Department of Health and Social Care
(1 day, 11 hours ago)
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Mr Deputy Speaker (Sir Roger Gale)
The debate will be opened by a member of the Health and Social Care Committee, Paulette Hamilton.
Paulette Hamilton (Birmingham Erdington) (Lab)
I am delighted to open this debate on the Department of Health and Social Care’s main estimate. My remarks will focus on the recent spending review, which includes some welcome funding increases and sets out some ambitious reform objectives. However, it also raises questions about deliverability, particularly of objectives to do with capital investment, efficiency savings and the role of social care.
Let me begin with capital investment. The Government have rightly emphasised the need to shift from analogue to digital systems across the NHS. The increase of nearly 50% in technology and transformation funding will mean that it reaches up to £10 billion by 2028-29, which is a welcome and substantial commitment. However, the NHS has a poor track record on digital transformation. The National Audit Office has highlighted the risks around fragmented delivery, unclear governance and unrealistic timelines, and those lessons remain highly relevant. Its 2020 report on digital transformation in the NHS found that despite £4.7 billion in national funding, many trusts were still reliant on systems that were outdated and not integrated.
The capital budget is being asked to do a great deal more than achieve digital transformation. The Government have committed to the new hospital programme, and to addressing critical infrastructure risks, such as those posed by reinforced autoclaved aerated concrete. Over five years, £30 billion is allocated for maintenance and repair, and £5 billion is allocated for critical risk. However, by the end of the decade, there will be no real-terms uplift in the capital allocations, compared with this year. In fact, in 2027-28, the funding settlement actually falls to £13.5 billion from £14 billion the previous year, meaning that inflation in construction costs and materials will significantly erode its purchasing power. The British Medical Association has warned that current funding cannot cover both the new hospital programme and essential maintenance, and now that programme must also compete for funding with the vital digital transformation. Can the Minister explain how the Department will choose its priorities from those competing essential demands on the capital budget?
Turning to resource spending, the Department’s day-to-day budget will grow by an average of 2.7% per year in real terms. That funding will be used to deliver several welcome commitments, including investment in elective recovery and urgent and emergency care; a £4 billion increase in adult social care funding; 700,000 additional urgent dental appointments annually; 8,500 more mental health staff; and £80 million a year for tobacco cessation programmes. Those are all positive steps.
Danny Beales (Uxbridge and South Ruislip) (Lab)
I thank my hon. Friend for giving way, as well as for her excellent chairing of the Health Select Committee at the moment and for opening today’s debate. Does she agree that this Government’s record investment in our health service will be vital to turning around the health service after 14 years of under-investment and a lack of reform? As my hon. Friend has touched on, that investment also needs to be targeted to enable the three shifts that the 10-year plan talks about. In particular, we need to reverse the trend of more spending going towards secondary care while less goes to primary care. We need a big uplift in dentistry, which my hon. Friend has mentioned, but also in primary care—in GPs—and in pharmacy.
Paulette Hamilton
Hear, hear. My hon. Friend makes some valuable points, and I agree with every one of them.
Underpinning the settlement I have described, however, is the Government’s pledge to generate £17 billion in efficiency savings over three years, with a staggering £9.1 billion expected in the final year of this Parliament. Critically, those savings have already been factored into the settlement—in effect, they have been spent before they have been delivered. In the light of that, we need absolute confidence that there is a clear and robust plan to generate those savings. The Government are assuming an annual productivity improvement in the NHS of 2%, more than triple the long-term average of 0.6%. They appear to be relying on digital transformation to unlock the bulk of those savings, which is risky, given the history of digital change programmes in the NHS.
Another source of savings is the plan to cut reliance on temporary staff by reducing sickness absence and overhauling staff policies, including limits on agency spending and eliminating the use of agencies for entry-level roles. Again, this is a welcome ambition, but delivering it will be a significant challenge, one that will require meaningful, sustained improvements to staff wellbeing and working conditions. We cannot build a sustainable workforce on good will alone. Therefore, will the Minister say when we can expect an updated and fully costed workforce plan to deliver on these ambitions?
Delivering the reforming elective care for patients plan is also central to achieving those efficiencies. It proposes reforms such as optimising surgical pathways through hubs, streamlining referrals, expanding remote monitoring and reducing unnecessary procedures. The plan assumes a rapid transformation of services, with significant improvements in productivity and patient flow expected within just a few years. That is ambitious, especially given the context of ongoing workforce shortages, ageing infrastructure and rising demand. Reform is essential, but it must be realistic, properly resourced and paced to succeed. We cannot afford to set targets that look good on paper but falter in practice, damaging morale and patient care. What steps is the Minister taking to ensure that the projected £17 billion in savings will materialise and be delivered on time? What happens to those additional resources for frontline delivery if those savings are delayed or fall short?
I will also touch on adult social care, which is in desperate need of reform. The Casey commission has an important job to do, but the terms of reference for the first phase of Casey’s work state clearly:
“The commission’s recommendations must remain affordable, operating within the fiscal constraints of Spending Review settlements for the remainder of this Parliament.”
Now that those settlements have been reached, can the Minister provide clarity to the House about precisely what fiscal constraints Baroness Casey’s recommendations will have to conform to? The £4 billion for adult social care announced in the spending review includes an increase to the NHS minimum contributions to the better care fund.
Andrew George (St Ives) (LD)
I thank my fellow member of the Select Committee and stand-in Chair for giving way, and I congratulate her on how she is introducing the issues today. Does she agree that the length of time set for the Casey review to report does not give us a sense of confidence that the Government have injected sufficient urgency to address the serious problems of ensuring that we have a robust social care system that can stand up to the pressures that lie ahead?
Paulette Hamilton
I thank the hon. Member for that deep and thoughtful point. He is absolutely right. Timescales are an issue, and that is why, as a Select Committee, we are asking the Government a number of questions so that we can scrutinise what is happening and get the information.
My Committee considered the better care fund in our inquiry into adult social care. It was introduced with the aim of driving better integration between health and social care, and shifts resources upstream from NHS acute services. However, the evidence we heard was stark. These resources have been overwhelmingly focused on hospital discharge. While timely discharge is important, that does not match the fund’s original objectives. How will the Government ensure that this increase in funding leads to a greater focus on prevention? The Chancellor referred to the Government’s plan for an adult social care fair pay agreement. Reaching such an agreement is not just desirable but essential. Staff working in care homes are far more likely to live in poverty and deprivation than the average British worker.
Joe Robertson (Isle of Wight East) (Con)
The hon. Member is making her points very well, and I congratulate her on her success in bringing this debate to the Chamber. I agree with what she has said about fair pay for social care workers—I support that as well—but does she agree that a fair pay agreement will put undue pressure on providers unless there is some money or financial incentive attached to it so that they are able to meet their fair pay requirement?
Paulette Hamilton
The hon. Gentleman has made a valuable point. The problem is that we in the Committee are waiting for the workforce plan, and we are not sure what is being planned. What the hon. Gentleman has suggested is desirable, but at this moment we do not know what the workforce plan will throw up. It is possible that what he has suggested is already in the plan; let us just wait and see.
The current position is both morally unacceptable and economically short-sighted, fuelling the workforce crisis. What concrete progress has been made in establishing the fair pay agreement? Can the Minister give the House an update? Will she also tell us whether the funding that is required to pay for this essential agreement will come out of the £4 billion that has been announced for social care?
While both the main estimate and the spending review present a vision of reform, it is clearly a vision built on some highly optimistic assumptions. We need to see robust, detailed plans to deliver the digital transformation and the unprecedented scale of efficiency savings that the Minister is counting on. Without such plans, and without realistic assessments of the challenges, the risk is not just that these reforms will fall short, but that they will do so at the expense of frontline services, patient care, and the morale of our dedicated health and social care workforce.
I urge the Minister to address the specific questions that I have raised today.
Several hon. Members rose—
Mr Deputy Speaker (Sir Roger Gale)
Order. It will not have escaped Members’ notice that we are playing “beat the clock” this afternoon. There is another debate to follow, with a very large number of speakers, and we are going to have to try and split the time between two debates. That means two things. First, after the next speaker I will impose a limit of three minutes on every speaker. The Liberal Democrat Front Bencher has agreed to cut her speech to six minutes and the other two Front Benchers have agreed to cut theirs to eight minutes, with no interventions. Secondly, it is up to Members, but if they intervene, we will not get through this, or else some Members will not be called—and it may be that Members who have spoken in earlier debates will not be called at all.
Gregory Stafford (Farnham and Bordon) (Con)
I congratulate the hon. Member for Birmingham Erdington (Paulette Hamilton) on securing the debate.
We have learned this week that rather than the Government ensuring that funding reaches the frontline, spending on staff at the Department of Health and Social Care and seven other arm’s length bodies has increased by more than 10% since Labour came to power, while GPs, social care providers and hospices are forced to do more with less.
The situation is further compounded by rising financial pressures. Despite repeated promises that additional funding would improve patient care, the chief financial officer of NHS England has confirmed to the Select Committee that all the extra money allocated to the NHS will be swallowed up by national insurance increases, inflation and pay settlements, which means that none of it will go towards real improvements in frontline care.
The rise in national insurance contributions was supposed to bolster the NHS and social care. In reality, it has landed like an extra tax on providers themselves. GP surgeries, care homes, hospices and community services are all grappling with the additional payroll costs, just as they struggle with surging demand and chronic workforce shortages. The Institute of General Practice Management estimates that the average GP practice now pays an extra £20,000 a year in national insurance alone. Across the nearly 6,500 practices, that adds up to around £125 million a year—money that could otherwise pay for more than 2 million GP appointments, at a time when patients are struggling to be seen.
Adult social care providers face an equally stark reality. The Nuffield Trust projects that employers will shoulder nearly £940 million in extra national insurance costs in this financial year, on top of the £1.85 billion required to cover the rise in the national living wage. Local councils already face a £665 million shortfall in delivering their legal social care duties. The Government have promised a 3% real-terms rise in NHS revenue spending each year to 2028-29, reaching £232 billion by the end of that financial year, yet despite the headline increases, capital investment is being held flat in real terms. NHS leaders have made it clear that it will not be enough to rebuild or modernise our hospitals, or to fund the facilities required to support more care in the community.
The Health and Social Care Committee’s recent inquiry, “Adult Social Care: the Cost of Inaction”, has drawn attention to the enormous human and economic toll of the Government’s failure to reform the care sector. From the burden of unpaid carers to the economic impact of people leaving the workforce due to unmet care needs, the system is under severe and unsustainable strain, but rather than tackling this issue, the Government have once again kicked social care into the long grass and are waiting for a report from Baroness Casey that will probably not emerge until the very end of the Session. The cross-party talks that this Government promised have been scrapped again.
Although the spending review includes £4 billion in additional adult social care funding and an increase in the NHS minimum contribution to the better care fund, there remains little clarity on how the Government will fund their commitment to deliver a fair pay agreement for care workers. It is also far from clear that the better care fund is currently structured to meet the real needs of the care sector, rather than simply alleviating pressures in primary care. These estimates are not abstract figures; they translate directly into longer waits for elderly patients, overstretched family carers and staff driven to exhaustion.
Can the Minister confirm exactly how much funding the Government will allocate next year to tackle the social care workforce emergency, reduce waiting lists for assessments and services, and ensure that councils can meet their statutory obligations? What concrete recruitment and retention measures will be put in place to attract and retain carers, nurses and support workers in this vital sector, and how much new capital investment will be committed to help providers to modernise facilities and expand capacity to meet the needs of our growing and ageing population? When will the cross-party talks that the Government promised on social care happen? They must happen; otherwise, all the good effort—from Members on both sides of the House—on this issue will be lost. Finally, with social care vacancies entrenched and NHS productivity still trailing pre-pandemic levels, will the Minister set out what credible workforce and capital investment plans will be included in the forthcoming NHS 10-year plan to address these challenges once and for all?
I pay tribute to all the health and social care workers—employed or voluntary—across this country. This Government, with their massive majority, have a real opportunity to make real changes. They must start doing so now, and quickly.
Lewis Atkinson (Sunderland Central) (Lab)
I welcome the estimates and the CSR settlement from the Government —a record settlement for the Department of Health and Social Care and the NHS. Given the time constraints, I will focus on three key points: financial management, underlying demand and the prioritisation of spend in the estimates.
We rightly focus on the headline settlements in estimates such as these, but what we do not talk about enough is the importance of good public administration in the Department. In the 19 years that I spent in the NHS before coming to this place, I saw how the previous Government had a sticking-plaster approach not just to politics, but to public administration. Budgets were confirmed at the last minute and planning guidance was outlined at the very last moment of the financial year, meaning that there was no opportunity for NHS leaders and health leaders to plan appropriately for resource spending. I particularly welcome the emphasis the Secretary of State for Health and the new chief executive of NHS England have put on restoring accountability through the foundation trust model and multi-year settlements that mean that, although I am sure NHS colleagues would like more, they at least know and can plan investment and spend-to-save decisions over that period.
Secondly, Members have queried why the NHS seemingly continues to require increases. I draw the House’s attention to the Nuffield Trust’s work showing that this is about not health inflation but underlying health demand. The Nuffield Trust estimates that, as a result of population changes—mainly the ageing of the population—there is a 1.1% increase in demand every year. In addition, advances in technology add a further 1.8% increase in healthcare demand, so there is already a 2.9% increase in underlying demand before inflation, which highlights that the Government’s emphasis on reform accompanying investment is critical.
Finally, to deliver that reform, the investment going in must be very carefully targeted. The evidence base is clear that investment in primary care—and we are fortunate in this country to have a world-leading gatekeeper system of healthcare through general practice—represents the best return on investment in health. Work done by Michael Wood and the NHS Confederation confirms that. Alongside investment in mental health services and wider public health, this creates the best chance for the health system to live within these estimates and to meet our constituents’ expectations.
Rachel Gilmour (Tiverton and Minehead) (LD)
There are very legitimate concerns about rumoured plans to merge integrated care boards across the country. When ICBs merge, the promise of unified oversight gives way to a bureaucratic structure that prioritises large-scale efficiency over the nuanced understanding of local communities. Each locality and its environs has its unique challenges, such as variable demographics, socioeconomic disparities and distinctive health issues that demand targeted solutions. A merged ICB risks offering one-size-fits-all strategies that overlook the finer details of local care. The resultant dilution in responsiveness not only alienates patients, but stifles innovative local approaches that have proved successful in addressing community-specific challenges. While attempts at driving efficiency are certainly laudable, we risk sacrificing the local approach for local needs.
In my constituency of Tiverton and Minehead, community hospitals in Williton, Minehead, Tiverton and Dene Barton in Cotford St Luke are anchor institutions providing essential care for my constituents. Communities in rural areas simply cannot afford to lose them. These facilities are often the only nearby source of medical attention, and that is critical when timely treatment can mean the difference between life and death.
Moreover, community hospitals offer the family and friends of patients the opportunity to visit and check on them without having to travel great distances to do so. As we know, this familiar contact is so often a crucial part of a patient’s journey to recovery. It is certainly true in Tiverton and Minehead that community hospitals help to reduce the health disparities found in rural settings compared with urban centres. Without them, residents in more remote areas would simply not have access to the same level of healthcare as those in more built-up areas. That is why, where possible, we must resist administrative reforms that ignore local distinctiveness, and at the same time invest robustly in the community pharmacy network and community hospitals.
Ben Coleman (Chelsea and Fulham) (Lab)
I am grateful to my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton) for her excellent speech and for securing the debate.
I am quite excited about Saturday week, not just because it will be my birthday on 5 July—[Hon. Members: “Hear, hear.”] Thank you so much—but because the national health service will be 77. Yes, it has survived that long. [Interruption.] I have survived slightly less long, I would like the House to think. Despite the years of cuts and chaos which have left the NHS broken, it is not beaten and we are rebuilding it. There is a huge amount to do, but we are making progress. After record funding in our first Budget, I am delighted that the spending review has put the health of our nation first. And, as touched on by colleagues, I am equally delighted that the Government are determined to reform how the NHS works to get a bigger bang for our buck and better outcomes for patients, because we need that.
We know we have masses to do. My hon. Friend set out many of the splendid things we have done so far, including getting waiting lists down to their lowest for two years, which is quite an achievement after only 11 months of this Government. On a more personal level, I am delighted that my constituency is benefiting directly from having a Labour Government. Charing Cross hospital has been given millions of pounds extra to upgrade vital infrastructure, including new MRI scanners, modernised operating theatres, better energy security and a big refurbishment of the ground and first floors, all under this Government. I also hugely welcome the new investment in GPs in my patch: the Cassidy medical centre, Ashville surgery, Palace surgery in Fulham and the Chelsea practice have all been earmarked for new funding under the Government to improve facilities and help provide better care.
Finally, I am excited by the possibilities of the new neighbourhood health service, which we are looking forward to in the 10-year health plan. Locally, I look forward to playing my full part in bringing together all the local health and social care practitioners, so that my residents get the better healthcare they have been waiting so long for and deserve. While I do that, I will also be working to ensure that we confront health inequalities and end the situation that we have now where people get less good access to health, less good treatment and less good outcomes simply because of their colour, what they earn or their disabilities. We must end that.
The spending review continues the work we have begun of repairing a health system that has been left bruised and battered, down but not out. Combined with the 10-year plan, we will be putting the nation’s health on a better path for the future and creating the change that people so vigorously voted for.
Steff Aquarone (North Norfolk) (LD)
In the limited time available, I want to press the Government on a very live and urgent issue, which is the establishment of a dental school at the University of East Anglia. Currently, there is no dental school in the entire east of England. The Government accept that Norfolk is the Sahara of dental deserts. My constituents were excited by the prospect, as early as next September, of Norfolk training its own dentists. Just last week, the General Dental Council gave its approval for the new dental school and work is already under way at the UEA to create the facilities for this training.
Things ground to a halt, however, when the Government were unwilling to allocate the funding to ensure that places would be available in time for the UCAS deadline for 2026 entry, saying that we all needed to wait for the spending review. A frustrating delay, lost time to prepare and perhaps a lost year, but we reluctantly accepted the need to wait to receive this good news. And then the spending review came. And went. And we heard nothing: total radio silence from the Government on the future of this much-needed dental school. I tabled a written question to the Government directly after the review and they have refused to answer it. The silence is causing worries to increase.
There is a clear link between the lack of training opportunities in the east and the massive oral health inequalities we are facing. If we do not train in Norfolk, we cannot retain in Norfolk. People love our area. When they study here, many stay. It would be just the same with dentists. And we need it to be, because in Norfolk and Waveney we have so few dentists that each new one would be required to serve 3,000 people, based on current ratios. It is not tough maths to realise that, with the number of hours in a day and days in a year, people will go a long time without seeing a dentist, if they can get on an NHS list at all.
These are not just numbers and stats, these are real people: the people in my community. I would welcome anyone who is moving the money around spreadsheets in the Treasury or the Department of Health and Social Care to come to explain the dither and delay to their faces—some of which can no longer manage to muster a smile.
The situation has become untenable, but we have the opportunity for real improvement. We have cross-party support across Norfolk’s MPs from all parties, and I know that the Minister responsible, the Minister for Care, gets it—he has heard the stories, and I truly believe he cares. I hope that he can now deliver on the concern and warm words that we have welcomed and deliver us the dental school we need now.
Mr Connor Rand (Altrincham and Sale West) (Lab)
Fourteen years of Conservative Government left our national health service on its knees, with waiting lists at record highs, patient satisfaction at record lows and millions living in pain and fear, suffering without the treatment they need.
Turning that around is a mammoth challenge, but thanks to this Government, the green shoots of recovery are there. In my local NHS trust, waiting lists have fallen now for four months in a row. We promised an extra 2 million appointments in our first year, and we have delivered 3.6 million. We have hired an extra 1,700 GPs over the past year and provided much-needed extra investment, including for the Village surgery in Timperley, in my constituency.
However, there is still so much further to go, and the spending review and the settlement it gives the Department is a recognition of that. In delivering a £29 billion increase in annual NHS day-to-day spending over the next four years, the Chancellor has acknowledged the mountain there still is to climb to ensure that our health service is there for us when we need it. Accepting the scale of the challenge and putting forward the money needed to meet it separates this Government from the Opposition parties, which either want to abandon our national health service entirely or forget their record and wish away its problems.
The difficult decisions that this Government have taken have given us the space for record investment, and I am pleased that the Government also acknowledge that that must come with much-needed reform. We have seen it with the scrapping of NHS England and the efficiency savings that will generate, and we have seen it with the £10 billion investment in NHS technology over the next four years.
As part of that effort, may I suggest that, following my conversations with the Secretary of State on this topic, the future of Altrincham Hospital in my constituency is considered very carefully? We lost our minor injuries unit because of the Conservatives’ failure on NHS staffing, and the temporary skin cancer diagnostic hub that occupies its space must be turned into a permanent diagnostic centre.
To conclude, we finally have a spending review settlement that recognises the scale of the challenges facing our national health service, and we finally have a Government who are serious about fixing the problems it faces. Residents across Altrincham and Sale West are already feeling the benefit of that, with more to come. We have saved the national health service before and, thanks to this Government, we are going to do it all over again.
Andrew George (St Ives) (LD)
It is a pleasure to follow the hon. Member for Altrincham and Sale West (Mr Rand). Of course, in this debate we have to reflect on the fact that the Government inherited the NHS in the very worst state in its 77-year history, which the hon. Member for Chelsea and Fulham (Ben Coleman) reminded us of. The Government must pick up the NHS and try to restore it to the state that we would all like to see.
I approve of the three shifts the Government are proposing—no one could argue against prevention rather than ill health. Obviously we want to see advances in prevention, technology and delivery of services into the community, with better integration and improvements in the workforce plan. With that, however, I would like to see the Government advance the case for safe staffing. When I was last in this place, I was part of a campaign on that, which sought to achieve, for example, a ratio of never more than seven on acute wards—seven acutely ill patients to every registered nurse on acute wards. We should be aiming to try to support staff on the frontline, rather than leaving them under the pressures they currently face where they are seriously understaffed.
There are incredible pressures within the service itself. I know that, at the weekend, the A&E department of the Royal Cornwall hospital had more than 100 patients waiting to be treated, with ambulances often waiting outside. Our ambulance service is currently proposing to cut co-responders from some of our rural areas—where fire service staff support the ambulance service—which is a matter of great concern. The Royal Cornwall Hospitals Trust is also facing a £50 million cost improvement programme this year, and many other trusts on the frontline are also facing similar pressures.
The Government must look at the capacity of the nursing home sector, as there are often many unused beds. We talk about the difficulty of discharging patients from a hospital, but there is also the risk of the independent sector cherry-picking the profitable bits of the NHS. We need, above all, to back up our NHS. As the hon. Member for Birmingham Erdington (Paulette Hamilton), the temporary Chair of the Health and Social Care Committee, pointed out, social care is vital. If one in four social care workers are leaving the sector every year, we know that we have a serious crisis. The Casey review cannot come soon enough.
Anna Dixon (Shipley) (Lab)
First, I draw the House’s attention to my entry in the Register of Members’ Financial Interests. I am a trustee of the charity Helpforce, a member of the Public Accounts Committee and an officer of the patient safety all-party parliamentary group.
It was a Labour Government who founded the NHS on the principle that it would be there for us when we needed it. Patients in my constituency lost that confidence under the Tory Government. When they rang for a GP in the morning, they were told that it would be three weeks before they could be seen. If they rang 999, they were not confident that the ambulance would arrive. When they were referred for tests, they would be waiting months rather than weeks. These estimates show that this Labour Government believe in the NHS, believe in its future and can turn it around, so that again it is there when we need it.
The spending review gives an uplift in day-to-day spending as well as a huge rise in capital budgets. It is those capital budgets that will enable the rebuilding of Airedale Hospital, which has been plagued by RAAC, and is vital to my constituents. I have seen at first hand the difference that good-quality primary care facilities can make with the completion of the extension at Grange Park surgery. I know that, with this settlement, the Government will want to see further investment in primary care, and I hope the Minister will confirm that.
It is imperative that this extra spending helps deliver the shifts from treatment to prevention, hospital to community and analogue to digital. As a member of the Public Accounts Committee, I helped to challenge officials at the Department of Health and Social Care and NHS England as to why, despite commitments over many years to community and prevention services, the money had never followed under the Tories. I hope that, with Labour’s NHS 10-year plan, we will make it clear that the money will be there for community services and for prevention. I am very pleased that the Chancellor has put a stop to the raiding of capital budgets to fund everyday expenditure.
These estimates rely on very ambitious productivity savings. At the heart of that is the health of our workforce, because too many are sick and absent from work. Volunteers can make a huge difference to retention because they improve staff wellbeing. Volunteering can also be a route for people to try out a career in healthcare. I urge the Minister to back the initiatives that support the use of volunteers.
Anna Dixon
I will not give way, because we are under a time limit.
In conclusion, I am confident that this funding settlement will help to put the NHS back on track and make it fit for the future.
Seamus Logan (Aberdeenshire North and Moray East) (SNP)
I rise to set the record straight in Scotland when it comes to the much-vaunted but false largesse of this spin-doctoring Labour Government.
After the autumn statement, the Government spent much time and energy telling the Scottish people how generous they were—the largest settlement in the history of devolution, they said. However, what they did not tell the people of Scotland was that when their inflationary policies were taken into account, driven by their eye-watering borrowing—when we consider pay and prices rises and the punitive employer national insurance increases —the settlement that looked big in cash terms was not so big in real terms. If Scottish Labour Members would spend as much time dealing with the things they were elected to deal with as they spend attacking the Holyrood Government, they might locate the spine that some Labour Back Benchers seem to have found recently in regard to the welfare Bill.
Turning to the estimates, under the Barnett formula, Scotland’s taxpayers depend on the generosity of the Westminster Treasury, even though it is our money—and do not give me the usual nonsense about higher per capita spend. If the Treasury did its sums correctly to include all our produce, if our needs were properly calculated and our geographic size and rurality compared to our population and demography accounted for, the numbers would be very different.
The results of the spending review and these estimates are not good. The UK Government’s spin on the spending review was so misleading that the independent and well-respected Fraser of Allander Institute said, “We have seen Labour MPs and MSPs describing the spending review event as increasing the block grant by £9.1 billion over the spending review period, but this is a figure that is neither transparent nor helpful”—not my words but those of the institute. Its conclusion, based on the Scottish Fiscal Commission’s forecast, is that rather than representing a £9.1 billion uplift, Labour’s spending review actually brought in a £700 million cut to Scotland’s funding against May’s central estimate.
Our health service depends not only on our excellent NHS workers but on our infrastructure. That is why it is so disappointing that in the spending review the UK Government imposed a real-terms cut on Scotland’s capital spending in the latter half of the spending review period. In effect, Scotland has been short-changed by more than a billion pounds.
Despite Labour’s continuing austerity in Scotland, the Scottish Government is investing heavily in our health service. Over the past year there has been a significant fall in long waits and an increased amount of GP appointments and surgical procedures—for example, there has been a 50% increase in hip and knee replacements. The SNP will continue to fight for our NHS and against successive Westminster Governments who do not have Scotland’s interests at heart.
Rebecca Smith (South West Devon) (Con)
We know that a key part of primary care is community pharmacy. Indeed, that was recognised in the Darzi report, which stated:
“One of the great strengths of the health service in England has been the accessibility of community pharmacy.”
The previous Government committed to community pharmacy through the introduction of Pharmacy First. The Darzi report also highlighted that 1,200 pharmacies have shut their doors since 2017, and increased medicine costs and rising national insurance costs will not be helping.
Mr Richard Holden (Basildon and Billericay) (Con)
Does my hon. Friend recognise that it is not just community pharmacies that are being hammered in this sector but hospices too, such as St Luke’s hospice in Basildon, which is facing a £450,000 rise in its national insurance costs? Does she also agree that Ministers are putting these costs on to pharmacies and charities that cannot make them back, which is absolutely killing community infrastructure in the health service sector?
Rebecca Smith
I entirely agree with my right hon. Friend. Indeed, St Luke’s hospice in my constituency will be facing exactly the same issues.
At risk of closure is Tubb pharmacy in Newton Ferrers in my constituency, which I have raised in this place before. Pharmacist Esi has been helped massively by an incredibly active community. The pharmacy supported a petition I delivered here in Parliament, and it provides essential services to the two rural villages of Newton Ferrers and Noss Mayo, but it is seeking Government action in order to secure its future.
While the estimates may highlight a commitment to delivering care closer to home, according to Community Pharmacy England there is still no clear path to the sustainable funding and operational model that is required by community pharmacy. It is needed by community pharmacies such as Tubb in Newton Ferrers, and it is needed by community pharmacists such as Esi. It is needed by the whole country to be able to deliver community pharmacy, Pharmacy First and, ultimately, to relieve pressure on primary care. I urge the Minister to provide this substantial funding for community pharmacy. I know that the Minister agrees that this work is incredibly important, and I urge her to ensure that we bring it to the fore as quickly as possible so that there can be a future for community pharmacy across the country.
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Due to time constraints, I must now call the Front Benchers, starting with Helen Morgan.
Helen Morgan (North Shropshire) (LD)
I congratulate the acting Chair of the Select Committee, the hon. Member for Birmingham Erdington (Paulette Hamilton), on securing this important debate and on her excellent opening speech on the risks inherent in the spending review settlement.
The Conservatives left our NHS in a disgraceful state that is impacting every one of our constituents. On their watch, people with life-threatening emergencies were left waiting hours for ambulances, hospitals were left to crumble, and accessing a GP became a huge challenge. The collapse of NHS dentistry has left some people pulling out their own teeth at home. It is essential that the new Labour Government are bold and ambitious in turning the NHS and care sectors around. The Liberal Democrats support the principles of the Secretary of State’s three shifts and have stated on many occasions the alternative means we would use to raise the necessary funds, but today’s debate is about how the money should be spent.
I was pleased that the Chief Secretary to the Treasury’s statement last week incorporated a measure that the Liberal Democrats have long called for, not least in our last Opposition day debate in April: a ringfenced fund for maintenance, to deal with the huge repair backlog that has built up across the NHS estate. However, I must reiterate the need to go faster with the new hospital programme. We know that the Conservatives’ plans were unfunded, but this capital spend must be brought forward so that crumbling hospitals in places like Torbay, Watford, St Helier and Stepping Hill can be rebuilt as soon as possible, because spending billions on maintaining buildings that face demolition in the next 20 years is not a wise use of taxpayers’ money.
The Liberal Democrats believe that the crisis in the NHS—particularly in accident and emergency—cannot be solved unless we transform social care. We have long argued that investment in the NHS will be pouring good money after bad if hospitals cannot discharge patients because there are no care workers to help them recover. The fair pay agreement for care workers is a start, but it will not touch the sides of the yawning abyss of current and forecast vacancies in the care sector. At a bare minimum, we need a higher minimum wage for care staff to stop the sector haemorrhaging workers. It is more urgent than ever that the cross-party talks for which the Government had such enthusiasm at the start of the year are reinstated. The terms of the Casey review, which leaves fundamental restructuring of the care sector to 2036, are not ambitious enough. The review needs to be completed this year, so that meaningful change is not put off while our population ages.
I turn to mental health. The Darzi review outlined in stark terms the fact that mental and physical health are not given parity in the health service; mental ill health takes up 20% of the caseload and only 10% of the funds. Proper investment in mental health is essential to the shift from treatment to prevention. It was disappointing to see the Government abandon mental health waiting list targets and reduce the overall proportion of money spent on mental health, while proclaiming that they were meeting the mental health investment standard because, at integrated care board level, there had been a fractional increase. I urge the Minister to ensure that mental health is given priority, and to ensure that prevention, through early intervention, can bring about improved outcomes.
Yesterday, the Secretary of State announced a new national investigation of maternity services. I was disappointed that no oral statement was made. Many MPs represent constituents whose families have been left distraught by maternity service failings at Shrewsbury and Telford, East Kent, Morecambe Bay, Nottingham, and potentially other trust areas. Those voices deserve to be heard in Parliament, but that opportunity was denied.
I welcome the inquiry, but remain dismayed at the slow progress since Donna Ockenden’s shocking report into the Shrewsbury and Telford hospital trust in spring 2022. She recommended 15 immediate and essential actions for national implementation; three years later, that has not happened, and the Government have removed the ringfence from funding intended to ensure safe staffing levels. Her findings were consistent with those after other maternity scandals, and the Government accepted her recommendations. It is vital that the inquiry moves the situation forward and is not used as a distraction tactic to delay real action.
Before concluding, I will raise the subject of the fundamental reorganisation of the NHS, which is being undertaken without any meaningful parliamentary scrutiny. NHS England announced the decision to slash ICB running costs by 50% by the end of this year, with detailed plans to be submitted by the end of last month. No impact assessment for that drastic change was undertaken by the Department and, as far as I can see, there is no funding from the Treasury for potential redundancy costs and no confirmed redundancy scheme. ICBs will be expected to transfer some statutory duties to other trusts without that change being on any formal statutory footing. The guidance from the soon-to-be-abolished NHS England has been hastily prepared.
If ICB money can be spent more efficiently, the Secretary of State has our support, but surely such radical change requires scrutiny, particularly when it was not in the Labour manifesto and there has been no White Paper, no consultation, no legislation, and not even a short ministerial statement on the subject. We would all appreciate the opportunity to better understand how the process will improve outcomes for our constituents.
The new Labour Government face an enormous challenge in turning around an NHS left at breaking point by the Conservatives. The Liberal Democrats’ job as an effective Opposition party is to urge the new Government to go further, faster, in tackling the issue of access to GPs and dentists, in ending the appalling scandal of corridor care and dangerous ambulance waiting times, and in bringing urgency to the issues of spiralling mental health waiting lists and the crisis in social care.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I congratulate the acting chair of the Health and Social Care Committee, the hon. Member for Birmingham Erdington (Paulette Hamilton), on securing this important debate. It is almost one year since the Labour Government took office. They came to power promising that they had a plan to improve our NHS. However, what they actually had was a plan to get a plan by launching a consultation asking professionals and the public for ideas. The consultation was launched in October last year, and I understand that more than 220,000 people have contributed, but despite it being promised for spring, there is still no sign of it. Will the Minister commit to publishing a plan before the summer recess?
While the Secretary of State considers what the plan should say, over in No. 11 we have seen the Chancellor follow the usual Labour playbook: higher spending, higher borrowing and higher taxes. There will be more funding for the NHS, yet as the chief executive of NHS England noted, the NHS budget is now equivalent to the entire GDP of Portugal, reaching £226 billion in 2028-29. That is around 50% of public spending. It is said that 18th-century Prussia was an army with a state attached to it; 21st-century Britain is at risk of becoming a health service with a country attached to it. This is not the Government’s money; it is taxpayers’ hard-earned cash, yet the Government have provided no clarity—no meaningful detail and no credible plan—on how such vast sums will be used.
In the autumn Budget, an additional £10.6 billion in extra funding was promised for 2025-26. However, Julian Kelly, NHS England’s former chief financial officer, told the Health and Social Care Committee that most of it will be consumed by pay settlements, the national insurance hikes and non-pay inflation. Today, 64% of NHS spending goes towards personnel wages and pensions, which is a far higher proportion than in other comparable systems, but the NHS still faces staff shortages and expensive agency costs. Will the Minister confirm how much of the overall funding will go to salary increases? How much will be diverted into covering the national insurance increases for hospitals, social care, pharmacies, GPS, NHS contractors and social care providers?
As we speak in this Chamber, resident doctors and nurses are balloting for industrial action. Strikes would only add to the disruption and delay in care for sick and vulnerable people. Do the Government have a plan to minimise the impact of strikes, should they occur?
Let us look at one proposal that the Government have announced: the scrapping of NHS England. This Government by press release announced NHSE abolition without adequate planning. Ministers have dodged basic questions about costs, staffing changes and structural reform. There is, once again, no plan. The details that we know about do not inspire confidence. NHS England has asked the ICBs to reduce their costs by up to 50% by October 2025. ICBs will have to cluster, with the number expected to fall from 42 to 27 in two years. Many have warned that services will be cut, and redundancy payments linked to those restructurings could reach £1 billion in 2025-26. Has the Minister costed that in the Department of Health and Social Care revenue settlement?
The Government promised to restore the 18-week hospital waiting time within this Parliament. However, their departmental modelling shows that only 80% of patients may meet that standard for routine operations. Will the Minister confirm that the Government will deliver that promise?
Moving on to capital spending, the Minister says that she wants to continue the new hospitals programme, albeit more slowly than we would have done, and invest in technology, but capital budgets remain flat in real terms. The chief executive of the NHS Confederation says that this leaves
“a major shortfall in capital funding”.
The Nuffield Trust said that
“it will be difficult for the NHS to invest in the technology and facility upgrades it needs to meet the government’s…targets.”
Will the Minister explain how they will prioritise, and what will be delivered?
The Government have said that they want to shift funding from hospitals to primary and community care. Will the Minister confirm or deny reports that the NHS 10-year plan will delay the planned increase in spending on primary community care until 2035, instead of 2029, as was originally promised? A key part of community care is social care, but as Daniel Elkeles, the chief executive of NHS Providers, noted,
“social care…hasn’t been given the focus it needs”,
and that is
“a significant blocker on progress for the NHS.”
Cross-party talks on reform have quietly been abandoned in favour of an independent commission led by Baroness Casey, but that process is not due to complete until 2028. Yet again, we see headline-grabbing announcements from the Government, with no delivery plan and no real reform, leaving patients, staff and families waiting for the care they desperately need. The Government aim to deliver £13.8 billion in efficiency savings by ’28-29, with more than £9 billion of that total expected to come from DHSC alone. Will the Minister clarify where, within the Department, those savings will be found, and what impact assessments have supported those decisions?
The Government say that prevention is better than cure, and I agree. A good example is the “Act FAST: face, arms, speech, time” campaign, which we will all be familiar with, but just last week, in an answer to a written parliamentary question, the Minister admitted that
“the Government have made reductions in the Department and NHS England’s communications and campaigns.”
Can the Minister tell us which public health campaigns are to be affected?
Finally, the dental contract requires reform. The Government started negotiations a year ago, yet the Public Accounts Committee has noted:
“NHSE and DHSC do not yet know what reform might look like or to what timescales it can be delivered”.
Will the Minister tell us when the Government expect to conclude negotiations and get on with dental reform? In summary, the Government need to stop governing by headline. They need to publish a robust evidence-based plan, and start delivering.
The Minister for Secondary Care (Karin Smyth)
I thank the interim Chair of the Health and Social Care Committee, my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton), for securing this debate, and all colleagues for taking part. I have been asked to condense my comments, so I hope that I can address her questions, but if I do not cover them, we will of course make sure that she has a written response.
We are honest about the challenges facing the health service, and we are serious about solving them. That is why we published the independent review led by Lord Darzi, which provided a full and frank assessment of the state in which the nation’s health service was left by the Conservatives after 14 years of government, aided in the first five years by Liberal Democrat colleagues. That investigation highlighted the critical challenges facing the NHS, and we have heard about more of them today. They include a significant increase in people living with multiple long-term conditions, and growing demands for mental health services, particularly among children and young people. That is why we are taking the steps that we are taking.
The investment we are already making in 2025-26, the outcome of the recent spending review and the forthcoming 10-year health plan will address these root causes by delivering our plan for change commitments, investing in preventive health care and modernising NHS infrastructure, so that we radically reform the NHS. We will deliver three shifts to ensure that the health service can tackle the problems of today—caused by the Conservatives—and of tomorrow. They are: shifting care from hospitals to community; shifting from analogue to digital; and shifting from sickness to prevention.
My hon. Friend the Member for Birmingham Erdington said that there were highly optimistic assumptions in the planning process, and that robust, detailed plans and efficiency savings were needed if we are to deliver on those assumptions. I agree. I am optimistic about our ability to deliver, but I am also realistic and very focused on delivery. Like my hon. Friend the Member for Chelsea and Fulham (Ben Coleman), I am already seeing improvements, as are most Members in their constituencies. May I wish him a happy birthday for July, while we are here? My hon. Friend the Member for Altrincham and Sale West (Mr Rand) rightly said that the Labour Government did this before, and we will do it again.
The estimates set the Department of Health and Social Care a resource spending budget of £208.1 billion and a capital DEL—departmental expenditure limit—budget of £13.6 billion, an increase from the 2024-25 supplementary estimates budget of £9.6 billion and £2 billion respectively. On capital, we have, as my hon. Friend the Member for Shipley (Anna Dixon) said, reversed the shocking decision by previous Governments to keep raiding capital budgets in order to keep the revenue going. That is why NHS buildings across our constituencies are in the state that they are in, and why we do not have the infrastructure that we need. I was pleased to visit Airedale hospital recently to see the work being done to repair it. On digital and tech, my hon. Friend the Member for Birmingham Erdington will notice that we have a £10 billion dedicated spend for the issues that she quite rightly raised.
The Department covers a wider family of organisations, and I can assure the House that we are focused on all parts of the departmental family to make sure that taxpayers’ money is spent as efficiently and effectively as possible. Everybody here has raised particular issues to do with the NHS, so I will briefly remind Members of the outcome of the spending review that my right hon. Friend the Chancellor recently announced. The spending review includes £29 billion more day-to-day funding in real terms than in 2023-24 and the largest-ever capital health budget; there will be a £2.3 billion real-terms increase in capital spending over the spending review period. That is our commitment to the British public. My hon. Friend the Member for Sunderland Central (Lewis Atkinson), with his great experience of the health service, said that we need to make sure that we have good public administration. The multi-year settlements can help the system to plan much better.
This record investment puts the NHS on a sustainable footing to deliver for the British people. We will cut waiting lists so that, by the end of the Parliament, 92% of patients will start consultant-led treatment for non-urgent health conditions within 18 weeks, delivering on the Prime Minister’s plan for change commitment to prioritise people’s health. We will support the shift from analogue to digital with the investment of £10 billion in NHS technology and transformation between 2026-27 and 2028-29—an increase of almost 50% from 2025-26. We will repair the NHS estate, continuing to deliver the 25 hospitals, with £30 billion over the next five years for day-to-day maintenance and critical safety risks, including the eradication of RAAC. None of that happened under the Conservatives.
We will enable 2% productivity growth per year, unlocking £17 billion of savings to be reinvested in frontline services. As well as delivery, the British people rightly expect us to ensure value from this huge investment in the health service. The Secretary of State has marked 2025-26 as a financial reset year with the publication of this year’s planning guidance. He has been clear that all systems must live within their means, exhausting all opportunities to improve productivity, tackle waste and take decisions on how to prioritise resources to best meet the health needs of their local population.
All systems are now planning to achieve a balanced financial position in 2025-26, recognising that £2.2 billion of deficit support has already been provided. We will therefore close the £4.4 billion initial gap in full. Financial plans support the delivery of key operational performance targets for elective, cancer, and urgent and emergency care at a national level set out in the guidance. We are working closely with NHS England on key aspects of delivering that. I assure the Chair of the Select Committee that I meet colleagues from across the Department of Health and Social Care and NHS England weekly to go through those plans in a robust manner.
There is a lot to get through, so I am sorry that we have lost a lot of time to respond to colleagues. We are particularly looking at productivity and efficiency targets. We are ensuring that the financial performance and improvement programme for 2025-26 learns the lessons of the past. We will focus on cost variation and on upskilling finance teams and wider leadership to ensure that there is good governance in our reporting practice. We will issue the NHS performance assessment framework and have a targeted approach to recovery because the current model does not work. We are looking at ICB reform, as has been discussed. We want to ensure there is a reduction in the variation of cost across the system so that we can get more care and support to the frontline. We are focusing much more on medium-term planning to have a long-term financially sustainable system for systems and providers.
Thanks to this Government’s record investment, we are taking steps towards fixing the foundations of our NHS to make it fit for the future. We will set out more details on our plans shortly in the forthcoming 10-year plan, which will lead the NHS to meet the challenges set out in the plan for change and build an NHS fit for the future.
Paulette Hamilton
I thank all right hon. and hon. Members who have spoken. The Health and Social Care Committee will continue to scrutinise the health and social care sectors. The Committee remains united in the view that we need a programme in place to reform social care. The spending review and the funding tells us the scale of the challenge. On 5 July, the NHS will be 77 years old. I want to pay tribute to and thank all the healthcare staff and workers in the NHS and say a big happy birthday to the NHS.
Question deferred until tomorrow at Seven o’clock (Standing Order No. 54).