by Dick Barry
National Health Service Funding
On 22 November, Jonathan Ashworth, Labour’s Shadow Health Secretary, moved a motion on NHS funding. The motion was amended by the government. Below we publish Ashworth’s speech with the motion, the government’s amendment, and a speech by Dr Sarah Wollaston, a medical GP and Conservative member for Totnes. Labour’s motion was defeated by 306 votes to 213. The motion as amended was therefore carried. There is no record in Hansard of which MPs voted.
Jonathan Ashworth (Leicester South) (Lab) I beg to move,
That this House notes with concern that the deficit in the budgets of NHS trusts and foundation trusts in England at the end of the 2015-16 financial year was £2.45 billion; further notes that members of the Health Committee wrote to the Chancellor of the Exchequer about their concerns that Government assertions on NHS funding were incorrect and risked giving a false impression; and calls on the Government to use the Autumn Statement to address the underfunding of the NHS and guarantee sustainable financing of the NHS.
I begin by reminding the House that, six years ago, the then Conservative leader promised to “cut the deficit and not the NHS.” The previous Chancellor, the right hon. Member for Tatton (Mr Osborne), told us that he would “properly fund public services” and that “investment in public services would come before tax cuts.”—[Official Report, 27 November 2006; Vol. 453, c. 837.]
Robert Flello (Stoke-on-Trent South) (Lab) My hon. Friend is most generous. He might have missed something. Did the Chancellor not say that he would wipe out the deficit by 2015?
Jonathan Ashworth My hon. Friend is eagle-eyed, and I congratulate him on reminding us that the Government should have balanced the books by 2015, and that they completely failed on that pledge. Then the new Prime Minister made this promise: “We will be looking to ensure that we provide the health service that is right for everyone in this country.”—[Official Report, 7 September 2016; Vol. 614, c. 333.]
Fine words, but it is by their deeds that they shall be known. What did we actually get? An NHS that is going through the largest financial squeeze in its history. Far from protecting the NHS through the years of this Tory Government, NHS spending will represent an average annual increase of just 0.9%—a decade of barely any increase in spending despite an ageing population with increasingly complex needs.
By 2017, NHS spending per head will level out, and, head for head, by 2018 NHS spending will be falling under this Conservative Government. Trusts ended last year in deficit for the second year running—they were £2.45 billion in deficit and they are reported to be heading for a deficit of around £670 million at the end of this financial year.
Helen Goodman (Bishop Auckland) (Lab) Is this the explanation for the secret plan in County Durham to cut the number of beds for frail elderly people by 20%?
Jonathan Ashworth My hon. Friend makes a very important point. I will be coming on to those secret plans as I develop my speech.
We will be spending less on the NHS as a proportion of GDP than our European neighbours such as Germany, France and the Netherlands. The NHS maintenance budgets have been repeatedly raided, with billions that had been allocated to capital routinely being switched to revenue to plug gaps.
The maintenance situation has got so bad that the NHS faces a backlog of £5 billion in repairs.
Public health budgets, which fund projects to tackle teenage pregnancy, excessive alcohol consumption, sexually transmitted infections and substance misuse and to provide anti-smoking interventions, will have been cut by 9.7% by the end of this Parliament. That is a completely false economy leading to greater demands on the acute sector. As my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) so brilliantly outlined last week, the adult social care budget has been slashed.
Sir Simon Burns (Chelmsford) (Con) I am so grateful to the hon. Gentleman. The House would take him somewhat more seriously if he pointed out that, by 2019-20, the real-terms increase in spending on the health service will be £10 billion. During the last election, his party promised to increase spending in this Parliament by only a quarter of that— £2.5 billion.
Jonathan Ashworth The right hon. Gentleman was the Minister who took the Health and Social Care Act 2012 through this Parliament, and who wasted £3 billion on an unnecessary top-down reorganisation. He should be apologising to the House, not making those comments.
We are seeing unprecedented cuts to social care, which means that the number of people aged over 65 accessing publicly funded social care will fall by 26%. UK public spending on social care is set to fall to less than 1% of GDP by the end of this Parliament. Just yesterday, Baroness Altmann, the former Conservative pensions Minister who was appointed last year to great fanfare by David Cameron, said that we are “sleepwalking into a crisis” and that the NHS will not be able to pick up the pieces of a “broken system”.
Gloria De Piero (Ashfield) (Lab) Does my hon. Friend agree that when funding is cut, our hospitals seek to raise cash in other ways, such as the unacceptable level of car parking charges at our hospitals—charges which the Government promised before the last election to clamp down on?
Jonathan Ashworth My hon. Friend is running a brilliant campaign on that. I hope that when the Minister responds, he will reply to that point. The scale of the financial pressures engulfing the NHS are such that the chief executive of NHS Providers, Chris Hopson, said recently: “The gap between what the NHS is being asked to deliver and the funding it has available is too big and is growing rapidly.”
The King’s Fund said, with respect to the NHS deficit, that “it signifies a health system buckling under the strain of huge financial and operational pressures.” In the most damning assessment of the Government’s handling of the NHS, the National Audit Office concluded today that financial problems in the NHS “are endemic and this is not sustainable.” Even the former Health Secretary, Andrew Lansley, said that “in 2010 we knew we had to implement a tight budget squeeze for five years, but we never thought it would last for ten.”
David T. C. Davies (Monmouth) (Con) Surely the hon. Gentleman has seen the report from the Nuffield Trust on the four health systems of the United Kingdom, which shows very clearly that there is only one part of the United Kingdom that has seen a real-terms cut in NHS expenditure, and that is Wales under a Labour Government.
Jonathan Ashworth There will be a cash injection in Wales in 2017, whereas spending per head in the English NHS will be levelling out and then falling in 2018.
Joan Ryan (Enfield North) (Lab) In Enfield we are short of 84 GPs going forward and we have just had a hospital crisis at the North Middlesex hospital, where there were not enough doctors for our A&E to be safe for patients, yet the only thing we hear about is the sustainability and transformation plan locally which, as far as we can see, is not only secret but about taking £22 billion out of the NHS.
Jonathan Ashworth My right hon. Friend is right and she is a brilliant campaigner for the health service in Enfield. The points that she makes about the staffing crisis in the NHS are well made. I hope that the Secretary of State will respond to her.
Things are so bad for the Health Secretary that even the NHS chief executive told the Health Committee that “2018-19 will be the most pressurised year for us…will have negative per-person NHS funding growth.” Those were the chief executive’s words. Will the Health Secretary sit up and listen, and respond to the chief executive, or will we get what we saw in the Sunday newspapers—briefing against him. We heard that the Government are “gunning for” Mr Stevens and are going to “fix” him. I hope the Secretary of State will repudiate that briefing when he responds to the debate and distance himself from it.
The only people who do not appear to accept the need for more money for the NHS are the Prime Minister and Secretary of State. We anticipate what the Secretary of State will tell us from the Dispatch Box. The right hon. Member for Chelmsford (Sir Simon Burns) alluded to it and I will now answer his question. The Secretary of State will not only tell us that we have a generous, munificent Conservative Government who have given the NHS the money it asked for, but persist with the fiction that the NHS is receiving an extra £10 billion. However, we all know—and I suspect that the Secretary of State knows, because he now distances himself from the figure when he does interviews—thanks to the Health Committee and others that this £10 billion claim is bogus. It is a claim universally derided and discredited, apart from in the drawing room of 10 Downing Street.
Michael Gove (Surrey Heath) (Con) The chief executive of the NHS, whom the hon. Gentleman has just mentioned, welcomed that additional £10 billion and said that it gives the NHS the extra headroom we need. Will the hon. Gentleman repudiate his criticism now and make it clear that he associates himself with the chief executive of the NHS in welcoming that £10 billion of extra funding?
Jonathan Ashworth The chief executive’s comments to the Select Committee speak for themselves. Talking of repudiation, when are we going to get £350 million a week, or were the Tories typically saying one thing before the people voted and something completely different after they had had their say? That is what the ex-Education Secretary should be telling us.
Let me remind the House what the Health Committee said. I see the hon. Member for Totnes (Dr Wollaston) in her place, and she said: “The continued use of the figure of £10 billion for the additional health spending up to 2020-21 is not only incorrect but risks giving a false impression that the NHS is awash with cash.” She is sitting only a little further down from the right hon. Member for Surrey Heath (Michael Gove). Perhaps he can have a word with her if he disagrees.
The Secretary of State hopes we do not notice that he is stretching the timeframe over which he presents this funding allocation. He hopes we do not notice that NHS spending has been redefined by the most recent spending review. He hopes we do not spot that he is cutting billions from public health budgets and other Department of Health funding streams—a £3 billion cut. But we have noticed.
We have spotted the Secretary of State’s conjuring act because we have seen this Tory trick before—robbing Peter to pay Paul. The result of this trick is cuts and underfunding, more pressures flowing through to the frontline, and, as the NAO said, “Financial stress…harming patient care”. In all our constituencies we see ever-lengthening queues of the elderly and the sick waiting for treatment. Across the board, we see the worst performance data since records began.
The Secretary of State for Health (Mr Jeremy Hunt) Nonsense.
Jonathan Ashworth What world is the Secretary of State living in? Half a million patients have waited for four hours or more in A&E in the past three months—the worst performance for this time of year for more than a decade—and he says it is nonsense. Some 350,000 of our constituents are waiting longer than the promised time for elective treatment—some have been waiting more than a year—and he says it is nonsense. Delayed discharges from hospitals are at record levels, and he says it is nonsense. The number of people waiting for 12 hours or more on trolleys has increased by over 700% since 2011-12.
Anna Soubry (Broxtowe) (Con) Will the hon. Gentleman tell the House why it is that, after 12 minutes, he has yet to praise all our hard-working doctors, nurses and other health professionals? Why is he constantly talking down our great NHS, including the hospitals in Leicester?
Jonathan Ashworth I praise the hard-working staff in the NHS every day of the week, but I rather suspect that staff in the NHS will have more sympathy with the position I am outlining than with the right hon. Lady’s position, not least when, according to surveys, 88% of NHS staff think that the NHS is under the most pressure they can remember, and 77% think that there is less access to resources, putting the quality of patient care and clinical standards at risk. That, I say to her, is what NHS staff are saying.
Mr Jackson ??? Perhaps I can just allow the hon. Gentleman to break off from reading his press release. I think we are moving towards a consensus on this issue, in that we do need to integrate acute clinical care and adult social care, and I understand that. In that vein, why was it that, in 13 years, when there was significant demographic change, the Labour Government failed to bring forward a better care fund or a precept for social care?
Jonathan Ashworth It beggars belief! We tripled investment in the NHS, and the hon. Gentleman and his hon. Friends voted against every penny piece. When we left office, we had the best waiting times and the highest satisfaction levels on record. That is the difference between a Labour Government and a Conservative Government on the NHS.
Henry Smith (Crawley) (Con) Can the hon. Gentleman explain, then, why the Labour Government closed the maternity and accident and emergency departments at Crawley hospital?
Jonathan Ashworth Well, reconfigurations are always going ahead. [Interruption.] If Conservative Members are so concerned, I look forward to the hon. Gentleman campaigning against the STPs for his area, when they are published in a few weeks.
We have seen what the reality of six years of Tory underfunding and cuts in our NHS are all about, and there are more stealth cuts to come, which will add further pressures. For example—these are small things, but they all add up—cuts to the Care Quality Commission mean that it will increase its fees for NHS hospitals, other trusts and other providers. Some trusts will have to pay over £100,000 as a result of these cuts. Reductions in education and training tariffs will put more pressures on trusts and on the frontline. In the House the other week, we debated how cuts to community pharmacies will lead to increased demands on the NHS.
Only last week, news slipped out about the privatisation of NHS Professionals. A body that makes a profit for the NHS and ploughs that back into the NHS is going to be privatised, and that profit will presumably go to private companies.
The combination of all these cuts and privatisations, the utter failure to deal with the crisis in adult social care, and the lack of planning for an ageing population with complex needs will directly lead to greater demands on the NHS, bigger cuts, and deficits across the board. It is in this context that the NHS is also expected to find £22 billion of so-called efficiencies and to redesign services across England completely as part of the sustainability and transformation process.
Where sustainability and transformation plans are about transforming services in the interests of patient care, reversing fragmentation and ensuring more collaboration in geographical areas, we will consider them carefully. We will want to look at every single STP to see whether those plans are genuinely jointly owned, and whether they tackle the crisis in social care, guarantee better access to care for the long term, and are transparent and financially viable. What we know so far, though, is far from reassuring, because we can see from the 19 or so STPs that have been published that the ground has shifted. It has become obvious that what began as a project to transform services for patients and build up community services is now more about closing the financial gap:
“Of course, the driving force behind STPs is the emergence in the last two financial years of substantial deficits.”
Those are not my words, but those of Andrew Lansley just a few weeks ago. The STP areas that we have seen so far have been racking up shortfalls of about £10 billion that can be filled only by cuts to hundreds of beds, closing hospitals, downgrading A&Es, downgrading maternity wings and withdrawing treatments.
Helen Jones (Warrington North) (Lab) Does my hon. Friend agree that proposals to downgrade A&E in an area such as Warrington, which is surrounded by motorways as well as containing many people who suffer from health deprivation, is a recipe for disaster? If people have to travel further for emergency care, that will not improve their care in any way.
Jonathan Ashworth My hon. Friend is extremely knowledgeable about the health service and has been campaigning vigorously on the STPs. She is completely right. We will see hospitals merged in the Merseyside area and in London, hospitals lost in Durham, and efficiencies found by changing staffing levels. In fact, the STP for Cheshire and Merseyside, the area that she represents, talks enticingly of “Exploration of a Factory Model”. Doesn’t that sound nice?
With cuts to services and rock-bottom staff morale, we have the Sports Direct approach to the NHS, with the Secretary of State playing the part of Mike Ashley. The public deserve better than this bargain basement approach. Scaling back the acute sector while not investing in the community sector simply does not work. The Prime Minister might have ruled out extra funding—
Michael Gove I have listened with great interest to the hon. Gentleman. He has spoken eloquently of his concerns about the NHS, but has not, in the course of 18 minutes, put forward a single positive policy or explained where a single penny of additional funding would come from. He has secured the time for this debate, so would he at least put forward a positive policy for the NHS, or a suggestion as to where the money should come from?
Jonathan Ashworth The right hon. Gentleman really does have a brass neck. We still do not know when we are going to get the £350 million from him, but next time he intervenes perhaps he will tell us.
Michael Gove Answer the question.
Rosie Cooper (West Lancashire) (Lab) Perhaps the right hon. Member for Surrey Heath (Michael Gove) would like to tell me how cutting the A&E at Southport and Ormskirk hospital and giving local community and acute services to Virgin Care can be a positive story for the NHS.
Jonathan Ashworth This is exactly the sort of point that we are making; my hon. Friend is absolutely correct. That is why we need to look carefully at all these STPs. Of course, we do not know much about them at the moment, because all we see is glossy brochures that tell us that everything is going to be all right and not to worry. We want transparency. The Secretary of State should insist that every single STP is published and that we have the details of the cuts that will be made in our communities.
Dame Rosie Winterton (Doncaster Central) (Lab) Is not one of the problems with local planning the recruitment of GPs and the lack of GPs locally? Would it not help if we were to amend the Health and Social Care Act 2012 so that clinical commissioning groups and NHS England could provide directly salaried GPs instead of being prevented from being doing so, as is the case at the moment? That is a practical example of something that would save money and increase the local provision of GP services.
Jonathan Ashworth My right hon. Friend is absolutely right. Morale among GPs is at an all-time low. She identifies another problem that has emerged because of the 2012 Act. I hope that the Minister will respond to her important point.
Helen Jones Is my hon. Friend aware that the Cheshire and Merseyside group has not only refused to publish details about the STP, but refused my Freedom of Information Act request for information about the meetings that were held on the STP and who was present at them? Does that not simply give rise to suspicion that this whole process is being driven by cuts rather than the need to improve care?
Jonathan Ashworth My hon. Friend is absolutely right. The Chancellor should respond tomorrow to the growing body of evidence that the NHS has not been given the money that it needs. Tomorrow, we need an end to the scandal of crumbling hospitals. Tomorrow, the Chancellor must put right the Government’s greatest betrayal on adult social care. Tomorrow, the Government must deliver the long-overdue investment that our NHS needs.
Michael Gove Where is the money coming from?
Jonathan Ashworth What sense does it make to carry on cutting inheritance tax, capital gains tax and corporation tax, at a cost of billions to the Exchequer, while at the same time failing to fund our national health service or to give social care the money it demands? The Prime Minister lets the CBI know that she is prepared to give away billions extra in corporation tax, but she tells us that there is no more money for the NHS. The Chancellor will be prevented from acting tomorrow not by financial constraints, but by the ideological constraints that the Government have placed on themselves. It is time to give the NHS the funding that it needs. I commend the motion to the House.
The Secretary of State for Health (Mr Jeremy Hunt) I beg to move an amendment, to leave out from “House” to the end of the Question and add
“welcomes the Government’s investment, on the back of a strong economy, of significant additional funding and resources each year for the NHS during the 2015 Parliament; notes that this settlement was frontloaded at the specific request of the NHS in NHS England’s own plan to deliver an improved and more sustainable service, the Five Year Forward View; and further notes that the NHS will receive a real terms increase in funding in each year of the Spending Review period, while the Labour Party’s Manifesto at the last election committed to only an extra £2.5 billion a year by 2020, far less than the NHS requested.”.
Dr Sarah Wollaston (Totnes) (Con) I want to touch briefly on the importance of clear data, the current financial position, and the need to agree on a settlement for the future in this House rather than continuing to have such confrontational debates.
I can see how the £10 billion figure has been arrived at: by adding an extra year, starting from 2014-15, and by transferring budgets to NHS England. When the Secretary of State refers to the NHS, he is actually referring to NHS England. He is not including public health. He is not, for example, including Health Education England. However, it is crucial that they are considered. As my hon. Friend the Member for Central Ayrshire said, when we talk about transferring money from public health to the NHS England budget, we are cutting off our ability to control the increase in future demand. We face significant challenges, which we will not address unless we invest in those future services.
We sometimes talk about public health as if it were not front-line care, but it is. We are talking about, for instance, services to help people with addictions and sexual health services—really important costs for the NHS. There is also the challenge of the reduction in Health Education England’s £5 billion budget, £3.5 billion of which is spent directly on the wages of health service doctors who are undergoing training, but also delivering front-line services. Cuts to Health Education England cut us off from future sustainability, because that is the budget that trains, retains and sustains our existing workforce. This is all crucial to front-line services.
The other way in which the £10 billion figure has been arrived at is by changing the baseline from which we calculate real-terms increases. I would say that it has never been more important than it is now for the public to have confidence in the data that we use. Trying to return us to talking about total health spending is not trying to be awkward; it is trying to be honest with the public. It is difficult to argue that more funding for health and social care is necessary if a £10 billion increase has been claimed. It is important that we continue to use the same consistent baselines that have been used in the past, so that the public can see what has happened to total health spending.
I welcome the front-loading of the settlement, and I welcome the fact that the NHS has been relatively protected in comparison with other departments, but the scale of the increase in demand is extraordinary. When Simon Stevens talked about welcoming the increase that had been granted, he made it clear that it was dependent on a fair settlement for social care and a radical upgrade in public health, and those two aspects are lacking.
I think that both sides are correct. I can see how the Secretary of State has arrived at the £10 billion figure, but whenever that figure is used we should also present a figure that refers to total health spending in the way in which it has always been referred to in the past. I think that that would help to build the Secretary of State’s case for an increase in funding as we go forward.
Like others, I hope that we shall see an uplift for social care in the autumn statement, because the impact of social care on the NHS is now profound. There cannot be a Member in the House to whom it has not been made clear by people who come to his or her surgery that the state of the care system is in collapse and providers are in retreat. Even those who can afford to pay are finding it difficult to gain access to care.
Helen Goodman (Bishop Auckland) (Lab) In my constituency there are some villages where no social care is available because none of the private providers can afford to deliver it. Does the hon. Lady, in her role as Select Committee Chair, know whether that applies in other parts of the country as well?
Dr Wollaston We know it does, and the CQC report describes social care as being at a tipping-point; it is in a very fragile state and we owe it to all our constituents to try to come together to agree where we go from here. Many have proposed a royal commission to look at future sustainability, but we have had commissions: the Barker commission set out the options, and the House of Lords is looking at future sustainability and the range of options.
I urge colleagues across the House to try to agree, rather than having this continual confrontational debate. The best way forward would be for all parties in this House to agree that this is an enormous challenge. My personal belief is that we should stick with our current very equitable system of state funding of our NHS, look at the various options and agree between us that we need to address this. We cannot keep ducking it; we owe it to all our constituents to adopt a much more constructive tone to our debate.
We know that the current position is unsustainable, and that was reiterated in today’s National Audit Office report. We can continue to shout across the Chamber about how much is spent, but we know this will be a challenge whoever is in power, and I urge all colleagues to focus instead on a different approach. Yes, more can be done within the NHS, but I am afraid that the elastic is stretched far too tight for social care to make any more efficiencies. We now need to work together to see how we can fund this going forward.