PARLIAMENTARY DEBATE
NHS: Independent Investigation - 12 September 2024 (Commons/Commons Chamber)
Debate Detail
Unlike the last holders of this office, this Government will be honest about the problems the NHS faces and serious about fixing them. That is why I asked Lord Darzi, an eminent cancer surgeon who served both Labour and Conservative-led Governments with distinction, to conduct an independent investigation into the state of our national health service. I am sure the whole House will want to join me in thanking him for producing this expert, comprehensive report, a copy of which I have placed in the Libraries of both Houses.
I told Lord Darzi that we wanted hard truths, warts and all. His findings are raw, honest and breathtaking. He says:
“Although I have worked in the NHS for more than 30 years, I have been shocked by what I have found”.
He has uncovered an enormous charge sheet, too long to list in this statement, so these are just a few: the NHS has not been able to meet its promises to treat patients on time for almost a decade; patients have never been more dissatisfied with the service they receive; waiting lists for mental health and community services have surged; 50 years of progress on cardiovascular disease is going into reverse; and cancer is more likely to be a death sentence for NHS patients than for patients in other countries. It is not just the sickness in the NHS that concerns Lord Darzi, but sickness in society. Children are sicker today than a decade ago and adults are falling into ill health earlier in life. That is piling pressure on to the NHS and holding back our economy.
Those are some of the symptoms; the report is equally damning on the causes. First, a decade of under-investment left the NHS 15 years behind the private sector on technology, with fewer diagnostic scanners per patient than almost every comparable country, including Belgium, Italy and Greece, and in 2024 mental health patients are treated in Victorian buildings with cockroach and mouse infestations, where 17 men are forced to share two showers.
Secondly, there was the disastrous 2012 top-down reorganisation overseen by Lord Lansley. Lord Darzi’s assessment is damning:
“A calamity without international precedent…it took a ‘scorched earth’ approach to health reform”.
“By 2015…ministers were…putting in place ‘workarounds and sticking plasters’ to bypass the legislation”.
“Rather than liberating the NHS, as promised, the Health and Social Care Act 2012 imprisoned more than a million NHS staff in a broken system for the best part of a decade”.
“the effects…are still felt to this day.”
Just imagine if all the time, effort and billions of pounds wasted on dissolving and reconstituting management structures had instead been invested in services for patients—clearly, the NHS would not be in the mess it finds itself in today.
Thirdly, there was coronavirus. Everyone can see the lasting damage caused by the pandemic, but until now we did not know that the pandemic hit the NHS harder than any other comparable healthcare system in the world.
The NHS cancelled far more operations and routine care than anywhere else. As Lord Darzi writes:
“The pandemic’s impact was magnified because the NHS had been seriously weakened in the decade preceding its onset.”
In other words, it is not just that the Conservatives did not fix the roof while the sun was shining; they doused the house in petrol and left the gas on, and covid just lit the match. That is why waiting lists have ballooned to 7.6 million today. [Interruption.] If I were an Opposition Member, I would not complain about the diagnosis. I would take responsibility.
Fourthly—this sits firmly at Opposition Members’ door, so they should sit and listen—there was the failure to reform. From 2019 onwards, the previous Government oversaw a 17% increase in the number of staff working in hospitals. Did it lead to better outcomes for patients? No. At great expense to the taxpayer, the NHS has instead seen a huge fall in productivity. We paid more, but got less—a deplorable waste of resources when so many parts of our health and care services were crying out for investment. As Lord Darzi has put it:
“British Airways wouldn’t train more pilots without buying more planes.”
Doctors and nurses are wasting their time trying to find beds for their patients and dealing with outdated IT when they ought to be treating patients.
Too many people end up in hospital because they cannot get the help that they need from a pharmacy, a GP or social care. The effective reforms of the last Labour Government, which drove better performance and better care for patients, have mostly been undone, and that is why patients cannot get a GP appointment, an operation or even an ambulance when they need one today. That is what the Conservatives did to take the NHS from the shortest waiting times and highest patient satisfaction in history to the broken NHS that we see today.
Lord Darzi has given his diagnosis. Now it is over to us to write the prescription, and we have three choices. The first is to continue the Conservatives’ neglect, and allow the NHS to collapse. That is the path on which they set the NHS, and the path that it is on today. Or we could—as some of my critics on the left demand—pour ever-increasing amounts of money in without reform, wasting money that is not there and that working people cannot afford to pay. That would be wasteful and irresponsible, so we will not take that path. This Government are making a different choice: we choose recovery and reform. We are taking action today to deal with the immediate crisis by hiring 1,000 GPs whom the Conservatives had left without a job while patients were going without an appointment, and agreeing an offer to end the strikes that they allowed to cripple our health service.
At the same time, we will introduce the fundamental reforms needed to secure the future of our NHS. Earlier today, my right hon. Friend the Prime Minister confirmed that the Government would publish a 10-year plan for change and modernisation, on the foundation of Lord Darzi’s report. Our plan will deliver the three big shifts needed to make our NHS fit for the future. The first is from analogue to digital, giving patients proper choice and control over their own healthcare, and finally realising the untapped potential of the NHS app. There will be fully digital patient records so that your surgeon can see the notes that your GP writes. By marrying our country’s leading scientific minds with the care of more than 1.5 million NHS staff, we will put NHS patients at the front of the queue for cutting-edge medicines and treatments that we can only imagine today.
Secondly, there is the shift from hospital to community, turning our NHS into a neighbourhood as much as a national health service so that patients can get their tests and scans on their high streets and be cared for from the comfort of their own homes. That means bringing back the family doctor and building a national care service that can be there for us when we need it, able to meet the challenges of this century.
Thirdly, there is the shift from sickness to prevention, which means taking the decisions that the Conservatives ducked to give our children a healthy, happy start in life. It means stopping the targeting of junk food ads at children, banning energy drinks for under-16s, reforming the NHS to catch illness earlier—starting by offering health checks in workplaces and on smartphones—and delivering the Tobacco and Vapes Bill that the Conservatives failed to pass, to tackle one of society’s biggest killers.
Lord Darzi’s diagnosis is that the NHS is in a “critical condition”—unless we perform major surgery, the patient will die—but he also finds that
“its vital signs are strong”:
an extraordinary depth of clinical talent, and a shared determination to improve care for patients. This is a public service, free at the point of use, so that whenever we fall ill we never have to worry about the bill. The NHS is broken, but it is not beaten. Every person I have met in the NHS during my first two months as Health and Social Care Secretary is up for the challenge. It will take time, but this party—the party that created the NHS—has turned the NHS around before, and we will do it again. I commend this statement to the House.
I call the shadow Secretary of State.
The NHS belongs to us all, and we all care about it, so let us stop the political posturing and talk constructively about its future. We all know that our healthcare system faces significant pressures, as do all health systems around the world. We are living longer, and with multiple and complex conditions. We have wider societal pressures, such as the impact of social media on the development of some young minds, as well as the cost pressures of miracle drugs developed by our world-class life sciences sector for their treatment benefits, and the shock of the pandemic has had catastrophic impacts on the NHS and its productivity.
I believe there is much to be proud of in the NHS. Its dedicated staff look after 1.6 million people a day— 25% more people than in 2010. It has more doctors, more nurses and more investment that at any point in its history. It is delivering tens of millions more out-patient appointments, diagnostic tests and procedures for patients than in 2010, and we delivered the fastest roll-out of vaccinations for covid in the world, freeing our society more quickly than other countries. We have more healthcare in the community, with the opening of 160 community diagnostic centres—the largest central cash investment in MRI and CT scanning capacity in the history of the NHS—and 15 new surgical hubs; and the launch of Pharmacy First, helping to free up 10 million GP appointments for those living with more complex conditions. [Interruption.] I say to the Secretary of State that I paid him the courtesy of listening to him in silence, so I hope he will do the same for me.
We on the Conservative Benches never pretended that everything was fixed. We have not pretended that we have a monopoly on wisdom or that there are easy answers to the difficult challenges we face. For the NHS to thrive in its next 75 years, it needs to reform, modernise and improve productivity. That is why the Conservative Government, working with NHS England, announced the NHS productivity plan at the spring Budget to transform how the NHS works through better IT systems for frontline staff, the expansion of services on the NHS app, which is used by three out of four adults in England, and the use of new technology, including voice-activated artificial intelligence. Together, that would see productivity grow by 2% a year by the end of the decade and unlock £35 billion-worth of savings, yet the plan is not mentioned in the 163-page report. Why is such an important and forward-looking reform missing from the report, and can the right hon. Gentleman confirm that he is choosing to cancel it—yes or no?
New medicines and trials are an essential part of the productivity challenge. There is only one mention of the National Institute for Health and Care Excellence in the 163-page report. Do the Government have a strategy for life sciences and the provision of rare medicines, including cancer and dementia drugs? Why have they paused the childhood cancer taskforce?
The need for reform was also why we implemented the first ever long-term workforce plan with NHS England to train even more doctors, nurses, midwives and other healthcare staff for the future. The plan was described by the NHS CEO Amanda Pritchard as
“one of the most seminal moments in our 75-year history”,
yet it is not mentioned in today’s report. Again, why is such an important and forward-looking reform missing from the report? Is the right hon. Gentleman going to cancel the new places and forms of training, including apprenticeships, that were to be provided through that plan?
The need to modernise is why, in 2019, we announced the largest programme of hospital building in modern history: 40 new hospitals across England by 2030 [Interruption.] I would be careful if I were some Back-Bench MPs. Today, seven new hospitals have opened, the Midland Metropolitan university hospital will open at the end of the year—I imagine the Secretary of State will enjoy going to its launch—and a further 18 are in construction. We are not even halfway through the decade.
Since January 2023, it has been Labour’s plan to pause, review, delay and, presumably, possibly cancel those new hospitals. That was when it published its health mission; it is on page 6 for those who have not read it. In other words, it was always Labour’s plan to delay and possibly cancel the new hospitals, and it has nothing to do with the Chancellor’s questionable accounting since the general election.
When that was pointed out in the general election campaign, Labour candidates ran around promising voters that their new hospital or community diagnostic centre was safe with them—in Torbay, Chelsea and Fulham, Basingstoke, Watford, Bracknell, Truro, Corby and Kettering to name a few. Will the right hon. Gentleman confirm that Labour will delay those hospitals?
There is one part of Great Britain where, on almost every measure, the NHS performs the worst: Labour-run Wales. The right hon. Gentleman has compared—
In fact, it has been a feature of debate in the House since the general election that the Opposition have taken absolutely no responsibility for the mess they left our country in, including a £22 billion black hole and the new hospitals programme that the right hon. Lady referred to, in which the timetables were a work of fiction and the money ran out in March. She knew that when she went to the country to claim that the programme was fully funded. She talks about the decisions made by NICE; that was a new Labour reform and modernisation—one that thankfully survived the last 14 years.
The right hon. Lady has endorsed the right hon. Member for Newark (Robert Jenrick) in the Conservative party leadership election. I wonder what she makes of his admission that the Conservatives failed to make the tough reforms that the NHS needed because they were afraid of what Labour might say. Is that not the most derisory excuse for 14 years of neglect?
My predecessor does not bear responsibility for everything in the Darzi report—this crisis was more than a decade in the making—but I wonder when the right hon. Lady will show some humility on behalf of her party and apologise for the mess that her Government made of our national health service. Otherwise, why should anyone trust what the Conservatives have to say ever again?
This Government were given a mandate for change, and nowhere is that more needed than in our NHS. The report must mark the beginning of the long, hard work of change. It is the platform from which we will launch a decade of reform that will make sure that the NHS can be there for us when we need it—for us, our children and our grandchildren. It must draw a line in the sand, so that we never go back to the pain, fear and misery that the Conservative party inflicted on millions of patients.
I welcome the Secretary of State’s statement. In 2008, the previous Labour Government commissioned a report from Sir Michael Marmot on the state of society and health, and he found that there was health inequality, particularly in deprived areas. Ten years on, his second report found that health inequality had become even worse against the backdrop of an underfunded NHS. Does that not demonstrate the urgency of the need to invest in those communities under this Government? What can my right hon. Friend do to direct resources into the most deprived communities in order to turn around those health inequalities?
But the report is long on diagnosis and short on prescription, so may I invite Ministers to read our fully costed manifesto to fix public health and primary care by recruiting 8,000 GPs, ending dental deserts, boosting public health grants by £1 billion, implementing our five-year plan to boost cancer survival rates, and putting a mental health expert in every school?
Does the Secretary of State accept that there is an elephant in the room: social care? Will he meet me to discuss the Liberal Democrat plans for social care, starting with free personal care? This bold idea would prevent many people from going into hospital in the first place, as well as enabling them to be discharged from hospital faster. Does he accept that it is a truth universally acknowledged that we cannot fix the NHS if we do not fix social care too?
As for the dire state of our hospitals and primary care estate, well, the Conservatives have left it to fester like a wound. Will the Secretary of State give the green light to hospitals that are ready to rebuild, such as mine in west Hertfordshire? Will Ministers look to reform outdated Treasury rules that are preventing our integrated care boards and hospital trusts from spending and investing their funds in the GP practices and hospitals that we need? This Government say that they want growth. Well, health and wealth are two sides of the same coin, which is something the Conservatives do not understand. If Labour wants economic growth, fixing our health and social care must be its top priority. And it must be a priority without delay.
As the Prime Minister reiterated again this morning, we are absolutely determined to address both the short-term crisis and the long-term needs of the century in our social care system. We want to work on a cross-party basis wherever possible, so I would be delighted to meet the Liberal Democrat spokesperson.
Regardless of the fact that there is a Scottish National party Government in Scotland or a unique arrangement in Northern Ireland, as well my friends in the Welsh Government, I am proud that in my first weekend as Secretary of State for Health and Social Care, I made it my business to phone my counterparts in Scotland, Wales and Northern Ireland. I made it clear that we will always work constructively, whatever our parties and however hard we will fight each other at the ballot box. Rather than pointing fingers at other parts of the United Kingdom, as the Conservatives did when they were in government, this Government are determined, just as the last Labour Government were, to create a rising tide that lifts all ships. I look forward to working with every devolved Administration to improve health and care outcomes across the whole of our United Kingdom.
I can reassure my hon. Friend’s constituents in Bassetlaw that within our first couple of months, this Government employed 1,000 more GPs on the frontline who had been left unemployed by the previous Conservative Government. We did that pretty much immediately. We have settled—I hope; we await the outcome of the ballot—the junior doctors’ dispute, so we can remove the cost of disruption and industrial action and start work on getting the waiting lists down. We will be working at pace to deliver 40,000 more appointments every week so that we can cut waiting lists, and 700,000 urgent emergency dentistry appointments so that we can ensure that people get the care they need. Every single promise in our manifesto, notwithstanding the challenges in the public finances, was a fully costed, fully funded promise that we will keep and that the country can afford.
“The result is that the basic structure of a headquarters, regions, and integrated care boards (ICBs) is fit for purpose.”
I draw the Secretary of State’s attention to the Suffolk and North East Essex ICB, which is one of the most successful in the country. Can we learn from that success, and build it into other areas?
On the hon. Gentleman’s point about learning from what is working well in the NHS, what gives me great hope for the future of our national health service is that every day there are amazing people providing great-quality care, reforming, innovating and showing us what the future looks like. It is the responsibility of this Government to take the best of the NHS to the rest of the NHS. That is exactly what we will do.
The pause is because we are looking at the breadth of the work of the Department to make sure that we have the right vehicles to deliver the outcomes that we want. That is why we have paused rather than cancelled, slammed or criticised the work that she was doing. I would be delighted to meet her to talk about the genesis of the taskforce and how we can take forward the outcomes that she wants to see. What we are trying to avoid is a plethora of taskforces, and the risk that there has sometimes been—this is not a party political point, because this spans successive Governments—of taskforces being an alternative for action. I know that she wants action, so let us meet and see what we can do together.
On a serious note, he is right that wherever we find waste and inefficiency designed in, we must deal with it. I want to see an NHS that is more clinically led, free from political interference. We must also be honest: as it is such an enormous part of the public sector, which the public pay an enormous price for and value so much, there will always need to be an accountability relationship. What I have tried to build with NHS England in the last couple of months, with real joy in the process, is a real team between the Department of Health and Social Care and NHS England, as well as the team across the country. I look forward to continuing to galvanise that team as we embark on the 10-year plan process.
The relationship between the NHS and local government, and between my Department and local government, is of particular importance in relation to social care, which is why I was especially delighted that the Prime Minister chose this week to appoint Tom Riordan, the chief executive of Leeds city council, as second permanent secretary. He is an outstanding public servant with a demonstrable record on health and care integration, public health and prevention. I look forward to having that local government perspective, and local community delivery perspective, at the heart of our Department.
I also saw the parents of a young woman who has epilepsy, a physical disability and profound anxiety. The failure to put in place a care plan to account for all that means that she is now self-harming. The other case was that of an elderly woman whose husband was discharged from the hospital without her consent. He is now in a care home 20 miles away, and she cannot visit him. Will the Secretary of State assure those people that this Government will not only fix our NHS, but restore their broken trust in it?
I appreciate the terminology used in the report, which outlines the seriousness of conditions in the NHS but also highlights the fact that the vital signs are still strong. Will the Secretary of State outline how he intends to address the fact that the NHS in devolved regions is in an arguably worse condition? Will he confirm that the review will incorporate Northern Ireland and will he ensure that the findings, new practices and standards will be in place for Northern Ireland, along with increased funding in a new funding formula?
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