Speech to National Voices Annual Members’ Conference 2015

This is my first major speech as Labour’s Shadow Health Secretary and I am pleased to be making it at National Voices Annual Conference.

All of us here today are bound by a common cause – to strengthen the voices of people who use health and care services. Like me, you believe in empowering people to be involved in decisions about their own health, giving people the information they need to live healthier lives and creating a health and care system fit for the 21st century.

Your values are my values – and they are values that will guide the Labour Party as we develop our policy in opposition.

This is an important time for my Party. We have just elected a new leader who is determined to do politics differently. And we have a very important job to do in holding this Government to account.

My job, as Shadow Health Secretary, is to do two things. First, we must review our policy and develop a credible vision that we can put to the electorate in 2020. Our health and care services will need to change, and Labour must provide answers to what those changes should be. In the last Parliament, Andy Burnham and the Shadow Health Team led many of the big health debates from opposition, and I want to do that again. And I’ll be honest, I am going to need your help to develop the ideas for what a new Government could achieve in 2020.

But it is also the responsibility of my party to provide a strong and effective opposition to the Government’s plans today. And that’s the second part of my job. We will be an opposition that works with the Government when they are doing right, but that is robust in its arguments when they are doing wrong. Although we start this parliament with a broad degree of consensus about how the NHS and care services need to change, we also start this period with our health service facing unprecedented challenges. Two thirds of hospitals in debt with the Care Quality Commission rating 1 in 10 as unsafe. Social care services close to collapse, leaving older people suffering in silent misery. And public health and prevention budgets once again an easy target for cuts.

Many people in this room would have heard politicians or journalists say before that this coming winter is set to be the worst ever. But with the longest funding squeeze in generations, growing demand and a stretched and demoralised workforce, it’s hard to imagine how it won’t be. Key commitments in the NHS constitution – targets that exist for a reason – to ensure people are treated swiftly – are now repeatedly missed. They have been missed so often that failure has now become the norm. We even have the so-called “Success Regime” to deal with failure in whole health economies.

So how can we turn this around?

That’s what I want to talk about today, and in the spirit of robust opposition, I want to set out three demands that I am making of George Osborne ahead of this month’s Spending Review.

Let me start with social care. You may think that a means-tested service funded by local authorities and individuals is a strange place for a new Shadow Health Secretary to begin. But I do so for a reason. If we don’t invest in care for the elderly and vulnerable people outside of hospital, the NHS will collapse. The neglect of social care, by successive governments, has gone on far too long. At various points experts have put forward solutions, or at least improvements to the system, but time and time again politicians have failed to grasp the nettle.

Social care has been left in the “too difficult” box. As a consequence too many older people are left suffering in silent misery, unable to get the basic help they need to keep their dignity and independence. Estimates suggest that up to £4.5 billion was cut from adult social care over the last parliament. And with further cuts to social care seemingly inevitable the ability of councils to go on providing care for vulnerable older and disabled people is now being questioned.

The knock-on effect to the NHS of these cuts is clear. I could quote the stats – two-thirds of new requests for social care support being denied or passed on to charities; 300,000 fewer older people receiving care; a 68 per cent increase in delayed discharges in just 5 years. But I can’t put it better than what someone tweeted me the other day: “cuts to social care leave the NHS bleeding too.”

In the last parliament, there was a degree of consensus around the thrust of the Dilnot reforms. But shortly after the election, the Government announced they were delaying the implementation of the cap on the costs of care – despite having made it a key manifesto commitment and despite having set money aside to implement it. A long-term solution for funding care now looks further away than ever. But what’s now apparent is that action in the short-term is needed too. The Local Government Association estimate that the funding gap in social care is growing by more than £700m a year. That means increasing numbers of older people and more vulnerable people losing vital support, and more pressure piled on the NHS.

So this is my first demand of George Osborne. Give the money that was previously earmarked for funding the Dilnot reforms to local councils to help close the funding gap in social care. Do this in addition to making good on pre-election promises of extra money for the NHS. This isn’t an either-or, it has to be both. This won’t solve the social care crisis, and it shouldn’t distract from the need to find a long-term solution to how we pay for elderly care, but failure to act now will let down hundreds of thousands of people and will simply store up problems for the NHS in the months and years ahead.

Enabling people to leave hospital when they are fit to go home is one thing. Stopping them ending up there in the first place is just as important though. If we are serious about making the NHS sustainable then we need a radical upgrade in prevention and public health. Those aren’t my words. It’s what the Five Year Forward View said. And yet it seems that rather than a radical upgrade, we’re about to take a massive step back. £200m to be taken out of this year’s budget. A rumoured removal of the public health ring-fence leaving it open to further cuts in the Comprehensive Spending Review.

You know as well as I do that public health is about preventing problems before they start – it is central to averting ill-health, to reducing health inequalities and to realising long-term savings to the NHS. And so cutting these services is just about the worst possible kind of short-termism. Indeed it makes the aspiration of £22 billion efficiency savings even harder, if not now impossible, to achieve.

Last Friday the Government published their response to their consultation on these cuts, which said the following: “Local Authorities felt that the decision to make the saving was inconsistent with the emphasis of the NHS Five Year Forward View on prevention.”  I agree. And the sad thing is that, as many experts have warned, we could be seeing the effects of these cuts for many years to come. Analysis by the Faculty of Public Health suggests that the eventual knock-on cost to the NHS could be in excess of £1 billion. The Advisory Group on Contraception has forecast that cuts to sexual health services alone would cost the NHS an additional £250m this year – wiping out the entire £200m saving in one go.

So not only do these cuts contradict the emphasis on public health in the Five Year Forward View, but they don’t make any financial sense. The truth is these cuts are a political choice and they should not go ahead. So this is my second demand – reverse these damaging cuts to public health services that will end up costing the NHS more than they save.

The truth is, the NHS can’t afford to make short-term cuts which will simply increase the numbers of those needing more expensive care in future. It is now clear that unless there is an urgent and significant injection of money into the NHS, then standards of care will be compromised. At the election the Government promised to give the NHS an additional £8 billion by 2020 – but they have yet to identify where any of that money will come from, or crucially when it will appear. It’s no good underfunding the NHS for four years and then throwing £8 billion at it in 2020. The NHS needs money now. It needs money this winter. In my short time in this job, it is a message I have heard from almost everyone I see or speak to.

Hospital bosses tell me they are facing a stark choice between balancing the books and delivering safe care. GPs tell me they can no longer deliver quality care for their patients. Nurses tell me they are overstretched and understaffed. And junior doctors tell me they simply cannot give any more. Simon Stevens was absolutely right earlier this week to warn about the inadequacy of the Government’s current spending plans.

So this is my final demand – for now – of George Osborne: Bring forward any additional investment, and make sure hospitals have the money they need THIS WINTER to cope with additional pressures. So, there you have it – three demands – I did say I would be robust.

I am making these demands not to make political capital but to ensure that each and every single person in our country is able to access high quality care at the point in their life when they need it most.

I am relatively fit 40 year old woman. I’ll be honest – in my life, I have had comparatively little contact with the health and care system. But the NHS has been good to me and my family. It saved my brother’s life when he contracted meningitis at the age of 17. It enabled my father-in-law to continue his teaching career after a triple heart by-pass. It safely brought my two beautiful nieces into the world and as of Tuesday, a new nephew. The NHS is personal for each and every one of us.

It matters. It matters because it is there for us at the best of times and the worst of times. It matters because it says something about the sort of country we are and the sort of country we want to be. A country where the size of your bank balance doesn’t dictate the quality of service you get. A country which, as the Secretary of State said this morning I believe, is the best country in the world to grow old in. I share his aspiration. I know our NHS and care system needs to change.

I could have spoken to you today about how I feel our mental health system struggles to respond to the increasingly fast-moving, individualistic, hyper-aware world that we live in. How obesity is probably one of the most pressing public health challenges we face. How tackling loneliness amongst older people and providing decent end of life care are challenges which I think we have not paid enough attention to. I could have spoken about how the NHS workforce and NHS estate should be used differently to ensure the right people are in the right places to provide the right care. How we need to reshape services to smooth patient experiences and tackle waste in what can seem at times like an unwieldy bureaucracy. Or how we need more honesty when things go wrong and more urgency in learning from failures in care.

I could have spoken about all of these things but the gravity and urgency of the funding questions before the NHS are too important to ignore. I will not put my head in the sand and I will not let Ministers do so either.  So thank you for listening to me today. I look forward to working with you all over the coming months. Thank you very much.