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Future of the National Health Service

Volume 701: debated on Wednesday 22 September 2021

[Hannah Bardell in the Chair]

[Relevant document: e-petition 581077, Protect the NHS, Press Pause on the White Paper for Health and Social Care.]

Before we begin, I encourage Members to wear masks when they are not speaking, which is in line with current Government guidance and that of the House of Commons Commission. Please also give each other and members of staff space when seated and when entering and leaving the room.

I beg to move,

That this House has considered the future of the National Health Service.

Against the backdrop of the deepest health crisis in decades, the Tories have launched a dangerous NHS Bill. The Bill is not an attempt to address the deep failings of the past decade, driven by austerity, cuts, privatisation and the disastrous 2012 reforms that marketised our NHS. It is about entrenching an even greater role for private companies in our NHS.

The new Health and Care Bill should really be called the NHS Americanisation Bill, because it is the latest stage in the corporate takeover of our NHS, one where private companies not only profit from people’s ill health but increasingly get to decide who gets what treatments and when. Those who believe, as we do, in the real principles of our NHS—free treatment, based on need, guaranteed as a right in a comprehensive system—should be deeply alarmed. Others will address their concerns about the Government’s latest plans. Here are just a few of my concerns.

The Bill will not end or reverse privatisation but will open the door to greater private involvement. It is a charter for corruption, with the dodgy allocation of contracts we have seen throughout covid becoming the norm. It will mean even more politically compliant cronies, as it gives the Secretary of State powers to decide the heads of the new local health boards—expect more Dido Hardings, and accountability to local communities to be reduced.

It will introduce strict caps on budgets, which could lead to serious rationing, with services cut to match funding, rather than funding matching health needs. We will have a postcode lottery for treatments. A new payment system would give providers, including private providers, a say in how much they should be paid for contracts won. It has the potential for staff to be paid according to local rates and conditions, creating a race to the bottom with the deregulation of the medical professions, potentially undermining the quality and the safety of care.

These reforms are part of a wider plan. That plan depends first on deliberately underfunding the NHS. Under the previous Labour Government, NHS funding increased by 7% a year; under the Tories, it increased by just 1.2% a year between 2009-10 and 2018-19, and by even less when the growing and ageing population is factored in. Although some new funding is planned through regressive taxes on working people, funding under this Government will still be well below the historic average that is needed. As Matthew Taylor of the NHS Confederation said:

“Extra funding is welcome. But the Government promised to give the NHS whatever it needed to deal with the pandemic, and while it makes a start on tackling backlogs, this announcement unfortunately hasn’t gone nearly far enough. Health and care leaders are now faced with an impossible set of choices about where and how to prioritise care for patients.”

That deliberate underfunding always goes hand in hand with greater privatisation. Waiting lists grow and people start to seek health provision elsewhere. As budgets are cut, that is used as the cover to bring the private sector into the NHS under the false arguments of efficiencies and savings, when the reality is that every pound spent bolstering the private companies is a pound less spent on people’s healthcare. Instead of more privatisation, the public overwhelmingly back the NHS being returned fully to being a public service.

The Bill is being spun as a way to address the huge failings of the Health and Social Care Act 2012, which placed markets at the heart of the NHS, but, in reality, it is simply a way to entrench privatisation in a different way. The Bill does not address the deepest failings of the 2012 reforms. For instance, while dropping the absurd competitive tendering process, the new Bill does not make it a requirement that the NHS is the default option for providing healthcare services.

The legal structure for the market remains. The profit-hungry vultures will still be circling and trying to pick a profit from human suffering. Foundation trusts will still be able to make from 49% of their income by treating private patients, and key outsourced services, including those provided by porters and cleaners, will not be brought back in-house.

As well as allowing private companies still to pocket public money, the Government’s plans also give private companies a chance to shape health policy directly. The Bill opens the door for private corporations to sit on the 42 local health boards—the so-called integrated care boards—that will make critical decisions about NHS spending. In a sign of what might be to come across the country, Virgin Care already has such a seat in Somerset. The Government are under political pressure on the issue, as we know, so we have seen some limited concessions, but they are not enough. The real solution must be that private companies have no role at all on these boards or in the running of our national health service.

The Bill also allows NHS local boards to award contracts to private healthcare providers with even less transparency than they do now. Contracts will be exempted from the public contracts regulations, which opens the door to yet more dodgy handouts to the Tories’ corporate mates, something that has become all too common during the pandemic—and the public know it.

What we have seen with test and trace over the past year is what the Tories want to do with the whole of our NHS. But this stealth privatisation does not end with test and trace. An unbelievable £100 billion has gone to non-NHS providers of healthcare over the last decade alone. Earlier this year, 500,000 patients had their GP services passed over to a US health insurance company, Centene, which is one of the biggest companies in the United States. Its UK subsidiary, Operose Health, now runs 58 GP practices and is thought to be the largest private supplier of GP services in the UK. It is no coincidence that Operose Health’s former chief executive officer, Samantha Jones, was appointed as an adviser to the Prime Minister. An adviser on what? An adviser on NHS transformation. Nothing to see here, of course.

The public have not consented to any of this. In fact, the Government have gone to great lengths to ensure that the public are not even aware that the process is happening, because a new poll by EveryDoctor showed that just one in four people know that up to 11% of the NHS budget goes to private companies.

Finally, when we consider the future of our NHS, we must tackle its staffing crisis. There are many tens of thousands of vacancies, including nearly 40,000 nursing vacancies alone. Yet NHS staff are set to get just a 3% pay increase this year, with most or even all of that increase being eroded by inflation. That will not only fail to tackle the shortages; it is a kick in the teeth, after everything—everything—that our NHS heroes have done over the past 18 months and after a decade of real-terms pay cuts. Nurses’ pay has fallen by around 12% since 2010, so the 15% pay increase that nurses are demanding would address that fall, even if it will not make up for the thousands of pounds in lost pay over the past decade. NHS staff have been balloted and they reject the current pay offer. I wish to place on the record that NHS staff have my full support in their campaign for 15%.

To conclude, instead of addressing the immediate crisis of 5 million people—and rising—on waiting lists, or the tens of thousands of staff vacancies, we are getting yet another top-down reorganisation, the aim of which is to accelerate the stealth Americanisation of our national health service. Of course, the Tories deny that their latest Bill is about privatisation and Americanisation, but I would argue that their response to the pandemic reveals their real ambitions.

Members will be aware that there will be a Division very shortly and the debate will be suspended. I would like to call winding-up speeches by 3.28 pm and I appeal to Members to speak for around five minutes.

It is a pleasure to follow the hon. Member for Leeds East (Richard Burgon). He made a powerful speech, true to his beliefs and values, and he made some powerful points.

It reminded me of my more radical background when it comes to politics, especially in terms of health. I remember attending—not participating in—a demonstration and march in 2011 in Chorlton, shortly after the new Government came in. It was a reasonably left-leaning march and there were a few Soviet Union flags with the hammer and sickle. One of the most powerful contributions was from a trade union rep, who said, “We don’t need change. We don’t need innovation in the National Health Service. The only change you ever needed in the NHS was in 1948 when it was created. We don’t need any change from then.” That was the spirit, and it is the view that too many people have.

The NHS ought to be changing all the time, in different ways, to keep up with the way people work, and with technology and culture. There are so many ways in which the national health service ought to be changing all the time. We need legislation, led by my hon. Friend the Minister, to make sure that we keep up with changes in society. People would be outraged if we had not moved on culturally from 1948.

What does that lead to? Fundamentally, we ought to be focusing on the importance of patients’ values and needs, to make sure that they are at the centre of the national health service. It is not fundamentally about NHS structures, although those are incredibly important, or about maintaining structures as they are forever, but about ensuring that those structures reflect the needs of the national health service so that it is as effective as possible.

We hear discussions and talk about globalisation, which we know is a reality. Many parts of globalisation are a threat, as highlighted by the hon. Member for Leeds East, who talked about the threats and concerns. However, there are also significant opportunities. We want better access to drugs and medicines, especially innovative drugs and the latest drugs. If we look at figures from the European Medicines Agency about the adoption of drugs, we see that England is behind Germany, Denmark, Austria, Switzerland and Italy. We ought to be at the forefront of the adoption of new drugs and new ways to look after people’s lives.

What do we need to understand when we are thinking about this, especially when we consider treatments and support for people with rare conditions? The UK is often not big enough to provide the innovation for these new treatments, so we need international collaborations. The national health service and other UK bodies need to work with countries around the world, but there is a place for corporations, whether in America, Japan or other places.

We need to ensure that our research and development effort collaborates and works with countries around the world. That cannot be on a Government-to-Government or Government agency-to-Government agency basis only. It has to be right through the system. If we do not have that approach where we need clinical trials at scale to support people or to find new treatments for people with rare diseases, it will not happen. We need to participate in international trials as well.

I would expect these things and I hope my hon. Friend the Minister will articulate that they give more potential to the national health service, because we need more engagement. At the moment, the national health service does not function in the way that many people around the country believe it ought to function. It ought to be far more engaged in clinical trials. Talking to many people from the sector, my sense is that that is down to individual leadership in particular trusts.

Too many trusts do not lead and participate in innovation or the adoption of new drugs, once they have been approved. The system is too slow and it often takes far too long, so patients and patient groups know that their trust or clinical commissioning group does not have the life-enhancing or even life-saving treatment that is available. We need that reform of the system to ensure that it looks after the patients.

There is another aspect that needs changing, which is the way that the NHS is funded or operates. I have a strong sense that it is relatively straightforward for the NHS to adopt a new drug. However, it is far more challenging for the NHS to adopt a new medical device because of the up-front costs and the training needs at the beginning. It is more difficult to adopt a device than it is a drug, and we need to have parity in that. We need the NHS to have the ability to adopt these devices and adapt to them.

That naturally leads on to what devices do. A key part of devices is the generation of data. Data is important for understanding the performance and ability of new treatments to make a difference to people’s lives. The NHS does not operate, to any extent, as a system that works and engages properly and fully with data systems. We need reform of the NHS to do that.

I will. The integrated care systems ought to be part of this, with local leadership, and hopefully strong accountability, to ensure that leaders in those areas can drive that engagement with medical research technology charities, corporations, institutes and universities, to ensure that the NHS is innovative, adopts new technologies and ensures that patients have the best they can. That is a huge amount of reform, and it must start now.

It is a pleasure to serve with you in the chair, Ms Bardell. I thank my hon. Friend the Member for Leeds East (Richard Burgon) for opening the debate with so many facts that we need to reflect on. From before our first breath, to our very last, since 5 July 1948, the NHS has worked day and night to give us hope.

The principle was that, no matter who we were—duke or dustman, as Bevan said—we knew that, when the hands of the NHS reached out to us, it neither judged nor differentiated. It simply did everything it could to invest in our health. That equality was the way out of health inequality, which is, sadly, so stark today in constituencies like mine, where the most affluent can expect to live for 10 years more than the poorest.

Reading Michael Marmot’s report, there is something fundamentally missing from the NHS. This reorganisation will not address it. We must sew that into housing, air pollution, jobs—the things that really will bring about a fundamental change.

Sitting suspended for a Division in the House.

On resuming

Before I call the hon. Member for York Central again, I advise Members that the new end time for the debate will be 4.15 pm, and that I would like to call Ministers by 3.45 pm.

Unless and until public health is the Government’s first priority, the demands will be ever-growing, but now, unlike before, it is uncertain whether those demands will be met. Just look at covid-19: the countries that put public health first had the lowest sickness and mortality rates, yet over 135,000 lives have been lost here. Whether it is covid or cancer, poverty is the greatest enemy of health, yet as we speak, the surge in poverty that this Government are imposing on our constituents through the changes they are bringing about—whether through national insurance contributions, or by taking away the £20 universal credit uplift and other benefits—is resulting in poorer mental and physical health. After a decade of austerity, poor workforce planning and a continued drive to profit off the sick have taken their toll on our NHS. In 2019-20, according to the King’s Fund, £9.7 billion was spent on private provision, up by £500 million on the previous year. According to the data provider Tussell, £37.9 billion-worth of covid contracts have been let.

The economic and health shock of covid should prompt us to hit the pause button on the NHS. Last Friday, I spent half a day with York Medical Group, with clinicians, managers, GP partners and support staff; I was there to listen. This Friday, I will be at York Hospital, which is also struggling. The GP practice has received 41,000 calls from a population of 44,000 patients on their books in a month; add to that the 5.6 million, rising to a possible 13 million, waiting for treatment in secondary care. The system is imploding, the staff are imploding, and the NHS is imploding. We cannot just keep feeding money into the NHS, and we cannot keep selling it off.

When I read the subject of the debate—“the future of the NHS”—I did not consider the Health and Care Bill to be that, nor did the staff who I met with. In fact, they see the Bill as a massive distraction from dealing with the current crisis that they are having to grapple with, and another assault is just one step too many. Staff are saying that to save their own mental and physical health, they are now having to walk. We therefore have a workforce crisis on top of a health crisis, and the NHS is now in a clinically dangerous place. Government Ministers who completely misunderstand how the NHS works cannot just keep interfering in the system. They need to pause. They misunderstand the professionalism, care, dedication and love of the people who give all that they have—day in, day out—to care for us. As Ministers introduce more complex systems and more private companies into the health service, the NHS itself is falling apart. The Health and Care Bill is not the solution; it cannot be the way forward.

On the integration of the health service and social care, if we do not put the money together, we cannot put the systems together. However, the reforms will create more barriers and more division, rather than solving the challenges before us. The World Health Organisation describes health as

“a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

A future NHS must start here. Public health has been so underfunded over the last 10 years, and even under-utilised during the pandemic. It is absolutely vital that it is at the forefront of the future NHS. Regular population screening will start addressing severe health inequalities. Health counselling will ensure that people make the right choices about their future and will divert people who do not access the health service when they need it into early intervention and prevention. If we invest in clinicians in the community to undertake that dialogue and those discussions, and if we invest in social prescribing and other ways of improving people’s lifestyles, we have a real chance to turn this system around.

We cannot delay putting together an integrated public health agenda to drive forward our health service. If we continue as we are, our NHS will not be here. The pressures bearing down now are just indescribable. After listening to staff, all I can say is that the Health and Care Bill is just not the solution.

It is a pleasure to serve under your chairship, Ms Bardell. I thank my hon. Friend the Member for Leeds East (Richard Burgon) for securing this important debate. I know that 83 of my own constituents signed the petition, and many more have emailed me expressing concerns about the Government’s Health and Care Bill. I concur with those concerns.

Over the last 18 months, billions have been wasted on failed track and trace systems and failed personal protective equipment contracts that have been awarded to mates down the pub, while our amazing NHS workers have not received the pay rise that they deserve. Of course, we want to see greater collaboration between health and social care services, especially on the back of the ongoing pandemic and the lessons that we have drawn from it. No longer can health and social care services work in silos. We saw how social care, particularly residential care, played second fiddle to the NHS in the early part of the pandemic. That is superbly illustrated by the Channel 4 drama “Help”, based in my city of Liverpool. However, I am resolute that the Health and Care Bill must be paused, as too many questions remain unanswered. I will try to outline some of those questions.

We can expect integrated care boards to spring into life in the new year. They will, certainly in a governance sense, vary from area to area. While having a place-based strategy that is responsive to local health needs and inequalities is welcome, we cannot be subject to a postcode lottery, with the influence of private providers greater in some areas because they have been awarded places on the boards and others have not. Nothing in the draft legislation prohibits such a conflict of interest, nor is it clear anywhere that the NHS is the preferred provider for medical and clinical services. The potential for interference from the Secretary of State for Health is a major cause for concern when it comes to awarding contracts, particularly given the Government’s own support for privatisation.

On the integration of health and social care services, I remain a sceptic, even if the intentions are sound. I fear that there is a real risk that adult social care will be the poor relation to a resource-hungry NHS, especially with a huge elective care backlog. That is the only conclusion we can draw from the Prime Minister’s announcement of extra spending on health services and the non-plan for social care. Out of £36 billion, £5.4 billion over three years to be put aside for social care is not enough and will not make an tangible difference for local authorities, as the primary commissioners of adult services.

Locally pooled NHS and local government adult care budgets—if that is to be the direction of travel—could well enhance the provision of adult social services, but equally the reverse could be true. That is why, through integrated care partnerships, the importance of place and locality is emphasised as part of every established integrated care board. Accountability must float sideways, down and up. It is essential that integrated care boards must be held accountable by ICPs and vice versa, right through to smaller partnerships working at local level. Local government needs to be front and centre of the development of any integration strategy, as the custodians of adult social care.

The draft legislation should mandate ICBs to develop comprehensive workforce strategies in their localities. Labour councils in my own north-west region, alongside Unison North West, are already engaged in such work, but are coming up against an unforgiving social care market, with too many providers refusing—yes, refusing—money to increase the wages of their staff. Many of the Labour amendments and others will significantly improve the Bill and answer many of the questions I have raised. Sadly, I suspect the Government will not give them a fair hearing.

I congratulate my hon. Friend the Member for Leeds East (Richard Burgon) on securing this important debate, especially at the moment.

In essence, the NHS is about people. It is about its workforce. There can be as many hospitals and clinics as we want, but without any staff in them, they will not make anyone’s health any better. I am painfully aware that after covid, so many of the people who work in the NHS are—I think the medical term is—knackered. They are completely and utterly exhausted. I know of dermatologists and pathologists who ended up helping out in intensive care units in addition to doing their ordinary day job. They were doing hours and hours every week and have got to the end of the year and are completely and utterly exhausted.

There is a phenomenal backlog; we all know about the numbers of people on waiting lists. That is partly because lots of people did not to present to their doctors because they did not want to bother them or were frightened of getting covid. There are lots of terrible stories of people who are presenting very late, particularly with cancers. I had a stage 3B melanoma, and I am painfully aware that if I had left it a few more months, I might not be here today. At the time, I was given a 40% chance of living a year. I know what it is like for all those families who feel desperate that someone has been delaying, and then get terrible news. It is also a phenomenal additional cost to the NHS if somebody presents later, because the surgery and the treatment will be far more complicated.

There are all the cancelled operations for elective surgeries that are not necessarily life threatening but life enhancing, such as knees and hips. When I was first elected in 2001, we still had the waiting list hangover from the previous Government, with people waiting five years for a new hip or knee. That is where we are now. That leads me to a real concern that the Government, with their new healthcare levy, are frankly putting the cart before the horse. If we do not have the people to deliver, throwing money at the NHS will not make the blindest bit of difference to health outcomes.

In the UK, we have roughly three doctors per thousand head of population. The rest of the EU, including countries that have many, many fewer than us, have 4.2. We are 1,939 consultant radiologists short. That is one of the things that will make a difference to whether people with late-stage cancer live or die. In oncology, 189 more clinical oncologists are needed in the UK now, and that is without considering the increase required to deal with the backlog, as well as the new presentations. We have roughly 650 consultant dermatologists in the country; we need roughly another 200. Skin cancer is one of the fastest-growing areas of cancer death in the UK. Only 3% of diagnostic laboratories in the UK are fully staffed at the moment. That means delays in getting results, in particular from histopathology, to doctors to be able to start the necessary treatment.

I have some quick-fix answers, and I hope the Minister will implement all 11 of them. First, reward staying on in the profession, because lots of people are retiring early. Secondly, reward coming back into the profession, because getting more retirees back in would really help with the workforce problem.

Thirdly, sort the gender pay gap. That is one of the problems that is making it much more difficult for lots of women to stay in the profession.

Think about providing sabbaticals to people. Sometimes burnout can be prevented just by allowing somebody to have a three-month or six-month sabbatical, knowing they will come back in.

Sort out the pension problem. I know the Government think they have done that, but it is still an issue and is why lots of people are not carrying on.

We have to deal with the fact that overtime is now paid less than it was five years ago. Lots of people are saying, “I don’t really want to do an extra clinic on a Saturday morning or a Sunday afternoon.”

We have to deal with pay erosion—a point that was made earlier. If we keep on not paying doctors enough in the NHS, in the end they will choose to go to Australia, Canada or New Zealand.

We have to sort out the issue of private sector capacity sucking far too many consultants out of their NHS work, day in, day out. That simply means that people, including in very poor constituencies such as mine, will say, “You know what? I’m going to find the £5,000, £6,000 or £7,000 to have that hip or knee operation for my Auntie Val, because it is about the quality of her life.”

We have to train more people. I do not know why we are still lagging behind what we know we need. We should have more places for training, and we should be encouraging other disciplines, such as pathology, dermatology, emergency care and so on.

We have to sort out the immigration factors, which play into all this and mean that so many doctors who have worked here for some time are going back to the countries they were born in because they do not feel that they have a place here in the UK. Finally, please stop putting the workforce last in deciding what we do about the NHS. We cannot run an NHS permanently at 95% or 98% capacity, because then when there is a crisis, such as the one we have had over the past two years, the whole thing is—and this is a technical term—buggered.

It is a pleasure to serve under your chairmanship, Ms Bardell. I congratulate my hon. Friend the Member for Leeds East (Richard Burgon) on securing this important and extremely timely debate.

The NHS is under great strain. Nurses I met over the summer told me how over-stretched the service is, not just because of covid but because of staff shortages, which my hon. Friend the Member for Rhondda (Chris Bryant) spoke so eloquently about. In June, there were almost 94,000 full-time equivalent vacancies in the NHS, and then of course we have the backlog of patients waiting for hospital treatment in England, which is getting worse. In July, 5.6 million people were waiting. Sadly, that is not just because of the impact of covid; the upward trend was in progress before the pandemic. In February 2020, there were about 4.4 million people waiting for hospital treatment, up from 3.7 million in February 2017.

Yet instead of addressing those extremely serious issues, the Government are pressing ahead with a major reorganisation of the NHS in the form of the Health and Care Bill, through which they will establish statutory integrated care boards and statutory integrated care partnerships, thus breaking the NHS up into 42 local integrated care systems. Each will set out which services to prioritise and which to reduce in their area, embedding a postcode lottery into the NHS in England. It is clear that that variation in the offer, depending on where people live, coupled with strict local financial limits, would lead to increased rationing of healthcare. If that is allowed to happen, I am concerned that people will have to wait longer for care or go without. That is contrary to the founding principles of the NHS.

It is important that we understand just how fortunate we are to have the NHS and why we must defend it. Looking across to America makes very clear our good fortune. Over there, typical costs for health treatment, as advertised by insurance companies looking for business, are as follows. People can expect to pay anything between $400 and $1,200 for an ambulance; between $9,000 and $17,000 for a baby to be delivered; and between $7,000 and $10,000 to have surgery for a broken wrist. Typical annual insurance costs for an individual are around $1,440 and for families around $5,700. That covers only part of the cost because, in America, employers pay the bulk of insurance costs for the individual, with all the cost that that adds to the business communities. Clearly, we do not want an American-style insurance-based system here.

As it stands, the Government’s Bill would put big business at the heart of our NHS. The Government have indicated that they would ensure that individuals with significant interests in private healthcare are prevented from sitting on ICBs, but that is simply not good enough. Private companies should have absolutely no say in how public money should be spent in the NHS. There should be no place whatsoever for private companies on ICBs or integrated care partnerships.

The Government intend to revoke the national tariff and replace it with an NHS payment scheme, with NHS England consulting with ICBs, NHS and independent sector providers. There are real concerns that this will give big business the opportunity to undercut NHS providers. We will see healthcare that should be provided by the NHS increasingly being delivered by big business, with all the implications that that has for patients, for all those working in the service, “Agenda for Change”, and the future of national collective bargaining.

The Government’s reforms would also create a power to deregulate NHS professions, and would have serious implications for the quality of care as well as the employment status, pay, terms and conditions of workers in the service. The NHS is our finest social institution and it has served us well since 1948 but now its future is in peril.

During the campaign against the Conservative-Lib Dem privatisation Bill, which became the Health and Social Care Act 2012, a man told me of his experience of life before the NHS. When he was about eight years old, his baby brother was seriously ill. Everyone in the street was worried for the child. One of the neighbours called for the doctor but, on hearing that, the mother said to the boy, “Run up the street and tell the doctor he is fine and there is no need to call.” The boy ran to the doctor, who had just turned into their street, and sent him away, just as his mother had told him to. Shortly after, the baby died, as the mother knew he would. She had told him to send the doctor away because she knew she could not afford to pay him.

We cannot begin to know the agony that that woman went through. The man who told the story had carried the burden of that action with him through life. That was life and death before the foundation of the NHS, when that family and countless others could not afford medical treatment. It is sobering to think that, after 73 years, the Government’s Bill undermines the principles of the NHS as a comprehensive and universal service.

History will not be kind to those who support such changes. I believe we all have a responsibility to protect the NHS and fight for it as a universal, comprehensive, public service for this generation and those to come. I ask Government Members to reflect on the importance of the decisions that they face in the coming weeks and months, and I urge them to consider the needs of their constituents and oppose the Health and Care Bill.

It is a pleasure to speak and listen in this debate. I thank the hon. Member for Leeds East (Richard Burgon) for setting the scene and all those who have made contributions. Every one of us is definitely agreed on one thing: the importance of the NHS, what it does and what it has done over time. If we needed further reinforcement of that, what we have seen in the past year has told us. In my family, I lost my mother-in-law to covid, so I do understand. During those difficult times for families, health service workers are there, masked up and doing their best to try to preserve life.

As my party’s health spokesperson, I must emphasise the importance of the NHS and highlight the issues of concern for my constituents, to ensure that the future of the NHS is maintained and provides hope to those who currently feel that it is not being maintained in the way that it should. It is a devolved matter, as the Minister knows. During the 18 months of the pandemic, we might have taken our NHS for granted in a way. We did not take the staff for granted; that is not the point I am making. The point is, the NHS was there, we depended on it and it was important to have it in place to help out. I put my thanks on record to all those healthcare workers across the United Kingdom of Great Britain and Northern Ireland.

I know we clapped the NHS staff. I live out in the countryside but, believe it or not, I could hear the clapping starting three miles up the road. I could hear the clapping in the midnight air from people in the village of Greyabbey down the road. People were out in numbers creating that crescendo of noise. We need to galvanise public compassion and our sense of community and wartime spirit to restore to the NHS the pride we have. I look to the Minister to do that.

This is a debate about the NHS, but the Northern Ireland protocol is preventing 910 medicines from getting into Northern Ireland. That will have an impact on the NHS. It is not the Minister’s responsibility, but would he convey to the relevant Minister the importance of our having medications that are available in the rest of the United Kingdom? They are available on the mainland, but we cannot get them in Northern Ireland. It is terribly frustrating, and a further 2,400 medicines may be at risk. It is an important issue, and it is an NHS issue. It needs to be on record.

I feel that the prioritisation of treatments and services are at the forefront of the future of the NHS. Too many people are awaiting cancer treatment. I am pleased that the hon. Member for Rhondda (Chris Bryant) is here. His story is a personal one. I remember speaking to him in the Chamber. I did not quite know what was happening, but I had not seen him for a while, and I did notice that there was a scar on the back of his head.

Well, I noticed it after the surgery. Our NHS saved our honourable Friend’s life. It is good to hear his personal story as well.

Health reconfiguration is crucial to ensure that our NHS is held to its highest standard. By the same token, these changes must be assessed to ensure that they benefit the future of the NHS. We want the correct funding. I hope that the Minister will reaffirm that he will encourage the Secretary of State to undertake discussions with his counterparts in the devolved institutions to weigh up how this will impact on other parts of the United Kingdom. People are waiting for life-saving cancer treatment, and people are waiting years for a consultation. Unfortunately, some of my constituents waited and did not get the surgery. They did not get their diagnosis early on and some of them are not here today. That is the reality of the waiting times that we all worry about.

The King’s Fund states that

“even under the most optimistic circumstances outlined in the NHS Five Year Forward View, an additional eight billion a year in funding was to be needed by 2020.”

We are already a year behind. If we want to protect and maintain our NHS, we must ensure that the correct funds are in place to secure its future in the United Kingdom. I urge the Minister to listen to NHS workers and focus on what they are telling us. The Minister needs to protect their jobs and livelihoods and the NHS.

It is a pleasure to serve under your chairship today, Ms Bardell. I congratulate my hon. Friend the Member for Leeds East (Richard Burgon) on securing this important debate. The NHS is undoubtedly the pride and joy of British society. Very few could argue against the claim that it is our nation’s greatest creation. That is why we should thank the thousands of NHS staff who put their lives on the line throughout the pandemic at every chance we have. It is also the reason why I support in full all 11 recommendations from my hon. Friend the Member for Rhondda (Chris Bryant). Our NHS staff have for some time now been overworked, understaffed, under-appreciated and severely underpaid. Over the past 18 months, that has been exaggerated almost to breaking point.

From a dangerous shortage of ventilators and personal protective equipment and general issues of overcrowding, it is clear that the NHS was bled dry long before the pandemic began. At a time when the nation relied on the NHS so heavily, we began to see the true effects of a gruelling combination of Conservative austerity and privatisation. After the sham of track and trace and all those private contracts through the pandemic,

I would have thought it was even clearer that privatisation of the NHS was wrong in any form and that a Government who care about the success of our NHS would halt any further attempts at privatisation, but it is strikingly obvious that it is not the case for this Government.

It is clear that this Government continue deliberately to mislead the public, because every time we discuss the issue, they make claims that the NHS is not being privatised in any way. However, during the pandemic, the Government allowed the sell-off by stealth of 49 GP surgeries to the US healthcare insurance giant, Centene. Twenty of those surgeries are in south London and they include three Streatham GPs: the Edith Cavell surgery, the Streatham High practice and the Streatham Place surgery.

Centene is a company that is bigger than Pepsi and Disney, and almost as big as Boeing. The UK arm of Centene, Operose Health, has stated openly that its market strategy is to exit NHS contracts that do not make a profit, revealing its worrying intent for our GPs. I fear the impact it will have on my constituents and others across the country who have had their local surgeries taken over by this profit-hungry health insurance giant, which has been taken to court for poorly treated patients in the US.

Our taxes should be going into the essential services that we all rely on for our health, not lining the pockets of wealthy shareholders and filling the coffers of profit-greedy American corporations. My concerns about the takeover and the threat it poses to our NHS are definitely not misplaced, because guess who No. 10 recently hired as a health adviser? None other than the outgoing chief executive of Operose Health. It is no wonder we are seeing disastrous legislation, such as the Health and Care Bill, coming from this Government. It is a harsh reminder that life and health are just products to be turned into sales for the Tories.

I am proud to have joined campaigners to raise awareness about these damaging changes on a local and national scale, and I echo their calls, as well as those made by other Members during the debate, that attempts to privatise our NHS must end with immediate effect. Furthermore, the Government must address a decade’s-worth of NHS mistreatment in the autumn spending review, so I would like to hear more from the Minister about exactly how the Government will do that.

The Government must commit to proper investment in the NHS and the 15% pay increase for our hard-working NHS staff, because that is exactly what they deserve. I end with NHS staff because they are what makes the NHS. Clapping and empty rhetoric are not enough. We need meaningful action from this Government if we are going to secure the future of our NHS as publicly owned and free at the point of use.

It is a pleasure to serve under your chairmanship for the first time, Ms Bardell. I commend the hon. Member for Leeds East (Richard Burgon) on a remarkably important debate, not just in terms of timing, but in everything the four nations have gone through in the past 18 months, which has underlined for all of us how crucial the NHS is. It is there at our time of need and it is there in our time of crisis as well. We owe a great debt of gratitude to the NHS and its staff. Members from all parties must prioritise and defend the NHS and ensure that those staff have our support moving forward, just as they supported us in our time of crisis.

The hon. Member for Leeds East spoke eloquently about the dangers of privatisation creeping into the NHS and about accountability reducing for local patients. He used the phrase that I used to hear as a union rep in the NHS and which created great fear: the NHS was no longer the preferred provider. That is extremely important because, as other Members have said, it means corporations can bid for NHS services and contracts and cherry-pick the most cost-effective ones, leaving the most complex and vulnerable patients to the NHS and placing it under even greater strain. I thank him for setting that out as the crux of today’s debate.

The hon. Member for Strangford (Jim Shannon) thanked all of our NHS staff and heard the clapping for them and those on the frontline during the pandemic. He also made an excellent point about the fact that available medications in Northern Ireland are sometimes not equal to those available on the mainland. That is not what should be at the heart of the NHS system; it should be about equality of access, and I would be pleased if the Minister responded to that point about Northern Ireland.

The hon. Member for Streatham (Bell Ribeiro-Addy) spoke about the impact of covid-19, and, once again, about privatisation. The hon. Member for York Central (Rachael Maskell) spoke about how equality of service at the point of access is not just about treating illness; it is about wellbeing and dealing with life’s inequalities and day-to-day inequalities in our system and our country as a whole. She spoke about the backlog in the system due to covid-19 and how this has led not just to a staffing and workforce crisis, but to many people who need urgent treatment perhaps falling through the gaps. We must plug those gaps urgently for anyone who may be affected.

The hon. Member for Rhondda (Chris Bryant), who always speaks eloquently about brain injury, did not mention acquired brain injuries today. I must confess that my husband has suffered a brain injury, so I am always grateful to the hon. Member for bringing it to the fore. It is often overlooked, and is one aspect of the NHS that we must seek to fund. It is also much wider than that; it is part of our armed forces covenant and affects our veterans and those in criminal justice services. The hon. Member gave very practical solutions today, which I think is always helpful, on staffing retention and recruitment. Those are the very practical aspects of care and treatment that the Minister will have to grapple with and take forward. I thank him once again for that today.

The hon. Member for Liverpool, Wavertree (Paula Barker) spoke about the potential for interference in contracts due to the Secretary of State’s additional powers. Given some of the decisions made during covid, and some of the funding that was perhaps not best utilised, I think that is something that concerns us all across the House. We must focus on that, to ensure that the NHS provides good value for money, and that there is not any interference with the making of clinical best-practice decisions.

The hon. Member for Wirral West (Margaret Greenwood) spoke about a postcode lottery in NHS England, and really set it out with her example of life and death before our NHS and what that meant for most people across the United Kingdom. We should never lose sight of that, because that is the crux of why our NHS is so important, so special, and why we must protect it with everything that we have.

The hon. Member for Bolton West (Chris Green) spoke about rare conditions and the importance of international trials and collaborations, which is an extremely important point. Yes, we must protect our NHS, but we must also incorporate innovation, in a safe way, into our NHS structures, to ensure that our patients have the best treatments possible, and a choice in the types of treatment that they believe would be effective for them. We must, of course, undertake drug trials and, particularly for rare conditions, those must involve international collaborations. Otherwise, we would not have enough participants in the United Kingdom alone.

It has been an excellent debate. In the few minutes that I have left, I will say that the NHS is about health and clinical care, but it is also about mental health. It is important that we come out of this pandemic knowing that it is about wellbeing—it is a wellbeing recovery, and we must focus very much on mental health. I therefore hope that the Government will bring forward an announcement on the new mental health spokesperson in the near future. That is something that should be prioritised. I am sorry that it has not happened before now.

I would also like to mention a bit about what is happening in Scotland. The Scottish Government will increase NHS frontline spending by at least 20% to support the recovery and renew Scotland’s NHS. That builds on the Scottish Budget of 2021, which took the total health portfolio spend to £16 billion, in an increase of more than £800 million. The Scottish Government have also developed the NHS Pharmacy First Scotland scheme, placing local pharmacies at the heart of frontline provision. I went to visit Abbeygreen, a local pharmacy in my constituency, which is doing a lot of excellent work on the frontline, protecting resources for GP services and ensuring that people can access medications extremely rapidly.

I am always keen that we support best practice across the four nations and I do not think the NHS should be a political football. When I worked there, we always dreaded changes because they meant more admin and sometimes did not change the service but just gave more work to those who were already stretched. I would like to see things such as Pharmacy First, which is working extremely well in Scotland, being something that the Minister might consider and discuss with colleagues there. There are best practice examples right across the United Kingdom that we can all seek to replicate, which is extremely important.

NHS Scotland staff remain the best paid anywhere in the UK and this year “Agenda for Change” staff, including nurseries, ancillary administration and allied health professionals, received a 2.95% pay rise as part of a three-year pay deal offering a minimum 9% pay increase for more staff and more than 27% for some still moving up their pay scale. That was in excess of a 2.8% uplift. The Scottish Government are also seeking to abolish NHS dentistry charges, eye examination costs and non-residential social care charges for those in need of support. There is great progress being made.

I think everyone has come to the debate with the real value of the NHS in their heart and in their speeches. Collaborating, working together and sharing best practice right across the board, and making sure we protect our NHS, that the NHS is the preferred provider in the future and that we seek to protect it from private contracts, is going to be extremely important in supporting the staff who have given their all. We need to do that and we need to work together and collaborate to do that. I know that people across the House want to champion the NHS into the future. I look forward to the responses from the shadow Minister and the Minister.

It is such a pleasure to serve under your chairwomanship today, Ms Bardell. I want to declare an interest: I am proudly an NHS doctor and have been for 16 years.

It is an absolute pleasure to wind up today for the Opposition. I thank my hon. Friend the Member for Leeds East (Richard Burgon) for securing this hugely important debate, and I thank all hon. Members for their thoughtful contributions and suggestions. My hon. Friend the Member for York Central (Rachael Maskell) reminded us of the inequalities that are already deeply rooted in our society, and my hon. Friend the Member for Liverpool, Wavertree (Paula Barker) spoke movingly about residential care. My hon. Friend the Member for Rhondda (Chris Bryant) spoke about the value of our NHS staff, and my hon. Friend the Member for Wirral West (Margaret Greenwood) reminded us in no uncertain terms how life looks without the NHS. My hon. Friend and neighbour the Member for Streatham (Bell Ribeiro-Addy) spoke of the privatisation by stealth that she already sees in her community and the detrimental impact that it will have.

There is no institution that unites us quite like our NHS, and it represents the very best of our values: collective, compassionate and co-operative. Our health service was once the envy of the world and laid the blueprint for publicly run, universally free healthcare for the modern age. The outbreak of coronavirus reinforced the need not only for a universal health service, but for health services to be properly funded and fully resourced. I am in no doubt that we lost more lives than we needed to because of the drastic and protracted underfunding of our NHS over the last decade. The pandemic reminds us of the risks of Conservative underfunding and undervaluing of our NHS, leaving it ill-prepared to handle winter, let alone a global pandemic.

Despite our unwavering pride in our NHS, it has suffered a decade of decline under consecutive Conservative Governments, and we have already lived through a botched reorganisation in 2012, which was supposed to cut down bureaucracy and deliver better care for patients. Instead, the Lansley reforms had the opposite effect, by complicating processes and increasing the reliance on private providers. The reforms introduced market elements, putting shareholders and companies ahead of patients. Shame! The changes meant that services went out to tender to anyone, resulting in private companies competing against public ones to deliver care at a local level. Those changes completely fragmented our health service, creating a route for private companies to make a profit on community services.

The damage of that reorganisation is still being felt profoundly today. Waiting lists are skyrocketing and people are finding themselves stuck in A&E. Routine operations are being cancelled and cancer waiting times are not being met. Operations are being postponed at an alarming rate, and the backlog in mental healthcare is reaching an all-time high. We are letting down a whole generation of young people, who are so reliant on timely access to mental healthcare services.

Like my medical colleagues across the country, I have been in A&E to comfort young people with eating disorders, who are stuck there because there are no appropriate beds for them. They feel that they cannot trust anyone, because they continue to be passed from pillar to post. I have been with families who hope that their elderly relatives get discharged so that they can spend their final days at home. What must it feel like for a family who are waiting for the person they love to be discharged, just so that person can die with dignity at home and in the arms of those they love? Because of fundamental flaws in social care, however, they find that they cannot be reunited with and cared for by the ones they love. Shame!

We have seen a rise in the use of more expensive agency staff throughout the last 10 years, while nurses, doctors and porters have had their pay squeezed. During this decade of decline, we have also had the first doctors’ strike in the history of the NHS, with junior doctors forced to take industrial action because of contract disputes. The Government expect doctors to work longer for less. The last thing that we frontline NHS staff want to do is to strike. We want to be serving our patients but, sadly, the Government have given us no choice but to know that the best thing that we can do for our patients is to demand better pay and working conditions.

Our NHS staff have worked incredibly hard throughout the pandemic. Through each lockdown, each wave and each new variant, NHS staff have kept going, putting themselves at risk in order to keep us safe. The personal sacrifice is astounding, and we know that so many have paid the ultimate price with their lives. Staff are exhausted, burnt out and in desperate need of respite, and yet they are not receiving sufficient support from the Government. Throughout the pandemic, I have had medics, nurses and colleagues from all around the country messaging me in the middle of the night, unable to sleep from the stress that they have been put under and the amount of death that they experienced in such a short period of time. They were not trained for such conditions.

As hon. Members have said, it is no wonder that around a third of NHS staff stated in the most recent survey that they were considering leaving their jobs. With vacancies already high throughout the healthcare service, losing more staff would be absolutely catastrophic and would definitely impact on patient care. Healthcare staff need to feel valued and appreciated by the Government, but despite the sacrifices they have made and continue to make, their only rewards so far have been empty claps and a real-terms pay cut. If the Government truly appreciated the efforts of NHS staff, they would offer those staff a fair pay rise. The Government might also consider taking up my offer to work with them on a cross-party basis to address the mental health crisis among NHS and care staff. There is nothing I would like more than to work with the Government to deliver what our frontline NHS and care workers need.

On the subject of pay, fair pay is not simply a moral imperative; it is about the future functioning of our NHS. The NHS is one of the single largest employers in the world, but it is in the midst of a workforce crisis. By refusing to offer a fair pay rise, the Government risk causing workers to leave the health service. That would create more vacancies, further shortfalls of staff during shifts and increased workload for the staff who remain. We know that 56% of NHS staff already work unpaid additional hours, and that percentage will only increase if the workforce becomes even more stretched. It is a cycle that will lead only to further burnout among staff and eventually to more staff looking to leave. The Government have known for years that further action must be taken to recruit, retain and train more staff, yet nothing is being done at a fast enough pace to ensure that future demand will be kept up with.

Despite the mishandling of the NHS since 2010, it seems the Conservatives have not learned their lessons, because they are forcing through another reorganisation. The Health and Care Bill, like the Lansley reforms before it, fails to grasp the real challenges facing the NHS. It will only serve to create more problems, rather than solutions, and it will put our entire health service at risk. It does nothing to stifle the market forces present in NHS services, meaning that we will have more private companies running vital community services. A modern NHS has to take a whole-society approach, working closely with local authorities and other public services to reduce the inequalities that drive poor health. A joined-up approach would better serve communities, but the new Bill fails to outline how such an approach would be achieved, and that will result in more fragmented services and worse outcomes for patients. Instead of adopting such an approach, the Conservatives are more interested in consolidating power and guaranteeing private providers a voice in how local services are run.

As we look ahead to the future of the NHS, it is important that we never forget the principles on which it was founded: free at the point of delivery, publicly funded and publicly run, universally available and based on clinical need, not the ability to pay. The Conservatives, who voted against the creation of the NHS 22 times, have been working hard ever since to slowly erode the collective foundations on which it was built. We cannot let that happen. We must never, ever lose sight of the founding principles of the NHS, and we must never let the market control healthcare in this country.

It is a pleasure to serve under your chairmanship, Ms Bardell; I think that I do so for the first time.

Although I suspect that it is fair to say that the hon. Member for Leeds East (Richard Burgon) and I are not fellow travellers in the same direction on many things politically, I congratulate him on securing this debate on a very important subject. Although his speech was long on opinion and perhaps short on fact, I do not think that anyone could doubt the passion or the sincerity with which he spoke, whether one agrees with everything he says or not. I pay tribute to him in that respect.

I think it is clear to everyone in this Chamber, as I hope it will be to people watching on Parliament TV and those who read the transcript of our debate, the genuine affection and respect that every Member of this House has for our NHS and those who work in it. It is right that I join the shadow Minister, the hon. Member for Tooting (Dr Allin-Khan), and others—I often do so on these occasions, because this cannot be said too often—in paying tribute to those who work in our NHS, including the shadow Minister herself. On the occasions when she and I see each other across the Dispatch Box, I always try to make that point.

A number of key themes have emerged today. The legislation is currently in Committee, and I know that a number of Opposition Members have argued that it should be paused or even scrapped. I have to say that the former chief executive of the NHS, Lord Stevens, said that about 85% of the Bill is exactly what the NHS asked for, wanted and wanted done now—ideally, the NHS wanted it done two years ago, before the pandemic.

In the evidence sessions of our Bill Committee, which continues to meet, we heard NHS Providers, the NHS Confederation and the Local Government Association all saying, “This is the right Bill at the right time.” I should acknowledge that some of those witnesses said there were certain elements that they would question or challenge, but they said it was the right time to pass this legislation. In fact, in a joint statement the NHS Confederation, NHS Providers and the LGA said,

“we believe that the direction of travel set by the bill is the right one.”

At the heart of this legislation is the principle of integration underpinned by evolution. Colleagues across the House who have served with me since 2015 will know that I am not by nature revolutionary, so the legislation is evolutionary in what it seeks to achieve, but it seeks to achieve greater integration. I think it was the hon. Member for Liverpool, Wavertree (Paula Barker) who spoke about accountability needing to be upwards, downwards and sideways. With these proposals we seek to do exactly that: to achieve greater integration at a local level within the NHS and, at the ICP level, to achieve greater integration with local authorities.

What would the Minister say to the British Medical Association council, which passed a resolution overwhelmingly

“calling for the Health and Care Bill to be rejected, arguing that it is the wrong time to be reorganising the NHS, fails to address chronic workforce shortages or to protect the NHS from further outsourcing and encroachment of large corporate companies in healthcare, and significantly dilutes public accountability”?

I will turn to those key points in a moment, but first I will address the specifics. The point I made to the Chair of the BMA council in Committee was that, if I recall rightly, every single piece of legislation on the NHS, including the National Health Service Act 1946 that brought it into place, has been opposed by the BMA. I challenged him to tell me which pieces of legislation the BMA had supported, and he said he would write to us. I have yet to get that letter; I am sure, knowing Dr Chaand Nagpaul as I do, that he will write to us, but in the Committee he was unable to say which piece of legislation—including Labour legislation in 1999, 2001, 2003 and 2006—the BMA had supported.

I will make a little bit of progress, because I want to address the hon. Lady’s allegations about privatisation and workforce. If we have time at the end, I will of course seek to let her come back in.

On allegations or suggestions of furthering privatisation, I know it is tempting for some, even when they know better—and they do—to claim that this is the beginning of the end for public provision. It is not, and Opposition Members know it. There have always been key elements of the NHS that have involved private providers, voluntary sector providers and so on.

What is instructive is the extent to which that was accelerated when the Labour party were in power. The shadow Minister talked about the 2012 legislation and any qualified provider, but that was not brought in by the 2012 legislation; it was brought in by the Gordon Brown Government in 2009-10 under the term “any willing provider”. The name was changed, but nothing substantive changed from what the Labour Government had introduced in terms of the ability to compete for contracts.

The other point I would make is that one of the key changes allowing private sector organisations to compete for and run frontline health services came in 2004, under the Labour Government, when the tendering for provision of out-of-hours services by private companies was allowed.

So often—not only from Conservative Ministers, but from hon. Members generally—we hear about things that Labour did in the past. I remind the Minister that the Conservatives have been in power since 2010. We are telling him what we think the issues are with the NHS, and we do not want to hear about what Labour or the ghosts of Labour Prime Ministers past did. We want to know what the Conservative Government, who have been in power for 11 years now, are going to do to improve our NHS.

I appreciate why Opposition Members might not want to hear what Labour Governments did in the past, given the extent to which they massively accelerated the privatisation of our NHS. To address the hon. Lady’s point directly, we do believe that there is a role for private providers, the independent sector, voluntary organisations and others in providing healthcare services in this country.

Workforce is an issue that a number of colleagues have rightly raised. I am afraid I cannot say to the hon. Member for Tooting and others that, among other things, I am taking on responsibility for mental health in my new portfolio. However, following the departure of my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) to the Treasury, as of about three days ago, I will be assuming responsibility for workforce alongside the other responsibilities in my portfolio. I look forward to working with her and the hon. Member for Ellesmere Port and Neston (Justin Madders), who I believe is the shadow Minister, as well as meeting with Opposition Members who take a close interest.

The hon. Member for Rhondda (Chris Bryant) spoke with typical wisdom on that matter and made a number of very powerful points. At the risk of a negative impact on my career prospects—although the reshuffle has just happened, so hopefully I can get away with it now—I agree with a lot of what he said. He highlighted that, were it not for a prompt diagnosis, he would not be here. For what it is worth, I think I speak for everyone in the Chamber—if not on all points, then certainly on this one—when I say we are all extremely pleased that he is still with us. He is a man of great integrity and strong beliefs, and I look forward to working with him. We meet on a number of things. I am happy to meet with him to talk about his suggestions and how they might factor in to how we move forward, in the spirit of bipartisan and constructive discussion.

With the meeting or the job, or both? A number of hon. Members have raised “Agenda for Change” and pay and conditions. I hope I can reassure them, as I sought to do with the hon. Member for York Central (Rachael Maskell). It is not our intention that integrated care boards depart from “Agenda for Change”. The Bill is drafted in such a way as to seek to replicate what is currently there. On Second Reading, I offered to have a meeting with her. I would be very happy to have that meeting, if she gets in touch.

On funding, this Government have passed legislation increasing NHS funding by £33.9 billion by 2023-24 and put £2 billion into elective recovery. In addition, the Prime Minister announced a massive cash injection into our NHS a couple of weeks ago.

I want to give the hon. Member for Leeds East a little time at the end, so I will just make a couple of quick points. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) is right: we are always happy to learn from our Scottish friends. In response to the hon. Member for Strangford (Jim Shannon), that is a matter of medicine supply which I discuss regularly with the Northern Ireland Health Minister, and it is absolutely vital that we seek a resolution. I believe that the previous approach by Lord Frost is the right one to find a sustainable way forward.

On sharing best practice, I meant to mention that artificial intelligence technology is being used by NHS Greater Glasgow and Clyde and has reduced the heart failure diagnostic waiting times from 12 months to six weeks. I know that Lord Bethell will be visiting to find out more about that. I wanted to highlight it to the Minister today, because I think that technology can support NHS staff workload as we move forward.

The hon. Lady has rightly highlighted the benefits of technology, while my hon. Friend the Member for Bolton West (Chris Green) highlighted the need for us to continue to move with the times and seize those initiatives. I fear that my noble friend Lord Bethell will not be visiting, as he left the Government at the end of last week. However, I have received a very kind invitation from the hon. Member for Central Ayrshire (Dr Whitford) to come and see how the NHS in Scotland is innovating and driving change. I look forward to taking her up on that invitation as soon as I can.

Just as medical devices and drugs innovate change over time, does the Minister agree that the place where the NHS operates and works must also change? Whether those are local surgeries or hospitals, they have to move with the times. In that context, would he also turn his mind to any needs that Bolton Royal Hospital may have in terms of new hospital infrastructure?

My hon. Friend makes a fair point about the need for us to create the conditions—the physical spaces with the technology—in which the workforce, which is the heart of our NHS, can work. He makes a subtle—or not so subtle—plea for his own local hospital. He will not be surprised that I will not comment on the detail of that.

To finish my response to the hon. Member for Strangford, the Command Paper recognises the challenges posed by the current arrangements in the Northern Ireland protocol around the supply of medicines and other goods, for example. The approach that the hon. Member set out, of removing medicines and medical devices from the orbit of the protocol, is reasonable. I hope that discussions between the European Commission and Lord Frost are productive, and that a consensus can be reached on the way forward.

I have to take issue slightly with the hon. Members who raised the role of Sam Jones, one of the Prime Minister’s advisers. They focused on one particular aspect—that for a brief period she worked for an independent provider. What they did not do, which is extremely unfair to a dedicated public servant, is highlight that she worked for NHS England, running new care models; that she has been an NHS paediatric and general nurse; that she was the chief executive of Epsom and St Helier University Hospitals NHS Trust; that she was the chief executive of West Hertfordshire Hospitals NHS Trust; and that she was the Health Service Journal chief executive of the year for 2014 and was highly commended for her work in driving forward patient safety. I gently say that it ill behoves Members of the House to attack public servants, who cannot answer for themselves in this Chamber, with partial references to their careers rather than recognising that they have contributed a huge amount in the past.

The hon. Member for York Central was absolutely right to highlight health inequalities as one of the greatest challenges—not the only challenge—that we face as a society and as a health system. The measures on integration and change in the Bill will help us tackle those health inequalities. I suspect that on Report and Third Reading she may test and challenge me on those assertions and assumptions, but she is absolutely right to highlight the centrality of health inequalities.

The hon. Member for Liverpool, Wavertree (Paula Barker) spoke about residential care and the link to social care. While I am not the social care Minister, everything that I do in my role as Health Minister must have an eye to social care. I was a cabinet member for adult social care in the dim and distant past, when I had rather more hair, and I also sat on the primary care trust, as it then was, at that time. I recognise the need for those two parts of the system to work together to achieve the best outcomes for our constituents. She makes a valid and important point.

I found what the hon. Member for Wirral West (Margaret Greenwood) said about the US experience of great interest and instructive, but it is utterly divorced from what the Bill and the Government are doing in respect of our NHS. It was an interesting reflection on what is going on in America, but it certainly does not bear any resemblance to what is happening or will happen in this country.

Does the Minister not recognise that, where we have a postcode lottery and the increased rationing of care—my constituents are very aware of the rationing of care, and a number of Members have spoken about what happens when people cannot get the treatment that they need on the NHS—there is the spectre of an individual, private insurance-based system? Members of his own party have in fact argued for such a system. People need to be mindful of just how dangerous for us all it would be to introduce a private insurance-based system.

Will the hon. Lady forgive me? I was not questioning the integrity of what she said, but I was suggesting that there was no risk of that system as she described it developing in this country.

I will sum up, because I want to give the hon. Member for Leeds East a little more than two minutes, if I can. We are determined to continue supporting our NHS; this Bill, this legislation, the funding announcements we have made and the reforms we are putting in place do just that. We want to create an NHS that is fit for the future, renewing the gift left to us by previous generations, building on that gift and strengthening our NHS as it evolves to meet the challenges of the future. We remain the party of our NHS; we will give it the support it needs—as we always have done.

Thank you for presiding over this debate, Ms Bardell, and thank you to all hon. Members for taking part. I do agree with the Minister on one thing: he said that we should not omit public servants’ past records from our discussion, so it was very remiss of me not to mention—as I always do—the Minister’s career as a Serco spin doctor before he became a Member of Parliament. He is, in fact, an expert on public money going to failed private companies—which is what we have been warning against.

Colleagues have made some excellent speeches. In particular, I thank and congratulate my hon. Friend the Member for Wirral West (Margaret Greenwood) for all the detailed work that she has been doing on this issue. She vividly outlined the reality of the eye-watering costs for medical assistance in the United States of America. We do not want, in any way, to go towards the US healthcare model, where they feel for a wallet before they feel for a pulse. That is what motivates Opposition Members.

I am pleased that the hon. Member for Bolton West (Chris Green) had a progressive past—it is a pity that he does not have a progressive present or future. In his recollections of the demonstration that he attended in 2011, he falls foul of unfairly characterising NHS staff by saying that they were conservatives with a small c, wanting to keep things frozen in time. However, when we listen to my hon. Friend the Member for Liverpool, Wavertree (Paula Barker) and others, talking about the real dedication of NHS staff, we hear that they want things to work and want the best possible outcomes for patients. Before my hon. Friend the Member for York Central (Rachael Maskell) became a Member of Parliament, she had an honourable history working for the NHS and representing its staff; she talked about the dedication, care and love that people give, day in, day out. That is the reality of NHS staff.

I welcome the speech by my hon. Friend the Member for Rhondda (Chris Bryant), in which he said that the NHS was about people. That is, indeed, what it is about. It has got to be about people, not about profits or profiteering companies. He made some very important points about the dangers of delayed diagnosis and treatment. I thank my hon. Friend the Member for Streatham (Bell Ribeiro-Addy) for raising the issue of Centene and its UK subsidiary. I thank the Front-Bench spokespeople, the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) and my hon. Friend the Member for Tooting (Dr Allin-Khan). I thank the hon. Member for Strangford (Jim Shannon) who is prolific and, to his credit, seems to speak in every debate, for talking about the passing of his mother-in-law due to covid, and his recollections of the great service that the NHS staff gave at an incredibly difficult time.

I want to end by reading five facts that we should be mindful of. First, £100 billion has gone to non-NHS healthcare providers over the last decade. In 2019-20, the NHS spent £9.7 billion on private services, an increase of 14% on 2014-2015. Earlier this year, half a million patients had their GP service transferred into the hands of Centene, the US health insurance giant. Five point six million people are waiting to start routine NHS hospital treatment—the highest number since records began in August 2007. Since the NHS was established, the average budget rise has been 3.7%, but between 2010 and 2019, on this Government’s watch, budgets rose by less than half of that—1.4% when adjusted for inflation. That is the reality that our NHS faces. The future of our NHS cannot be governed by the direction set by this Government, but the alternative as laid out by the Opposition.

Motion lapsed (Standing Order No. 10(6)).