other amendments had been selected by Mr Speaker. I have now had an opportunity to look at my notes on my Order Paper. For the sake of clarity, let me tell the House that Mr Speaker has not selected amendment (e) in the name of Mr Bryant, as I predicted earlier. He has selected amendment (g) in the name of the hon. Member for Walthamstow (Stella Creasy), the right hon. Member for Haltemprice and Howden (Mr Davis) and others. He has also selected amendment (i) in the name of the leader of the Scottish National party.

I remind hon. Members that, although their contributions should address the terms of these amendments, it is in order for them also to refer to other matters relevant to the Gracious Speech.

--- Later in debate ---

[Matt Hancock]

Yes, I am absolutely happy to stress that point. This is a consensual process taking into account all the expertise from those who rightly want to influence. The hon. Gentleman almost made a joke about lobbying. The truth is that listening to people who have an expertise and an interest is absolutely critical to getting such a sensitive piece of legislation right. The legislation that this will replace was introduced in the early ’80s, so it is essentially 40 years old. There have been some updates, but there are still some extraordinarily antiquated things in our current mental health legislation. For instance, if someone does not declare then it is automatically assumed, if they are unmarried, that their father should take decisions on their behalf, rather than them choosing who might take those decisions—not their mother and not just one of their parents, but their father. That is just one example of the antiquated practices in this area that we need to address.

Finally, turning to our digital reforms, the pandemic has shown that one of the greatest allies we have in our battle for the nation’s health is data and technology. Digital health has truly come of age over the past year. There is no doubt about it: data saves lives. As we reshape health and social care, we will do it underpinned by a modern data platform, so we can get the most out of this powerful new technology. I am glad, again, that this is an area of cross-party consensus. Telemedicine has taken off. The NHS covid-19 app has been downloaded almost 24 million times and the wider NHS app, on which we can now demonstrate our vaccine status, was downloaded more times on Monday this week than on any previous day. If Members have not downloaded it yet, I recommend that they do. They can see their medical records and show somebody when you had the jab. NHSX committed to delivering the app by the ambitious schedule of 17 May, and it delivered. I am grateful to everybody who worked on this incredibly important project. The lesson of our data-driven vaccine roll-out must be applied everywhere. As citizens, we value the ability to see our data—after all, it is about us and it effectively belongs to us—and we want to see it used to drive better decisions, better research, better treatment and better support for colleagues on the frontline.

My view is that for years the health system has shied away from the modern use of data, and struggled on with paper forms, fax machines and clunky systems that do not talk to each other—but no longer. The pandemic has proved without doubt the incredible value to patients and clinicians alike of the modern use of data. Because of the gift of a universal NHS, we have the opportunity to have the best data-driven healthcare in the world, and I am determined that we seize it. Our health and care Bill and our new data strategy will drive a whole new approach to unleash that potential.

In addition to all those changes, we must, throughout, support all those who improve our health, including those in our life sciences and those who work in the NHS. Last week, I attended with colleagues a service to commemorate the life of Florence Nightingale. In his bidding, the Dean of Westminster reminded us that in Florence Nightingale, compassion and care had the power to deliver not just healing, but change. That must be our mission too: not just to heal, but to change. I am proud to be a member of a Government who deliver on our commitments. We delivered on our commitment to Brexit. We delivered on our commitment to protect the NHS. We are delivering on our commitment to vaccinate all. This Queen’s Speech is a commitment for healing and for change, for a United Kingdom that is stronger, healthier and more prosperous together, and I commend it to the House.

[Madam Deputy Speaker (Dame Eleanor Laing)]

It might be helpful for the House to know that the initial time limit on Back-Bench speeches will be five minutes, and in that cohort of five-minute speeches we have two maiden speeches this afternoon. I can see the hon. Member for Twickenham (Munira Wilson) looking at her notes, and I am sorry to have to say that when we come to her and those after her on the list, the time limit will reduce to three minutes. [Interruption.] She is taking it very well. [Laughter.] Now we go by video link to Dr Philippa Whitford.