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  • Jonathan Ashworth – 2020 Speech on Medicines and Medical Devices

    Jonathan Ashworth – 2020 Speech on Medicines and Medical Devices

    Below is the text of the speech made by Jonathan Ashworth, the Shadow Secretary of State for Health and Social Care, in the House of Commons on 2 March 2020.

    We do not intend to divide the House on the Bill this evening. We understand the need for the Bill because its purpose is for the UK Government to take the powers they need as a result of Brexit. In that respect, we broadly support the principles of the Bill, and we offer to work constructively with the Government on strengthening and improving aspects of it. I have a couple of remarks to make that are related to this, but not to the exact contents of the Bill.

    May I start by saying that we all know, not least because of the coronavirus outbreak, that disease knows no borders and defeating disease cannot be done in isolation? International co-operation and research and development are vital and must be accelerated, not hindered. Will the Secretary of State—or indeed the Under-Secretary of State for Health and Social Care, the hon. Member for Bury St Edmunds (Jo Churchill), in her winding-up speech—explain or comment on the press reports today suggesting that the UK is not seeking to participate in the EU pandemic preparedness measures, which may obviously help in relation to coronavirus and other future outbreaks?

    I am of course talking about the early warning and response system. It was suggested in The Daily Telegraph today that No. 10 had overruled the Secretary of State. Since then, a former Minister, Baroness Blackwood, has told Sky News:

    “My advice while I was in there was that I thought it was absolutely appropriate that we should stay engaged with that system… I think this is something that the EU would want to maintain and we as Britain should seek to maintain.”

    I agree with her. I believe it would be foolhardy to pull out of something like this at the best of times, but to do so at the time of an outbreak such as this is surely putting narrow dogma before the public health of the country. I would be grateful if the Minister responded on that.

    Secondly, we also learned at the weekend that the UK will not participate in the unified patent court, which will make developing medicines here in the UK more expensive, not cheaper and easier, and it may make doing ​clinical trials here less attractive. The Government have done lots of briefing on this Bill, but over the weekend they slipped it out while briefing trade magazines that the UK will not be seeking involvement in the unitary patent system. Again, that is disappointing, and I would welcome some remarks from the Minister on that front when she sums up.

    However, this Bill is important, and we do not want to see anything that undermines what has been built up over many years in the United Kingdom. We do have much to be proud of in the field of medical innovation. We have long history of taking a leading role in scientific advance and novel trial design. Indeed, the recent deal to give NHS patients early access to a new cholesterol treatment demonstrates that the UK is already a world-leading destination in which to develop cutting-edge treatments. We want to build on that, not undermine it.

    Members across the House will be aware that our pharmaceutical industry is the single largest private sector investor in UK R&D and provides many jobs across the country for many of our constituents. We should be proud of that sector and of the contribution that life sciences make in providing access to the most cutting-edge treatments. We should be proud that they are vital to economic growth, enhance UK productivity and ensure prosperity for the future.

    Yet while the opportunities before us to develop medicines and medical devices are transformative—both saving lives and radically improving the quality of life for those with the most debilitating of conditions—we also know that things can go wrong. There must never be any compromise on patient safety. Patients put their trust in practitioners, literally trusting them with their lives, and they rightly expect medicine and medical devices to be safe, yet too often in recent years the system has failed patients.

    For many years, long before I acquired the health brief in my party, I worked closely with a constituent, Emma Friedmann, who has campaigned for justice for women whose children were impacted by sodium valproate. Members from across this House have spoken with passion and eloquence on behalf of women affected by Primodos. Equally, we have heard heartbreaking stories in this House about the surgical mesh scandal. My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), the shadow Minister, has been one the leading campaigners on this issue, along with colleagues across the House. We eagerly anticipate the Cumberlege independent medicines and medical devices review, but there have been other scandals too—breast implants, hip replacements—that are not necessarily covered. We would welcome an update from the Minister about that review and some remarks on whether the Government expect to implement its findings.

    My point is that a robust regulatory framework for medical devices to protect patients and users is paramount. We will be testing this Bill to ensure that it provides the safety standards that our constituents deserve, while at the same time ensuring it is forward looking enough to be the correct framework to capture the fast pace of innovation in this field, which the Secretary of State mentioned. However, I believe that the existing regulatory framework has become complex and, arguably, unwieldy.​

    The House will be aware that much of the regulatory landscape derives from EU directives that have been implemented in domestic legislation. At the end of the transition period, these frameworks will be preserved as retained EU law, but as I understand the Bill, the Secretary of State is proposing to take delegated powers to allow these existing regulatory frameworks to be updated without the need for primary legislation. The Bill requires the Secretary of State, as he said, to have regard to the safety and availability of medicines and medical devices, as well as to the attractiveness of the relevant part of the UK with respect to the life sciences sector. We argue that that attractiveness clause could benefit from some definition, and it would allay concerns if the Government accepted an amendment in Committee to indicate that the Secretary of State, or some other appropriate authority, would always prioritise safety.

    The overall effect of the provisions is to confer on the Secretary of State an extensive range of delegated powers to make regulations that span the manufacture of medicines, marketing and supply, falsified medicines, clinical trials, fees, information and offences, and emergencies. That extensive range of powers risks inadequate scrutiny of what will become major policy decisions, and in Committee Labour will press Ministers to support time-limiting those delegated powers.

    Matt Hancock

    I am sure that this debate will continue in Committee, but for clarity, those delegated powers existed under the European Communities Act 1972. The Bill proposes to replace existing delegated powers from the 1972 Act with new powers to make such regulations under the new Act. This is not a new set of delegated powers; it replaces one set with another—indeed, the Bill replaces those powers with clearer safeguards on those matters to which the Secretary of State must have regard.

    Jonathan Ashworth

    That is a welcome clarification, but I am sure the Secretary of State will agree that it is important that decisions made in this field are properly scrutinised through the usual procedures. We are keen to ensure that by tabling an appropriate amendment in Committee.

    We are leaving the EU, but Labour Members consider it essential that we stay closely aligned with it on medicine regulation. With that in mind, the Government should clarify their attitude to new EU regulations such as the in vitro diagnostic medical devices regulation, which is due to be implemented in 2022. As I understand it, that regulation will not automatically apply to the UK. Is it the Government’s intention to align with it? The EU tissue and cells directive is being reviewed. Do the Government intend us to align with it? To ensure that the UK remains a world leader in scientific research and discovery, it is vital that we align with guidelines on clinical trials. Otherwise, patients could miss out on participating in trials and the UK could find it harder to access funding.

    Effective joint working with our European partners has been vital for the NHS over recent years on everything from infectious disease control to the licensing, sale and regulation of medicines. Patients in the UK can access EU-wide trials for new treatments and the UK has the highest number of phase 1 clinical trials across the EU, as well as the highest number of trials for rare and ​childhood diseases. It is vital for improving health outcomes in the UK and EU that the UK continues to access those networks. Otherwise, we run the high risk of patients with rare diseases being adversely impacted.

    The Bill contains provisions to extend the range of professions that can prescribe medicines, thereby allowing additional health care practitioners such as paramedics and midwives to be given restricted prescribing rights. We welcome those provisions and, assuming that their competencies have been assessed in the same way as those of other prescribers and that equal safeguards are in place, we support that sensible and timely reform. Will there also be plans for a consultation on the future prescribing rights of physician associates and surgical care practitioners?

    I will not say too much about part 2 of the Bill, other than to confirm that any measures that help in the battle against anti-microbial resistance have Labour’s support. Part 3 is about medical devices. I have already commented on the use of delegated powers, and as I said at the outset, patient safety must be the priority and we will look to strengthen regulation in that area. Unlike medicines and drugs, many surgical innovations can be introduced without clinical trial data or centrally held evidence. That is a clear risk to patient safety, and it undermines public confidence. Manufacturers are often in charge of testing their own products after faults have developed and they can shop around for approval to market their products without declaring any refusals.

    Two years ago, freedom of information requests to the Medicines and Healthcare Products Regulatory Agency revealed 62,000 adverse incident reports that were linked to medical devices between 2015 and 2018, and more than 1,000 had resulted in death. Most devices are cleared through a pathway that allows new products to inherit the approval status of “substantially equivalent” products already on the market. In some cases, after lengthy chains of equivalence-based approvals, the new devices scarcely resemble the original version. Indeed, a study in The BMJ in 2017 found that the family tree of 61 surgical mesh products related to two original devices that were approved in 1985 and 1996. Unless we fix that and put patient safety at the heart of the regulatory framework, patients will suffer and lack confidence.

    We know the Secretary of State is a great champion of and has promoted many health-based apps. We need a robust and sophisticated mechanism to evaluate app-based healthcare for use in the NHS, and in Committee we will look to strengthen the regulation of that. We welcome what appear to be plans for a devices register, and I took note of what the Secretary of State said in his interaction with my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe). We believe, however, that such a register must provide comprehensive data on who, where, how and why devices were implanted, and by whom, so that any recall could be quickly enacted.

    To achieve that, we encourage Ministers to strengthen the Bill by reflecting provisions in existing EU regulation and to ensure there are unique device identifiers, such as serial numbers on medical devices that are labelled with tracking information, as well as the power to track the use of those devices, so that the NHS can find and notify affected patients if and when problems arise. By the same token, the Government must reassure us that with such a register it is practically possible to cover all ​devices, including everything from implants to bone screws, software, apps, mesh, medical cannulas, pacemakers and so on. That is an extensive list of different devices, and I would be keen to hear how such a register could be implemented practically.

    Dr Luke Evans (Bosworth) (Con)

    The hon. Gentleman’s point about “why?” is important. As a doctor, I know that things move on, and when someone leaves medical school 50% of what they have learned is out of date. With devices that are likely to exist for 10, 20, 30 or 40 years, looking back it can be difficult to work out exactly why something was implanted. I would like the Bill to request an explanation from the clinician at the time to say what the thinking was. In the future, that would inform people who needed to deal with someone who had something implanted in their heart 20 years ago, for example, by which time the history might be exactly that—history.

    Jonathan Ashworth

    It has taken me some time, but let me welcome the hon. Gentleman to his place, particularly as a fellow Leicestershire MP. His contribution is well made, and I look forward to working constructively with him on health matters, as well as on various Leicestershire matters. I hope the Minister will reflect on his contribution and answer it when responding to the debate.

    The Opposition will not seek to divide the House. We want the Bill to proceed to Committee, and we will work constructively with the Government to improve and strengthen it. It is up to Ministers to allay concerns about patient safety and about the UK’s ability to develop medicines rapidly for NHS patients in the future, and we look forward to a constructive debate on the Bill.

  • Jonathan Ashworth – 2020 Speech on the Wuhan Coronavirus

    Jonathan Ashworth – 2020 Speech on the Wuhan Coronavirus

    Below is the text of the speech made by Jonathan Ashworth, the Shadow Secretary of State for Health, in the House of Commons on 11 February 2020.

    I thank the Secretary of State for advance sight of the statement and advance notice of the regulations and steps he was going to invoke yesterday.

    Our thoughts must be with all those diagnosed with novel coronavirus and those in quarantine, and I place on record again our thanks to NHS and Public Health England staff and all other staff involved in responding to the outbreak.

    On the specific issue of the quarantine arrangements, I understand the approach the Government have taken, and the Secretary of State will recall that in response to last week’s statement I asked him what would happen should an evacuee wish to leave Arrowe Park. In response he understandably reminded the House that evacuees had signed contracts that effectively offered passage back to the UK in return for compliance with the Government’s quarantine arrangements. However, given that questions were raised around how practically enforceable those contracts were, and indeed wider questions about what was allowed under human rights legislation, I understand why the Secretary of State has invoked the regulations that he is entitled to do under the Public Health Acts. He has our support.

    Quarantine arrangements must be seen to be necessary, proportionate and in accordance with law, and enforcement of those quarantine arrangements, including with powers of restraint where necessary, must be fully transparent, and the rights and freedoms of the quarantined evacuees must be fully understood so as to ensure they are treated with dignity and respect. We agree that a legislative framework for this is far preferable to the ad hoc contracts that were the original basis for the quarantines.

    In order to maintain public confidence in these arrangements, that framework must be understood and scrutinised by Parliament. With that in mind, on the instrument the Secretary of State laid before the House yesterday, at what point will the House get an opportunity to consider the regulations and will that be on the Floor of the House? I appreciate that the Secretary of State is not one of the business managers—although there is going to be a Government reshuffle so who knows by the end of the week—but if he can give us some clarity at this point on that, we will appreciate it.

    Turning to the UK response more generally, can the Secretary of State tell the House if he is asking clinical commissioning groups and trusts to make plans should this outbreak turn into a pandemic in the coming months? What work is he doing to ensure that the local plans are robust, and can he guarantee they will be fully resourced? What communications have directors of public health in local authorities received and how will they continue to be kept informed?

    Is the Secretary of State confident that NHS 111 has sufficient capacity to deal with increased numbers of calls? Will community health trusts, which I understand will be tasked with visiting suspected patients in their homes to carry our swab tests, be given extra resources to scale up capacity, or will they be expected to fund this extra work from their existing baselines?

    With respect to the capital facility the Secretary of State has announced, I understand that hospitals are being given specialist pods to quarantine patients and access to this facility. Can he tell us whether GPs have the necessary equipment and resources to cope with patients who may present with novel coronavirus? Will they be able to apply for this capital facility?

    I welcome the Secretary of State’s advice on travel arrangements, not least with school holidays coming up next week. Many people will want clarification. Can he assure us that Foreign Office advice is fully aligned with Public Health England advice, and tell us what monitoring arrangements are in place at airports for flights returning not just from China but other places across the world where there has been a coronavirus outbreak?

    Finally, can the Secretary of State update the House on international efforts to share research and intelligence, as well as attempts to find a vaccine, and a timescale? He will know that there is a World Health Organisation summit today, for example.

    On behalf of the official Opposition, we again thank all our hardworking NHS staff, particularly those on the frontline, some of whom have been diagnosed with coronavirus. We thank the Secretary of State for coming to the House, and reiterate our hope that he will continue to keep the House updated in the weeks ahead.

  • Jonathan Ashworth – 2020 Speech on the NHS Funding Bill

    Jonathan Ashworth – 2020 Speech on the NHS Funding Bill

    Below is the text of the speech made by Jonathan Ashworth, the Shadow Secretary of State for Health, in the House of Commons on 27 January 2020.

    This is not a serious funding Bill; it is an underfunding Bill. It is a political gimmick of a Bill. The Secretary of State hoped that the Bill would signal the Tories’ commitment to the NHS, but it actually reveals their lack of commitment to the NHS. I remind the Secretary of State that the last Labour Government, who I did indeed work for, did not need a piece of legislation to increase NHS funding by record levels—6% extra a year. We just got on and delivered record investment in the NHS in spending review after spending review. That record investment delivered the lowest waiting times, the highest satisfaction ratings, and 44,000 more doctors and 89,000 more nurses. He is unable to match that record.

    This Bill essentially caps NHS funding—[Hon. Members: “No it doesn’t.”] It certainly does because, as the Secretary of State outlined, the amounts in the Bill are in cash terms, not real terms, which is what the previous Secretary of State presented to the House in summer 2018. The amounts in the Bill are in cash terms, and when my hon. Friend the Member for Nottingham South (Lilian Greenwood) asked the Secretary of State whether the NHS will get the real-terms increases that the previous Secretary of State outlined should inflation run at unforeseen levels, he could not give that commitment.​

    The Secretary of State could not give my hon. Friend the cast-iron commitment needed by the NHS chief executives on the ground because this Bill outlines only the cash figures. If inflation runs at a higher level than expected, the NHS will not get the extra money that the Secretary of State boasts about from the Dispatch Box unless we have that commitment. As the hon. Member for Glasgow North (Patrick Grady) said, the money resolution has been tightly drawn to restrict hon. Members from tabling amendments to give the NHS the levels of funding it needs. This Bill is a political stunt.

    The Bill attempts to enshrine revenue spending in law, but the test will be whether the uplift outlined by the Secretary of State, albeit in cash terms, is sufficient to deliver on the promise made by the Prime Minister at the Dispatch Box two weeks ago:

    “We will get those waiting lists down.”—[Official Report, 15 January 2020; Vol. 669, c. 1015.]

    That means reversing the significant deterioration in care under this Government over a decade of decline.

    This Bill fails the Prime Minister’s test, because the level of health expenditure that the Secretary of State is asking the House to put into law will not drive down waiting lists or drive up A&E performance to the levels our constituents deserve. The level of expenditure that the Secretary of State presents as an act of great munificence are not sufficient to enable the NHS to deliver the aspirations of its long-term plan. What he says is not what NHS Providers, the British Medical Association, the Health Foundation, the Institute for Fiscal Studies, a whole host of think-tanks and staff representatives are saying about the Bill.

    Matt Hancock

    It is what the British people say.

    Jonathan Ashworth

    That is pretty dismal by the Secretary of State’s standards. [Interruption.] I am aware that his party won the general election, but it does not mean he is correct about NHS funding.

    The Secretary of State is not prepared to put it in the Bill, but let us suppose he delivered on the real-terms increases outlined by the previous Secretary of State—around a 3.3% annual uplift for NHS England revenue. The problem is that NHS activity usually increases by 3.1% a year. We have an ageing population with a wide variety of complex conditions and a wide variety of co-morbidities, and we have seen years of austerity for which the Secretary of State was responsible as George Osborne’s right-hand man. We have seen health inequalities widen, needs increase and demands on the NHS rise, which is why health experts, including the IFS, the Health Foundation, NHS Providers, the BMA and a whole range of Royal Colleges, have said that health expenditure should rise across the board—not just in NHS England but in capital, education and public health—by 3.4% just to maintain current standards of care.

    If we are to start driving down waiting lists, improving performance in A&E and driving down GP waiting times, as the Prime Minister promised on the steps of Downing Street, the NHS needs at least a 4% increase across the board. As the Health Foundation has said, investing in modernising the health service, as set out in the NHS long-term plan, requires around a 4.1% uplift a year. The Government are not giving the NHS 4.1% a year.

    ​Feryal Clark (Enfield North) (Lab)

    In my constituency and the borough of Enfield, almost 16,000 people do not have access to a GP. Does my hon. Friend agree that the chronic GP shortage in this country is an absolute disgrace?

    Jonathan Ashworth

    The Secretary of State talks about recruiting all these new GPs. The Tories fought the 2015 general election on delivering 5,000 extra GPs, but GP numbers have gone down. Now he is imposing pension tax arrangements that are driving GPs and other doctors out of the NHS or driving them to cut back on their shifts. He has no solution to that and, again, it was another one of George Osborne’s ideas—the Secretary of State probably came up with it when he was George Osborne’s bag carrier—so I do not believe anything he says on recruiting extra GPs.

    The 4% increase is the historic increase that the NHS used to get throughout its 61 years until the coalition Government were elected. That is why we tabled an amendment in the debate on the Loyal Address calling for the 4% increase. Every Tory Member voted against it, but a 4% increase is what the NHS traditionally got—indeed the previous Labour Government gave it 6%. Instead, we have now had a decade of decline where it received an uplift of about 1.5%. This Tory decade of decline with 1.5% increases is why the funding settlement is inadequate, because it simply cannot make up for that decade the NHS has gone through. This Bill simply cannot make up for the decade of decline in which those gains in quality care and outcomes made by the last Labour Government have been squandered by this Tory Government. The Bill cannot make up for the decade of decline where these Ministers forced the NHS through the tightest financial squeeze in its history, which has left hospital trusts with deficits of £571 million and billions in debt, and left the NHS facing a repair bill of £6.6 billion, leaving hospitals with roofs leaking, pipes bursting, equipment faulty, IT systems breaking and ligature points in mental health trusts deeply unsafe. This decade of decline means the NHS is short today of 106,000 staff and our brilliant NHS staff are being pushed to the brink every week, working a million hours extra than they are contracted to work. They are working every hour God sends to make up for the austerity these Ministers have imposed.

    The speech we have just heard from the Secretary of State bears no resemblance to the realities of what is happening on the ground after the decade of decline under the Tories. Month after month, week after week, we see NHS performance data showing our hospitals recording the worst performance on record against the four-hour standard for accident and emergency. Month after month, we see the number of people on the waiting lists for routine surgery and treatment rising—it is has now risen to 4.4 million. More than 690,000 of our constituents are waiting beyond 18 weeks for treatment. That is an increase of more than 185,000—a 37% increase—since this Secretary of State took up his post. Waits for diagnostic tests are at their highest levels for a decade, cancer waiting times are their worst on record and we are bottom of the league for cancer outcomes.

    Since 2010, more than 17,000 beds have been cut. Hospitals are dangerously overcrowded. Patients are left languishing for hours as trolley waits, being moved from cubicle to corridor in need of a bed. We read in the ​newspapers about 90-year-old war veterans left for hours upon hours on trolleys. We see photos of toddlers treated on floors or sleeping in makeshift beds on chairs. Trolley waits are not some inconvenience for patients; they lead to increased mortality in our hospitals. Research from the Royal College of Emergency Medicine shows that almost 5,500 patients have died in the past three years because they have spent so long on a trolley waiting for a bed in an overcrowded hospital. That is utterly unacceptable.

    Eddie Hughes (Walsall North) (Con)

    Given the vision the hon. Gentleman has just created of the NHS in such a parlous state, why does he think the British public chose not to hand over the management of it to the Labour party?

    Jonathan Ashworth

    We lost the general election, but that does not give Tory Members a free pass on the state of the NHS. We have seen an increase in trolley waits in hospitals in December of 65%, and trolley waits in the past year, on this Secretary of State’s watch, have risen to 847,000—the highest number of trolley waits in hospital corridors on record.

    Siobhain McDonagh (Mitcham and Morden) (Lab)

    Is my hon. Friend aware that twice in the past fortnight St George’s Hospital in Tooting has been on OPEL—Operational Pressures Escalation Level—alert in A&E? It has been one level below having to close its doors to all emergencies because the hospital was so full. Such a closure would have a devastating impact on south-west London.

    Jonathan Ashworth

    My hon. Friend speaks movingly about the situation in her local trust. Of course, St George’s is one of the trusts that has a high maintenance backlog of around £99 million. The reason why hospitals such as St George’s have maintenance backlogs, which mean that they cannot get the flow through the hospital that is needed so that my hon. Friend’s constituents are treated on time, is because capital budgets have been raided repeatedly. The underfunding of the NHS has been such that NHS chiefs have had to shift money from capital budgets into the day-to-day running of the NHS. That is what Tory austerity has done to our NHS. That is what Tory austerity means for my hon. Friend’s constituents.

    Janet Daby

    Does my hon. Friend agree that we have a crisis in respect of mental health nurses, who are not being recruited and supported in the way in which they should be? Not only is that putting strain on the mental health nurses who are there, but it will affect patient care as well.

    Jonathan Ashworth

    My hon. Friend is absolutely right. Of course, we are short of 44,000 nurses across the whole national health service. One of the most damaging policy decisions that George Osborne made—probably another of the Secretary of State’s ideas—was to cut nurse training places in 2011 and get rid of the training bursary. The Government say that they will bring back a grant, but they are not going to go the whole hog, are they? They are not going to get rid of tuition fees. They still expect people to train to be nurses and build up huge debts, because the nature of the training that they have to go through means that they will not be able to take a job on the side. I do not believe that is the way we ​should recruit nurses for the future; we should bring back the whole bursary for nurses, midwives and allied health professionals.

    Seema Malhotra (Feltham and Heston) (Lab/Co-op)

    My hon. Friend is making an important speech and has just made reference to the cuts to capital budgets. Does he agree that it is staggering that since 2014 we have seen five consecutive switches from capital budgets to revenue budgets, totalling about £4.29 billion? The consequences are now being felt by all our constituents throughout the country.

    Jonathan Ashworth

    My hon. Friend is absolutely right. Because of the austerity that the Government have imposed on the NHS, its leaders—trust bosses and clinical commissioning group bosses—have had to raid capital budgets repeatedly and transfer from capital to revenue, as my hon. Friend said. These sorts of smash-and-grab raids, which have happened five times, have taken around £5 billion out of the capital budgets, which is why so many of our hospitals now have this huge £6.6 billion-worth of repair backlog, with sewage pipes bursting and roofs falling in.

    It is all very well for the Secretary of State to stand there and talk about 40 new hospitals, even though he has not outlined a multi-year capital settlement at all. He just went around the country telling Tory candidates, who have now become MPs—congratulations to them—that he will build a hospital here and they will have a new hospital there. I lost count of the number of times that he committed to new A&E departments and new hospitals that were not on any list that he has published in the House of Commons. We do not actually have a multi-year capital plan to deal with the more than £6.5 billion backlog that faces our hospitals. This is not a serious way to make policy for the national health service. Our trusts’ chief executives need certainty on capital, which is why we need to see the multibillion-pound capital plan. We do not even know whether we are going to get one in the Budget. We do not know when it is coming: the Secretary of State has given us no detail or clarity on that whatsoever.

    Whether it is waiting for pre-planned surgery, for cancer treatment, for test results, in A&E or on trolleys, thousands of our constituents wait longer and longer in pain, agony and distress, thanks to years of austerity that the Secretary of State designed. As George Osborne’s right-hand man and chief bag carrier, he designed the years of austerity and is now asking the House to endorse the continued underfunding of the NHS.

    Sarah Atherton (Wrexham) (Con)

    I refer the hon. Gentleman to the NHS in Wales, which is run by the Welsh Labour Government. In north Wales, Betsi Cadwaladr University Health Board has been in special measures for five years, and it is run by the Welsh Labour Government. Last year, in north Wales alone 6,600 people waited more than 12 hours to be seen in A&E. I would like to hear the hon. Gentleman’s comments.

    Jonathan Ashworth

    It is unacceptable, and sadly it is happening constantly in the English NHS. Of course, on certain performance targets there is improvement in Wales; there is no improvement on any performance targets when it comes to A&E or electives in the English ​NHS. I welcome the hon. Lady to her place and she is right to raise that issue, but I hope she will also raise with the Secretary of State his poor leadership on performance data for the English NHS.

    The long-term plan rightly calls for more investment in areas of the NHS that have been neglected for many years, particularly mental health services, community health services and primary care. We endorse the approach outlined in the long-term plan. Mental illness represents around 23% of the total disease burden, but only 11% of NHS England’s budget. Mental health patients are some of the most let down by the decade of decline in the NHS. We regularly read heartbreaking reports in the newspapers of patients forced to wait up to 112 days for talking-therapy treatments, when we know that people are supposed to get an improving access to psychological therapies appointment in six weeks. We regularly read of the shortage of mental health beds, which means that too many people—often young people—are sent hundreds of miles across the country. They are often young people in desperate circumstances, sent away from their family and friends, often receiving ineffective care in poor-quality private providers. The rationing of care for children in particularly desperate circumstances has seen more than 130,000 referrals to specialist services turned down, despite those children showing signs of eating disorders, self-harm or abuse. It is totally unacceptable.

    The long-term plan calls for increased investment in mental health services, which we welcome. Had we won the general election, we would have gone further and invested more to deliver parity of esteem for physical and mental health, and we would have legislated to ensure health and wellbeing in all policies with a future generations wellbeing Act. None the less, we welcome the ambition in the long-term plan to increase the proportion spent on mental health. In the past 10 years, under intense financial pressures because of underfunding and austerity in the NHS, commissioners have had to raid budgets, especially child and adolescent mental health services budgets, to fund the wider NHS. In the past 10 years, mental health services have often lost out because of financial pressures in the system so, if such an amendment would be in scope, we will seek to amend the Bill to ensure guarantees for mental health funding and that mental health funding can be ring-fenced. We will also seek look to ensure that there is a framework of accountability, under which the Secretary of State would come to the House, perhaps once a year, to update it on mental health funding and where it is being spent.

    We endorse the increased funding for mental health, community services and GP services at a faster rate. If the Government are genuinely committed to that, and if at the same time the NHS is to live within its 3.3% uplift, that means that by definition less money will remain for growth in funding for the acute sector. The Secretary of State will need to moderate the rate of growth in acute demand, because if he cannot, there is a risk that either the money that he is allocating to mental health services will be diverted back to hospitals, as has happened in the past 10 years, or waiting times will have to increase and A&E performance will have to worsen ever further.

    The problem is that the Secretary of State will not be able to drive up performance and moderate need without a fully funded plan for the whole of the health and social care sector. That is why the Bill is fundamentally inadequate. When in June 2018 the previous Secretary of State, the ​right hon. Member for South West Surrey (Jeremy Hunt), came to the House to outline the funding settlement, he quite rightly said that he would not be able to fix the various problems facing the NHS if that did not happen alongside a funded staffing plan, a funded multi-year capital plan and a funded social care plan. The previous Secretary of State was correct. The problem with the Bill is that, as the Secretary of State conceded, it excludes key areas of health spending, such as public health; health visiting; the training of doctors and nurses; the capital budgets to build and maintain hospitals; and the capital budgets for community health facilities. That is before we even get on to social care funding, which is another issue that has in effect been kicked into the long grass by the Secretary of State.

    We all know that public health services are crucial services that keep people well, prevent ill health and keep people out of hospital. A year ago, the Secretary of State would do interviews to tell us that public health and prevention was his big, No. 1 priority. I remember his interview in The Sunday Times in which he said that he had ordered the behavioural insights team to target those who are obese, smokers and people who drink to excess. He said he would “not rule out” using social media to target people to change their ways. Pregnant smokers would get emails to encourage them to stop smoking. This is my favourite; this is what he actually said—well, it is quoted in the article:

    “Those in hospital with ailments related to alcohol abuse will be targeted for a ‘stern talking to’”.

    That is what he said on prevention a year ago. What did we get instead? We got more cuts to smoking cessation services, more cuts to alcohol addiction services, and more cuts to drug misuse services. That is what we have had in the past 12 months, because budgets have been cut as part of the wider £870 million cut to the public health grants. The Secretary of State did not mention public health in his remarks. We still do not know what the public health allocations will be for this year. He is asking the House to legislate for a funding allocation that the previous Secretary of State outlined to the House 18 months ago. He cannot even tell us the public health allocations beyond the next three months. That just reveals what a ridiculous political stunt this Bill is.

    Kevin Hollinrake (Thirsk and Malton) (Con)

    In his earlier remarks, the hon. Gentleman mentioned social care. He will be aware that the Health and Social Care and the Housing, Communities and Local Government Committees recommended in a joint report a range of options, one of which was a social insurance premium. Will he agree to cross-party talks, and does he think that all those different options laid out in that report should remain on the table for discussion?

    Jonathan Ashworth

    I am grateful to the hon. Gentleman for his intervention. He is a considered authority on these matters, and I appreciate the spirit in which he has made his intervention. We are not convinced that a social insurance model will work. In those countries where there is a social insurance model—I think in Germany and in Japan—they have largely been building on a social insurance model for their healthcare delivery. In Japan—I may be wrong on this, and I will correct the record if I am wrong—there is a taxation element as well.​

    We believe that there is a degree of political consensus on the future funding of adult social care. We agree with the House of Lords Committee, which includes people such as Michael Forsyth and Norman Lamont, that we need a form of free adult social care paid for by taxation. There is a version of it in Scotland and in Northern Ireland. We believe that, if the Government are prepared to talk to us on those terms, we could find political consensus, but at the moment the Secretary of State stands outside that political consensus.

    Kevin Hollinrake

    The hon. Gentleman makes some interesting points, but is it not the case that the best way forward is not to have a precondition about the subject of those talks, and that we should simply have a cross-party discussion? In that way, he can find out more of the detail behind the Japanese system, which he says he is lacking. Why does he need to make preconditions to those talks?

    Jonathan Ashworth

    The Government have no proposals whatsoever. They have been talking about bringing forward a social care plan for years now. As I have said before in the House, Members are more likely to see the Secretary of State riding Shergar at Newmarket than see a social care plan. The truth is that, if the Government want to put forward some proposals, we will always be happy to talk to them. We are clear that taxation is the best way to fund adult social care, and that we need a version of free personal adult social care. That is what we have put in our manifesto, and that is what the House of Lords has proposed, and, as I have pointed out, there are some very Thatcherite Tories on that Committee in the House of Lords—they are by no means red in tooth and claw socialists. They have looked at all these different options and came to the conclusion that a taxation-funded system is the best way to go, but, of course, we are prepared to have discussions. I am grateful to the hon. Gentleman for the way in which he put his question. He is a very thoughtful figure in the House and he has done a lot of work on this matter, and Members on both sides of the House appreciate that.

    As I was saying, the Secretary of State cannot tell us the allocations for public health budgets beyond the next three months. We have talked about capital, but we still do not have a multi-year capital settlement. We still do not know whether the Secretary of State will rule out the capital to revenue transfers that have taken place over the past 10 years. If we can find an amendment in scope, we will put it down to rule out capital to revenue transfers. If he agrees that capital to revenue transfers are not in the interests of our hospitals that desperately need to deal with their repair backlog, I hope that he will support such an amendment.

    The Bill does not provide a proper costed plan for the workforce. There is nothing in the Bill on training budgets, when every single trust chief executive reports that understaffing is their biggest challenge, and a hindrance to delivering safe care. The numbers employed by trusts over the past decade have grown at half the rate of 2000, and this is at a time of increasing need. As I have said, with vacancies numbering more than 100,000, the situation across the NHS is chronic. Staff shortages mean overcrowded wards, lengthening queues in A&E, cancelled operations and exhausted, burned-out staff with low morale who feel that they must do more with less. Perhaps we should not be surprised that the numbers leaving the NHS citing bad work-life balance has trebled under this Government.​

    In these circumstances, the Government expect to retain 19,000 nurses and recruit an additional 31,000, although they are not actually bringing back a full bursary to do so. At the same time, vacancies for nursing today stand at about 44,000, so the Government are hardly going to resolve the crisis in nurse vacancies that our trusts are facing. Not only have the Government failed to train enough nurses, they have not dealt with the taxation changes affecting doctors. On diagnostics, one in 10 posts are vacant in England, so if the Government are to meet their promise to diagnose three in four cancers at an early stage by 2028, we need to see significant growth in the NHS cancer workforce as well. We have no funded workforce plan, even though it was promised by the Government when they announced these funding allocations back in summer 2018.

    This all matters, because the NHS will simply not be turned around without the investment in public health that is needed, without recruiting the extra staff that are needed, without modernising buildings and equipment and without fixing our broken social care service. The Secretary of State will not be able to improve performance across the NHS and level up health outcomes while the Government continue to pursue their austerity agenda.

    We have seen a decade of cuts, which has seen child poverty rising—it is set to rise to record levels—increasing rough sleeping on our streets, insecure work becoming the norm, poor quality housing becoming commonplace, local services being cut back and closed, and an increase in air pollution. All of these things determine the health of our constituents.

    Austerity means that the advances in life expectancy that we have come to expect since the second world war have begun to stall. Infant mortality rates have increased three years in a row. The last time that that happened was during the second world war. We are seeing increasing mortality rates for those in their 40s—so-called deaths of despair from suicide, drug overdose, and alcohol abuse—and the gap between the health of the richest and the health of the poorest getting wider and wider. Not only have we seen in this decade of austerity widening inequalities in health outcomes, but we are now seeing widening inequalities in access to health services—the poorest wait longer in A&E, the poorest wait longer for a GP appointment because there are fewer GPs in poorer areas, the poorest have fewer hip replacements, and the poorest are less likely to recover from mental ill health.

    Siobhain McDonagh

    Is my hon. Friend aware that there is also a tendency for capital funding in new schemes to go to those areas that are far more wealthy than those with the greatest health inequalities? Let me give my own experience of Epsom and Saint Helier Trust, where the local NHS is consulting on moving all acute services to Belmont.

    Madam Deputy Speaker (Dame Eleanor Laing)

    Order. The hon. Lady will have her chance to speak for quite some time later in the debate, and I think that the hon. Gentleman is just concluding his speech.

    Jonathan Ashworth

    My hon. Friend’s point is absolutely right, and she is right to raise it.

    The point is this: those most in need of health services now experience the poorest quality of care. It is an absolute disgrace. This political stunt of an underfunding ​Bill will not deliver the scale of improvements that our constituents deserve. We will not divide the House tonight, but instead seek to amend the Bill. Let us be clear: the Government should have brought forward a fully funded financial settlement for our NHS and social care. The ever lengthening queues of the sick and elderly in our constituencies deserve so much better.

  • Jonathan Ashworth – 2019 Speech on the NHS Long-Term Plan

    Below is the text of the speech made by Jonathan Ashworth, the Shadow Secretary of State for Health, in the House of Commons on 1 July 2019.

    I am grateful to the Secretary of State for an advance copy of his statement. I had hoped for a greater sense of urgency from him. He talks about the 100-year anniversary of the Ministry of Health, but this year is the first time in 100 years that the advances in life expectancy have begun to stall, and even go backwards in the poorest areas. Just the other week, we saw that infant mortality rates have risen now for the third year in a row. As this is the first time that they have risen since the second world war, I would have hoped for a greater focus on health inequalities in his statement today, not least because public health services—the services that, in many ways, lead the charge against health inequalities—are being cut by £700 million. Now he says that we should wait for the spending review for the future of public health services, but we do not know when the spending review is. The Chief Secretary to the Treasury has said that it will be delayed, so it could be next year.

    In the past, the Secretary of State has talked about a prevention Green Paper. Will that prevention Green Paper be before the spending review or after the spending review? Will he also tell us whether it is still the intention of the Department to insist that local authorities fund their public health obligations through the business rates?

    At the time of the publication of the long-term plan last year, the then Secretary of State for Health said that we cannot have one plan for the NHS without a plan for social care, yet we still have no plan for social care. We have been promised a social care Green Paper umpteen times. We are more likely to see the Secretary of State riding Shergar at Newmarket than see the social care Green Paper. Where is it?

    The Secretary of State talks about the better care fund revenue increase. May I press him further on that? Is he saying that the clinical commissioning group allocations to the better care fund, which tend to be the bulk of the better care fund, will increase in line with the NHS revenue increase, or is he saying that there will be new money available for the better care fund? Adult social care has been cut by £7 billion since 2010 under this Tory Government, which is why hundreds of thousands of elderly and vulnerable people are going without the social care support that they need. Presumably, we will have to wait for the spending review for proposals on social care.​

    The Secretary of State talks about the workforce. We have 100,000 vacancies across the NHS. We have heard about the interim people plan, but of course we have seen the bursary cut, the pay restraint, and the continuing professional development cut. That plan is all good and fine, but when will it be backed up by actual cash?

    The Secretary of State talks about IT systems and apps—we know that he is very fond of that—but again he gives us no certainty on capital investment. Hospitals are facing a £6 billion repair bill—ceilings are falling in and pipes are bursting. The repair bill designated as serious risk has doubled to £3 billion. When will we have clarity on NHS capital?

    We broadly welcome what the Secretary of State said about mental health, but 100,000 children are currently denied mental health treatment each year because their problems are not designated as serious enough, and over 500 children and young people wait more than a year for specialist mental health treatment. He talks of a fundamental shift, so can he guarantee that clinical commissioning groups will no longer be allowed to raid their child and adolescent mental health services budgets in order to fill wider gaps in health expenditure? On mental health resilience and prevention, only 1.6% of public health budgets is currently spent on mental health, so will he mandate local authorities, when setting their public health budgets, to increase the money they spend on mental health?

    On cancer, we broadly welcome what the Secretary of State has said, but patients are waiting longer for treatment because of vacancies and out-of-date equipment. Today we learned that consultant oncologists with shares in private hospitals are referring growing numbers of patients to those hospitals. Is that not a conflict of interest? When will we see tougher regulation of the private healthcare sector?

    The Secretary of State talked about the clinical review of standards that is being piloted in 14 hospitals, yet those hospitals are not publishing the data. If he wants to abandon the four-hour A&E target, will he insist that those pilot hospitals publish all the data? He did not mention waiting lists. We have seen CCGs rationing treatment because of the finances. We have seen 3,000 elderly people refused cataract removals. We have seen CCGs refusing applications for hip and knee replacements. We have even seen a hospital that until last week was inviting patients to pay up to £18,000 for a hip or knee replacement—procedures that used to be available on the NHS. When is he going to intervene to stop that rationing of treatment, which we are seeing expand across the country because of the finances?

    Finally, there are many laudable things in the long-term plan that we welcome. Alcohol care teams were a Labour idea. Perinatal mental health services were a Labour idea. Gambling addiction clinics, which the Secretary of State announced last year, were a Labour idea. Today he is talking about bringing catering back in-house, which is also a Labour idea. Why does he not just let me be Heath Secretary, and then he could carry on being the press secretary for the right hon. Member for Uxbridge and South Ruislip (Boris Johnson)?

  • Jonathan Ashworth – 2019 Speech on Tessa Jowell Brain Cancer Mission

    Below is the text of the speech made by Jonathan Ashworth, the Shadow Secretary of State for Health, in the House of Commons on 13 May 2019.

    I thank the Secretary of State for an advance copy of his statement. We warmly welcome today’s announcement. His tribute to our much-missed friend and colleague was moving and powerful. It is an extraordinary testament to Tessa’s bravery that in the final harrowing months of her life, faced with a highly aggressive and very-difficult-to-treat cancer, and in full knowledge of the life expectancy associated with such a devastating cancer, Tessa led from the front to campaign for better brain cancer treatment for others. She spoke with extraordinary courage in the Lords, she brought the then Secretary of State and me together, and she convinced Ministers to shift policy, not by garnering sympathy, understandable though that approach would have been, but by persuasion based on facts and policy argument. It was typical Tessa.

    Tessa would have been delighted by the Government’s announcement—some 2,000 brain cancer patients a year will now benefit from the “pink drink” solution—but she would be keen to go further still. Almost 11,000 people ​are diagnosed each year with a primary brain tumour, including 500 children and young people, which is 30 people every day, and more than 5,000 people lose their lives to a brain tumour each year. Brain tumours reduce life expectancy by around 20 years, which is the highest of any cancer, and are the largest cause of preventable blindness in children.

    We live in hope of dramatic improvements, but further research is needed, given that less than 2% of the £500 million spent on cancer research is dedicated to brain tumours. I welcome the Secretary of State’s commitments on research, but does he agree that we also desperately need more involvement in clinical trials? The number of brain cancer patients taking part in clinical trials is less than half the average across all cancers. How will the Government encourage more trials and data sharing?

    Finally, we know that the NHS remains under considerable strain generally. The 93% target for a two-week wait from GP urgent referral to first consultant appointment was not met once last year. Neurosurgery is no exception. In March 2019, the 18-week completion target for referral to treatment pathways stood at 81.3% for neurosurgery— 5% lower than the average for all specialties—which made neurosurgery the worst performing specialty. This is a question of both resourcing and staffing. I know the Secretary of State has his answer on revenue resourcing—we disagree, but we will leave our political arguments for another day—but on workforce there are vacancies for more than 400 specialist cancer nurses, chemotherapy nurses and palliative care nurses, and there are diagnostic workforce vacancies too.

    Meanwhile, the staff who are there are reliant on outdated equipment, and we have among the lowest numbers of MRI and CT scanners in the world. Failing to diagnose early is worse for the patient and more costly for the NHS, so will the Secretary of State update us on when we can expect Dido Harding’s workforce plan? Can he reassure us that the cancer workforce will be a key part of that plan? On equipment and MRI scanners, can he guarantee that the NHS will see increased capital investment budgets in the spending review so that it can upgrade existing equipment and increase the number of MRI and CT scanners?

    Overall, however, we welcome today’s announcement. It is a fitting tribute to our friend Tessa Jowell, and like Tessa herself will touch the lives of so many.

  • Jonathan Ashworth – 2018 Speech at Labour Party Conference

    Below is the text of the speech made by Jonathan Ashworth, the Shadow Secretary of State for Health, at the Labour Party conference in Liverpool on 26 September 2018.

    70 years ago Nye Bevan had the vision to build a National Health Service universal in scope, free at the point of use, covering everyone irrespective of their means.

    The Tories fought it tooth and nail.

    But working men and women refused to give up the struggle.

    And so a National Health Service was established not because it was inevitable, it was established because of Labour.

    In place of fear, was offered hope.

    It was as Bevan said “a real piece of socialism.”

    And it has survived because of the men and women who have sustained it through 70 years.

    So let us Conference in this the 70th anniversary of the NHS thank the nurses, the midwives, the surgeons, the doctors, the dentists, the junior doctors; thank the paramedics, the patient transport staff, the psychiatrists, the health visitors, school nurses, the OTs, the ODPs; thank the pharmacists, the pathologists, the radiologists, the lab technicians. Thank the porters, the cleaners, the catering staff, the assistants, the clerks and medical secretaries.

    Let us thank each and every one of the staff who do us proud every day.

    And let us thank those who have come from across the world to care for our sick and elderly whether from the EU, the Indian sub -continent and yes the Windrush generation too.

    But instead of hope today there is fear.

    The fear of languishing on a trolley in an overcrowded A&E;

    The misery of cancelled operations;

    The distress at social care snatched away;

    The anguish when hip and knee replacements are refused;

    Or heartbreak when women are denied a chance to start a family because IVF is restricted.

    Eight years of Tory austerity mean waiting lists growing, beds cut, communities losing services, hospitals forced into a fire sale of land.

    Eight years of austerity sees hospitals crumbling, equipment breaking down.

    Austerity has meant we are so short of midwives that last year half of maternity units shut their doors at some point to women in the throes of labour.

    Understaffing has become so chronic, they are now even saying you’ll need to book an appointment to go to A&E. How out of touch. What part of accident and emergency do these Tories not understand?

    It doesn’t have to be like this. Austerity was a choice.

    In place of fear, it falls to Labour to offer hope again. If a Jeremy Corbyn Labour government had been elected last year, austerity in our NHS would have ended as we’d have invested £7.7 billion extra this year.

    We’ll invest in general practice, we’ll invest to prepare our NHS for winter, we’ll establish a National Care Service and to ensure we have the most up to date lifesaving technology and equipment we’ll invest £10 billion extra in infrastructure too.

    And when hospital rebuilds are left stalled like here in Liverpool we will step in, take control and ensure hospitals are completed using public money not PFI.

    NHS staff care for us in times of most desperate need. It’s time we cared properly for staff.

    We will deliver fair pay now and always, based on collective bargaining.

    We will safeguard the rights of all NHS and social care staff from the EU and end hostile restrictions on international recruitment.

    And, we will expand training places and bring back the bursary too.

    Bevan said ‘financial anxiety in time of sickness is a serious hindrance to recovery.’ He was right.

    So we will end the tax on the sick that is hospital car parking charges.

    And for hospital patients bed bound, sometimes for weeks on end, whose main comfort is the television, it’s a disgrace they can be charged £35.00 a week just to watch TV. We’ll end these rip offs and deliver a fair deal for patients.

    Children and young people with cancer often have to travel far for specialist cancer care. But when your child is facing cancer you shouldn’t have to worry about paying for train tickets or petrol just to get to the hospital.

    I can announce today a Labour government will cover the costs of travel to and from hospital for cancer treatment for children.

    Patients come first and as your Health Secretary I would never abandon my responsibilities to patient care and safety. I certainly wouldn’t be pushing untested private health apps like this new Health Secretary. It’s so irresponsible.

    Because we know privatisation puts patient care at risk.

    Privatisation means patient transport services run by companies that leave patients stranded.

    It means GP out of hours services that aren’t available out of hours.

    It means a failing hospital cleaning contract that led to infectious waste flowing through a children’s ward.

    And it means Virgin Care suing our NHS.

    Now I don’t know if Sir Richard Branson follows the proceedings of the Labour Party Conference.

    But I know this. Richard Branson and his shareholders should give that money back to the NHS.

    The shadow health team – Barbara Keeley, Justin Madders, Sharon Hodgson, Paula Sheriff, Glenys Thornton, Julie Cooper and Alex Norris have been campaigning on these issues – we thank them today.

    But we have more to do.

    Last year, conference, you asked me not to break your heart, well I don’t want to break anyone’s heart. So I can tell you.

    In Parliament, we will vote against Tory accountable care proposals that usher in more privatisation and cuts

    And the next Labour government will end privatisation, will end PFI, we will repeal the Health and Social Care Act and yes will bring forward reinstatement legislation as we begin the process of renationalising our National Health Service.

    And we’ll block transfers of hospital staff to subsidiary companies too.

    In the coming days I’ll join those unions like Unison and Unite on a picket line against this backdoor privatisation.

    The creation of a National Health Service wasn’t just about the relief of a mother’s anguish who otherwise would have to pay for a doctor to come to the bedside of her sick child.

    It was also about something really, really fundamental – equality.

    Yet today after years of austerity health inequalities are getting wider.

    Advances in life expectancy are stalling. In some of our poorest areas its going backwards.

    In our most disadvantaged communities we see the greater prevalence of diabetes, cardiovascular disease, cancers and stroke.

    We know a child born into poverty and deprivation is more likely to be admitted to hospital, to leave school obese, to suffer poorer health outcomes throughout life.

    Place of birth too often determines length of life.

    We shouldn’t settle for that.

    So a Labour government will establish a specific target to narrow health inequalities.

    Rather than cutting prevention budgets we will fully fund public health provision including sexual health services and drug and alcohol addiction services.

    Our ambition is the healthiest children in the world so we’ll start tackling childhood obesity through ending junk food advertising on family TV and introducing universal free school meals.

    To support parents and babies we’ll recruit more Health Visitors and invest properly in perinatal mental health services too.

    But there is something else we need to do.

    I recently met Rachel, she told me her story of trying to get help for her anorexic daughter.

    Rachel told me how her daughter was sent ‘out of area’ three times over six years to different hospitals including over 300 miles away to Scotland.

    Care was always inconsistent in a mental health system fragmented, understaffed, cut back suffering from years of neglect.

    It meant a vulnerable teenage girl, desperately ill, left trapped in an endless cycle of admission, relapse and discharge.

    As a father of two girls, I’m not ashamed to admit that I cried listening to her story.

    We can’t allow – I won’t allow – families to be let down like that.

    So we will fully fund child and adolescent mental health services, we’ll invest in eating disorder services and end the injustice of children treated on adult wards or sent miles from home. As we finally deliver true parity of esteem for mental health services.

    So in place of fear, we offer hope again.

    And if anyone doubts us, let the message from this Conference be clear.

    If it was possible from the rubble, the debris, the austerity of the 1940s to build a National Health Service covering every man, woman and child free at the point of use then it is possible 70 years later to fund our NHS properly and provide the quality of care people deserve.

    So let us face the future.

    Yes in place of fear, we offer hope.

    In place of fear, the hope of a rebuilt National Health Service.

    In place of fear, the hope of a Labour government for the many not the few.

  • Jonathan Ashworth – 2018 Speech to Hospital Caterers Association

    Below is the text of the speech made by Jonathan Ashworth, the Shadow Secretary of State for Health, at the Hospital Caterers Association on 12 April 2018.

    Can I begin by saying what a pleasure it is to be here, in the 70th anniversary of our National Health Service, but a very special pleasure to be here to congratulate you on your 70th anniversary as the Hospital Caterers Association.

    And as we look back over the last 70 years of the NHS and pay tribute to the millions who have cared for the sick, thank those who have helped bring babies into the world and pay tribute to those who attend to us in our final moments, we are reminded that it is the care, dedication and compassion of our NHS staff that always has done and still does make the NHS the pride of Britain.

    I was so keen to be here in your 70th anniversary year because I know, just as you do, that quality care is about so much more than medicines, bandages, dressings, treatments and surgical procedures, extraordinary as they all are.

    Quality care is dependent upon good nutrition and hydration.

    So today let me thank hospital caterers for your service to the NHS, for your care, compassion and dedication and for your work as part of the healthcare team in caring for the sick, injured and elderly.

    Just like all members of the NHS staff, you have played your part in every illness defeated, in every bout of suffering relieved and in every life saved so today I not only thank you but join with you in readily endorsing your mantra that food is indeed the best form of medicine.

    I’ve witnessed this myself when earlier this week I spent time with catering staff working out of the in-house central production unit at the Nottingham City Hospital part of University of Nottingham’s Hospital Trust. Chris and his team working closely with Nicola the Chief Dietetic Technician produce 8,000 meals a day cooked on site with food sourced from local farms and suppliers.

    Here the catering team work with nursing staff, dieticians, speech and language therapists to put together nutritional fare that helps and supports the recovery of patients.

    This is a very real implementation of the Power of Three initiative that the HCA has championed in recent years emphasising that quality healthcare delivery isn’t about fragmentation and silos but about seamless collaboration where catering staff work alongside nursing staff and dietician staff.

    But Nottingham has gone even further too in developing a new memory menu following consultation with the local community offering patients the healthy nutritional meals they want.

    And because the catering team at Nottingham recognise that the NHS’s responsibility for the health and wellbeing of patients doesn’t simply end when the patient walks out the door, so they ensure the most vulnerable patients leaving to go home are offered a discharge parcel of food basics – bread, a pint of milk, tea, coffee, tinned soup – to help them in the first few days out of hospital.

    This is exactly the sort of in-house, high quality service offering nutritional meals to a high standard that I believe is integral to the future of the NHS and one I want to see developed across the service as Labour’s shadow Health Secretary.

    I opened my remarks by reminding you this is both the 70th anniversary of the National Health Service and the 70th anniversary of the Association.

    In 1948 the overriding endeavour of a National Health Service universal in scope was both to relieve the suffering of those who otherwise would have to pay for a surgeon to come to their bedside but also to wage war on the great infectious diseases that stalked the land and took far too many so early in life such as polio and diphtheria.

    70 years later the world is very different and so the challenges facing our National Health Service have changed fundamentally too.

    In 1948, life expectancy for men was 66 and for women it was 71.

    Today it is 79 and 82 respectively and over the coming years is expected to become 83 and 86 respectively by 2041.

    By 2024 the number of over 75s will have increased by around two million compared to 2014.

    So today our first big challenge is how the NHS supports those who live longer. And if we are all living longer our second challenge is how the NHS supports living with complex needs, as well as those across all ages living with chronic conditions whether from diabetes, to arthritis to heart conditions.

    I think we have a further challenge too.

    Health inequalities are widening not narrowing. Sir Michael Marmot, the world-recognised authority on public health, has warned that this country has, since 2010, stalled in the task of improving the life expectancy of our population.

    Added to this, he also points out that differences in life expectancy between the poorest areas in the country and the English average has started to widen again.

    Just look at what that means for someone born today in the poorest areas. They are likely to live for fewer years than someone born in wealthier areas. Ill health is more likely to blight their childhood. And a child born into poorer areas is more likely to leave school obese than a child growing up in the most affluent area.

    Across the population we face an obesity crisis with hospital admissions where obesity is a factor more than doubling in England during the last four years. The UK is spending about £6 billion a year on the medical costs of conditions related to being overweight or obese and a further £10 billion on diabetes. That means British taxpayers are spending more on treating obesity-related conditions than on the police or the fire service

    But as just as we face an obesity crisis in society we are on the verge of a malnutrition crisis too.

    Child poverty is increasing, with an extra million children predicted to be pushed into poverty by 2022. Across our communities more and more charities and faith groups are forced to open food banks and The Trussell Trust report in the last year they have handed out over 1 million three-day emergency food parcels.

    A recent All Party Parliamentary Group Report into Hunger estimated there around 1.3 million elderly people suffering from or at risk from malnutrition in society.

    We have seen a 122 per cent rise in admissions to hospital for malnutrition since 2010. There has been a 20 per cent increase in the number of pregnant women admitted to hospital with primary or secondary cases of Vitamin D deficiency over the past year

    Not only should it offend our sense of decency, indeed I would even go further because I believe these rates of malnutrition shame us a society for a nation that is the sixth biggest economy in the world.

    And it makes no economic sense either. Rising malnutrition is predicted to cost our health and social care services £13 billion by 2020. For example an increase in malnutrition amongst the elderly means an increase in hospital admissions, longer recovery times with longer hospital stays.

    So the reason I highlight all of this is because my burning ambition as hopefully the next Labour Health Secretary is to lead an all-out assault on unacceptable heath inequalities in society by beginning to tackle some of these wider determinants of ill health.

    That means a strong commitment to investment in public health provision in the wider community; it means investment in social care provision with an extra £8 billion across a Parliament, as well as supporting elderly people to live independently in their communities.

    It means prioritising child health and focusing support to improve the health and wellbeing of every child.

    It means improving the quality of air that we breathe, the fabric of the housing we live in and the economic conditions in which our society is ordered, to encourage the eating of a healthy diet.

    Because we know a healthy diet means healthy body weight and reduces the risk of developing major health problems like high blood pressure, heart disease, diabetes, certain cancers and osteoporosis.

    And we also know eating a healthy diet positively impacts our mental health. Following a healthy balanced diet reduces the risk of developing specific mental illnesses such as depression, schizophrenia, Alzheimer’s disease and Parkinson’s disease.

    So yes we must take much bolder action to fight obesity.

    So while we welcome the sugar tax we would want to see it extended to milk based sweet drinks, we want to end the advertising of junk food on family TV viewing and we would ban the sale of high energy drinks to under 18s.

    And so when we focus on improving the quality of care across our NHS we must also focus relentlessly on improving the quality of food we offer patients, visitors and staff as well.

    Because what sense does it make to offer patients the very best medicines, treatments by the very best clinicians and surgeons, to offer patients access to some of the very best cutting edge technology and yet deny them the best quality nutritional food that will help them make a full recovery.

    And when we know that poor diet is a major driver of ill health across the nation then surely it should be our obligation to support patients with their diet when in hospital.

    Indeed all of us who are passionate about securing the future sustainability of the NHS have a responsibility to ensure the NHS promotes healthy eating in order to reduce the chronic conditions that poor diet is contributing to in wider society which in turn are increasing the pressures on the NHS.

    In the last year across the NHS in England 144 million inpatient meals were made at a cost of £560 million.

    Some hospital trusts according to the Estates Return Information Collection – and I appreciate not everyone accepts this data, believing it puts a rosier tint on the reality on the ground, but nonetheless it is the only official data set we have – suggests that some hospitals are spending as little as around £3 per meal per patient.

    Of course cost does not necessarily equate to quality but I was shocked to learn from Jeremy Hunt’s own data that nearly half of hospitals failed to meet the food expectations as outlined in the NHS Standard Contract.

    Nearly half of hospitals did not meet dietician guidelines outlined by the British Dietetic Association. And despite one third of people aged 65 years or over being at risk of malnutrition on admission to hospital, yet only half of hospitals screened every patient for signs that they were struggling to get enough to eat.

    It is quite simply unacceptable that the standards in the contract are not enforced and I believe this fails patients and NHS staff alike.

    Given we all accept that good food is important to our health, it’s time to apply the very highest standards to hospital food across the board.

    So today I can announce that the next Labour Government will put hospital meals on the same legal basis as school food standards, and ensure hospitals mandatorily meet minimum standards for the food served to patients, staff and visitors.

    We will be setting new, higher quality standards for hospital food so it is nutritious and made with care by highly trained staff using the best sustainable ingredients

    I can also confirm these standards will be independently monitored and enforced.

    We believe over time this will increase the numbers of freshly cooked meals served, reduce the amount of hospital food uneaten and wasted and most fundamentally of all help us start the addressing malnutrition in our hospitals helping staff nurse patients to recovery quicker.

    And because the NHS is and must continue to be the trusted authority on health and well-being, I strongly believe all food served on NHS premises should be healthy food.

    As far as I am concerned hospital is no place for junk food, super-sized confectionery and sugary drinks. So I praise those hospitals like Tameside and Glossop Care Trust who have taken all sugary drinks and fizzy drinks off their menus in Tameside General.

    But when we have junk food burger bars in the forecourts of Addenbrooke’s Hospital I believe we still have a long way to go. So if trusts don’t move speedily in implementing national guidelines then the next Labour government will look at mandatory legal requirements on the sales of junk food and supersized confectionery products as well.

    But of course I don’t want to be a Health Secretary who keeps expecting those who work across the service to deliver more and more on less and less.

    I’m not going to place upon our NHS staff unrealistic demands while refusing the NHS the investment it needs.

    We are now in the eighth year of severe underfunding alongside deep cuts to social care budgets in England.

    Today the impact of this sustained underfunding has been revealed. Across England we’ve seen the worst A&E figures for March on record and the impact of a blanket cancellation of elective operations has seen waiting list rise by nearly 5 per cent compared to last year.

    With more patients turning to private sector provision through ‘self-pay’ arrangements, the old fears of a middle class flight of people who can no longer tolerate waits for treatments from the NHS is returning, leaving a two tier service for the rest of us.

    It’s now clearer than ever that we face a year-round crisis in our NHS, which places the very future of our NHS at risk and requires a sustainable long term investment plan.

    At the last General Election my party offered the country a new approach.

    We said we were prepared to increase taxation for the wealthiest in society, the top five per cent and allocate the yield from that tax change to the NHS.

    It would have meant this year spending an extra £5 billion on the NHS itself plus around an extra £1 billion to invest in staffing such as bringing back the training bursary and an extra £1 billion as the first stage of our plans to stabilise social care.

    And because too many of our hospitals are crumbling, because too often our IT systems are slow and vulnerable and in too many places equipment is out dated we would allocate an extra £10 billion across a Parliament for infrastructure investment too.

    This is the sort of financial package our NHS in its 70th year needs and the challenge for Theresa May as we approach the NHS’s July birthday is as to whether she will offer the NHS this level of support.

    But we know a funding package is desperately needed. The ongoing underfunding has in many areas forced trusts to outsource in the belief a better deal can be found by not delivering in-house. It’s often a false economy.

    I can tell you we are opposed as a Party to the current moves towards wholly owned subsidiaries which many trusts are currently pursuing in order to gain a VAT advantage.

    We fear this will create a two-tier workforce amongst facilities management staff and we are calling on the government to close down this loophole and block this practise.

    And I was struck by the quality offered when I visited Nottingham this week. That’s a service that has been brought back in-house when previously Carillion ran the contract. I’m told since coming back in-house staff morale as improved.

    The current Government has too often left valuable public services like hospital catering exposed to the risk of failing companies like Carillion.

    The Labour Party has said it will introduce a new presumption that public sector contracts will come back in house across the public sector. So today I want to begin a dialogue with you about what that means for your sector and how a Labour government could meet its ambitions on out-sourcing.

    Where catering managers and hospital management want to bring services back in house because it serves the best interests of patients and taxpayers then a Labour Government will want to give them the support and the resources to do so.

    So in closing let me reiterate under a Labour Government high quality hospital catering will be at the heart of our vision for the NHS with legally enforced standards for hospitals meals, fully resourced and given the support from government to be delivered in-house.

    And as we celebrate 70 years of the NHS this July and as you celebrate 70 years as an Association you can be proud of all you have achieved and you have my commitment to working together in the coming years to improve and support the high quality care every patient deserves.

    Thank you.