Hospice Funding

John McDonnell Excerpts

Monday 22nd April 2024 Commons Chamber

[John McDonnell (Hayes and Harlington) (Lab)]

I am a trustee of Harlington hospice, and have been for the past decade. I hope to stand down shortly, because we have recruited four excellent new trustees and I am terrified that someone might ask me to run a marathon or something like that.

[Eddie Hughes (Walsall North) (Con)]

Together with my hon. and learned Friend the Member for Eddisbury (Edward Timpson) and the hon. Member for Glasgow North (Patrick Grady), I did run the marathon yesterday —on behalf of St Giles hospice, for which I raised more than £3,000. May I invite the right hon. Member to join us in that endeavour next year? Let us not allow the opportunity to pass.

[John McDonnell]

I set myself up for that, didn’t I? I congratulate all those who did run, but running a marathon might well see me off.

Over the last year or two, our hospice has merged with the Michael Sobell sports centre. We now provide a bedded unit, daycare facilities, respite care—particularly for unpaid carers—and a hospice-at-home service. My hon. Friend the Member for Hammersmith (Andy Slaughter) said that debates such as this allowed us to pay tribute to organisations, and I certainly pay tribute to Harlington hospice. I pay particular tribute to the volunteers, including the chairs over recent years. I hope they will not mind my naming them: Brian Neighbour, who was formerly one of our local councillors, Carol Coventry and, now, Michael Breen. These volunteers give up their time and bring their professional skills to this work. We have a wonderful medical director, Ros Taylor, and an incredibly hard-working chief executive, Steve Curry. Their efforts provide the services and have enabled us to survive, but it has been tough. Like the hospices mentioned by a number of other Members, we have just had to lay off some staff. There is nothing tougher than having to lay off staff who are so dedicated.

The issue for us, as always—this has been reflected throughout the House today—is the need for core funding on a sustainable basis. We need something like a five-year plan that we could work to. I know that sounds a bit Stalinist, but sometimes they work; sometimes they do produce the tractors! We need consistency over a period. As Members on both sides of the House have said, including my hon. Friend the Member for York Central (Rachael Maskell), if we could rely on staff funding from the state, that would lift the burden to a certain extent. We will continue the fantastic fundraising that is currently happening, but in a working-class community like mine, during a cost of living crisis, it is not that people do not want to give, but they do not have the resources to give. We have had a bit of a rough time now and again. A number of corporate organisations have helped us through, but even then, when they are looking at their margins during an economic recession, or when times get hard, there is a downturn for us as well. We just need the consistency of funding over a period that will enable us to build on our services.

At present our services are swamped, and the range of services is becoming more complex as well. We were providing a lymphoedema service at one point. The complexity of the millions with which we are dealing requires more specialists, and that in turn requires more funding. Although there have been percentage increases in NHS funding, they have gone nowhere near meeting the real costs that are challenging us at present. We have a good relationship with our ICB—we work with bids for contracts, and with other community organisations delivering on the ground—but we want consistency of approach.

We have organised a conference for 8 May. It is called “Death, Dying and all that Jazz!”, and it will bring together a range of clinicians and others, along with Hillingdon Hospital and other volunteering services, under the auspices of Harlington hospice. We will look at what we are undertaking, what is needed, and how we plan for the future. If the Minister would like to visit the conference or send representatives, we would welcome that. We want to engage in discussion. We are coming up to a general election, but I hope that this will not become a general election issue, because what we have seen in the House and in the work of the all-party parliamentary group, which I commend, shows that there is consensus on the core principles of the way forward.

If we could secure a long-term commitment on a cross-party basis, we could go back to our hospices, talk to our executives and trustees, congratulate them on what they are doing, and give an assurance that they will have a rock-solid financial base on which they can build, thereby allowing them to rise to the challenges in our communities.

My final point is about the demand that we face. Eight people die in hospital for every person who dies in a hospice, yet most of those eight people would prefer to die either at home or in a hospice. That is the challenge we face, and we have seen tonight that we have the wherewithal to meet that challenge, and ideas on how to do so.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Hastings and Rye (Sally-Ann Hart) for setting the scene so well, as well as all those who have made substantial contributions. Hon. and right hon. Members have been incredible in their joint efforts to support hospices across this great United Kingdom of Great Britain and Northern Ireland, and I want to add my bit from a Northern Ireland perspective.

There will be no Member in this House who has not had some form of contact with hospice care, either through our roles as Members of Parliament or in a more personal nature, as many of us have. I will tell the House a quick story about that. We cannot talk about hospice care without acknowledging the level of care that is provided by the world- class staff in hospices. Every one of us knows that, having dealt with those who give that care. Having seen the work that they carry out and the compassion with which they do so, I know that it is certainly a calling, because money could not pay enough to deal with the emotional toll of this work.

I knew a lady who worked as an occupational therapist in the national health service, and we got on quite well. She went on holiday to Greece one September, and she came back and went to the hospice. She was not feeling well, and the doctor told her that she had only four weeks to live—she had cancer of the liver. I remember going to see her at the Marie Curie hospice care headquarters on Knock Road, Belfast; it was my first introduction to hospice care. I said to the girl on the desk, “Would you tell Anne that I came to speak to her?” And the lady said, “Just a minute, and I’ll go and see if she wants to speak to you.” I said, “No, don’t worry about that, because it’s not important—just tell her I called.” I realised that day that Marie Curie hospice care is incredible, having seen what it did for Anne and her family.

As I said in my intervention on the hon. Member for Hastings and Rye, I believe that faith and family are important whenever our heart is breaking and our world is falling apart. The Marie Curie hospice in Belfast makes sure that people have faith to help them through those difficult times, which is important.

From offering light-hearted banter while helping people in embarrassing situations to being the scapegoat for anger or frustration, to being the last person to hold a person’s hand when their family do not make it in time, being a care giver in a hospice is more than a job. From the bottom of my heart, and from the bottom of all our hearts, I thank all those who do what most of us could not do—love and serve to people’s last breath, day in and day out. I thank every healthcare attendant, every nurse, every doctor, every porter and every pharmacist, and the entire team who provide the best end of life care and offer a support system to lost and grieving families.

[John McDonnell]

The shops that do the fundraising for our hospices have been mentioned, but an unmentioned group of heroes are the shop volunteers who provide a wonderful service in my constituency—a wonderful recycling service, as well—and funding for many of our hospices.

[Jim Shannon]

That is good to remember. I will mention the volunteers.

The hon. Member for Walsall North (Eddie Hughes) is no longer here, but he mentioned a sponsored walk and encouraged the right hon. Member for Hayes and Harlington (John McDonnell) to be involved. Like the right hon. Gentleman, I could not run a marathon, and I probably could not walk it, but he and I could probably dander it—that is the third category. We are danderers. I could do 26 miles, but it would be at my own pace. I am sure everyone else would be on their way home whenever he and I crossed the line—that is a story for another day.

We cannot pay hospice workers enough, but we have a responsibility to ensure that there is enough money to pay them. I do not feel we are currently doing enough, as other Members have said very clearly. The consensus is that we all want to see them paid better, and we want to see the care continue.

Northern Ireland Hospice provides specialist palliative care for more than 4,000 infants, children and adults in Northern Ireland with life-limiting conditions. The charity, which includes the only children’s hospice in Northern Ireland, says that it faces a number of challenges,

“not least of which is the ever-growing cost of this service. Government funds approximately 30% of service costs”.

The hon. Member for Darlington (Peter Gibson) spoke about Foyle hospice, which has to find 65% of its service costs. Well, every other hospice in Northern Ireland has to find 70%, relying on the

“goodwill and generosity of voluntary donations and other fundraising activities.”

Eating Disorders Awareness Week

John McDonnell Excerpts

Thursday 29th February 2024 Westminster Hall

[John McDonnell (Hayes and Harlington) (Lab)]

I congratulate the hon. Member for Bath (Wera Hobhouse) not just on securing this debate, but on her dogged pursuit of this issue over the years. The Minister should be aware that the all-party parliamentary group on eating disorders is one of the most active and effective in Parliament, as a result of her work. She has collected around her hon. Members, such as my hon. Friend the Member for Sheffield, Hallam (Olivia Blake), who are extremely committed in representing their constituents.

We all come to this issue as a result of dealing with our constituents and the hardships that they have faced. I thank Hope Virgo for her work, her campaign and the book she has written. If it was not for her, I do not think we would have been on this agenda as effectively as we have been in recent years.

I thank the Government as well because, early on, they recognised that there was an issue and brought forward some resources. I am grateful for that, but this is one of those issues where things are moving so rapidly in terms of the scale of the problem. We will have to come back to the Government regularly to look at how we top up those resources.

Much has been said about the statistics. I heard the figure of 1.25 million people mentioned and others have said 1.6 million, but it seems like a bottomless pit. The health survey was really interesting. If I remember rightly, it looked at those who had the potential for an eating disorder, so it was trying to get ahead of the numbers, and it said that 16% of the population—19% of women and 13% of men—could be at risk. One of the issues that the APPG has been really good at breaking through on is that this is not just about women; a large number of men are also affected by this problem, and that needs to be addressed.

In all these debates, we try to get across the impact and, to a certain extent, highlight to our constituents that we understand how their lives are affected. Of course, the mental health issues are fundamental. There have been suicides and deaths, but there has also been an outbreak of self-harm among people suffering from this condition. People have reported that there has been an impact on their ability to work, meet socially and engage in a full life. What has worried me most is the huge increase in the numbers being admitted to hospital—I think there has been a fourfold increase in recent years.

As has been said, this is the mental health condition with the highest mortality rate. Part of that is because there is a mismatch between the scale of the problem and the resources available, and that includes the number of hospital beds. I understand that there are only 450 specialist beds, but the admission rate is about 20,000, so there is a startling difference between what is needed and what has been provided.

[Wera Hobhouse]

Does the right hon. Gentleman agree that the biggest problem is that for too long, this condition has been seen as a lifestyle choice rather than an illness? We still need to make a breakthrough on that.

[John McDonnell]

Thanks to the work that the hon. Lady, the campaigners and others have done, the media reporting of this issue has, to a certain extent, changed dramatically, but that has taken years to achieve. I agree that this is still seen as a lifestyle choice. It is not seen as serious; people do not relate deaths to this condition, but we all know from dealing with our constituents that that is what happens.

The other issue about the access to hospitals and clinics is that we have all had to map out, across the country, where constituents can go. Often, what happens is that they are discharged from one unit and it is then almost impossible to get them into another, particularly if there are specialist concerns.

The issues that we are reiterating today include the fact that the funding needs reviewing again, because the situation has moved on since we last discussed funding with the Government. There is also a lack of clarity, so we need a concrete action plan for the coming period. One of the issues is how we bring people together. There is a real concern about the lack of monitoring. One of the proposals, which I think Hope Virgo first raised, is to have a discussion about how we are monitoring this situation, both in terms of incidents and the effectiveness of different treatments. A proposal from one of the discussions we had is that it is time to bring together again those with experience of the condition and the key clinicians in the field, so that we can stand back and objectively look at where we are at. When we have dealt with homicides and suicides in other fields, we have set up independent inquiries because of the seriousness of the matter. In some instances, I feel that we need some form of inquiry to see where we are at and what is needed in the future.

The hon. Member for Bath and my hon. Friend the Member for Sheffield, Hallam mentioned the staff. The impression I get from the discussions I have is that, because of the increasing demand, staff are experiencing a level of exhaustion and a morale issue about simply being able to cope with the numbers and severity of the conditions they are dealing with. One thing we can do today, as others have, is to acknowledge the commitment and dedication of those staff, while recognising that they need greater support, in terms of both numbers and pay, to demonstrate just how valued they are.

The issue around the NICE guidelines has already been raised, and my experience is the same as others’, really. It is hit or miss; there is a postcode lottery in the provision of treatment under the guidelines. The Dump the Scales campaign by Hope Virgo and others has been effective at moving the debate on from just talking about BMI, so that a wider range of discussions are now taking place, which I really welcome. However, there is still no recognition across services that eating disorders are a mental health issue, and that therefore mental health practices that have been effective elsewhere need to be applied here. I argue very strongly for the need to fund cognitive behavioural therapy, which has a success rate of 70%, I think. It has also reduced readmission rates down to about 15%, so it is a huge money saver for the NHS. Again, we need to look at the levels of investment, both in training staff for that and in ensuring access.

I want to mention another issue that has been raised before. We have found too many examples of the provision of palliative care to eating disorder sufferers, which we are hoping will end. Palliative care should be offered only if there is another life-threatening condition; it should not be offered just because of this condition. We hope that that has now been ended, but it needs monitoring again to ensure that the message is out there. Our overall view is that, with the right support and early enough intervention, people’s lives can be saved, and that their lives can be transformed as a result, but it does need adequate funding.

The hon. Member for Bath mentioned the ringfenced fund that is needed for research. At this stage, it is time to stand back, bring together sufferers and clinicians, and look at what the strategy should be. We need an adequately funded, concrete strategy that we can all sign up to. This is a cross-party issue; it is not party political. As I say, I welcome what the Government have done so far. We are now at the stage where we know so much more about the escalation of the problem and the need for therapeutic interventions, and about what works and what does not.

My final point is to pay tribute, as others have done, to all the campaigners who have put this issue on the agenda and provided support throughout. I pay tribute to all the clinicians, of course, and to one group in particular, which is the school nurses—Members may recall that we held a session with them. They brought forward their programme for how they would provide advice and assistance to pupils, which proved to be incredibly effective. Of course, I also pay tribute to all those who have supported the all-party parliamentary group of the hon. Member for Bath with such expert advice, as well as consistent nagging.

[Mr Philip Hollobone (in the Chair)]

We now come to the Front Benchers, the first of whom will be Patricia Gibson for the SNP.

Podiatry Workforce and Patient Care

John McDonnell Excerpts

Tuesday 20th June 2023 Westminster Hall

[Peter Dowd (in the Chair)]

I will call John McDonnell to move the motion, and I will then call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up.

[John McDonnell (Hayes and Harlington) (Lab)]

I beg to move,

That this House has considered the podiatry workforce and patient care.

The background to this debate is a meeting I had with a number of local podiatrists representing the Royal College of Podiatry, so let me thank them for the briefing that the royal college has sent me. I want to talk about the development of a workforce strategy for podiatry.

To explain for those who may take an interest in the debate, podiatrists are highly skilled healthcare professionals. They are trained to assess, diagnose, prevent, treat and rehabilitate complications of the foot and lower limbs. They manage foot, ankle and lower-limb musculoskeletal pain, and skin conditions of the legs and feet. They treat infection, and assess and manage lower-limb neurological and circulatory disorders. They are unique in working across conditions and across the life course, rather than on a disease of a specific area.

A podiatrist’s training and expertise extends across population groups to those who have multiple chronic, long-term conditions, which place a high burden on NHS resources. The conditions largely relate to diabetes, arthritis, obesity and cardiovascular disease. In addition to delivering wider public health messages in order to minimise isolation, promote physical activity and support weight-loss strategies and healthy lifestyle choices, podiatrists keep people mobile, in work and active throughout their life. They contribute to the wellbeing of our economy and workforce.

Podiatry is intrinsic to multiple care pathways too, and podiatrists liaise between community, residential, domiciliary, secondary care and primary care settings. They specialise in being flexible and responsive, ensuring focused patient care, irrespective of the clinical setting. Podiatrists are at the forefront of delivering innovation in integrated care. They deliver high-quality and timely care, as well as embracing safe and effective technologies that lead to improved patient outcomes.

The role of podiatrists in managing diabetic foot complications is key. They play a vital role in the prevention and management of diabetic foot complications, which, at the last estimate, cost the NHS in England £1 billion a year. In the three-year period from 2017-18 to 2019-20, there were over 190 minor and major amputations per week in England. Of the people affected, 79% will be confined to one room within a year, with 80% tragically dying within five years. That is a shocking outcome for patients, and it is even worse than the outcomes for the majority of cancers we seek to deal with.

The impact of lower-limb amputations on patients’ quality of life and chances of survival are shocking, so we must do everything we can to prevent diabetic foot complications. We have to act in a timely and targeted manner to ensure that people have the best possible chance of living long and fulfilled lives.

It is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer, infection and amputation free.

[Jim Shannon (Strangford) (DUP)]

I declare an interest as a diabetic, so I understand exactly what the right hon. Gentleman is saying. I am aware of the silent but vital work carried out by podiatrists throughout the United Kingdom. In my constituency of Strangford, a nursing home where funded podiatry appointments were cut was still visited by a podiatrist. He was able to attend, but he treated people without taking any money. Does the right hon. Gentleman not agree that access to podiatry for the elderly in care homes should be fully funded and that they should not have to rely on family or kind-hearted podiatrists to get their health needs taken care of?

[John McDonnell]

What I have discovered on my journey of finding out about podiatry, which I knew very little about before I met podiatrists in my constituency, is that of course people need professional care, and that care needs to be properly funded. There are volunteers, but we should not have to rely solely on volunteers; we need professionals leading the way. Podiatrists are skilled and trained in the prevention and management of diabetes-related foot complications. That is why many of us believe that they must be at the heart of the NHS plan to eliminate unnecessary amputations and the consequent avoidable deaths.

As I said, the broader cost of diabetic foot ulcers to the NHS is more than £1 billion per year—the equivalent of just under 1% of the entire NHS budget. Effective and early intervention for diabetic foot complications prior to ulceration could save thousands of lives and millions of pounds each year.

The situation in my area in Hillingdon exemplifies what is happening elsewhere in the country, which the hon. Member for Strangford (Jim Shannon) has mentioned. Hillingdon’s community podiatry service is part of the Central and North West London NHS Foundation Trust. It is suffering from severe workforce issues, which is having a detrimental effect on the people delivering the service and those suffering from foot ulceration, infection and amputation.

The service is currently failing to meet its timescales for seeing patients at high risk of developing a foot ulcer. What should be a team of 13 clinical podiatrists is now just 3.5 full-time equivalents and three support workers. The immediate concern is the pressure that puts on the staff who remain and the impact it has on the patients who need a minimum of weekly wound re-dressings to enable healing and prevent infection and life-changing amputation. The opportunities to prevent life-changing and life-threatening complications are minimised by the shortage of staff.

We also have concerns that support workers are being asked to triage and treat people beyond their scope of practice due to the staff shortage. That is not a criticism of them, but it is the reality. We should be filling the service with professionals who are fully trained to deal with the range of complications that they might come across. The workforce challenge facing podiatry is the real issue.

There is a need for focused recruitment. As I said, it is estimated that by 2025, 1.2 million people with diabetes in the UK will require regular podiatry appointments if they are to remain ulcer and amputation free. In the absence of that, there will be a greater risk of premature disability and death. There are currently just under 10,000 podiatrists registered with the Health and Care Professions Council. That is just one per 5,500 residents in England, and that number is due to decline as a result of demographics.

Following the removal of NHS bursaries for student podiatrists in 2016, the number of undergraduates studying podiatry has declined by 38%. Prior to that, the student bursary was set at £9,000 a year and it covered the cost of tuition for a year. In 2020, in a welcome move, the Government reintroduced student bursaries, but at £5,000. That has caused a slight improvement in recruitment to the profession, but it falls far short of ensuring the future of the podiatry workforce that will be required to deal with the oncoming wave of severe diabetic complications coming out of the pandemic.

Another issue is that the average age of podiatry students on graduation is 32. The majority of students are pursuing a second degree, and the need for a second student loan is having a damaging impact on universities’ ability to recruit undergraduates to train as podiatrists. By leaving it up to the market, we face the prospect of not training the workforce required to meet the needs of an ageing population.

The other issue raised with me is the limited career progression in NHS settings. Of the podiatrists currently qualified in England, approximately 40% work in the national health service. It is projected that many of those podiatrists not heading for retirement are likely to move to work in the private sector in the next five years. The reasons cited for that include lack of career development opportunities; repetitive workloads, with limited skill mix; and high demand and low capacity to meet it, leading to what people consider are unsafe staffing levels and to staff burnout.

Expansion of the podiatric workforce across primary, community and secondary services may address some but not all of those issues. Support for workforce growth is critical, but support for those already qualified to progress to advanced clinical practice and consultancy is also critical to workforce retention and ensuring adequate capability in senior clinical, leadership, education and research roles.

We need policy to ensure closer working across providers and the delivery of a foot health strategy. There is significant opportunity to expand the foot health workforce to include non-registered roles, supported by qualified, expert podiatrists. There is also opportunity to consider alternative workforce models that are inclusive of podiatrists working in private practice or the wider foot health workforce in the third and voluntary sectors, for example. A clear workforce strategy is desperately needed now. It needs to explicitly underpin how the foot health workforce is optimally configured, funded, implemented and trained and what the core outcomes of foot health services must be to meet the needs of our future population.

Currently, there is no workforce strategy, no clear statement of aim, and no standardised set of core outcome measures informed by public health or policy. Clear foot health policy is urgently needed to maximise all the benefits that podiatry can offer across an integrated care system, before the profession becomes—as we predict it will—unsustainable, with staffing levels even more unsafe and avoidable patient harms, amputations and deaths relating to lower-limb disease rising dramatically.

I therefore have three key asks. First, I ask the Government to reinstate the £9,000 bursary for student podiatrists. If podiatrists are to be able to support the millions of people who will require their expertise, the Government must reinstate the full podiatry student bursary of £9,000 a year. That is essential if the workforce is to be secured and expanded for future generations. In the absence of long-term funding confidence, allied health professions such as podiatry are unable to commit substantial and consistent investment towards maximising recruitment and retention, both of which will be crucial in securing the future viability of this vital profession.

My second ask is for national collection of podiatry vacancy rates and inclusion of podiatry in workforce planning. Publishing a national workforce plan that considers future need for allied health professionals such as podiatrists must be a priority for the Government. That plan must take into account current trends in recruitment and retention and, for future needs-based public health, comorbidities and their impact on disease prevalence. A national workforce plan will also act as a crucial evidence base for the allocation of long-term workforce funding.

My third ask is for the guidance on integrated care system membership to be strengthened to include allied health professionals. The absence of national guidance or recommendations regarding which organisations and individuals should be included in integrated care partnerships has resulted in a patchwork of involvement for allied health professionals, including podiatrists, in integrated care decision making. Without their meaningful engagement in those discussions, there is a danger that the invaluable contribution podiatrists can make to the delivery of care might simply be overlooked. Strengthened national guidance on the make-up of integrated care partnerships, to include representation of allied health professionals such as podiatrists, should be developed and implemented at the earliest opportunity.

I conclude by thanking the professionals who work in my constituency, as well as those who work nationally. I recognise the pressures they are under and the valiant way that they cope with them.

[Peter Dowd (in the Chair)]

I remind the Minister that the debate must conclude by 4.41 pm.

--- Later in debate ---

[Will Quince]

I thank the hon. Member for his intervention, and I pay tribute to all those who volunteer. This is not the only area in our national health service where volunteers play an important role, but it is important that they are add-on and add value—supporting professionals as opposed to replacing professionals. That is why, at the heart of this debate, we must ensure that we have the podiatry workforce that we need across all four nations—although this debate is specifically focused, understandably, on England.

As the right hon. Member for Hayes and Harlington pointed out, demand for the NHS continues to grow. That is why we have already done a significant amount to invest in the education and training of our future workforce. NHS England—until recently, this was done by Health Education England—has worked extensively to enhance and modernise the podiatry profession. One central factor, which the right hon. Gentleman alluded to, is the development of the foot health standards for the education and training of the foot health support workforce.

However, I am certainly conscious that we have more to do. As part of that process, we developed the podiatry apprenticeship, which is a degree apprenticeship, and supported the implementation of that route into the profession. The numbers are still small, but they are growing, which is great to see. We are keen to promote that route into the profession, not least because it comes with significantly reduced costs for those taking part in the training.

With the promotion of more podiatry apprenticeships, we are offering a more diverse number of training options for students. Furthermore, the learning support fund, which the right hon. Member for Hayes and Harlington pointed to, provides all eligible nursing, midwifery and allied health professional degree students—including podiatrists—with a non-repayable training grant of a minimum of £5,000 per academic year. I say “minimum” because there is an additional hardship element to that of up to £3,000 per year, and additional support is available for childcare, dual-accommodation costs and, where appropriate, travel. The right hon. Gentleman specifically asked for an increase; there are no plans for that at present, but I will of course take that away and have a look at it.

[John McDonnell]

I am here if the Minister needs any assistance in—I was going to say beating—negotiating the Treasury into submission.

I think I mentioned a figure of one podiatrist to every 5,500 people, but I think that I have got that wrong; I think it is actually one to every 55,000 people. That is a huge demand that is placed on podiatrists.

On the Minister’s point regarding the bursary, the British Society of Rheumatology pointed out in one of its briefings that an estimated £15 million a year would be saved on the costs of rheumatoid arthritis if sufficient support was given, particularly through podiatrists. In our argument or discussion with the Treasury, this is therefore an investment that will save money, and we know that directly from the evidence that has been provided.

[Will Quince]

I thank the right hon. Gentleman for his intervention. We are constantly looking at those spend-to-save arguments in areas in the health service where it makes sense to invest. Following this debate, I will gladly look at the podiatry courses and see how over-subscribed or under-subscribed they are, because that may—or may not—help to make the case.

I just spoke about training. Training is important because, of course, we need to see new podiatrists coming in to practise. However, as the right hon. Gentleman mentioned, retention is as important as recruitment. As important as increasing numbers of podiatry trainees is, it is also important to retain the highly qualified, highly skilled, experienced people we already have practising podiatry in the NHS.

I am determined—I know that the Secretary of State is too, because we have had this conversation many a time—to ensure that staff in our NHS feel supported and that the NHS works to ensure that staff feel valued, both by individual organisations and across the system. We are working closely with NHS England—and indeed, through NHS England, with individual trusts—to ensure that that is happening. We regularly meet staff to get a better understanding of how they could better feel valued and supported in their workplace.

The actions of the NHS people plan and the NHS people promise are helping us to build the kind of culture that will go a long way towards helping to support and hold on to dedicated and hard-working colleagues. That very much includes a stronger focus on health and wellbeing and, importantly, on strengthening leadership. People often say that they do not leave trusts or organisations but their managers, so we must make sure that management culture is right. We also know from speaking to staff that it is vital to increase opportunities for flexible working.

One of the right hon. Gentleman’s other asks was on the long-term workforce plan. He is absolutely right. To help us ensure that we have the right numbers of staff with the right skills to transform services and deliver high-quality services that are fit for the future, we have commissioned NHS England to develop a long-term workforce plan for the NHS for the next five, 10 and 15 years.

That high-level workforce plan will look at the mix and number of staff required across the country and will set out a number of actions and reforms that are needed to reduce those supply gaps and, importantly, improve retention. We have committed to publishing that plan shortly—and it will be shortly; I know it is soon. I am very keen to ensure that it is published, because I know how much work NHS England has put into it. In addition, the Chancellor committed that it will be independently verified. We have to make sure that we get it right.

The plan will also include projections for the number of professionals that will be needed, which goes directly to the right hon. Gentleman’s point—it will include podiatrists—and will take full account of improvements in retention and productivity that we plan and hope to see. I thank the right hon. Gentleman for securing this important debate. Through long-term planning, we are ensuring that the NHS has the robust and resilient podiatry workforce that it needs for the future.

The third and final question the right hon. Gentleman posed was on integrated care system guidance relating to allied health professionals. As tempting as it is to make policy on the hoof, that does not sit within my portfolio. I will commit to raise that with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O'Brien), who is the Minister with responsibility for primary care. I will ask him to write to or meet the right hon. Gentleman.

We are working to ensure that we have the right people with the right skills in the right places and are working to ensure that they are well supported and looked after, so that they in turn can look after those who need our great NHS services and can keep delivering the great standard of care that people need now, but also in the future.

Question put and agreed to.

National Carers Week

John McDonnell Excerpts

Thursday 8th June 2023 Commons Chamber

[John McDonnell (Hayes and Harlington) (Lab)]

I will try to get through my 10-minute speech as rapidly as I can, Madam Deputy Speaker.

I chair a group of unpaid carers, and have been doing so for the past 18 months. They are all Labour party supporters. It is a Labour carers group because we seek to influence our own party’s policy. It is not set up on a sectarian basis; it is just that that is the motivation for our coming together. I wish to report back on some of the issues that have been raised in our discussions, and they reflect much of what has been said already.

One key issue is ensuring that carers are properly recognised. Recognition should then lead to the assessments. The reports that we get are that it is almost impossible in some areas to secure an assessment. We have to be honest in this debate. I am not trying to be party political here, but this is, I am afraid, about the cutbacks in local government. Councils are not capable of undertaking the assessments themselves, because of the loss of staff over recent years. Unfortunately, lack of assessments means lack of access to services themselves. That lack of a passporting mechanism is causing incredible suffering.

Another issue is that, even where there are assessments, there is a real concern about the lack of fully trained staff in the range of specialisms to deal effectively with the people involved. What that means is that the assessments are sometimes crude—this is not a criticism of the staff—and do not reflect the reality of what is needed. Again, this comes back to the resourcing of both the local councils and the NHS.

The other issue is exactly as reflected in the debate so far, which is that unpaid carers are often living in absolute poverty. Many of them have given up their own careers to care. They do so willingly, because they want to care for their loved ones, but at the moment many of them cannot survive on the benefits that they are receiving. We are grateful for the meetings that we have had with my hon. Friend the Member for Leicester West (Liz Kendall). The request of many in the group is clear: they want a real living wage to reflect the care that they provide. In the short-term, a measure that could be introduced fairly rapidly is at least for the carer’s allowance to reflect other caring allowances, such as maternity leave. Benefits in the past have been linked to earnings, but, because of the break with earnings, some benefit levels have been undermined over the past 20 to 30 years. If this carer’s allowance had kept pace with earnings, it would be double what it is at the moment, which would be somewhere near to the levels of maternity leave payments.

The other issue that has come up in our discussions is the plight of external carers. There is almost a sympathy for them—or an empathy with them—from the unpaid carers. As has been said, carers who go into homes are underpaid, not recognised and often disrespected. We must acknowledge that care has largely been privatised, which means that many of the workers are on very insecure contracts. The result of what I can only regard as exploitation is that they cannot provide the care that is needed in many instances, or that they struggle to do so.

I will not dwell too much on the issue of respite, which has been covered. None the less, the lack of access to, and the withdrawal of, respite in many areas because of cutbacks is causing real concern. The Government could focus on that as a priority in the development of their initial strategy.

Another concern, which is heartrending to hear about, is from those carers who are elderly or getting on. They are worried about the succession planning of care for the children or the people whom they care for when they are no longer around.

[Hannah Bardell (Livingston) (SNP)]

Does the right hon. Gentleman agree that the Primodos case highlights the tragedy that our constituents face? I have constituents who have suffered at the hands of Primodos and they are genuinely concerned as they get into their elderly years about how they will be able to care for their children, while the Government remain intransigent and refuse to support them.

[John McDonnell]

I am glad that the hon. Member has raised that issue. I have constituents in the same situation, and that overhanging worry has come out in our conversations. People worry about what happens when they are no longer here, or are not capable of caring. Having some form of succession plan in place is critical.

Briefly, there is a demand from the group that I work with—I think this is felt across the political spectrum—for an independent living and national social care service. The argument is that this should be based on the NHS principles: free at the point of need and paid for directly through taxation. The proposals that I have heard so far, including those from the Fabian Society which were published today, are somewhat limited and do not live up to the challenge that we face. They are somewhat anaemic.

We must be honest with everybody about the scale of the costs involved and how that can be funded. I am happy to run through a whole range of taxation measures, but I shall just put on the table equalising capital gains tax with income tax, which, the TUC estimates, would provide £17 billion. That would cover the cost of introducing social care and independent living services. That requires political will and political courage, so there is the potential to go forward and form a cross-party alliance to secure a future for social care and support for unpaid carers.

I congratulate the hon. Member for Gosport (Dame Caroline Dinenage) on securing this debate. After the session yesterday where we met the different caring organisations, I would say that, if anyone wants any motivation, all they have to do is sit down with a few of those carers to realise how urgent and how desperate the situation is at the moment—and what willingness there is across this House to secure quite radical transformative change on the issue.

Brain Tumour Research Funding

John McDonnell Excerpts

Thursday 9th March 2023 Commons Chamber

[John McDonnell (Hayes and Harlington) (Lab)]

There is a tradition in the House that people say it is an honour to follow the hon. Member who has just spoken. Usually, most of us do not mean it, but it really was a privilege to be in the Chamber to hear the speech by my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh). Some Members may not have got the subtleties with regard to Margaret. Margaret is not someone who will take no for an answer. In fact, you are lucky if you are still standing when you have said no to Margaret on many issues—I want to make that absolutely clear. We all send Margaret our love and wish her the very best. I thank my hon. Friend for sharing that, as I know how difficult it was.

We are all coming to the debate with different experiences. I want to thank a lady called Sonya Kean, who approached me some time ago to ask whether I would involve myself in campaigning for brain tumour research funding. Sonya has a son called Conall who suffers from brain tumours. It really brought home to me the distress that this illness causes for the sufferer and for the whole family, but also the incredible courage and fortitude that families display when they have to rise to the challenge and cope with seeking treatment and supporting the family member.

My experience with Sonya and others is that there is a real struggle to be heard at times. There is a struggle in access to treatment but also to find support for some basics. One example is time off for family members when they are taking another member for treatment, and financial support is another. The financial impact can be quite devastating on a family. That relates to the inadequacy of the welfare benefits system, particularly support for carers and carers allowance, to follow on from what my right hon. Friend the Member for Leeds Central (Hilary Benn) said.

What comes across is how wonderful the support and treatment is from incredibly dedicated, devoted, caring and hardworking doctors, nurses, oncologists and others. Paul Mulholland has been mentioned time and again by a number of people, as an example of the standard of care that everyone should receive throughout the NHS. I want to profoundly thank Sonya, Conall and the family, and all the staff and professionals who have been working so hard. I also thank the chair of the APPG, the hon. Member for St Ives (Derek Thomas), and all its members. We have hundreds of APPGs but that is possibly one of the most effective. As a result of its diligent commitment, we have in front of us an extremely professional report that the Government now can use as the guide and agenda for their work. I thank the APPG for all that it has done.

I will not go through all the points that have been made, but there are some fundamental steps that need taking. We have been having a debate for some time around these particular areas of work. The reality is that all the health imperatives require a foundation of funding—conditional funding, I accept that. Last year we debated cancer treatments overall, and the figures are worth getting on the record. Nearly £150 million has been spent on breast cancer research; £130 million on leukaemia research; £130 million on prostate cancer research; £24 million on brain tumour research. The issue today is not just the allocation of funds but access to funds. The report very succinctly but effectively demonstrates what barriers exist and how they could be overcome.

The sufferers and families I have met are at a loss as to why the money that has already been allocated has not really reached the frontline of research. The report gives reasons for that, but it also demonstrates how the hurdles could be overcome relatively easily. It is about ensuring an element of co-ordination. I was shocked to read on page 12 that a number of researchers are simply moving away from research in the field, as my right hon. Friend the Member for Leeds Central and others have mentioned, because they cannot overcome the hurdles in access to funding support.

The next step, as the report mentions, is to address the profound need for leadership. The appeal for a champion who sits across the two key Departments—the Department of Health and Social Care and the Department for Science, Innovation and Technology—is fundamental. We need someone who can bring everything together dynamically and drive the report’s agenda. Frankly, there are plenty of ex-Ministers on the Government Back Benches with enough experience to drive that agenda effectively.

One of the first steps, exactly as the chair of the all-party group says, is to have a ministerial meeting to go through the agenda with members of the all-party group and work with the appointed champion to chase the progress of its implementation. There have been too many reports on different conditions that have been well received but largely shelved because there has been no drive. The APPG has demonstrated that it can work effectively to produce a report, and I think it could work hand in glove with the new champion to ensure that the agenda is implemented effectively. It could happen relatively quickly: we could have an announcement within a fortnight, we could get the new champion in place, the APPG could meet that person and the Minister, and we would then have some drive.

The report makes a recommendation to look at the US system whereby reports are regularly submitted to Congress—in this country it would be this House—on the implementation of the agenda. I may have got this wrong, but I believe that the APPG report includes an element of legislative enforcement so a statutory duty is placed on all those participating.

Another point is about the co-ordination of the different groups, which the APPG seems to have brought together. Not only has it received information and evidence from the individual research bodies, but a discussion has clearly taken place with the pharmaceutical industry. The APPG has almost been like a summit meeting for the different agencies. Trying to formalise that in some form would be really helpful.

On pharmaceutical companies, I want to make a point that might sound discordant but is not. The report makes a recommendation about tax reliefs for pharmaceutical companies. Having looked at tax reliefs in other areas, I am not confident in the role that they have played. The argument is that they will attract venture capital towards the research and development of various drugs and treatments. I am not convinced about tax reliefs, however; I think it is better to award conditional grants, which I think are much more effective. My own view, for which I have been arguing for some time—I have to throw this in—is that we should have a state-run and owned pharmaceutical company so that we can have stable investment, rather than just investment driven by short-term profit.

What I see as the key element in the report, for which I am really grateful to the APPG, is the immediate review of the speed of decision making on the award and allocation of funding for research. That is critical. As my hon. Friend the Member for Mitcham and Morden says, it is also about the speed of access to treatment. People with nine months do not have time to wait for the decision-making processes that we have at the moment, which are literally costing people’s lives. We desperately need to speed up the overall process, and the report lays the foundations for that. I also agree with the report about the ringfencing of funding for research into child brain tumours: it is a tragically neglected area and so many people suffer as a result.

The report says, rightly in my view, that many brain tumour patients and their families are feeling let down by a lack of leadership and drive from the Government. When we explain to people in our constituencies that this is the biggest killer among the under-40s, they begin to wake up and ask why it is happening. Well, I do not want to be here in a year’s time for another debate like this, and another report from the APPG, and to hear that it is still happening because the current report has not been implemented in full. I urge the Government to meet the APPG, establish a champion and start work on this agenda in the next couple of weeks. If they do so, we may be able to turn this around, and perhaps prevent more tragedies such as those that many of our constituents have experienced in recent years.

Future of the NHS

John McDonnell Excerpts

Thursday 23rd February 2023 Commons Chamber

[Kate Osborne (Jarrow) (Lab)]

I beg to move,

That this House has considered the future of the NHS, its staffing and funding.

The national health service is a beloved national institution. Everyone in the country and in this House will have interacted with the NHS and have their own personal connections and stories that they can reflect on, from the birth of their children to the death of a loved one or seeing a general practitioner about a health condition. It is undeniable to most of us that the NHS is in crisis. It is being pushed into an avoidable and unprecedented collapse after 13 years of Conservative mismanagement.

All our constituents will have been impacted in some way by the crisis, a crisis so bad that nurses have taken strike action for the first time in NHS history. Ambulance workers and other NHS staff have also taken action, and this week British Medical Association junior doctors voted with a 98% majority to do the same. I thank all my constituents who work in the NHS, particularly those who got in touch about this debate, including paramedics from the North East Ambulance Service who tell me that on a daily basis they are unable to hand over patients because of delays in A&E and lack of beds, and how frustrating it is that many of the calls are for people who need social care or cannot get a GP appointment, rather than the acute calls that they are best placed to deal with.

That highlights the impact the crisis in social care is having on the NHS. Half of all people arriving in A&E by ambulance are over 65 and one third are over 75. The lack of adequate social care for basic daily needs is storing up problems and leaving older people less able to care for themselves, or arriving in hospital with preventable health problems, adding to the pressures in A&E and bed provision. People who work in the NHS have had enough of being failed by this Government’s mismanagement. The country deserves better.

NHS dentistry is on its knees, with patients facing a growing crisis of access and resorting to DIY dentistry. The NHS was in crisis pre-pandemic and the Government’s failures and mismanagement have made the situation far worse. For Ministers to dismiss the crisis as winter pressures, or even to flat-out deny that there is a crisis, is frankly absurd.

[John McDonnell (Hayes and Harlington) (Lab)]

The crisis in dental and mental health is affecting our children at the moment. In some of our constituencies, it is a direct result of the lack of local provision. We are feeding a generation of problems as a result of that failure.

[Kate Osborne]

I absolutely agree with my right hon. Friend. The problems for our children further down the line are worrying, but of course, they are preventable if the right action is taken.

The Conservatives blame everything else—the weather, the pandemic and even NHS staff—but their 13 years of failure have left the health service in crisis. At Prime Minister’s questions yesterday, the Prime Minister boasted about

“record sums into the NHS…and…a clear path to getting people the treatment they need in the time they need it.”—[Official Report, 22 February 2023; Vol. 728, c. 222.]

He is not living in the real world. Every briefing and communication that we have received has cited delays in treatment and the devastating impact that they have, as well as the decade of underfunding. It is hard not to agree with the British Medical Association, which called the Prime Minister “delusional”.

The last Labour Governments allocated, on average, a 6% rise in the NHS budget every year. Successive Conservative and coalition Governments have since allocated a rise of only 1% a year. The Prime Minister can talk about “record sums” all he wants, but he is fooling no one. In reality, the settlement is not enough, and it is nowhere near what previous Labour Governments invested. This crisis can be laid firmly at the Government’s door.

There are so many awful headlines and statistics, and I will delve into some of them, but let me say from the outset that we must all remember, when we talk about the 7 million people on waiting lists, or the 500 avoidable deaths every week, that we are talking about people. There are faces behind those statistics: the faces of women who cannot get urgent gynaecological treatment, the faces of children who cannot access mental health support, the faces of families whose loved ones have died—lives that could, should and would have been saved if this Government cared about communities and invested in our NHS.

When we talk about 133,000 NHS vacancies, we are talking about people who have left their work in the NHS because they cannot cope financially or emotionally, we are talking about the rest of the workforce working harder to pick up the slack, we are talking about the NHS being unable to recruit because of poor wages and conditions, and we are talking about the impact that that has on patients.

The only way to solve the NHS staffing crisis is by sorting out pay. The Government agreed yesterday to negotiate with the Royal College of Nursing, and nursing strikes have been paused for those negotiations to happen. The Government could have agreed to negotiations months ago, but they chose not to. Negotiations with the RCN alone will not solve the staffing crisis. Junior doctors have voted by 98% to strike, but the Health Secretary has not even offered a meeting. Negotiations with one section of the NHS workforce are not sufficient; all unions representing NHS staff need to be negotiated with. The Government must make a pay offer that is not linked to efficiency savings and productivity, because NHS staff are already working unacceptably long shifts.

An offer—such as the one we saw on Tuesday—of 3.5%, when inflation is at least triple that and NHS workers’ pay is worth less than it was a decade ago, is, as Sharon Graham of Unite the Union said, a “sick joke”. Christina McAnea of Unison announced further strike days next month. The Government are failing to resolve this dispute; instead, they are attempting to blame workers for putting patients in danger. Patients will never forgive the Conservatives for refusing to negotiate and using patients as bargaining chips.

The staffing crisis must be urgently addressed. The impact of waiting times on individuals can be severe and the consequences irreversible. Two hundred people in my Jarrow constituency have Parkinson’s disease. Parkinson’s UK is concerned about people waiting longer than two years for a diagnosis. Similarly, the MS Society has said that more than 13,000 people have been waiting more than a year for a neurology appointment. Those delayed diagnoses and treatments have a hugely detrimental impact on the individuals concerned.

Delays in cancer diagnosis and treatment are life-threatening. For years, the Government have missed cancer targets because of a lack of concerted action on matched funding. In South Tyneside and Sunderland NHS Foundation Trust, only 73% of people were treated within the target of two months following a cancer referral, and only 61% of people are treated within that target nationally. The UK is being left behind, and people are dying avoidable and preventable deaths. That is why we need a workforce strategy—yes, to pay people properly, but also to enable the NHS to save people’s lives.

Labour has a workforce strategy, while the Government have not even committed to fully funding their promised workforce plan. The Chancellor praised Labour’s plan, so why does he not put his money where his mouth is by implementing it? Labour will deliver a new 10-year plan for the NHS, including one of the biggest ever expansions of its workforce.

--- Later in debate ---

[John McDonnell (Hayes and Harlington) (Lab)]

I want to get back to some statistics; I am sorry if I am going to bore the House, but I want to get back to some of the harsh reality. I know that subjective judgments have been made, but we cannot get away from some of the stats. I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing the debate and on an excellent speech, particularly in light of the fact that it was the Durham miners’ gala fundraising dinner last night.

I come back to the some of the harsh stats because I want to deal with why we need to address the funding crisis more effectively than we are at the moment. Some of these stats have been used already but I am still shocked by this: we have 7.1 million patients on waiting lists, which is almost double the level in 2010; and the average ambulance response time for patients in category 2 is now 48 minutes, which is half an hour more than it was a short while back, with the target of 18 minutes. I have met our local ambulance drivers and paramedics, and I know that category 2 is the heart attacks and strokes. I had a heart attack about 10 years ago and I do not want to be waiting for 45 minutes, as we are talking about the difference between life and death for some of us.

On A&E waiting times, the NHS target is 95% of people being seen within four hours, but the current level is 40%. Most Members will have visited the A&E departments in their local hospitals. One of our local people described them as being like a warzone at times, given the number of injuries and scale of suffering. Members have mentioned the public satisfaction issue, but on the GP front—again, this comes just from working with local doctors—1 million people are waiting for more than a month. There are currently 4,500 fewer GPs than there were a decade ago. I understand what the Government and ex-Ministers are saying about the recruitment of more GPs, and I understand what my hon. Friends have said about a lot of that investment being from some time when the Conservative party was not in government.

I have been trying to look at the repairs backlog as well, because we have been promised a new hospital at Hillingdon. I am really pleased about that because I have been campaigning for one for years. We will be getting a new hospital, eventually, but that is largely because our existing one is in such a dangerous state; we are worried about the main structure collapsing at any stage and we have had to do temporary repairs. The repairs backlog has grown by 11%, to £10.2 billion-worth of backlog.

There is another figure that I have been worried about. Let me make it clear that I have been on the picket lines with nurses and in the campaigns. When talking to them on the picket lines, we get the true reality of what people are having to deal with, but I wanted to get behind the anecdotes and get to the stats. They show that one in five NHS trusts and health boards is providing food banks for staff, with a further third looking to provide them in the future. It must surely be shocking to everyone that NHS staff are having to rely on food banks —these are professionals.

If we look at the underlying causes of that, we see that this is about pay. I looked at the pay of the paramedics I was talking to and I found that it has gone down by £2,400 in real terms in the past year—that comes from some TUC analysis. There are now 3,000 ambulance staff vacancies in England. I went on to look at issues associated with nurses’ pay. The average nurse’s take-home pay is more than £5,000 less in real terms than it was in 2010—again, that comes from number crunching by the TUC, but all of this is verified elsewhere as well. There are nurse shortages, with 47,000 vacancies. The most worrying thing, which has been touched on to a certain extent by others, is that one in nine nurses left the profession in the past year, which is the highest level in a year in the recorded history of the NHS. That says something about morale. We have heard that the talks are scheduled for 1 and 3 March, and I am hoping that they will resolve the current dispute. However, it is difficult to see how it can be resolved unless all the unions are engaged in those discussions.

A few years ago, there was a junior doctors pay dispute. My right hon. Friend the Member for Islington North (Jeremy Corbyn) and I were on the picket lines and at the demonstrations for that as well. So I was looking at what has happened with the junior doctors, who are represented by the BMA. As someone has said, 98% have voted for strike action, on a turnout of 77%. I do not think we have seen those levels of turnout in recent history in these ballots for industrial action. Again, I have been trying to get behind the reason for that. BMA analysis shows that the pay of junior doctors has been cut by more than a quarter since 2008. It looks as though we are going to have a walkout for 72 hours in March, which, obviously, will have an impact on the service. When I talk to junior doctors, they tell me that they do not know what else they can do. They are beginning to struggle to survive on the wages they are getting. In constituencies such as mine, a west London, working-class, multicultural community, most of them will never be able to get onto the housing ladder to buy a property; in fact, because of the level of rents, many will struggle even to fund the rents there. Trying to come at this question as objectively as possible, it must come back to underfunding. There is no other reason that I can see.

[Rob Roberts]

I appreciate the right hon. Gentleman giving way and the tone in which he approaches the debate. He talks about funding, but Labour left office in 2010 and there was no argument about the fact that funding was not sufficient at the time of the last Labour Government. The King’s Fund says that statistics show that funding has increased or at least kept pace in real terms since then, so how is it not sufficient now?

[John McDonnell]

That is an extremely valid point that must be addressed. When some of us were doing health economics in the 1980s and onwards, we were always told that the level of funding required just to maintain a standstill operation for the growing ageing population was at least 4%. What happened under Labour was a 6% annual rate of funding.

I will be honest with the hon. Gentleman: when I was on the Government Benches and Labour was in government, I was asking for more. Gordon Brown, to give him his due, had a sense of humour; I always used to produce an alternative Budget, so he described me as the shadow Chancellor even when I was not. I did that on the basis that I thought 4% was not enough and, while 6% was right, we needed to go further, because it was about not just the ageing population but the increased levels of morbidity we were experiencing. In addition, as the hon. Gentleman mentions, new treatments come on board and are more expensive.

Even though I was looking for increased investment, beyond what Labour was doing then, Labour was not just keeping pace with the 4%, but was going beyond it at 6%. To be frank, although the hon. Gentleman swore in the Chamber earlier, he should have heard some of the language I used in 2010, because I was quite angry as well. Those of us who were there will remember that in 2010, investment dropped to 1%. We were saying to George Osborne, who was the Chancellor at the time, “You are going to reap the whirlwind here for dropping the level down to 1%, because it means an erosion of the services that are provided.”

In addition, that investment did not recognise our ageing population or the other emerging issues with morbidity. I understand that the covid inquiry will include analysis of the resilience of the health service to cope with the covid pandemic. I believe that a number of those representatives are seeking to have George Osborne appear before that inquiry, because he bears responsibility for that under-investment.

Other hon. Friends have mentioned mental health, and I agree that it has been the Cinderella service. When I looked at mental health funding, I found that it has increased at a faster rate than overall NHS funding—at times nearly 3% as against 1%. However, that follows years of small increases or real-terms funding cuts, and the number of NHS mental health beds is down by 25% since 2010.

Curiously enough, I was on a bus in my constituency yesterday with a former mental health nurse, who described to me the implications of that and the consequences for the individuals concerned. Community mental health nurse numbers were also impacted upon. Some of us will have dealt with the results of that in our constituencies; in my constituency, I have to say, it has meant dealing with suicides as well.

[Jeremy Corbyn]

Is my right hon. Friend aware that the impact of an inadequacy in healthcare provision falls on A&E departments, which take in people who have mental health crises but are ill-equipped to cope with them; on neighbourhoods that cannot cope with people going through crises; or on the police, who have to intervene simply to look after someone for whom there ought to be mental health provision. We fail to invest in mental health provision at our peril.

[John McDonnell]

Anyone who has talked with them will have heard local police officers say that they have become social workers, mental health workers and so on. In many instances, they are doing the best job that they can, but they need expert support, including from health workers in the community.

I looked at the figures, and there are now 1.6 million people on the waiting list for specialist mental health services. One of my concerns, which was raised in a debate some months ago, is what is happening with CAMHS —child and adolescent mental health services. Delays in treatment have increased massively since 2019, and waiting lists are getting longer. I have looked at the stats: 77% of CCGs froze or cut their CAMHS budgets between 2013-14 and 2014-15, which was the crunch year; 55% of the local authorities in England that supplied data froze or increased their budgets below inflation; and 60% of local authorities in England have cut or frozen their CAMHS budgets since 2010-11. Again, that is staggering.

To come back to mental health nurses, in 2010, we had 40,297 of them; we are now down to just 38,987. That does not seem a significant drop, but it is still a drop. As a number of Members on both sides of the House have mentioned recently, we are going through a mental health crisis—one that affects young people and young men in particular, as my right hon. Friend the Member for Islington North has pointed out.

Let me come to the stats on social care. Age UK estimates that more than 1.5 million people aged 65 and over have some form of unmet or under-met need—[Interruption.] Excuse me—[Interruption.] Thanks a lot; I could do with something stronger.

[Alex Cunningham]

That can be arranged later.

[John McDonnell]

That’s right.

The social care figures are startling. Some 1.5 million people aged 65 and over have some form of unmet care need. There are 165,000 vacancies in the social care sector across England and Wales—a 52% increase in the last year. The Health Foundation estimates that an extra £6.1 billion to £14.4 billion will be required by 2030-31 to meet the demand. As others have said, that has meant delayed discharges from the NHS, and—as I mentioned on Tuesday—it places a huge burden on unpaid carers, who are living on the pittance of the £70-a-week carer’s allowance.

The Institute for Government published a report today in which it basically argues for social care overhaul. It describes how social care has been overwhelmed in recent years and states that 50,000 fewer posts are filled than a year ago—the highest vacancy rate ever in social care. Then, there are the stats on what has happened as a result of under-funding—and I am afraid that it is because of under-funding; we cannot get away from that fact. I would be saying the same thing on these statistics no matter which party was in power. We need to go further in the coming month’s Budget.

[Rob Roberts]

The right hon. Gentleman is being very generous with his time. He will know, having been shadow Chancellor, that in the devolved Administrations, there is £1.20 in Wales for every £1 in England, and slightly more in Scotland. The results—I could say they are worse, but I will not—are measurably the same. Is it a problem only of funding, or is it one of structure?

[John McDonnell]

I am sure that the hon. Gentleman has made that point before. I looked at the Nuffield Foundation report on Wales a couple of years back. I do not think that Wales has had a good deal out of the Barnett formula over the years, and although the Government have addressed some of that over the past year, they have not done enough. The Nuffield Foundation said that Wales has not only an ageing population, but higher levels of morbidity, so the funding does not match the need. A whole debate needs to take place about moving forward. When I was shadow Chancellor, I talked about a review of the Barnett formula. That frightened a number of people, but it is needed. In fact, I think there is a need for a Barnett formula for the north of England as well. [Hon. Members: “ Hear, hear!”] I thought that might raise a response.

There is a long-term funding crisis that we have to address. I look forward to next month’s Budget for some resolution of this matter. Where can the money come from? I know that a lot of people say we should never make unfunded commitments. To be honest, I was the first shadow Chancellor who produced a Budget and a manifesto that was fully funded and costed, in the “Grey Book”, so I want to look at some ideas and just throw them out there.

On Tuesday, we heard that, as a result of the higher level of tax receipts received than the Office for Budget Responsibility predicted, the Chancellor now has £30 billion of headroom that he did not have previously. Some of that £30 billion needs to be invested in the NHS, and particularly social care. I would also like to see some of that money invested in relieving poverty, which is one of the major causes of ill health in this society.

We need to do something on capital gains tax. If we taxed capital gains at the same rate as earned income and charged national insurance on it, we would get £25 billion extra. Let me throw in a few others. If we lifted the higher national insurance rate, so that instead of 3.25% above £50,000, it was paid at what everyone else below that level pays—13%—that could raise us £15 billion. I cannot for the life of me see why dividends are not taxed at the same level as earned income. If we did that, we could raise £8 billion. Those on the Labour Front Bench have put forward the idea of scrapping non-dom status. Again, I claim copyright on that one. That would raise between £1 billion and £3 billion.

The Government have implemented a windfall tax on the excess profits of energy companies, and they should extend that, as those on the Labour Front Bench have advocated. Some Members may have read the recent reports on bank profits and the return of extremely excessive bank bonuses. There is an argument for a windfall tax on bank profits during this extremely difficult period. This is a time when we should all bear the burden of the challenges that we face. Taxing the bankers’ bonuses needs to come back on the agenda, and I deeply regret that the Government removed the cap on bankers’ bonuses, which we supported.

With regard to the City, I have been an advocate of the financial transaction tax for a number of years. All it does is close some of the loopholes in terms of stamp duty. If we look at the work on this recently by Advani and others, we see the potential. With limited changes, we could raise £8 billion to £10 billion.

It is time to start looking at how we tax wealth in this country more effectively. If we look at the proposals that have been produced by various think-tanks over the last year or so, a 1% tax on people who have assets over £10 million could raise an additional £10 billion. This is not revolutionary stuff. It is straightforward and pragmatic, making sure that we have a fair taxation system.

Those on the Labour Front Bench have argued strongly that we have to go for growth, as have the Government. I fully agree, but that needs a rapid programme of investment in the public sector, with matching private sector investment. If we can increase growth by just 1%, we usually match Governments receipts at the same time by 1%, which would mean about £7.7 billion, and for 2% it would mean £15.4 billion. In addition to the short-term taxation measures, redressing the imbalances in our taxation system at the moment, that would enable us to achieve the growth that will give us a stable form of income to meet the needs of our NHS and social care system.

We cannot continue with an NHS and a social care service that is paid for on the backs of people we are exploiting in long hours, undermining their morale by not paying them properly, and at the same time making them face challenges that are both heartrending and certainly not what many of them signed up for. The NHS workers I have met just want to provide a decent service in a caring environment that is fully funded, where their profession is respected by being properly paid. I hope that we can achieve that sooner, rather than later.

NHS Strikes

John McDonnell Excerpts

Monday 6th February 2023 Commons Chamber

[Will Quince]

Yes, yes—but where exactly is the funding coming from? The hon. Gentleman rightly pushes me on the elective backlog and he rightly pushes me on urgent and emergency care, but every 1% is £700 million that I would have to find from our NHS budget. That is exactly why we have to ensure that the pay review body makes the recommendation from April that is affordable to the NHS and recognises and rewards NHS staff, taking account of recruitment and retention and some of the challenges that we face, but that is fair to taxpayers too. That is why I would encourage the unions to get involved and take part in that pay review body process, so we can get it right.

[John McDonnell (Hayes and Harlington) (Lab)]

The Minister says that opposition is the easiest job. Well, we are hoping he is soon performing it. When he opened his response this afternoon, he said that the Secretary of State was at a Cobra meeting, but would it not be more worthwhile if he negotiated and met the unions themselves? In advance of the next meeting for discussions of wages, maybe he could visit a picket line, because if Conservative Members visit the picket lines, they will find groups of staff—nurses and ambulance workers—who are extremely distressed. I have met many of them who were in tears—tears because they are worried about the patients whom they want to support, but also tears because many of them cannot survive doing the service they want to provide due to their low wages. Unless negotiations are started soon, the Government could do irreparable damage to the national health service, so the Secretary of State needs urgently to leave the Cobra meeting, sit down with the unions and start negotiating.

[Will Quince]

The right hon. Gentleman says that many who work in the NHS are worried about patients: I spend every single day worrying about patients; I spend every single day ensuring the NHS has the resources it needs to provide the level of care and service our constituents rightly expect. I have a budget, and that budget has already taken into consideration a 4.75% on average pay award, with more than 9% for some of the lowest earners. There is an independent pay review body process for a reason; it is only two months away, in April, and I encourage the unions to take part in it. Of course I meet with unions, and of course I do and will meet with nurses and those who work in our NHS. I believe some of the points the right hon. Gentleman makes are correct, and I know those who work in the NHS genuinely want to ensure we are attracting and retaining the very best; that is all the more reason for us to get it right, and the way to get it right is the independent pay review body process.

NHS Dentistry: Salford and Eccles

John McDonnell Excerpts

Monday 19th December 2022 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

Let me start by congratulating the hon. Member for Salford and Eccles (Rebecca Long Bailey) on securing this important debate. I share her frustration and am aware that some areas in the country face serious difficulties with access to NHS dental care. She used some powerful examples, which are exactly the kinds of things that we are trying to fix.

As we recover from the pandemic, activity is going back up again and we want it to go up faster. Dentistry is an important part of the NHS. We are committed to addressing the challenges that NHS dentistry faces in some parts of the country. We are continuing to take important steps to improve access for patients. There are variations around the country, which was already an issue before the pandemic.

The specific risks from covid in dentistry, for obvious reasons given the nature of the treatment—looking down people’s throats and breathing in the same air—resulted in the need to reduce the amount of care that could be delivered, in line with infection prevention and control measures to keep patients and the workforce safe. The pandemic placed further pressure on the system. However, NHS dentistry provision has been increasing gradually and safely. I am pleased to say that NHS England asked all dental practices to return to 100% of their contracted activity in July this year. Many practices are already delivering at that level and, in some cases, beyond. I will go on to talk about delivering beyond.

To support the industry during this testing time, we took unprecedented action and provided over £1.7 billion in income protection, to ensure that NHS dentist capacity was retained and services were provided and available after the pandemic. We made an additional £50 million available for NHS dental services at the end of last year, to increase capacity in NHS dental teams. Appointments were given to those in most urgent need of dental treatment, including vulnerable groups and children. As a result of that funding, I am pleased that say that an additional 1,110 patients were seen in Salford. To support the provision of urgent care, more than 170 urgent dental care centres remain open across the country. One of those centres is in the Salford locality, as the hon. Lady knows.

Across the nation, the system is recovering and delivery of dental care is increasing. In 2021-22, 24,272 dentists performed NHS activity—an increase of 539 on the previous year. In the 12 months to 30 June this year, 5.6 million children were seen by an NHS dentist, compared with 3.9 million children in the same period the previous year. That represents a 43% increase.

[John McDonnell (Hayes and Harlington) (Lab)]

There have been reports in a number of our constituencies of almost a dental health epidemic. Can the Minister explain whether there will be targeted resources for a number of our constituencies where there is such a high level of child dental ill health?

[Neil O’Brien]

I am exploring how we can best target the places with the most acute problems. There are problems in a lot of different places, and we are thinking about that actively at the moment. I will come back to that as I make progress.

Draft Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022

John McDonnell Excerpts

Tuesday 6th December 2022 General Committees

[John McDonnell (Hayes and Harlington) (Lab)]

I have a simple question for the Minister. We have received a number of representations, and it is important to acknowledge the consultation that has taken place. Page 6 of the explanatory memorandum states:

“The Department received 1634 responses to the consultation from individuals and organisations…Over 70% of responses to the consultation were from dental care professionals.”

It goes on:

“Many respondents were supportive of improvements being made to the regulators’ international registration processes”.

It does not say “most”. What was the balance between supportive and oppositional responses to the proposals that the Government have taken forward? It would be helpful to know how many of the representations the Government have taken into account.

[Will Quince]

I take your instruction on the passing of notes, Mr Bone; it will not happen again.

Let me answer a number of the points made by the hon. Member for Enfield North, starting with dentistry more generally. Our aim is to ensure that everyone has timely access to NHS dentistry and that dentistry is an appealing career choice. In too many parts of our country, people do not have access to a dentist in the way that they should. In July this year, we announced a package of improvements designed specifically to increase access to dental services across England. That includes better remuneration, guidance on how patients should expect to attend for check-ups, and measures that enable dentists to make better use of staff in their dental teams. Of course, training has to be part of that. Health Education England undertook a three-year review of education and training as part of its 2021 “Advancing Dental Care” review. It is now implementing its four-year dental education review programme to improve recruitment and retention.

The hon. Member for Enfield North rightly raised internationally trained staff, who have been part of our NHS since its inception and continue to play a vital role. We are doing everything we can to invest in growing our domestic workforce and move towards a more sustainable domestic supply. We are training more, retaining more and encouraging staff who have left to return. Having said that, ethical international recruitment remains a key element of achieving our workforce commitments. As the hon. Lady will know, we have recently recommitted to publishing our NHS long-term plan, which is a commission for NHS England. As the Chancellor of the Exchequer set out in the autumn statement, it will be independently verified.

The hon. Member for Coventry North West asked about the performers list. Although it is not directly relevant, Mr Bone, perhaps you will indulge me for one moment, so that I can explain what we are doing. The Department is currently reviewing the National Health Service (Performers Lists) (England) Regulations 2013—that is, the route by which a dentist can become registered to undertake NHS services—to identify where regulatory requirements could be streamlined and simplified while maintaining the high professional standards that ensure patient safety. Any proposed legislative changes will be subject to consultation.

I think the question raised by the right hon. Member for Hayes and Harlington follows a number of emails that we received overnight. These related to the essence of this statutory instrument, which is about closing a loophole. I understand why people are exercised about that. I do not know the exact figures from the consultation, but it is on that exact point where we expect there will have been a higher percentage that we disagreed with, but I am happy to write to the right hon. Member and the Committee with the exact percentages of people who responded in a particular way. On that one point, I will go into detail because, although we recognise the opposition to that proposal, we intend to take forward this amendment in the interests of patient safety.

[John McDonnell]

Will the Minister write to us, with regard to not that specific proposal, but the generality? If we could receive a breakdown on that, that would be really useful. Can he say at this stage—sometimes, inspiration does come via notes—whether the majority were in favour or opposed?

[Will Quince]

My understanding is that, on this particular point around dental care professional registration with the GDC, the majority were opposed. That is the one major point where we disagreed with the consultation response.

If it is helpful to the right hon. Member for Hayes and Harlington, I will explain why. The change introduces fairness and consistency between UK and international routes because UK dentists cannot qualify or apply to join the DCP register using their dentistry qualification in other countries. I make clear that international dentists already registered as DCPs with the GDC will still be able to maintain their registration following these changes, but the amendment will allow the GDC to process applications from dentists to join the register as DCPs that are received until this order comes into force, which is likely to be in the spring. It guarantees that any live DCP title applications—I suspect those are the driver of some of the emails we received last night—submitted before the legislation has passed will still be processed.

Although we recognise that the majority of respondents to the consultation disagreed with the proposals and many argued that international dentists are already qualified, or have enough clinical experience, to work as a DCP, others also highlighted that in some cases overseas qualified dentists work as dental care professionals outside the UK, and in many countries there is not a separate job title for dental care professionals.

However, in the UK the GDC recognises dentists and DCPs as distinct professions; they undertake similar but different tasks. I understand from the GDC that the majority of such applications from international dentists are, in any event, unsuccessful. This reinforces that one of the GDC’s priorities must be on ensuring that only suitably qualified people join the profession here in the UK, in the interest of patient safety.

I hope that my answers to those questions—notwithstanding the exact point on the numbers and percentages of people that objected on particular points, which I will write to the Committee about—will provide sufficient reassurance. The order promotes flexibility for the General Dental Council and the Nursing and Midwifery Council as independent statutory regulators to fulfil their duties in developing and maintaining robust and proportionate international registration processes. I commend the order to the Committee.

Question put and agreed to.

Childhood Cancer Outcomes

John McDonnell Excerpts

Tuesday 26th April 2022 Commons Chamber

[John McDonnell (Hayes and Harlington) (Lab)]

I thank the hon. Member for Gosport (Dame Caroline Dinenage) for her terrific work in securing this debate, which provides us with the opportunity to raise incredibly moving individual cases. The hon. Member for Stroud (Siobhan Baillie) is no longer in the Chamber, but many of us also feel tearful, unaided by pregnancy. We raise these individual cases so that we can build the lessons learned into policy.

We are inspired by the courage and determination shown in these cases. I was lobbied by Sonia Kean—she is not my constituent, but she is lobbying terrifically hard—and she has been through this experience with her son, who had to tackle cancer again after it returned. She is working hard on behalf of a range of families to further this debate.

These debates are good because we are able to draw on the experience of colleagues such as the hon. Member for Kirkcaldy and Cowdenbeath (Neale Hanvey). They also give us an opportunity to thank people, and we have heard about the many charities that are working so hard. We should thank them on the record.

It is not often done in this place, but I thank the hon. Members for St Ives (Derek Thomas) and for Scunthorpe (Holly Mumby-Croft) for the work of the all-party parliamentary group on brain tumours and its inquiry on research. Its report will be significant in influencing the flow of not only research but the funding behind it, too.

I agree with the hon. Member for Gosport that we need a mission-based approach, one element of which is research, but I want to put another proposal on the table. Many people working in different areas of cancer are arguing for greater investment in research, and they have been given confidence by the way in which research has enabled us to tackle covid by bringing together the pharmaceutical companies, the research bodies, Ministers and others. There might be an opportunity for a summit of pharmaceutical companies, research bodies and others to give a new impetus to developing the research we need to tackle childhood cancers. If we can do it on covid, we can also advance to a much higher plateau on childhood cancer through such an initiative.