Cass Review
Emma Hardy Excerpts(1 week, 3 days ago)
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Victoria Atkins
I thank my hon. Friend for his careful and considered question. I very much hope that the Scottish National party Government will look at the evidence very carefully and find the recommendations to their liking. It is to NHS England’s credit that it has acted so promptly, and I would hope and expect that the devolved nations, let by the Scottish National party and the Welsh Labour party, will follow with similar speed.
As I have had to say, because it is in line with the atmosphere in which clinicians are having to operate, the Hate Crime and Public Order (Scotland) Act 2021, brought forward by the Scottish National party Government and supported by Scottish Labour, cannot help the considered debate that we wish to have about this very complex subject, and I encourage them to look at that as part of their overall approach.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
I welcome the Cass review and its recommendations. Mistakes have been made that must never happen again, but the polarised public debate that she mentions reflects badly on this House. Does the Minister agree that making jokes about trans people and trans children is cruel, cheapens the debate and moves the focus away from ensuring that all our young people get the help they need when they need it?
Victoria Atkins
True leadership is not just about being careful with the words we use. I will not recite the many words that other Labour Members have used about trans issues. They say, for example, that it is factually inaccurate to say that only women have a cervix—[Interruption.] I am not naming them, but that seems an extraordinary things for a Labour Member to say. [Interruption.] They do not like to hear their words repeated back to them, but I will resist that temptation and instead focus on the application of policy.
Trans prisoners, including those who are fully intact and have been convicted of serious sexual offences, are demanding to be held in prisons that match their chosen gender. This Government, including me and many of my predecessors as Prisons Minister, set clear rules to ensure that situations such as the Karen White case are not repeated, so it was very troubling that Opposition Members did not appear to have the same concerns when it came to the placing of a trans double rapist, Isla Bryson, in Scotland. [Interruption.] I am being told that it is not true but, if Opposition Members want to factcheck, apparently it was the deputy leader of the Labour party who said that it does not matter.
NHS Dentistry
Emma Hardy Excerpts(3 months, 2 weeks ago)
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Wes Streeting
My hon. Friend is absolutely right. We will have: 700,000 appointments, making a difference straightaway; supervised toothbrushing for three to five-year-olds to reduce future demand on NHS services; and reform of the NHS dentistry contract so that we can rebuild an NHS dentistry service worthy of the name. That change cannot come soon enough.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
My constituent Amy has been in contact with me about the difficulties that she and her five children have had getting NHS dentist appointments. She explained that her husband was in the military and therefore they had to move home frequently, and each time they moved they found it harder to get an NHS dentist. Does my hon. Friend agree that that is a shameful way to treat people who have served and given so much to our country?
Wes Streeting
I agree. I am afraid that when it comes to serving personnel and veterans, there is a gulf between what the Government say and promise and what they do; that is not the only example.
One thing not in the Government’s amendment to Labour’s motion is a pledge to protect the NHS dentistry budget. That is odd, because the Prime Minister promised to do exactly that 18 months ago. The truth is that the Prime Minister broke that pledge in November when he gave the go-ahead for dentistry underspends to be raided, effectively waving the white flag on the future of the service. Can you believe it? Despite everything we have heard, there are dentistry underspends, and the Prime Minister thinks that other things are greater priorities than this crisis. The consequences of that decision are now being felt. The budget in some areas of the country is running out and dentists are having to stop NHS work for the remainder of the year. It is so deeply frustrating.
NHS dentists want to do more NHS work; it is the Government who are standing in their way. The Nuffield Trust’s stark report into the crisis suggested that NHS dentistry may have to be scaled back and made available only to the least well-off. Such an approach would be the end of NHS dentistry as a universal public service, yet that is exactly the approach that the Government are piloting in Cornwall. Children, the over-80s and those with specific health needs are given treatment; everyone else has to go private or go without. They will not admit it, but this is the future under the Tories: further neglect, decline and patients made to go without.
Worse still, NHS dentistry is the ghost of Christmas yet to come under the Tories. That is not partisan overreaction on our part; that is according to the lead author of the Nuffield Trust’s report. He wrote:
“For the wider health system, the lessons are troubling: without political honesty and a clear strategy, the same long-term slide from aspiration to reality could happen in other areas of primary care too.”
What has happened to NHS dentistry under the Tories is coming to the rest of the NHS if they are given another five years. That is not the continuity that the country is looking for—it is looking for change with Labour.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
In a landscape where health conditions have become a barrier to opportunity, dental health has unfortunately joined this growing list. The state of NHS dentistry after 13 years of Conservative Government is nothing short of a national tragedy. However, I rise not just to address this dire state of affairs, but to give hope that there is a path towards real solutions and lasting change—a path that can only be available under a future Labour Government.
The national surveys by the NHS Business Services Authority and the British Dental Association evidence the stark reality of our dental health crisis. Children in parts of England endure waits of up to 18 months for dental procedures and our dental workforce has fallen to the lowest levels since 2013, with morale at an all-time low. In Hull and the east riding, the situation is even more alarming, with over half of adults in Hull not having attended a dentist’s for two or more years, which is double the number in 2015.
My Facebook post asking people to share their experiences got nearly 300 comments, mostly on the same issues: the limited access to dentistry for children and adults; long waiting periods for critical interventions, such as tooth extractions, leading to prolonged pain and suffering for those in need; the inadequate availability of emergency care that forced individuals, as has been heard in this debate, to resort to DIY dentistry and unnecessary visits to A&E; and the impact on children’s health, with alarming waiting times for crucial procedures under general anaesthetic.
Angie told tell me about problems with special educational needs dentists. She said that they
“have had to start outsourcing to other dentists in and around Hull who are willing to work with those with SEN. Still waiting on an appointment for my son to be seen by the dentist we chose over 6 months and he’s supposed to be seen every 6 months”.
Sarah told me:
“I needed a dentist during 2021 due to having chemotherapy…so I go to my local NHS dentist which I had been with for years!...they had struck us off with no notice…so I ended up ringing over 40 dentists with no response other than a waiting list. 2 years later after treatment I went private, in debt of over 2,000 pounds and having lost 1 tooth. I’m lucky to being back to OK health.”
Stephen told me:
“Yeah our dentist closed at East Hull...and it’s taken me 2 years to try and get my kids a dentist. I actually called 37 dental surgeries and even had to try York, Leeds, Scarborough, Lincoln. My Polish dentist could not resit the English dental exam after we came out of the EU in time due to Covid delays so she went back to Poland. Such a shame, she was an amazing dentist... She was fully qualified but there was an exam you had to resit…it was all delayed at the time so I think we lost quite a lot because of that.”
Despite getting moulded for a new veneer for a tooth, he had
“to superglue an Amazon £9 tooth on my front tooth for over a year”.
Locally, people are trying to make a difference, and I pay tribute to Chris Groombridge and the Teeth Team charity, which goes out talking to children—nursery age and primary age children—about oral health and hygiene. However, we need to train more dentists, and we need to do more to keep the dentists we already have. I really welcome the reform of the dental contract.
On dentist training, I presented a petition calling for a Hull York dental school based on the Hull York Medical School that the Labour Government set up in 2003. Unfortunately, the Government rejected that idea. However, there have been positive conversations with the integrated care board about a centre for dental development being set up in Hull, so some dentists could be trained in the city, albeit not in the dental school that we would like to see. If that does happen, and I do hope it does, we will still be waiting five years for dentists to be trained. The emergency is here and now.
That is why I so wholeheartedly support Labour’s plan to get 700,000 more urgent appointments annually, reforming the dental contract to keep the NHS dentists we have, introducing supervised toothbrushing as a strong preventative measure, and funding improvements. The plan will cost money of course, but it will be funded, as we have explained, by abolishing the non-dom tax status, because people in Kingston upon Hull West and Hessle need healthcare more than the ultra-wealthy need a tax break.
Under the Conservatives, NHS dentistry faces a slow demise, with dentists leaving vast areas as dental deserts. Unlike the Tories, the Labour party believes in accessible healthcare for all. We pledge immediate action for those in urgent need and long-term reforms to restore NHS dentistry for everyone. The motion I am voting for today is not merely a formality; it is a reflection of the urgency and gravity of the situation. This Government’s legacy is one of stagnant growth, soaring prices and a crumbling public service. It is a legacy of failure, and it is time for the positive change that only a future Labour Government can bring.
Mental Health Treatment and Support
Emma Hardy Excerpts(10 months, 3 weeks ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)
I beg to move an amendment, to leave out from “House” to the end of the Question and add:
“notes the increased burden on mental health following the pandemic, including on young people and those with severe mental illness; recognises the historic levels of investment being delivered by this Government into services, with an increase of £2.3 billion per year in front-line mental health funding over the past four years; notes that current NHS targets around access to talking therapies and intervention in psychosis are being met due to the efforts of NHS staff; and acknowledges the investment in mental health teams in schools, as well as the ongoing investment into open access mental health helplines in the 111 service and into the estate, including three new mental health hospitals to be opened in the next two years accompanied by a further £150 million in investment in new mental health ambulances and the development of better alternatives to accident and emergency services, including crisis houses, safe havens and step-down services.”
Improving mental health is a top priority for this Government. We can all agree that in the past it was not given the priority it deserves, and was seen as something to be ashamed of and not spoken about. Thankfully, we are changing that. We are working to achieve parity of esteem between physical health and mental health, with record amounts of investment going into NHS mental health services in England, and the stigma surrounding mental health is being reduced.
“The Five Year Forward View for Mental Health”, which was published in 2016, was a major step forward and secured an additional £1 billion in funding for mental health, so that an additional 1 million people could access high-quality services by 2020-21. It was followed by the NHS long-term plan in 2019, which committed an additional £2.3 billion a year for the expansion and transformation of mental health services in England by 2024, so that an additional 2 million people could get the NHS-funded mental health support that they need. It is also funding the increase in the frontline mental health workforce to meet the plan’s ambition for 27,000 additional mental health staff by 2023-24. There were 138,610 full-time equivalent mental health staff at the end of 2022, an increase of 8,900 on the previous year and of 20,700 on December 2010, so the mental health workforce in the NHS is radically bigger. In total, we spent around £3 billion more on mental health last year compared with four years ago. That is an increase of a quarter.
Backed by this huge investment, we are expanding access to NHS talking therapies for adults to meet the long-term plan’s ambition for an additional 1.9 million people to access National Institute for Health and Care Excellence-approved treatments for conditions such as anxiety and depression. From starting small in 2008, around 1.2 million people are now accessing NHS talking therapies every year, with 98% waiting less than 18 weeks for their treatment and 90% waiting less than six weeks. This means that we are delivering well over our national waiting time targets of 95% and 75% respectively.
Local mental health services are transforming community mental health care to give 370,000 adults and older adults with severe mental illnesses greater choice and control over their care and to support them to live well in their communities. We recognise that poor mental health is a major cause of sickness absence in the workplace and we are providing support to employees and employers on mental health in the workplace. We have announced additional measures to support workplace mental health, including a package to support the long-term sick and disabled to remain in or return to work. This includes £200 million for digital mental health to modernise NHS talking therapies, to provide free access to wellness and clinical mental health apps for the population, and to pilot cutting-edge digital therapeutics. There will be around £75 million to expand individual placement and support services to help more people with severe mental health illnesses into employment.
Neil O’Brien
I will make a little progress first.
We know that the number of children and young people experiencing mental ill health is rising, and that many of them will continue to experience mental health problems later in life. Spending on children and young people’s mental health continues to grow, from £841 million in 2019-20 to £995 million a year later, and now to £1.1 billion in 2022-23. This means that we are helping more children and young people than ever before. In 2021-22, there were over 743,000 new referrals to children’s and young people’s mental health services, which is 41% higher than the year before.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
There has been a narrative about whether it is increasing numbers of people becoming more aware of mental health that has led to more cases being reported, or whether there are actually more people suffering from mental health problems. I spoke to Michele Moran, the head on this issue for the Humber Teaching NHS Foundation Trust. She told me, indisputably, that we have more people suffering from mental health conditions. We only need look at the examples coming into each and every one of our surgeries to see how desperate the situation has become. Like other hon. Members, I would like to thank my staff for the work they do in supporting people with mental health problems. I will give two examples.
One example is a 13-year-old boy who has not been in school for two years. The school funded three counsellor sessions for him, but it cannot continue to give the boy the level of support he needs. This is a crucial point. Schools are very willing to help, but teachers are not mental health professionals. We need the professionals in the system, which is why Labour’s pledge to have professionals in schools matters so much. We all know how desperate the waiting list for CAMHS is and how difficult it is to get the level of support that is needed. We are left with families who are desperately struggling, having to rely on other family members and finding life incredibly difficult.
It is the same for another constituent with a 17-year-old daughter. She did not get the help she needed at the time she needed it. She could not access that primary care. What ended up happening was that she took an overdose, which she survived, but it was clear that her mental health was in such difficulties that she was sectioned. Her parents now find that only one of them is able to work, because the other parent has to be with their daughter at all times because of the difficulties she is facing. That is having a huge impact on their income and their standard of living.
In our area we have tried to do something different with the police. Right Care, Right Person is a joined-up approach from Humberside police, the clinical commissioning group—as it was at the time—local councils, mental health providers and hospitals to decide who is the right person to attend to someone in crisis, and then look at developments. It is not perfect, but it tries to address the difficulties we are having. Many of the cases the police have been sent to are still people actually struggling with their mental health, and the police, like teachers, are not the professionals always best placed to deal with someone in a mental health crisis. We are evaluating that as it goes along, but the demand for services is indisputable.
We need to take a step back a little and think about what is going on. We are talking about citizens advice bureaux providing counselling and support for people with mental health problems. The people that the citizens advice bureaux are supporting are not those who generally have mental health problems; they are people who do not have enough money to live, and their level of debt is causing them to have mental health problems. They are in a situation called negative budgeting, where, quite simply, the amount of money they have coming in is less than the amount of money going out. That is what is driving some mental health problems.
If we are to solve the mental health crisis, we must look at poverty, debt and the cost of living crisis. That is why I am so delighted that my hon. Friend the Member for Tooting (Dr Allin-Khan) said that a future Labour Government’s approach to mental health would be focused not just on health, but across the whole of Government. Until we have that joined-up approach, we will never really tackle the crisis our country faces.
Recovering Access to Primary Care
Emma Hardy Excerpts(11 months, 3 weeks ago)
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Steve Barclay
We plan to change planning guidance this year to address that specific issue. I have visited my hon. Friend’s constituency, and we resolved one of the issues in relation to the estate, which was extremely constructive. I know he has been discussing a further issue with the Department, but I hope he can take some comfort that his representations have been heard. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is planning to make changes to the guidance to better ensure that, where there is new housing, a contribution is made to primary care.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
The problem in primary care is that we do not have enough GPs to meet the demand for appointments. The problem is not with the telephone system. The area I represent has one of the lowest ratios of GPs to population in the whole country. Will the Secretary of State support our campaign to train more doctors at Hull York Medical School, and for Hull York Medical School to set up a training facility for pharmacists and dentists?
Steve Barclay
As I said in my statement, we have 4,000 doctors training in primary care, compared with 2,600 in 2014. We are also looking at how we can better retain the GPs we have. That is why we made the pension changes, which will affect around 9,000 GPs. It is also why we are looking at additional roles to take pressure off GPs, and at how we can reduce some of the burden of bureaucracy, too. We are training more doctors, and we are looking at retention and bureaucracy. No one is suggesting that this is solely an issue of telephony or online booking, as the hon. Lady suggests, but all of this will help to relieve pressure on extremely busy primary care.
Covid Pandemic: Testing of Care Home Residents
Emma Hardy Excerpts(1 year, 1 month ago)
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Each Urgent Question requires a Government Minister to give a response on the debate topic.
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Helen Whately
I know how strongly the hon. Member feels about this. Clearly, we are having ongoing conversations about visiting in care homes at the moment. As is evident in the WhatsApps, I was concerned during the pandemic about ensuring that families were able to see loved ones in care homes. As I have said in response to a number of questions, public health advice had to be taken into account all the way through the pandemic. Getting the right balance between protecting people from the risk of covid being taken into care homes and seeing friends and family will, I am sure, be looked into as part of the public inquiry discussions to answer questions such as his about the decisions taken on visiting. I will continue to work with him here and now to ensure that those who are currently in care homes get the visiting that they need.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
The front page of today’s Telegraph, which reveals that the medical advice was not followed, will be heartbreaking for so many families up and down the country, re-opening the grief that so many felt about the loss of their loved ones. I have listened carefully to the Minister’s responses, and she has basically said that she is unable to compel the public inquiry to move more quickly—that it is above her pay grade. But what she could do now is commit to lobbying the Government to complete that public inquiry before the end of the year, and to doing everything she can to bring those answers forward for all those families who are today feeling so deeply hurt and upset.
Helen Whately
On the first point about the use of public health advice, the hon. Lady is wrong; all decisions were informed by public health advice. On her request about the public inquiry, that inquiry is independent of government, so I cannot do what she asks.
Oral Answers to Questions
Emma Hardy Excerpts(1 year, 3 months ago)
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Steve Barclay
My hon. Friend raises an important point, and we are investing over a fifth more than in 2016, as part of our wider investment programme. I am very keen to work with her on the role of her ICB. It was set up operationally last summer, and its role is to commission primary care services for the community and to assess the needs of her Gosport constituents. I am very happy to work with her and her ICB on the issues she raises.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
Hull has the second highest ratio of GPs to patients in the country. Even though GPs see 46 people a day on average, it is clear that demand for their services outstrips supply. Of course the Labour Government will have a plan to resolve this, but in the meantime will the Secretary of State look at giving women direct access to specialist nurses and services, such as endometriosis or menopause specialists, to prevent them from having to go via their GP each time they need renewed treatment and updated medication?
Steve Barclay
First, that is exactly what the women’s health strategy is doing through designing women’s health hubs. It is exactly why we are appointing a wider portfolio of roles into primary care. The hon. Lady says that Labour has a plan, but Labour’s plan is to divert £7 billion out of primary care property, which will not improve services for women and will actually impede the ability to deliver exactly the sort of services she is calling for.
NHS Winter Pressures
Emma Hardy Excerpts(1 year, 3 months ago)
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Steve Barclay
That is a fair challenge. Let me divide it into three sections. First, there is a recognition that the combination of the legacy from the pandemic, the ongoing covid issues and, in particular, the massive spike in flu create an immediate pressure in our A&E departments. The package announced today shows that we have listened to those on the frontline, and have responded.
Secondly, there is a recognition—this is relevant to some of the questions asked today—that the system has been under pressure for some time. Therefore, the second phase looks at innovation, technology, artificial intelligence, virtual wards and ways of doing things differently. To take the example of the frail and elderly, that will address their needs upstream in the care home before they get to the emergency department or release them from hospital quicker, provided they have the safety net of being part of a virtual ward, where they are subject to ongoing clinical supervision. If they need to come back to hospital, they can do so much more easily than would otherwise be the case. That stops the boomerang of patients being released early and then coming back. That second phase includes the modular capacity, because space is needed to streamline and to triage. That compression within the emergency department also drives inefficiency and poor care.
Thirdly, the Government have invested in the life sciences industry. R&D investment of £15 billion to £20 billion is a big marker of that. One of the priorities is to say that we can do certain things at scale with companies such as Moderna that will shift the dial in healthcare. That is a third but significant part of this, particularly in respect of the prevention work that we can do.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
The failure to fix social care is having an impact on not only the acute service but the mental health service. I have raised directly with the Secretary of State the problems facing the Humber NHS trust, where 42% of adult learning difficulty beds have been taken by patients with delayed discharge and where 17% of adult mental health beds and 22% of child and adolescent mental health beds have been taken by patients waiting for discharge. What investment and support will be given to provide the right social care and support services, to enable beds to be freed up not just in the acute service but in the desperately needed mental health services?
Steve Barclay
The hon. Lady is right to highlight mental health, which is an extremely important part of the wider health landscape. That is why the Government are increasing funding for mental health by £2.3 billion. We must also consider how we get better value for money from that spending. The reform of the Mental Health Act 1983 that the Minister for mental health, my hon. Friend the Member for Lewes (Maria Caulfield), is taking forward will help us better target that funding in ways that deliver value for money.
NHS Workforce
Emma Hardy Excerpts(1 year, 4 months ago)
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Wes Streeting
I do not pretend that our plan is not vote Labour, but of course those are the means by which we get to better ends. What we propose today is the biggest expansion of the NHS workforce in history. I will explain how that will benefit patients across the country and how we will pay for it. I think that people in Peterborough, 2,788 of whom are waiting more than a month to see a GP, will welcome Labour’s plan for investment. That is why, after the next general election, Peterborough will have a Labour MP.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
I want to raise the case of my constituent, Mr Simpson, whose wife died last Tuesday after waiting 16 hours for an ambulance. On 29 November, his wife was confused. At 3 pm, he first called for an ambulance and was told that one might be sent and that he might hear from the service. At 6 pm, he rang the ambulance again. The person wanted to speak to his wife, but she was very confused and unable. He tried to give her a drink at 2.30 am; there was still no ambulance. His wife went to sleep, but she was still moving a bit. He fell asleep. He woke at 7.30 am and found that his wife was not moving; she had passed away. All the while they were still waiting for the ambulance to arrive. I do not believe for one moment that that happened because the ambulance service does not care. Does my hon. Friend agree that the service is desperately understaffed, desperately short of resources and in desperate need of adequate funding?
Wes Streeting
I thank my hon. Friend for raising that heartbreaking case. It is every family’s worst nightmare. All of us now know someone who is waiting for treatment. Many of us know someone who has called for an ambulance and waited for hours and hours—and, in some cases, given up on it and gone to hospital. I have spoken to ambulance service staff who, like many other staff across the NHS, feel a real sense of deep personal moral injury because they know that, despite their best efforts and busting a gut at work every single day, their best simply is not good enough because the system has collapsed. Ambulance turnaround times are not fast enough because A&E waiting times are too high. That is because people cannot see a doctor and the social care is not available, so the beds are full of people who are well enough to go home and would be better off at home. This is the problem in the NHS: the whole system is broken. I am afraid to say that political decisions made in this place by the Conservative party have led us to this tragic situation.
Steve Barclay
We are investing in more doctors. We have 2,300 more doctors—a 3% increase. We also have 3% more nurses than we had last year. In fact, under the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), there was the biggest ever increase in medical undergraduate places—a 25% increase—along with the opening of five new medical schools. Of course, the training takes about seven years, so that is still in progress. As was pointed out during Health questions this morning, we are dealing with the consequences of the pandemic, which is why we are investing in more checks, scans and other procedures, and there will be an extra 9 million of those by March 2025.
Emma Hardy
The right hon. Gentleman might recall that, when he was previously Health Secretary before his short break, I raised concerns around the criteria to reside and the number of people remaining in Hull Royal Infirmary who were unable to move into adult social care. At the moment, we have 30% vacancies in adult social care. The problem is that, although the money is promised, it is not delivered. That is partly because of the chaos that we have seen in the Government. He must acknowledge that, although this money was promised, it was not delivered and that we have 30% vacancies in adult social care across Hull and East Riding. Those vacancies always increase before Christmas because retail makes an attractive offer to those same workers. The money has not been delivered in time, and those 30% vacancies are only going to increase. With the greatest respect to the Secretary of State, there is little point in making promises if they are not quickly delivered in time to make a difference.
Steve Barclay
The hon. Lady mentioned the summer, and I think she knows that I visited the Jean Bishop integrated care centre and looked at the great innovations and brilliant work that her constituents, among others, are doing there. I looked at how it is bringing social care and the NHS together through an integrated model and how there has been new investment, supported by the amazing fundraising within the local community and by NHS funding. It would be great to get a bit of balance about the amazing feedback I heard from both staff and patients at the Jean Bishop integrated care centre who are working innovatively. I hope the hon. Lady would agree that the innovation of a centre such as the Jean Bishop is what we need to see in more places across the NHS. To her wider point, there are challenges in social care; she raises a fair point. That is why, despite the many competing pressures that the Chancellor faces, he has allocated £500 million for this year. It is also why he then committed the £2.8 billion for next year and the £4.7 billion for the year after—the biggest ever increase in that funding. But it is not simply about the funding increase; it is also about using new models such as that integrated care model to deliver far better care.
Steve Brine
Without the heckling from the back row of the Labour Benches, I can say that this has always been my No. 1 priority.
Back in July, the Health and Social Care Committee, which I now chair, published a crucial report entitled, “Workforce: recruitment, training and retention in health and social care”—I urge colleagues across the House to take a look at it, if they have not already done so. We looked at workforce issues right across the NHS, and the findings were stark. The report found that the NHS workforce is facing the biggest challenge in its history. It made the same point about the social care workforce. Although social care is not the focus of today’s debate, it is important to stress, as others have during today’s opening exchanges, that the two sectors are closely intertwined and the workforce problems in the NHS cannot be considered in isolation.
We had NHS Providers before the Select Committee this morning to discuss the industrial action. I asked them whether they support the independent pay review process. I would have intervened on the shadow Secretary of State with that question, but his speech had already gone on for an hour, so I thought he deserved to sit down. More than 1 million NHS workers under Agenda for Change have had, as the Secretary of State said, a £1,400 pay rise this year. That has come out of the independent pay review process. The question I asked NHS Providers this morning, to which the answer was yes, was: do they still believe in the independent pay review process?
Either we have that process, we believe in it and we respect it, or we do not. Are we saying that we have that process and it sticks until something else comes along? If Ministers then become directly involved in negotiating pay for NHS workers, that is a very different proposition. That is not the place we want to be, although the Select Committee is very happy to scrutinise that proposal if it is coming from the Treasury Bench. I would be interested to hear in the winding-up speeches what the Labour party’s position is on the independent pay review process, because it is independent for a reason.
The Committee’s report cited research by the Nuffield Trust suggesting that the NHS in England could be short of 12,000 hospital doctors and more than 50,000 nurses and midwives. The number of people on a waiting list for treatment rose to a record of just over 7 million in September, and the 18-week target for treatment has not been met, as is well known and is on the record, since 2016. Yet, as our report noted, the demand on the sector continues to grow relentlessly. There are estimates that an extra 475,000 jobs will be needed in health by the early part of the next decade.
One of the Committee’s most urgent recommendations was that the Government should do proper workforce planning. We noted that without workforce plans that are independently verified and publicly available, there would be little confidence among the public, the profession or NHS workers themselves that the Government have a grip on the problem.
I must say that the Select Committee has not yet had a Government response to our workforce report—it is a little overdue. The Secretary of State is on the Front Bench, and I know he is busy, but hopefully he will take that back to his officials. We look forward to receiving that response, because it is important that Select Committees get responses to reports in as timely a manner as possible, notwithstanding the fact that there has been a change of Administration.
However, I am encouraged that the Government are paying attention to what the Committee recommended, and I was delighted to hear my predecessor in this role, now Chancellor of the Exchequer, say in his autumn statement that he agreed with himself—his words—and that the Government would now be publishing an independently verified workforce plan for the NHS for the next five, 10 and 15 years, something the Committee has long called for. The Treasury outlined that the plan would
“include measures to make the best use of training to get doctors, nurses and allied health professionals into the workforce, increase workforce productivity and retention.”
Excellent—that is progress.
Questions remain, however—maybe the Minister can touch on this in her winding-up speech—about what the independent workforce planning will look like in practice. We need to know more about who will provide the independent verification once the work has been done. I understand the work has largely been done by the NHS, but we need to know who will be doing the independent verification, when it will be published and how regularly it will be reviewed. When we know that, we will look forward to talking to him or her in the Select Committee.
Our report contained a number of other important and detailed recommendations about how to tackle the NHS workforce crisis. I do not want to go into all of them today—as I have said, the report is on the record and published in the House—but among them I wanted to highlight the radical review of working conditions that was touched on by both the shadow Secretary of State and the Secretary of State.
Work conditions are critical. We talked about the need to reduce the intensity of work felt by so many people in the service—which I hear about both as a constituency MP and as Chair of the Select Committee—and the need to boost retention and of course recruitment of people who are looking at where they might work when they have done training. We recommended that the review should start with an overhaul of flexible working, which would mean that NHS workers were not driven to join agencies or become locums to gain control over their working lives. I often hear those words, “We just need control over our working lives.”
We also said it is a huge problem that senior doctors are being forced to reduce their working contribution to the NHS or to leave it entirely because of the long-standing problem around pension arrangements, which was a problem when I was a Minister in the Department. We accept that the Government have made some progress on pensions, with changes to the taper rate and the annual allowance, and credit to them for that, but we note that the problem persists and have called on the Government in our workforce report to address it.
In that context, to give credit where it is due, I was very pleased to see on Monday that the Government have announced plans to amend NHS pension rules to retain senior doctors and encourage staff to return from retirement. The Secretary of State was slightly mocked when he said that was subject to a consultation, but that is how government works. If the hon. Member for Ilford North (Wes Streeting) were to become Secretary of State—I like him very much, but I hope he does not—he would also publish consultations, because that is how proper government is done, and he knows that. We look forward to seeing the Government response to that consultation, which I know the Secretary of State is keeping a keen eye on
The Secretary of State is right to say that there are a record number of doctors in training, with five new medical schools, two of them focused on training GPs. That is true, but the Select Committee will return to our workforce work next year, and we will be taking evidence from anyone who wishes to contribute about the cap on training places. I have said to Ministers and to No. 10 that I think the Government are going to have to look again at that issue. I hear in my constituency from bright young boys and girls who wish to train as medics, whose parents have maybe worked in the profession and who have that ambition for themselves. The cap is a problem.
My other point is about demand. We had somebody from the British Medical Association’s GP committee before the Select Committee this morning, as part of our ongoing inquiry into integrated care systems, who was talking about the NHS being underfunded. That depends on which end of the lens we look at, does it not? We spend £150 billion or so of taxpayers’ money on the NHS. We could spend £300 million; that would be a choice. We would have to fund it, of course, because we know what happens when people make unfunded spending pledges from the Dispatch Box—the markets go into meltdown, and rightly so.
We need to have a serious and honest conversation with ourselves about how much of our national wealth we wish to spend on our health service and whether that would achieve the desired outcomes. We are the fifth-largest spender on health services in the OECD, but we do not get the fifth-best outcomes. I can give the House a bit of an exclusive here, because in the new year the Select Committee will be launching a big inquiry into prevention. Anyone who knew me when I stood at the Dispatch Box as a Minister will know that cancer and prevention are the two things that most get me out of bed in the morning, so we will do a big piece of work on prevention.
My view and the view of many others is that the NHS will have long-term sustainability challenges if we do not get serious about prevention. I do not just mean returning to the argument around obesity and all the things I wrote about in the child obesity plan when I was a Health Minister, although they are important and I urge the Government not to backtrack on any of those policies but to implement them, because weight is a major problem in our ill health. We need to get upstream of ill health.
I will say more about this in the debate in the House on Thursday, but when the Committee returns to cancer work, we must look at future cancer and at getting upstream of cancers. At the moment, we want to diagnose quickly, but people have to have symptoms in order to be diagnosed quickly and then we need to treat very quickly as well, within the 28-day standard. The Secretary of State and I have talked several times already about how we need to get far ahead of that.
We need to bring together predictive medicines, biomarkers and some of the life sciences work that is going on with the NHS’s genomic strategy, and get ahead of some of the illnesses that drive ill health in our country. Without that, in my humble opinion, the NHS has long-term sustainability problems.
Emma Hardy
This is a perfect point for me to lobby the hon. Gentleman on also looking into diagnosis times for people with endometriosis, who are waiting on average seven and a half years to receive a diagnosis, and women’s health treatment generally. That would be a wonderful inquiry for his Select Committee to look into and take under observation.
Steve Brine
Duly lobbied, thank you. The hon. Lady has mentioned this to me many times before; I take the point on board and other members of the Committee in the Chamber will have heard her too.
In all the work that we are doing on the Select Committee, whether on ICSs, prevention or cancer, or the work done by my predecessor chairing the Committee, workforce is without question the common theme that runs through all of that. We cannot get away from that. I think there are encouraging signs that the Government are listening to the Committee, and of course we have a great advocate in No. 11 Downing Street and in the Secretary of State, who I was pleased to see reappointed to his position.
I urge the Government to continue to listen to the Select Committee. We are a cross-party Committee, looking at things in a sober, calm, evidence-based way, and we look forward to the Secretary of State coming to see us soon to talk about these issues. The invitation is always there, as he knows.
The workforce challenges that the NHS faces are the bottom line. Without tackling them, we are not going to move forward on many of the challenges that I know the system has. I welcome this debate; I hope we can keep it sober, keep the party politics out of it and focus on the NHS, because ultimately that is what our constituents demand of us.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
In Hull West and Hessle, 1,730 people are waiting more than 28 days to see a GP and 6,225 are waiting more than 14 days. The ratio of GPs to patients in Hull is one of the lowest in the country, which is fuelling some of the many problems that we are seeing in accident and emergency. That is combined with the concerns that I raised with the Secretary of State about the delay to discharge; the 30% vacancies in our adult healthcare sector; and the delay in money that the Government promised to adult healthcare services, which means that delays are only increasing. I am incredibly concerned about what will happen over the winter.
I will focus my remarks on my concerns about radiotherapy, about which I have written to the Minister of State, Department of Health and Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately). With respect, I wrote to her on 3 September and received a reply on 28 November, which is disappointing on such a serious matter. I raise that issue today because, in August, I received an update from the Humber and North Yorkshire cancer alliance about the state of radiotherapy. For those who are unfamiliar, radiotherapy is used to treat and kill cancer cells and to shrink tumours. It is often used in the early stages of cancer.
In the briefing note that the Humber and North Yorkshire cancer alliance sent me, which I can only assume it sent to other Members of Parliament, it says:
“It is expected that the radiotherapy position at HUTH will worsen through the year. The reduced capacity obviously could pose a risk to patients (from a health and wellbeing perspective, as well as from a patient experience perspective).”
The reason it wrote to me to tell me of its concerns about radiotherapy is the shortages we have in the area. It says that the percentage of Hull University Teaching Hospitals NHS Trust patients who began radiotherapy as their first definitive treatment for cancer and who did so within 62 days of an urgent referral for suspected cancer—within 62 days of an urgent referral—was 22% in July, 50% in June and 29% in May, compared with over 50% previously. The percentage of HUTH patients who received radiotherapy following their first definitive treatment within the 31-day target was 44%. So the majority of people are not being seen for their cancer treatment within the 31-day target, and only 22% of people sent for urgent referrals for suspected cancer are being seen.
The reason for this is given in the briefing note, which says:
“Many of HUTH’s therapeutic radiographers have left the profession to pursue a better work-life balance, while those who have remained in their roles have also sought improved work-life balance by seeking roles closer to where they live to reduce commute times.”
That is the reason people are leaving—to seek a better work-life balance. It is not because they do not care or they do not wish to continue to treat people, but because they simply cannot maintain it at this level. The note says that
“staffing shortages is an issue experienced across the country.”
It also says—this is a key point because the Government’s defence is often that the pandemic has caused all these problems:
“Therapeutic radiography has been considered a vulnerable profession for years.”
Pre-pandemic we were having problems with radiographers, but no action was taken, and this is still considered a problem right now.
I wrote to the Minister and the Secretary of State about this, quoting from the briefing note. I sent the letter on 3 September, and I said:
“I am sure you will agree that the evidently increased waiting time for potential life-saving or life-prolonging treatment is extremely concerning.”
I understand that Hull University Teaching Hospitals NHS Trust is doing everything it possibly can. It has taken on two apprentices to be trained up as radiographers, but we all understand that we cannot instantly produce the radiographers we need. As I say, I sent the letter on 3 September, and it was also signed by my right hon. Friend the Member for Kingston upon Hull North (Dame Diana Johnson) and my hon. Friend the Member for Kingston upon Hull East (Karl Turner). It took the Minister until 28 November to reply, even though I started the letter by saying:
“I am writing having received a very worrying update from the Humber and North Yorkshire Cancer Alliance regarding a reduction in services”
in my constituency.
In her reply, the Minister admitted:
“HUTH advises that, to protect existing staff and maintain the service, it was necessary to reduce capacity to sustainable levels, which has in turn led to the inability to reach specific targets and a growing waiting list.”
So this is a problem that the Government are well aware of, despite their delay in responding to it. It is a problem that has been around for years, and it is a problem that is literally a matter of life and death. If people do not get the cancer treatment they need when they need it, we know the consequences. The failure to deal with and address the NHS workforce is not just a mild inconvenience; it is an incredibly serious matter that has been a long time coming and a damning indictment of 12 years of Conservative mismanagement of our NHS.
Emma Hardy
As I pointed out in my speech when I was talking about radiotherapy, the reason people are leaving the profession is to do with the work-life balance. It is not just a question of the number of people who are leaving midwifery, but a question of the number of people in midwifery who are reducing their hours to try to achieve that balance. Does my hon. Friend agree that something is seriously amiss when people have not fallen out of love with the job, but are simply finding that they cannot do the job while also maintaining the home life that they need?
Holly Lynch
Once again, my hon. Friend is absolutely right, as I know when I meet those children of NHS staff who hold up signs saying, “When my mummy is late home it means that I am a lonely kid”. As other Members have pointed out, when NHS workers are exhausted at the end of a shift but find that the cavalry is not arriving and there is no one to take over, they cannot walk out of their jobs as other people might be able to. They have to stay and deliver patient safety, rather than leaving those patients at risk. Questions about the life-work balance and childcare—who will feed the kids when they get home?—are not easy questions for workers in that position to answer.
We have to transform the experiences of mothers and families using maternity services. Like almost every other parent who has had to use those services in recent years, I can say that it is a massive worry. You are told, “Once your waters have broken and your contractions are this regular, come to the hospital”, but even after that point I kept being asked not to come to the hospital, because there was only one bed left and it might be needed for someone else. That is the last thing you want to hear when you are in labour. Worrying about staffing and bed shortages compounds what is already one of the most stressful experiences that women—indeed, parents—can go through.
Let me now say something about paramedics, and all those working on the frontline of our ambulance services. I have worked closely with paramedics, in particular with the GMB’s union representative, Sarah Kelly, on the Protect the Protectors campaign, and I have spent a day out with paramedics, seeing just how relentless their days are. Analysis carried out by the GMB found that there were 7.9 million calls for an ambulance in 2010-11, but by 2021-22 that had risen to 14 million, a pretty staggering increase of 77%. The monthly handover delays report from the Association of Ambulance Chief Executives reveals that the performance of ambulance services fell to its lowest ever level in October. The report shows that, across the month, 169,000 hours of ambulance crew time were lost due to delays. That meant that paramedics could not answer over 135,000 calls for help. That number represented 23% of ambulance services’ total potential capacity to respond to 999 calls. All three of these metrics are the worst in the NHS’s history.
Staff have balloted for industrial action, and we can see how they do not feel listened to and that they are carrying so much responsibility. My hon. Friend the Member for Ilford North (Wes Streeting) has already made this point powerfully from the Dispatch Box. None of us here in the Chamber today has to face the reality multiple times a day of knowing that, no matter how hard we work, there could be fatal consequences for the vulnerable people we are looking after because the system in which we work is fundamentally failing. We do not carry that burden; we ask the paramedics, and all NHS staff, to carry it.
We know that, in addition to this, too many workers—after making such an exhausting contribution to the NHS—are facing financial hardship for their efforts. Like in midwifery and other areas of the NHS, research indicates that one in 1,000 ambulance workers have left since 2018 to seek a better work-life balance or better pay, or to take early retirement. It is not that workers are asking for more pay for the sake of it; it is because inflation is at 11%, energy bills have gone through the roof and the cost of fuel to enable them to get to work has shot up. The National Institute of Economic and Social Research has predicted that around 30,000 households could see their monthly mortgage repayments become greater than their monthly income in the months ahead. If the Government got a grip of these factors, they would not have so many workers being forced to ask for more pay just to make ends meet. I ask the Government to please speak to workers, to work with their trade unions and to work through their concerns, which are very real.
Turning to NHS dentistry, I presented a petition to the Government on 1 November on access to NHS dental care, signed by 549 people online as well as a number of signatures in hard copy—some are still coming into my office. Like all MPs, I have had so much casework in recent months where local people simply cannot see an NHS dentist. The British Dental Association says that more than 43 million dental appointments were lost between April 2020 and April 2022, including more than 13 million appointments for children.
Dentistry is now the No. 1 issue raised with HealthWatch, with almost 80% of the people who contact the organisation saying that they find it difficult to access dental care. The General Dental Council says that almost a quarter of the population—24%—report having experienced dental pain in the last 12 months. More locally, HealthWatch in Calderdale contacted every dental practice across Calderdale last year to establish whether they were willing to accept new NHS patients, whether they would register a child and whether they were offering routine appointments. Every dental practice told HealthWatch that it could not currently register a new NHS patient of any age. It is the same story.
Data from the British Dental Association reveals that 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. For every dentist leaving the NHS entirely, 10 are reducing their NHS commitment by 25% on average. A BDA survey from May 2022 shows that 75% of dentists plan to reduce the amount of NHS work they do next year, with almost half planning to change career, seek early retirement or enter fully private practice. As in other areas of the NHS, the combination of pressures and remuneration is driving what remains of a depleted workforce away. It is a self-defeating cycle that the Government have to step in to break.
Other Members have made points today about the potential of community pharmacies. Having worked in a pharmacy when I was in the sixth form doing my A-levels, it became clear to me that this was often the longest standing and most trusted relationship that members of the community had with a healthcare professional. The pharmacy was the shopfront that was always open during the pandemic, where people could go and meet somebody who knew them and knew their circumstances. That really is the value of community pharmacies. We know they have the capacity to do so much more, and hon. Members on both sides of the House have spoken about unlocking that potential and relieving some of the pressure on A&E departments and GP surgeries by empowering community pharmacies to deliver the work they are best placed to deliver because of their deep roots in our communities.
Labour has a plan for the NHS. It is costed, comprehensive and will save the NHS. In today’s debate, the Government have not had the humility even to acknowledge that there is a problem in the NHS, never mind having a plan of action. That is why a Labour Government cannot come soon enough.
Oral Answers to Questions
Emma Hardy Excerpts(1 year, 5 months ago)
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Maria Caulfield
I thank my hon. Friend, who raises a good point. He does a huge amount of campaigning in Harrogate and Knaresborough on this issue. We recognise there can be long waits for diagnosis both for ADHD and autism, and that is why we refreshed our national autism strategy last year, backed by more than £74 million to help to reduce diagnosis waiting times. NHS England is now setting out the process of how children, young people and adults might receive a diagnostic assessment much more quickly.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
Delayed discharge from mental health beds is preventing people from getting the treatment that they need. In fact, in Humber NHS trust 42% of learning disability beds are taken by people with delayed discharge, 5.5% of secure beds have patients in waiting for adult social care, as do 70% of adult mental health beds, 22% of CAMHS beds and 27% of community beds. To deal with the problem in mental health, we need to deal with the problem of lack of adult social care placements. When will the Government be able to fix that?
Maria Caulfield
The Government actually started working on the plans around delayed discharges this summer, because of course they affect mental health services. They also affect a range of acute beds. With the winter coming, we know that there will be additional pressure on those beds, and that is why we are working with local government social care services and integrated care boards which have responsibility for that in their local areas.
Urgent and Emergency Care
Emma Hardy Excerpts(1 year, 7 months ago)
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Steve Barclay
As my hon. Friend knows, my parents live very near the hospital in question. I know he has been a huge champion of the additional funding. If the opportunity arises, I would be very happy to visit. I pay tribute to the work he has done to secure the additional facility, which will benefit his constituents and those across the Fylde coast.
Emma Hardy (Kingston upon Hull West and Hessle) (Lab)
In July, I met the Royal College of Emergency Medicine and the chief executive of Hull University Teaching Hospitals NHS Trust to discuss the ambulance delays and the delays at A&E. They both told me the same thing: the problem is actually with exit block. They cannot admit people if they cannot discharge people. I have been told by Hull Royal Infirmary that at points over the summer, more than 170 people were in the hospital who should not have been there because they were waiting for discharge packages. That works out at more than a fifth of hospital beds being taken up by people waiting for adult social care.
A number of months ago, I raised in this place a letter from the Conservative-led East Riding of Yorkshire Council, which said that it did not have the adult social care carers to meet the needs of the population. This situation will only get worse. The Secretary of State has said that he is looking at an international recruitment taskforce. I recommend a simpler solution: pay people more, and then we might get the workers we actually need to deliver adult social care. This is already a crisis and it will only get worse.