Future of the NHS

Marie Rimmer Excerpts

Thursday 23rd February 2023 Commons Chamber

[Jeremy Corbyn (Islington North) (Ind)]

I thank the hon. Member for Jarrow (Kate Osborne) for initiating a debate that enables us to discuss the real philosophy behind the national health service.

When Aneurin Bevan piloted the original NHS legislation through the House, he was inspired by the way in which those in the community of Tredegar supported each other. In many ways, our NHS owes as much to the mining community in south Wales as it does to anyone else, in the sense that that was a community providing for each and every person, irrespective of their ability to pay but absolutely cognisant of their needs. That, surely, has to be the principle behind the national health service. There has been a little bit of rewriting of history today; just for the record, the Conservative party opposed the foundation of the NHS in 1947. It is on the record. It is in Hansard. No one can rewrite that.

We must also recognise that on his mission to establish the NHS, Nye Bevan was forced to make a number of compromises, the biggest of which was over the GP contract idea. The then BMA, which has thankfully mended its ways and is now very much part and parcel of the trade union movement within the NHS, opposed the NHS and threatened not to take part in it at all, hence the contractual arrangement that GPs have. In a sense, it is that contractual arrangement that is a fundamental problem within the NHS, and it affects not just GPs, but many others as well. There has been a discussion about dentistry today. Surely, many other countries do not have this problem; they see a doctor as an important part of the health service, as we all do, and therefore we should employ them on a salary to be a doctor within the NHS. There are a small number of places around the country that have salaried GPs. I had one such practice in my constituency and it worked absolutely fine, until this Government interfered and handed it over to an American healthcare company, which, fortunately, has now been sent on its way, and the practice is now out for tender once again.

The original provision of the NHS was total healthcare, including preventive healthcare, such as optical treatment and dentistry. That was taken out of the NHS only two years later, and the prescription charges came in at the same time. As many have said today, we need to look at dental costs. Even within the NHS, they are so huge for many of our constituents that they either suffer the pain or borrow huge amounts of money to get private dentistry just to be able to get through the pain barrier that comes from not being able to get treatment. That is not acceptable. It is actually very expensive not just for the individual, but for our health service as a whole. We need to think a bit more about revisiting the totality of our national health service.

The undermining of the NHS went on for quite a long time. It reached its zenith, if you like, with the Health and Social Care Act 2012, which was piloted through by the coalition Government. That built on previous internal market ideas and specifically encouraged the contracting out of services, which are making a great deal of money through pharmacies in hospitals, through private finance initiatives in hospital and through a whole lot of other things. Money is being taken out of healthcare and handed over as private profit, which is why I intervened on the former Health and Social Care Secretary on this issue.

If we run the health service on the basis of internal markets and profitability, a massive bureaucracy is required to manage that internal market. That means that we end up with many managers working out who will get a contract to do which bit, rather than making the objective the totality of the hospital, the care system, the care service and whatever else it happens to be. We should be looking to more public ownership and intervention in the NHS, not less, and we should not be handing services over to private contractors.

It is not sensible to have a private contractor—say, Virgin Health—running a pharmacy within a hospital. That pharmacy should be part and parcel of the service of the hospital, where all are working for the same employer.

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

I agree entirely with the sentiments expressed by my right hon. Friend. However, does he accept that, when we do not have the supply of workers to meet the needs at the time, we should bring in more nurses and doctors from abroad? We should do that while we assess the numbers that we need to train. Once we have trained more people, we can stop bringing in the staff from abroad. The same applies to contractors and the private sector now. What is not known widely is that many GP practices are private companies—they are not part of the national health service. Where that is not happening, we should be recruiting more GPs.

[Jeremy Corbyn]

I agree that the issue of recruitment is crucial, which means that the issue of training is crucial. However, we have relied for a very long time, and we still do, on many medical professionals coming from other countries, making their homes here and making an incredible contribution to all of our lives. We should thank them, thank the Windrush generation and thank that generation of Irish nurses and others who came to this country to work in and run our NHS. My hon. Friend is right: when there is a shortage or a crisis, we need to reach out to somebody else—perhaps a private contractor—to help deal with it. I can see that happening in an emergency situation, but it has now become part and parcel of the NHS.

Most Members of this House grew up with the idea that the GP was the local person in a local practice. That GP might or might not have been in an NHS-owned building, but they were part of the NHS. We now have major American companies owning a large number of GP practices and providing that service. When I warned, during the 2019 election campaign, that the Government were in secret negotiations with the USA to allow American healthcare companies to enter our health market—as they deftly termed it—I was told that this was some kind of Russian plot that I was regurgitating. It was nothing of the kind. It was a dodgy deal done by this Government to bring in those private healthcare contractors who are making a great deal of money out of our NHS. What we need is public ownership of our NHS. I absolutely agree with the intervention of my hon. Friend the Member for St Helens South and Whiston (Ms Rimmer).

I think everybody would accept that the NHS performed brilliantly during covid. However, what the former Secretary of State did not say was that he managed to make a lot of monumentally ineffective contracts with Serco and others that made a huge amount of money out of track and trace—out of our NHS budget. Those places that used local public health services for track and trace had a much better outcome. We should recognise that the need to invest in local public health services for preventive measures such as track and trace, as well as for many other preventive health measures, is very important, because, as others I am sure will agree, that ends up reducing the overall costs.

A central part of my contribution today is about the care services in this country. Everybody knows that quite a large number of people in NHS beds cannot leave hospital because the care service is simply not sufficient and cannot accommodate them. That means that they are stuck in the worst possible situation. They are in a very expensive NHS hospital bed, where they do not want to be, and are in danger of picking up or passing on an infection while they are there. They want to be in a care facility, but there is not one available for them. That is a monumental waste of money and resources, and it is also very cruel on the individuals concerned. We have all met such patients in hospital.

There was a 15% reduction in care beds between 2012 and 2020. Now, 84% of our care services are owned and run by the private sector. There have been debates in this House for as long as I can remember about the inadequacy of social care, the need to invest more money in social care, and the need to provide for real social care.

Social care is a fear that stalks many families. It is the fear that an older relative—a parent, or whoever—will develop dementia or any other condition, and need social care as a result. The amount of money that they would have to pay into the private care system terrifies people. To avoid that cost, who pays? Usually it is women in families who give up jobs, careers, and their life to care for somebody. It is not that they do not love their relative—they do love them—but their whole lives are turned around by the needs of care. We must grasp this nettle.

If in 1948, with all the post-war problems of investment, public austerity and so on, we were bold enough to develop a national health service, surely to goodness by 2021 we can be bold enough to develop a national care service, which takes away the fear for so many people of the enormous costs of healthcare—healthcare that at the moment is largely provided by the private sector on low wages and in sometimes not very adequate conditions. I think we need to revisit that. An interesting report produced by Unison on social care makes five recommendations, and I will quote the first:

“Remove the profit motive from the care sector. This would involve transitioning to either a national care service or a mix of not-for-profit provider types. If coupled with sufficient Government funding that meets the true cost of care provisions (something which is currently not in place), it would offer a number of benefits including greater financial accountability, value for public money, and likely greater attention to achieving quality care rather than generating a return for investors.”

People are making a great deal of money out of those with social care needs. I think we need to turn that around and ensure it is a public investment.

Our NHS was founded and put forward by very brave people, and it is something we should value and preserve. I think of the people who campaigned for many years on the national health service, but it has problems within it. It has the care problem that I have mentioned, and the inadequacy of mental health provision has been mentioned by a number of colleagues. Some years ago we mounted a huge campaign in my constituency to prevent Whittington Hospital from closing its A&E department. We were successful. The local papers, the community—everybody—got behind the campaign, and the A&E department is open and treats more than 90,000 patients a year. At the end of the campaign we held a celebration rally, and the main organiser of the campaign, Shirley Franklin, said, “Would you all have been here if it had been a mental health unit to be closed, or would you have stayed away?” I think we all know the answer to that. Mental health is seen as something separate and different that we simply do not want to talk about. We must invest in it fully.

This debate is about investing and extending, and thanking those who have gone before us. Some weeks ago I learned with great sadness that the late Alice Mahon died on Christmas day. I will be attending her funeral the week after next. She was a fantastic worker in the NHS, an auxiliary nurse, and I remember her like it was yesterday, standing up in this Chamber and challenging Ministers, be they Tory or Labour: “What are you doing to defend the principle of an NHS that is free at the point of need?” We can learn from the inspiration of wonderful people like the late, great Alice Mahon.

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this debate and on her strong and informative opening. I also commend my hon. Friend the Member for Bolton South East (Yasmin Qureshi) for her detailed explanation of dentistry. I am acutely aware of the issue but I could not go into all that detail, so I thank her sincerely for that.

Our NHS is not a faceless organisation; it is hundreds of thousands of dedicated workers who look after us. Their commitment is being exploited. Our NHS is the people who work in it, and they need to be, and should be, valued and treasured. This Government should be ashamed of the way the people in our NHS are being exploited. After years of Conservative-led Governments, our national health service is reaching breaking point. We have heard from many Members today about the problems with waiting lists, ambulance times, GP appointments and dental health. We need a national assessment of need, and some kind of national inquiry to get down to how we meet that need.

Things need to change, and change quickly, and I have two points that largely read into issues with GPs and hospitals, although our health service is much bigger. There must be a commitment to look at social care, which must be considered and addressed. Without that, we will never get hospitals right, because most of the beds that are taken up—I hate to say that—but could be freed up, are as a result of problems with social care. We must ensure that the funding we give for social care goes to the funded body.

The relationship between GP surgeries and patients needs to be addressed. We have heard about how many members of the public are illiterate, and they do not have confidence when they go to a surgery to argue their point. I have a case at the moment that is driving me around the bend. It involves a simple admin error—any of us could make an error, so I am not criticising anyone—and it has caused such anxiety to my constituent that I am receiving texts minute by minute. The bureaucracy involved between a GP surgery and a consultant to get something right is unreal. The relationships and training within GP surgeries need to be addressed.

There has been an absolute failure to adopt a long-term plan to recruit doctors, nurses and social care workers—social care needs to be treated as a profession, rather than simply going into a house to provide a bit of care. The crisis has been allowed to reach such a stage that a long-term plan is not enough. Urgent action is needed to tackle the lack of doctors and nurses. There is now no option other than to make it easier for the NHS to recruit doctors and nurses from abroad. There are 130,000 vacancies across the health and care sectors, and there is not enough time to train sufficient people to plug the gap. I respect the quality of the nurses and doctors we recruit from abroad, so I am not doing them down; we have to bring them in because we do not have what we need. We are having to use the private sector to fill the gap, but we should be thinking about our long-term needs. We should be recruiting and training people so that we do not have to keep recruiting from abroad.

The Government have failed to outline anything like a long-term plan for the health service. We need home-grown doctors, nurses and carers, and we need to think about what else we can do. We have lost so many surgeries. Why does the NHS not employ GPs? One of our surgeries in St Helens is run by the NHS. The Government have failed to offer more training places for doctors and nurses, and they have failed to prepare our NHS for the future. The current crisis is putting a spotlight on the issue, which results from more than a decade of failure to adopt a long-term approach to staffing. Instead of adopting such an approach, each Health Secretary and Prime Minister has wanted to put their own short-term stamp on the NHS. We have had so many Prime Ministers and Health Secretaries in the past couple of years, and each has wanted to put their own stamp on the NHS. Our NHS is too important for that. It is too important not to have a long-term plan for recruitment and retention.

Labour will train 10,000 new nurses every year, and it will double medical school places. Training and recruiting staff is only half the story; the other important half is retention. NHS staff are leaving in droves, and morale is at an all-time low. We would not be able to handle another covid strain, as our NHS is not what it was three years ago because it has been drained and exploited. It is at its lowest ebb.

Keeping well-trained and experienced is staff is vital to delivering a good service to the public. We need to respect their skill and commitment. It costs a lot more to recruit and train new staff than it costs to keep existing staff. For more than a year, the Government clapped nurses on the doorstep, but they refused to give even the 2.5% increase that was already in the Budget, and now they will not sort out a third pay settlement.

If we want our NHS to care for us, we need to care for our NHS. The Government have lost the confidence of our NHS heroes, and that needs to change. Our NHS needs rescuing, and only Labour will do that. I think it is simple. The Government say they have a long-term plan, but Labour will deliver a long-term plan to save the NHS by plugging the staffing shortage with more training places, greater recruitment and better retention. That will give patients the service they deserve, a service for which we will always be thankful.