23 February 2023
Sir Geoffrey Clifton-Brown speaks in a debate on the future of the NHS

Sir Geoffrey Clifton-Brown recounts his recent visit to Denmark where he saw their digital health system and their standardised hospital building programme and calls on the Government to focus on these areas and the urgent need to invest in training more doctors and nurses, instead of relying on recruiting from poorer countries.

Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)

I am delighted to catch your eye in this important debate, Madam Deputy Speaker. I commend the hon. Member for Jarrow (Kate Osborne) on having obtained it, and the hon. Member for Blaydon (Liz Twist) on the sincere way in which she made her points. I share one point of absolute agreement with her, which I will make in my speech: the health service cannot function without enough properly trained staff.

I listened to the speech from the former Secretary of State for Health, my right hon. Friend the Member for West Suffolk (Matt Hancock), with great care. I absolutely agree—I doubt a single Member of the House disagrees—that we all want forevermore a universal health service free at the point of delivery. I commend his arguments and agree why that should be.

The health service was dealt a terrible blow during covid and we need to catch up from that. Two-year waiting lists are falling, but we need to improve on 18-month waiting lists. According to data from September 2022, the overall number of people working full-time in the NHS increased by 2.7%, or 36,000 people, compared with the previous year—a point made by my right hon. Friend the Member for West Suffolk. However, there are 130,000 job vacancies, and we need to try to fill those. The latest data published by NHS Digital up to September shows that there are almost 4,000 more doctors and 9,300 more nurses working in the NHS compared with September 2021. But compared with 2015, we have 1,622 fewer fully qualified GPs today. We are seeing the consequences play out in the health service.

Working in healthcare can be very rewarding. However, for many working with staff shortages, it can be incredibly tiring and stressful. The care that they want to provide to all patients is not always possible, and talented individuals are pushed to leave for new opportunities. As well as pay, employment conditions are critical. That is particularly true in the social care sector. In my constituency, double the number of people are in hospital today, clinically fit to be discharged but not able to leave hospital because there are not enough social care workers. We need to look critically at how to bolster that social care system.

The recovery of the NHS is very important to many of my constituents in the Cotswolds, who regularly contact me with concerns about accessing the treatment they require in a timely manner. As I have said, waiting lists in January fell for the first time since the start of the pandemic. Elective care was delivered for 70,000 more patients in November compared with the same month before the pandemic, as the waiting list dropped by almost 30,000 compared with the previous month. However, there were around 7.2 million incomplete treatment pathways as of December 2022, with 406,000 people waiting more than a year for a consultant-led referral to treatment.

There is much work to be done to be caught up from the pandemic. We all know that there are problems in the NHS, but I do not think we have had anything like the pandemic since the second world war. Actually, the health service is to be hugely commended on what it did during the pandemic: the speed with which it was able to administer vaccines, the tremendous care that saved the lives of my constituents and those of every other Member of Parliament. That was to be wholly applauded.

The key to combating waiting times and revitalising the NHS is to recruit more staff, especially filling those frontline positions, and increasing retention. That will enable us to get greater flow through our healthcare system and reduce the waiting time for all treatments, including the critical cancer pathway. We urgently need to invest to train more doctors and nurses, instead of relying on recruiting talented people from poorer countries. It is no good Opposition Members crowing about the training that was provided when they were in office. I seem to remember when Tony Blair was Prime Minister that he shut some of the nurse training centres.

I think it might be of interest to the House that two weeks ago I went on a Public Accounts Committee visit to Denmark, to inform the Committee on the hospital construction programme that we are about to embark on in the UK and ongoing work on the Department of Health and Social Care. Some of the things that we discovered on that visit could be introduced into the health service, and some chime with what my right hon. Friend the Member for West Suffolk said.

Denmark faced many of the same issues as we do now: an ageing population, an ageing workforce within the healthcare system, increased chronic disease, workforce shortages and new needs for educating staff in the latest technology and ways of working. However, it has completely reformed its approach to healthcare in the past 15 years and created a model from which I believe we can learn a great deal. It has closed dozens of old hospitals and is in the process of building 16 brand-new hospitals. Most are completed and the remainder are scheduled to be finished within the next five years. Critically, it has reduced the number of beds by 20%, instead opting for a policy of far greater out-patient treatment and treatment at home. Even quite complicated procedures, such as chemotherapy, are delivered in the home. GPs are absolutely the key to this system, and are described as the gatekeepers for the rest of their entire healthcare system. It was made clear that the policy decision, made in 2007, was not an easy one. They have faced significant cultural resistance from some residents who are now required to drive for up to an hour for care.

The overall vision was for patients to spend as little time in hospital as possible. Today in Denmark people spend an average of 3.5 days in hospital compared to six in the UK. The aim is to discharge people either to their home, or to the municipality nursing or residential homes, as quickly as possible. The system makes great use of telemedicine wherever possible. The increase in care was possible as the number of GPs within the healthcare system was increased by 50%.

Another important change in Denmark, which chimes with what my right hon. Friend the Member for West Suffolk said, was the health digital revolution. Ninety seven per cent of the population now have good broadband connections, and all citizens have a unique reference that covers a number of Government services, including tax and health. The whole healthcare system has been transformed into a digital and paperless system. Access to medical records is strictly controlled, but is available to the relevant physician treating the patient, with their consent. Those physicians update the records in real time. As my right hon. Friend said, appointments are made online through an app, eliminating a vast number of letters and phone calls.

Relevant to our building system for the 40 new hospitals is that the Danes have now produced a standardised hospital design. That was not easy, as different specialties have different requirements. For example, most Danish hospitals have introduced four different-sized but standardised theatres. There are no hospital wards; instead, all rooms are single, with their own bathroom and a bed for a relative to stay overnight or longer. That standardised design will enable hospitals to be built cheaper and more quickly, and it will eliminate the elementary problems that sometimes arise even when our hospitals are newly built.

As I have said, in the UK there is a pledge to build 40 new hospitals at an estimated cost of £1 billion each. While we have many similarities with the Danes—we are fortunate that we both enjoy a universal, equal and free healthcare system—the success of the Danish system comes from its ability to treat many patients outside of hospitals. In the UK, hospitals are often viewed as an inevitability for many people requiring treatment; in Denmark, they are the last resort. I believe there are some real lessons we could learn from the Danes. We need to do so, because it is clear that we cannot continue as we are.

Our health system is limping on, and the cost to the taxpayer is increasing. According to recent figures, £277 billion was spent on healthcare in 2021. That is 11.9% of our total GDP. Some people complain that this is out of kilter with other countries in the world. Certainly, health spending in the United States is 17.8% of GDP, but that is accomplished through both insurance and public finance. Our figure is comparable to the 12.8% of GDP spent in Germany, and the 10.8% spent in Denmark. Both the United Kingdom and Denmark do not have enough doctors, nurses, and, in particular, social care workers. For a health service to run efficiently, it must have sufficient staff who are well motivated and trained.


Other interventions in the same debate

Sir Geoffrey Clifton-Brown (The Cotswolds) (Con)

My right hon. Friend is being generous with his time. Is there not a fourth argument for a universal healthcare system, which my right hon. Friend was very keen on when he was Secretary of State: the ability to introduce new technologies, new procedures and new drugs? All of those things are much easier when one has a big bulk of patients to draw data from.

Matt Hancock (West Suffolk) (Ind)

Two of my arguments for what the NHS needs to do better in the future are responses to precisely the two points that have just been made. I cannot decide which order to go in, but both are absolutely vital. I agree with my hon. Friend, and disagree with the right hon. Member for Islington North (Jeremy Corbyn).



Sir Geoffrey Clifton-Brown 

I am grateful to my right hon. Friend for giving way again. I had to have a procedure the other day that I imagine cost the NHS quite a lot of money. When I was talking to the consultant, she told me that some days, she had a 50% no-show rate, which must cost the NHS several thousand pounds.

Matt Hancock 

I hear such stories all the time. We should separate out free at the point of use from not abusing the service. Of course, people miss appointments for good reasons, but too often they do not have a reason. We should be thoughtful about how we address that.



Sir Geoffrey Clifton-Brown 

I listened very carefully to what the leader of the hon. Lady’s party said on the “Today” programme this morning. He said that any proposals he would include in his manifesto for the next general election would be properly costed. Has the hon. Lady properly costed the proposals that she has just outlined, and if so, how much will they cost?

Liz Kendall (Leicester West) (Lab)

Yes, we have properly costed these proposals, because we—unlike the hon. Gentleman’s party, which announced huge amounts of borrowing without saying anything about where the money would come from under the former Prime Minister’s plans—will only set out our commitments when we can say where we will get the money from. We will get it by cancelling that non-dom tax status, and I urge the hon. Gentleman to encourage the Chancellor to follow that example in his Budget. I hope that when the Minister responds he will put the House and, more importantly, the public out of our misery. and just adopt Labour’s plan. If he does, he will surely have the backing of the Chancellor, who said only a few months ago that he very much hoped that the Government would adopt our proposals,

“on the basis that smart governments always nick the best ideas of their opponents.”