Health and Social Care — House of Commons, 2017-02-27
Topic: Health
Philippa Whitford (Scottish National Party, Centre-left): I certainly welcome the fact that, in recent months, since the hearing of the Health Committee, the Secretary of State for Health has stopped using the £10 billion figure and has recognised the £4.5 billion figure, which is much closer to reality. Spending is normally allocated on the basis of health spending, not just NHS England spending. The increase in NHS England spending was at the cost of significant cuts to public health, even though we all recognise the need for prevention, and cuts to Health Education England, despite the attempt to have 1,500 extra doctors every year, extra nurses and 5,000 extra GPs, which is therefore rather a challenge As has been said, last year was the good year before we come to the lean years. I am not going to go into details of the pockling that was required to get anywhere close to the required outturn, which was missed by £207 million, as that has been so clearly explained by those on the Public Accounts Committee. That results in what the Auditor General has described as short-termism—people simply working to meet the bottom line instead of lifting their chins up and looking at what the real challenges are There are three big challenges. We have talked about the ageing population, we recognise that we have significant workforce challenges, and we all know that money is tight and does not grow on trees. Those three things create a conflict. People are sometimes putting in a short-term patch that will actually cost more money in the end. Providers across England can be recognised for getting their agency costs down, although they are still more than twice what they are in Scotland, but what is lying ahead? How will we meet the challenge of providing the workforce after Brexit—not just the challenge of people leaving, but of how we recruit in future? The turnover at the level of nurse and social care worker is about 25%, and we need a constant stream. A Government Member mentioned the tiny proportion of population below the age of 65—of working age. That is exactly why we needed immigration in the first place. Are we going to end up with more agency workers, or will the Government take action to make sure that we can attract nurses, doctors and social care workers from Europe A lot of these problems are blamed on an ageing population. In fact, Scotland’s demographics are worse than England’s, and going through the hard winter that we have all faced, we did not meet our A&E target either. However, in Scotland the A&E department four-hour achievement level was 92.6%, while in England it was 79.3%—the worst level since records began. That shows that there is a real crisis. This is not meant to be a measure for us to attack each other with. In general, this has been a great debate compared with what some of our debates are like. Rather, it is meant to be a thermometer to take the temperature of the whole system—not just the whole hospital system from A&E to discharge, but from home to GP, to A&E, to hospital, to getting back home again. The problem lies in the significant cuts made outside the Department of Health but within social care. Obviously patients require the support to be able to get back into the community, and preferably even back to their own homes Why are we are managing, despite our demographics, to keep our nostrils above water when NHS England is not? It is partly because in Scotland we have focused absolutely on integration rather than financial competition. The convoluted system that now exists between CCGs and outsourcing contracts, bidding and tendering is estimated to take £5 billion to £10 billion out of NHS England’s budget. That would be enough to cover the deficits—to plug the social care hole—and yet the Department of Health does not even keep data on it, so it is not keeping track of how these administration costs are growing. There is no possibility of a cost-benefit analysis of bringing in outside providers and causing this fragmentation instead of people being able to work together In Scotland, as I have said before, we have gone down the route of integrated joint boards between health and social care, taking money from both sides so that we do not have the argument over whose purse is funding a patient. We have used other innovative approaches such as community pharmacies, which we have debated here previously, and minor ailments units within community pharmacies. As a result, in the past five years attendance at A&E in Scotland has increased by 3.4%, while in England the figure is 11.8%—three times our attendance rate The situation with admissions is similar. Our emergency admissions have increased by 4.6%, while those in England have increased by 14%. That is all because the effort is not being made in the community There is a lot of talk, all the time, about the five year forward view. Frankly, we are halfway through the five years, so we are left with a two-and-a-half year forward view. That does not look far enough ahead. Scotland did "2020 Vision" back in 2011, and we are now working on 2030, by which time the number of people aged 85 and over will have doubled. That is what we need to think about: how do we design not only our social care services, but out health services around the ageing population Our Cabinet Secretary is focused on what keeps people independent. Members may think that that is because I represent the Scottish National party, but I am talking about people being independent and living high-quality lives. What is it about? It is about hip replacements, knee replacements and eye surgery. If someone cannot see or walk and they are stuck in their house and lonely, we are going to have to look after them. Therefore, we have invested in—this is often laughed at here—free prescriptions so that people take medication to control chronic illnesses. We have also invested in giving free personal care to people in their own homes so that they do not land in hospital and get stuck there. That is why last year our delayed discharges went down by 9%, while here they went up by between 25% and 30% People also laugh at free bus passes. The hon. Member for South West Bedfordshire (Andrew Selous) mentioned loneliness, an issue that was championed by Jo Cox. It is as big a killer as diabetes. Older people in our community are out and about. They are taking day trips and going shopping, and they love it. They are not stuck in their houses. This is about starting with looking at that population STPs are the best change going forward, but at the moment they are being handed a bottom line and told to work back from it. It cannot be budget-centred care; it must be patient-centred care. All of us across the House can recognise that place-based planning for a community will provide the best service to those patients and our constituents. That is what we should be doing. We need to get real about public health and preventing chronic ill health in later life, and that means addressing health in all policies. It is really bad that, day by day, this House considers individual decisions that completely contradict each other. We should always ask of every decision, "Will this make the health and wellbeing of our citizens better or worse?" If it makes it better, in the end it will save money. That includes poverty—the biggest cause of ill health I call on Members to consider the systems and how we do things, but we need to provide the care in the community before we take it from the hospital. Let us also think a little more broadly in some of the other decisions that we make.