Health and Social Care Committee
Wednesday 4th November 2026
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09:31
09:31
Layla Moran
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Layla Moran
This session of the Health and Social Care Select Committee, where we will be looking at the work of the department. It's a delight to welcome the new Secretary of State, Yvette Cooper. Thank you for coming. And our dear friends. Now, Sir Jim Mackey and Sam Jones, thank you so much for joining us. I'll get right into it. Secretary of state, you've set out your priorities for maternity is one and early years and children is the other. We've got our ten year plan, and we've also got a prime minister who has put a lot of stock into social care.
Are you making any tweaks to the ten year plan to reflect your priorities? And what are they?
Are you making any tweaks to the ten year plan to reflect your priorities? And what are they?
09:32
Jen Craft
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Jen Craft
So thank you, chair. Thank you for having me. And it's actually 25 years since I last gave evidence to the health committee. So thank you very much for having me back. And I it's a huge privilege for me to be back as health secretary in the health department and for to be covering social care at a time which it is such a priority for the Prime Minister and his strong commitment to building a national care service. Of course, we have been reviewing all of the work around the ten year plan, around all of the work of the department over the last few months.
And what I would say is, I think the the commitment to the improving performance of the NHS, the turnaround that we need to do after the deterioration of performance under previous governments, but also through Covid, is crucial. The three shifts set out in the NHS plan around the shift to prevention, to community services and also to digital all remain as important as ever. But you are right, we are adding to this both the commitments to the National Care Service and also the priority that I am giving to maternity and child health, because I just think it was getting lost and we weren't putting enough priority.
What concretely.
And what I would say is, I think the the commitment to the improving performance of the NHS, the turnaround that we need to do after the deterioration of performance under previous governments, but also through Covid, is crucial. The three shifts set out in the NHS plan around the shift to prevention, to community services and also to digital all remain as important as ever. But you are right, we are adding to this both the commitments to the National Care Service and also the priority that I am giving to maternity and child health, because I just think it was getting lost and we weren't putting enough priority.
What concretely.
09:33
09:33
Jen Craft
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Jen Craft
As a result of maternity, child health? So we've obviously got the maternity task force is underway at the moment, and we expect to publish an action plan. It will be interim in terms of the things that we do before Christmas and a new modern services framework. A the national standards around maternity and neonatal care in the middle of next year. Interestingly, when I checked what I had given evidence on in the. The last time I gave evidence 25 years ago, it was on National service frameworks, which have since been cancelled. So establishing a national. That modern services framework of standards that will be important.
But the other thing that I am seeking to do is really bring back those sure start principles and the sure start approach to maternity and the early years. And that's why we've announced the rollout of the Healthy Babies programme. Those really the sure start health services to all of the family hubs across the country as well. So those are things that I think are either being strengthened or are different.
But the other thing that I am seeking to do is really bring back those sure start principles and the sure start approach to maternity and the early years. And that's why we've announced the rollout of the Healthy Babies programme. Those really the sure start health services to all of the family hubs across the country as well. So those are things that I think are either being strengthened or are different.
09:34
09:34
Layla Moran
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Layla Moran
You yourself are music to our ears. As a committee started talking about the cost of inaction when you were making the case for how we're going to pay for it. There's two sides to this. Obviously, a huge range between 3.5 billion and 17 billion of what some kind of form of personal care might cost. Our understanding is your best estimate is from the Health Foundation. Has there been any other work done on the different possible models? Because when Casey reports, the hope is we can just get on with it. I'm trusting you're preparing for this.
09:35
Jen Craft
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Jen Craft
So the way we're approaching this is, as you say, Baroness Casey is doing the commission and consultations, hearing from the public, but also looking at what does the the long term plan for a National Care service look like? The way we're approaching it is almost from the other end, looking at what the building blocks are. So what are the things that we need to do? What are the step by step measures that we can take? So that means the workforce, but it also means looking at how we better integrate health and social care, for example, around dementia and around frailty as well.
So we're looking at what the steps are. And we're also working very closely with Baroness Casey's commission so we can anticipate the direction of travel there as well.
So we're looking at what the steps are. And we're also working very closely with Baroness Casey's commission so we can anticipate the direction of travel there as well.
09:36
Layla Moran
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Layla Moran
Yeah. So is this because one of the things that was going to happen was an interim report soon. And then since the the reporting sooner next year, that's not happening soon. So is what you're saying is you're basically doing what the interim report would have said, because I am struck by the fact that if we wait until next year, the interim report in effect, and everything we could have implemented from that is going to be delayed.
What what what's your take on that?
What what what's your take on that?
09:36
Jen Craft
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Jen Craft
So we are we have a ministerial group that meets and meets with Louise Casey at intervals throughout so that we can get the updates on the direction of travel and so that we can do some of the preparation work as well. And I think Louise will decide herself what other further reports or interim arrangements that she wants to do between now and the summer. That's that's for the commission. But I think I would suppose I would see it as well. Look, there's some of the building blocks that we're looking at just to list them is the workforce strategy.
And I can say more about that if you want to. There's also we're looking at how you better combine the health and social care on prevention and preventing frail elderly going into hospital in the first place. How we improve the discharge processes, which I think have gone backwards since 25 years ago, and also progress around things like dementia and then looking as well at some of the issues around palliative care and end of life care, because that's an area where actually social care and health care already work closely together, but not in the way all of us want it to work as part of a new modern services framework.
And then Ali McGovern is also looking in some detail at effectively the structures we have in place at the moment, the way in which commissioning works and what improvements step by step we can do. So we're looking at building blocks step by step , while Louise works through what is the vision of a National care service that the Prime Minister wants to see?
And I can say more about that if you want to. There's also we're looking at how you better combine the health and social care on prevention and preventing frail elderly going into hospital in the first place. How we improve the discharge processes, which I think have gone backwards since 25 years ago, and also progress around things like dementia and then looking as well at some of the issues around palliative care and end of life care, because that's an area where actually social care and health care already work closely together, but not in the way all of us want it to work as part of a new modern services framework.
And then Ali McGovern is also looking in some detail at effectively the structures we have in place at the moment, the way in which commissioning works and what improvements step by step we can do. So we're looking at building blocks step by step , while Louise works through what is the vision of a National care service that the Prime Minister wants to see?
09:38
Layla Moran
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Layla Moran
Thank you. Would you write to us with more detail under those buckets? Because we would love to see it, but we probably not going to have enough time to delve into the detail that we'd love to. Yeah. Can I now turn to the change in pharmaceutical pricing, also known as the UK US pharmaceutical deal? This committee has been concerned about the lack of transparency in the impact assessment, in what it was going to affect downstream in the NHS, what the money might be spent on, the sorts of drugs that we might end up having to commission as a result, regardless of how one feels about if it's a good or a bad idea and there is a range of views.
The lack of transparency is the thing that's really concerned us. And you might be aware that the National Audit Office just yesterday have announced that they are starting a work stream on this Secretary of State. Bluntly, why should it take the Nao to do the transparency that this Committee and Parliament has been wanting from the department?
The lack of transparency is the thing that's really concerned us. And you might be aware that the National Audit Office just yesterday have announced that they are starting a work stream on this Secretary of State. Bluntly, why should it take the Nao to do the transparency that this Committee and Parliament has been wanting from the department?
09:39
09:39
Layla Moran
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Layla Moran
I mean, it's about the transparency point, not not not the wider thing we've covered this in. I appreciate you weren't Secretary of State, but we've covered this in length at before. But you're a new Secretary of State. Do you think it is right that it takes the NEO to give the level of transparency that should be just offered to Parliament as a matter of course? That's the question.
09:39
Jen Craft
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Jen Craft
So, look, I would say obviously, as a former select committee chair, I think the Nao does play a crucial role and always does across a whole series of areas. And actually it will always have a role to play in these processes. And I know that there's interest from a series of select committees on this issue, and therefore we welcome that as a process. I think, look, the key the big conclusions of the agreement around the increase in spending on innovative medicines over the next ten years and the impact that that has on long term investment in the UK.
That is all a sort of clear as part of the agreement. And so too is the immediate changes on the nice guidance that we brought in in the spring. The consequences of those changes have obviously meant, I think we've had ten new crucial drugs being licensed, being given granted nice approvals for the NHS as a result, including enhertu, which make big difference for patients and for families across the country. So on some of the clear, crucial, again, building block decisions that are part of that. I think there's a lot of transparency because there always is around the nice processes, but I don't know if Sam wants to come in on more of the.
That is all a sort of clear as part of the agreement. And so too is the immediate changes on the nice guidance that we brought in in the spring. The consequences of those changes have obviously meant, I think we've had ten new crucial drugs being licensed, being given granted nice approvals for the NHS as a result, including enhertu, which make big difference for patients and for families across the country. So on some of the clear, crucial, again, building block decisions that are part of that. I think there's a lot of transparency because there always is around the nice processes, but I don't know if Sam wants to come in on more of the.
09:40
09:41
Speaker 1
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Speaker 1
Yes. Thank you. And thank you. Secretary of State, the subject to a number of discussions, as you obviously are aware, in terms of the release of the commercial information associated with it and have had some initial conversations with the Nao. The you also, I know, appreciate because we discussed it before around some of the more technical aspects and some of the pilots that are currently underway as a result of the arrangement are currently being worked through, including what's the impact on drugs that we would not have received or drugs that we may have received, and that that in itself is informing the actual specific cost of the deal over over the period which has been has been set out.
But in terms of the commitment to your original question, the commitment to transparency, definitely just working through the commission, the commercial arrangements on how best we do that on a cross-government deal with a number of different select committees, a number of different departments involved. Okay.
But in terms of the commitment to your original question, the commitment to transparency, definitely just working through the commission, the commercial arrangements on how best we do that on a cross-government deal with a number of different select committees, a number of different departments involved. Okay.
09:42
09:42
09:42
Danny Beales
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Danny Beales
Turning to kind of other budgetary issues, the the committee's looked in many of our inquiries at the challenge of moving services from sickness to prevention. It's been an ongoing theme that we've often returned to. So we were quite excited to see the introduction of pedal in the budget. And for those watching who are wondering, kind of kind of preventative prevention based budget line is kind of my understanding. So I'd like to ask a bit further is, do you envisage pedal will be a kind of ring fenced element of spend? How do you envisage it working in practice?
09:42
Jen Craft
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Jen Craft
As you can imagine, our public health teams were extremely excited by the Treasury announcement about Pedal. We think actually a lot of our investment across not just public health but also across the NHS, actually has benefits in terms of in terms of keeping people healthy, keeping people in work as well as, you know. So a lot of those treatment budgets have a consequence in terms of helping people work as well as the prevention, the direct prevention. We don't know yet how this is going to play out, and I think these will end up being the crucial decisions for the spending review and ultimately decisions for the Treasury.
But we are already looking at, from our budget point of view, what would count in that way? To be honest, we're already doing this anyway , because one of the challenges for us is how you shift to to neighborhood health. How do you shift to.
But we are already looking at, from our budget point of view, what would count in that way? To be honest, we're already doing this anyway , because one of the challenges for us is how you shift to to neighborhood health. How do you shift to.
09:43
Jen Craft
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Jen Craft
As a former Treasury minister, I would say the benefit of this is keeping that focus and discipline around the things that you invest in now that have the long term benefits, because obviously, those are the areas that always come under shortest term pressure. And when when we're doing it at the moment, there are challenges with it. So we know, for example, if you can keep frail elderly people out of hospital, that is much more effective for the patients and also for the NHS as a whole, instead of the costly NHS acute care. Later on, once somebody has become more ill, you will save money.
So. But that is hard because of the current ways in which the NHS works to do so. We're trying to achieve that. I think having that pedal process could help with the discipline of doing that.
So. But that is hard because of the current ways in which the NHS works to do so. We're trying to achieve that. I think having that pedal process could help with the discipline of doing that.
09:44
09:44
Jen Craft
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Jen Craft
Yeah, mine would be quite broad. The we don't yet know what the Treasury's will be. But look, we do think there's primary prevention clearly is secondary prevention. I think strongly is. But also I do think a lot of actually our treatment services have an impact in terms of saving money elsewhere. Mental health is a really good example of that. We know that we have a lot of young people who are not in work, actually, who could benefit from mental health support.
09:45
09:45
Jen Craft
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Jen Craft
We need to make the shift regardless of how the Treasury categorizes the money. So we need that's part of our ten year plan shift. together. And we saw from Peter Donaghy's review into prevalence, the the real and significant increase in distress in mental health, particularly among younger people in common mental health conditions around anxiety and depression. We know that there are some of the talking therapies that we want to expand, and to do more on that can be effective. What we also know is that there are areas where we've got real problems in terms of waiting lists, and there are also we know so many people who could benefit from much earlier intervention, rather than letting that distress worsen and become embedded and have a huge impact on people's lives later on.
So the challenge for us is how you get the earlier intervention. And that involves that means working in schools, the new mental health teams that we have been rolled out in schools, but it also means doing more on the community services. So I announced in the summer some new community services walk in services on mental health, located on high streets, located in communities. To be able to do more of that kind of early intervention, I think will be hugely important.
So the challenge for us is how you get the earlier intervention. And that involves that means working in schools, the new mental health teams that we have been rolled out in schools, but it also means doing more on the community services. So I announced in the summer some new community services walk in services on mental health, located on high streets, located in communities. To be able to do more of that kind of early intervention, I think will be hugely important.
09:48
09:48
Danny Beales
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Danny Beales
On, on some of those issues you've touched upon waiting times. You mentioned the terrible, so 1.71 million people are waiting for their first or second referrals in July this year, and 82% saying their mental health deteriorated whilst waiting. You know, we've all, as MPs probably seen this in our own constituencies. I've seen young people really struggle to get access to Camhs until probably they're suicidal, they're not getting access. And parents are kind of, you know, deeply distressed about the situation that their children are in. Do you envisage that the strategy will actually grasp the nettle?
Will we have clearer standards and commitments around waiting times and mental health? There's obviously an absence of any clear standard and target for the system.
Will we have clearer standards and commitments around waiting times and mental health? There's obviously an absence of any clear standard and target for the system.
09:49
Jen Craft
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Jen Craft
So. I think the the the mental health strategy needs to look at all of these issues. Obviously, I can't pre-empt whether strategy gets to the I think the the picture on the waiting lists, there's obviously some areas where waiting lists are very short, but there are others, including some of the children, ADHD and autism assessments, for example, which are very long. And you saw some of the things that Peter review said about those and some of the problems with independent sector assessments as well. We've got other areas where actually the talking therapies, I think, are proving to be positive and effective, and some of the community services are positive and effective.
So what we need to do is to pull all of that in together in a strategy. We are absolutely going to have to look at waiting lists and waiting times as part of the strategy. So that is that's a commitment.
So what we need to do is to pull all of that in together in a strategy. We are absolutely going to have to look at waiting lists and waiting times as part of the strategy. So that is that's a commitment.
09:50
09:50
Jen Craft
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Jen Craft
So I'm not going to spell out what will be what we will say in the mental health strategy. But what I can say is we will have to look at the waiting times and the waiting lists as part of the strategy, but they are different for different bits of the system. And people often talk about overall mental health waiting lists. Actually, it is very different. So the most acute waiting times for some of the most serious things like eating disorders and so on, have already come very substantially down. So we can intervene quickly. But we've got to look at these across the board.
09:50
Danny Beales
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Danny Beales
I'm not going to kind of kind of claim that every aspect of the system may need some sort of waiting, but there's clearly an absence of any rigorous standards in mental health, even for, as you say, serious mental health and. Camhs as well. Do you envisage there being some level of kind of rigorous standard or target in the strategy or commitment to develop some?
09:51
09:51
09:51
Jen Craft
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Jen Craft
So our plan is to produce the mental health strategy before the end of the year. And we're also working in combination with the response to Alan Milburn's review on NEETs. And so we may end up doing things in a slightly different timescale on different bits of the system, depending on the timetable of the cross-government work on that.
09:52
Danny Beales
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Danny Beales
And investment is often crucial in driving decisions. And the mental health investment standard. Most, I think Icbs met this in 2425. It has driven increasing spending to mental health services, which had been neglected. It's been an ongoing discussion kind of year after year. The committee has been talking to the various Secretary of states. We've interacted with asking them to commit. Will the standard be kept eventually? Fortunately it has. What should we have a long term commitment rather than this year, year after year discussion about the mental health investment standard? Should we have a kind of long term commitment to it?
Is the strategy going to speak to this point?
Is the strategy going to speak to this point?
09:53
Jen Craft
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Jen Craft
So again, all of these things need to be part of the strategy. As you know, we we are attempting to do a sort of multi-year planning for the NHS. Of course, when there are continuing financial pressures that has to be kept under review. But we are attempting to do more long term planning and more long term ability and stability for the service across the board.
09:53
Danny Beales
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Danny Beales
That stability be a you know, the mental health will keep, which the investment is. Mental health services will keep pace with general NHS, you know, health services in terms of spending. Is that because it's great to have the certainty and the certainty is actually you're going to have declining funding. That's not great news for the service. So will it be, you know, a commitment to kind of ongoing, increasing funding?
09:53
Jen Craft
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Jen Craft
So I don't think any secretary of state is going to have any choice but to make sure that we are continuing to ensure proper investment in mental health services, because the the scale of need and the impact that it is having on, including on the labour market as well as on the distress for families, is really significant. There's a big issue for us about how we look more at prevention, because I don't think we can simply be thinking about what's the mental health services response to the increase in anxiety and depression among our young people.
So looking at the causes, whether that is around social media, whether that is the pressure on young people's lives, what are the early interventions, what should take place? And I would go right back to the early years. Part of the reason I feel so strongly about Sure Start is if you look at the evaluation of Sure Start, it had improvements in terms of mental health. A decade later in teenage years, you see those benefits. So personally, when I talk about early intervention, I would go right back to those very first early years as well.
So looking at the causes, whether that is around social media, whether that is the pressure on young people's lives, what are the early interventions, what should take place? And I would go right back to the early years. Part of the reason I feel so strongly about Sure Start is if you look at the evaluation of Sure Start, it had improvements in terms of mental health. A decade later in teenage years, you see those benefits. So personally, when I talk about early intervention, I would go right back to those very first early years as well.
09:54
Danny Beales
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Danny Beales
But just finally, do you recognise that the mental health investment stand is the reason that mental health spending has started to increase, and the cuts that those services previously saw have not taken place. And without that, do you accept that it's likely that areas may again start to reduce or not increase spending on mental health services?
09:54
Jen Craft
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Jen Craft
So I think look, it's been right. It is right for us to be clear to Icbs about the importance of mental health funding. I think that is really important. I think there will be different ways to look at how we ensure that there is proper investment in mental health in the future. Some of the things we're also interested in on devolution, particularly around response to young people who are out of employment and training and being male, may, may oral strategic authorities also being able to respond and bring services together at the local area, I think, might also be another way to strengthen the priority for mental health.
09:55
09:55
Jen Craft
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Jen Craft
People will be an issue for the spending review, and I expect us to have a strong focus around that. What we do have a commitment to do is to increase our focus on prevention and to make sure that we can do that as part of the ten year plan. So that is our overarching commitment, is we have to increase prevention. Of course, that means you have to look at therefore where you invest. But we're certainly do that even separate from whatever happens on pedal.
09:56
09:56
Allison Gardner
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Allison Gardner
Hello. Can I just pick up on a couple of things on mental health, but particularly and how it impacts on our A and E. I know and I have cases where people have arrived at A&E with extreme psychosis, have been either discharged from A&E because they can't get the the assessment that they need or they are put into waiting times for, you know, several days waiting to have that assessment. We are meant to have 24 over seven mental health liaison teams, which are, you know, attached to to A&E. Has any assessment been made of how effective those are working and whether that mental health support, when people are in crisis is happening?
09:56
Jen Craft
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Jen Craft
And I'll turn to Sir Jim on the detail of that. The one of the things we are trying to do is because you're right, you do need that specialist assessment that also has an impact, not just in terms of getting that patient to the right care, but also the impact on other patients and other staff. For someone who's in mental health crisis, the A and E is really often not the right place for them to be, certainly for long periods of time. But the other thing we are also trying to do is invest in effectively separate mental health crisis A and E centres.
So urgent care. So one of the things we announced in the summer as part of the 300 million investment was new, separate mental health emergency care centres, so that you can actually have a much more appropriate support for people who are going into mental health crisis.
So urgent care. So one of the things we announced in the summer as part of the 300 million investment was new, separate mental health emergency care centres, so that you can actually have a much more appropriate support for people who are going into mental health crisis.
09:57
Speaker 3
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Speaker 3
Yeah. And just to add to that, we've covered this a bit on Monday and PSC, I think everyone would agree the the assessment service that you've described is really valuable, really effective. But the whole system has got to work together. Once the assessments done, there's then going to be capacity, some provision for the individual involved. And that's usually where we're where the service gets let down. There isn't enough capacity there for to move that person into more appropriate setting.
And colleagues are working on that around the country.
And colleagues are working on that around the country.
09:58
Allison Gardner
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Allison Gardner
I'm going to come back to that working together issue in a second. When I talk about Icbs, another issue that, you know, for you to consider for the mental health strategy is when people are having long term mental health issues, they can do talking therapies, which is, I agree, has great bonus when they hit a crisis situation and they move into crisis care, often they come out of those talking therapies they have they're very short term crisis support that they have, and then they're back at the bottom of the waiting list waiting to go that one.
So when are you integrating these? So they, they have this continuous support going through. And that's really important with the mental health strategy. We've got to accept that people will go into crisis and will require additional support, but they cannot lose pre-existing support.
So when are you integrating these? So they, they have this continuous support going through. And that's really important with the mental health strategy. We've got to accept that people will go into crisis and will require additional support, but they cannot lose pre-existing support.
09:59
Speaker 3
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Speaker 3
Yeah. Do you want me to pick that up? So absolutely. And when I've talked to NHS leaders, they see that as an issue and are trying to deal with it. They're also trying to build out the neighbourhood mental health services as well. An important importantly, it looks to me at times like we've got services that are built for very discrete definitions or discuss this here before, I think. And sometimes packages stop when something else starts. But people are on a continuing the. They're moving in and out of different levels of escalation. So it is trying.
People are trying to address it, but it requires an awful lot of things to change. At the same time, the.
People are trying to address it, but it requires an awful lot of things to change. At the same time, the.
09:59
Jen Craft
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Jen Craft
The centre I went to in Sheffield, which is one of our first sort of community based mental health services. What they were doing was bringing together all of the different mental health teams, because you've got multiple different teams that might deal with or provide support in different circumstances, actually having them co-located, changing the way in which health services work. So as Jim said, that they are based around the patient rather than in the different silos, has to be what we try to do on this.
10:00
Allison Gardner
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Allison Gardner
Okay, so I am actually going to jump around to apologies. So I am going to jump to a question about section 75 agreements in the in the ICB reorganisations and the section 75. I think it's the 2006 NHS act requires and the duty to cooperate or collaborate between NHS providers. There's a strong recommendation that came from this committee that that should be extended to the local government authorities, particularly to get that wraparound care. I know from my own experience running a task force, synthetic cathinones we have a big issue with with a particular type of drug within Stoke on Trent that are very good.
Drug and Alcohol Service is a third sector provider that has been tendered by the local government, the local council, trying to get that cooperation with with the mental health service and all the other services really challenging. A section 75 would help make sure that that happens. Where that happens, it works. So I understand that the, you know, that call was to to do that and extend the section 75 agreements to local government authorities was rejected.
Why was that? And will you think about it again? Because I know it will make a difference.
Drug and Alcohol Service is a third sector provider that has been tendered by the local government, the local council, trying to get that cooperation with with the mental health service and all the other services really challenging. A section 75 would help make sure that that happens. Where that happens, it works. So I understand that the, you know, that call was to to do that and extend the section 75 agreements to local government authorities was rejected.
Why was that? And will you think about it again? Because I know it will make a difference.
10:01
Layla Moran
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Layla Moran
To be clear, the recommendation was to review section 75 arrangements because they can happen with local authorities, but they ought to often don't. So and that was rejected by the department, which was a real blow, I think, to the committee, because we see that as a really important way of solving some of these issues.
10:01
Speaker 3
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Speaker 3
So the mechanisms are great where there's agreement locally to use them. And I've experienced that in my in my trust life where we're really effective. Section 75 agreements are tied people together where there was a mutual will to do it. I think the issue is you can't mandate it everywhere. You can't you can't force people to do. It has to be a local will. There has to be a purpose around what they're trying to solve.
10:02
10:02
10:02
Allison Gardner
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Allison Gardner
What do I do? Apologies. What do I do where maybe that will isn't quite there because of all of the competing pressures that these providers have. And what do I do when I am also dealing with a third sector provider of a service that. So I then go down the chain. So yes, it's not you're not the council, you're a third sector provider. And we don't do it with those. And you end up with this very diffuse field where you've got very good providers, but they they can't or won't work together because of the pressures.
10:03
Jen Craft
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Jen Craft
I think this gets to the heart of the devolution question and the rewiring the state that the Prime Minister has raised and is one of the issues. That's the heart of looking now at how you do greater devolution. But it has to be in a way that that gets local organisations to properly work together around place so that you do you don't have that sense of, look, we've got individual organisations doing their own thing and based on different national requirements, and it's okay, we work in this silo, we work in that silo, and you don't get that partnership working.
So I think the biggest question that the Prime Minister is asking the whole of government, and whether it be mayors or local government across the country, is how do we rise to that challenge, and how do you get organisations working together now? You know, you can look at whether there are legislative duties and responsibilities on people to work together, or you can look at different ways of organising the way that funding flows, for example, different kinds of requirements on pooled budgets or giving them mayoral strategic authority oversight of the whole thing so that they can go in and bash heads together.
So there's different things being looked at, the Prime Minister said. We want the devolution White Paper to be published very soon, and a lot of that work is being led by number ten North. So I don't have a precise answer to you on this issue other than to say, I think this is exactly the thing that the Prime Minister wants to solve, based on his experience in Manchester and seeing areas where he is able to bring people together.
So I think the biggest question that the Prime Minister is asking the whole of government, and whether it be mayors or local government across the country, is how do we rise to that challenge, and how do you get organisations working together now? You know, you can look at whether there are legislative duties and responsibilities on people to work together, or you can look at different ways of organising the way that funding flows, for example, different kinds of requirements on pooled budgets or giving them mayoral strategic authority oversight of the whole thing so that they can go in and bash heads together.
So there's different things being looked at, the Prime Minister said. We want the devolution White Paper to be published very soon, and a lot of that work is being led by number ten North. So I don't have a precise answer to you on this issue other than to say, I think this is exactly the thing that the Prime Minister wants to solve, based on his experience in Manchester and seeing areas where he is able to bring people together.
10:04
10:04
Jen Craft
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Jen Craft
We are looking more broadly at devolution and what the devolution arrangements should be as part of the work being led by number ten North. So the reason I use the passive voice is because obviously this is being led by number ten North rather than by the department. But of course we are contributing to it. And they are looking at the sort of both the legislative issues and also sort of powers, responsibilities and budgets. We are one part of that picture, rightly, because the whole point is to make it a cross-government focus on rewiring the state.
10:05
10:05
10:05
10:05
Allison Gardner
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Allison Gardner
Okay, I'll carry on. So Co-commissioning would really help. I have to, I have to say. So that would be really helpful because you've mentioned devolution. I will I will again refer back to my own experience. So the ICB in Staffordshire was due to merge with the ICB in Shropshire. Now I might have queries as to whether that, you know, that makes sense for us. You know, in terms of our health economy, particularly in North Staffordshire, that was halted. So they went through they lost about 50% of their staff. And then because we didn't know about what we were doing with devolution, it was merged.
We have now been told in Staffordshire that we're going to have a Staffordshire mayoral strategic authority that is not coterminous now, with what was proposed for the ICB reorganisation. Likewise, and it'll be brought up by my colleagues. We've still got the issue with the NHS England and how we do the regional offices. So where are we at with the ICB mergers and the number of ICB and. And exactly are you confident that the 50% cuts in ICB will have the capacity needed to carry out all of the functions and visions to them? They're originally going to have quite a whole load.
Some have been taken off of them. And, and where does the enforcement rule sit in there? Because I'm quite worried that that is being that responsibility has been a bit diffused.
We have now been told in Staffordshire that we're going to have a Staffordshire mayoral strategic authority that is not coterminous now, with what was proposed for the ICB reorganisation. Likewise, and it'll be brought up by my colleagues. We've still got the issue with the NHS England and how we do the regional offices. So where are we at with the ICB mergers and the number of ICB and. And exactly are you confident that the 50% cuts in ICB will have the capacity needed to carry out all of the functions and visions to them? They're originally going to have quite a whole load.
Some have been taken off of them. And, and where does the enforcement rule sit in there? Because I'm quite worried that that is being that responsibility has been a bit diffused.
10:07
Jen Craft
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Jen Craft
Yeah. So first thing is we want to get to coterminous city. So I think having shared, having the same boundaries around different services is far more effective for local delivery of public services than not. That is being worked through at the moment. So that is why we have paused some of the work around some of the icbs in order to align with the mayors and the approach around strategic authorities across the rest of the government. I think if you can get that prize and get much better coterminous city in some areas, depending on what the local government geography is, that might mean an ICB covering two, for example.
It might be different in different areas, because the point about having the Icbs was to have a big enough footprint to be able to do effective commissioning of services, but that is what we are currently working through. But I think having boundary alignment, it just it makes it so much harder for local agencies if they don't have that.
It might be different in different areas, because the point about having the Icbs was to have a big enough footprint to be able to do effective commissioning of services, but that is what we are currently working through. But I think having boundary alignment, it just it makes it so much harder for local agencies if they don't have that.
10:08
Allison Gardner
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Allison Gardner
I will argue, though, it does get challenging because again, in Staffordshire, you know, if you're in Staffordshire, you'll go over to to Derby hospitals. If you're if you're South Staffordshire, you're going into the Birmingham hospitals. Obviously, if you're North Staffordshire and indeed Cheshire, you're coming into the Royal Stoke. So boundaries are a little bit.
10:08
Jen Craft
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Jen Craft
Yeah, it's it's harder because of patient referral patterns in the health service. It is not as simple as having the same historic local government patterns. So that is exactly what we're having to work through. So recognizing that complexity, if organisations can work in partnership, it's much more effective. But you're totally right. The acute service pattern.
10:08
10:09
Joe Robertson
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Joe Robertson
Thank you, Secretary of State. I'm going to stick with mental health, and I'll refer to the Professor Fonagy independent review as well. But in broadest terms, are you satisfied that the money is there? The money is in the NHS budget to deliver a better system for improving mental health and neurodevelopmental care, particularly in the community.
10:09
Jen Craft
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Jen Craft
So we have a record £16.3 billion of investment going into NHS mental health spending now. So I think we have to be able to use that investment as effectively as possible. Of course, look, there are always financial pressures and that is the case for the NHS, for the health department, just as it is for public finances overall, as a result of everything from, you know, the Strait of Hormuz to the different things that have been impacting the whole of the economy. But I do think we can do better within with the budgets that we have.
We can provide better services, have earlier interventions as well. And that's what we're looking to draw up as part of the mental health strategy.
We can provide better services, have earlier interventions as well. And that's what we're looking to draw up as part of the mental health strategy.
10:10
Joe Robertson
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Joe Robertson
So if the challenge is spending the money we have better and ensuring it reaches the people in need. Professor Fonagy has identified an issue of overdiagnosis or misdiagnosis. He prefers misdiagnosis. I think so that particularly among young people with autism and ADHD, the diagnosis rate is significantly above the expected population prevalence and rising further. How do you go about ensuring that the right support reaches the right people when we're facing that issue, which is something that has developed in recent years?
10:10
Jen Craft
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Jen Craft
Yeah. So I think there's a series of things. The first is we need much earlier intervention, so people shouldn't be waiting for diagnoses before they get support that they need. And that is the case when we're looking at the send reforms, for example, in schools, making sure you can get that earlier support. It's also the case in terms of the response from the NHS. So that's what we want to do, is shift the way that the NHS works, as well as the way that education support works, to being more based around need and early intervention, rather than long, slow processes that wait for diagnosis, where actually the earlier intervention, because it's all about what do you need to be able to keep working, to be able to stay in school, to be able to keep learning?
That should be what we focus on. Second thing is, there's a particular issue that Peter Fonagy raised around some of the independent provider diagnoses. That, and the way in which those independent providers are not regulated in the same way, because they're not doing prescribing, they're only doing diagnostics. They are not being regulated in the same way. We think that's a problem. We agree with Peter Fonagy assessment on that. That is a problem. And we need to and we're introducing regulation for those providers. What I think Peter Fonagy said is, look, there has been underdiagnosis. There is still underdiagnosis in some areas, there is misdiagnosis in other areas, perhaps, for example, someone who's getting a neurodevelopment diagnosis when actually they should be getting a mental health diagnosis.
So there are misdiagnoses. And he talks about the risk of overdiagnosis for the future because of the way some of those independent provider services are not regulated.
That should be what we focus on. Second thing is, there's a particular issue that Peter Fonagy raised around some of the independent provider diagnoses. That, and the way in which those independent providers are not regulated in the same way, because they're not doing prescribing, they're only doing diagnostics. They are not being regulated in the same way. We think that's a problem. We agree with Peter Fonagy assessment on that. That is a problem. And we need to and we're introducing regulation for those providers. What I think Peter Fonagy said is, look, there has been underdiagnosis. There is still underdiagnosis in some areas, there is misdiagnosis in other areas, perhaps, for example, someone who's getting a neurodevelopment diagnosis when actually they should be getting a mental health diagnosis.
So there are misdiagnoses. And he talks about the risk of overdiagnosis for the future because of the way some of those independent provider services are not regulated.
10:12
10:12
Jen Craft
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Jen Craft
So I accept the Peter Fonagy expert report. That was why Peter was asked to do this review. And, you know, he's brought together all of the expertise. So he talks about that complicated picture of underdiagnosis misdiagnosis and overdiagnosis, and how you actually need a system that can respond to that whole picture, not just one bit of it.
10:13
Joe Robertson
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Joe Robertson
I think I think the issue is this if we move away from requiring a specific diagnosis in order to access support, which seems to be what you're saying, it's what Professor Fonagy recommends, how do you ensure that you are still not that you are making sure people who need receive , when there is a significant number of people trying to access support, that plainly is not the right type of support, Fonagy identifies. That seems to me that if you remove a diagnosis system, you potentially create an even bigger problem of an increased volume of people trying to access something that is not going to meet their needs, and blocking out those with need.
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10:13
Jen Craft
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Jen Craft
Obviously you obviously still need diagnosis services. That's still immensely important for for lots of people. It can also be what means there may be medication prescriptions. As a result of that. There may be other just support services that that are linked to that. But I think the thing we're sort of recognising is that, you know, the mental health and mental health distress, which we know has increased issues around ADHD and autism, we know that there are very acute cases where people have very severe needs and distress and challenges. But we also know that there are milder cases where actually currently people are not working.
Was actually being in work can be really good for your mental health, can be really good for, you know, and you should if you've got the right support. We absolutely want people to be in work. So I think this is a mix of things. Look, this is what the mental health strategy needs to, to recognise is how you make sure you've also you've got proper diagnosis services, but you've also you've not got a whole load of people who end up waiting a huge length of time in distress for diagnosis services when actually, for some people, for example, it might be.
Getting early access to talking therapies might be much better for them than waiting a long time on a long referral pathway. Different things for different people. And that's what the strategy needs to respond to.
Was actually being in work can be really good for your mental health, can be really good for, you know, and you should if you've got the right support. We absolutely want people to be in work. So I think this is a mix of things. Look, this is what the mental health strategy needs to, to recognise is how you make sure you've also you've got proper diagnosis services, but you've also you've not got a whole load of people who end up waiting a huge length of time in distress for diagnosis services when actually, for some people, for example, it might be.
Getting early access to talking therapies might be much better for them than waiting a long time on a long referral pathway. Different things for different people. And that's what the strategy needs to respond to.
10:15
Joe Robertson
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Joe Robertson
Just on the wider meeting, the needs of people with mental health conditions, whether they're diagnosed or not. There's obviously a wider debate on the role that a system of welfare plays into that. And Stephen Timms is doing his own report. Do you accept the basic position that if the NHS fails to meet need, there is inevitable pressure putting people into welfare claims for cash payments?
10:15
Jen Craft
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Jen Craft
So we do think that the NHS has to play its part in supporting the workforce, and I think the original arguments around the NHS. So, you know, 80 years on from the passing of the NHS act, a lot of that debate was all about how it supports the workforce and how it helps people stay healthy or be get treatment quickly so they can get back into work. So the NHS has to see itself as part of that. And it's why we want stronger responsibility around Icbs to be actually supporting the process so that people can get back into work if they have health issues and health conditions.
And particularly, we know that is an issue around mental health for young people. So we want we are part of the work around responding to Alan Milburn's review. But the only thing I would say is that whilst the things like mental health services and so on have an important role to play, it can't be an alternative to providing people with support, job opportunities as well, because there are lots of people who actually, even with a mental health condition, with the right support, really should be in work and their mental health will be improved. That's the evidence from the Carol black reviews, from reviews going back through many years, that employment and education is good for your mental health.
And particularly, we know that is an issue around mental health for young people. So we want we are part of the work around responding to Alan Milburn's review. But the only thing I would say is that whilst the things like mental health services and so on have an important role to play, it can't be an alternative to providing people with support, job opportunities as well, because there are lots of people who actually, even with a mental health condition, with the right support, really should be in work and their mental health will be improved. That's the evidence from the Carol black reviews, from reviews going back through many years, that employment and education is good for your mental health.
10:17
Joe Robertson
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Joe Robertson
Would you accept the point that if the NHS is failing, to the extent it's failing to meet the needs of those with mental health conditions, it's more likely to push them into claiming for Pip and Universal Health Credit, a universal credit health element. I mean, it just seems to me that that is a natural conclusion of a system. Failure in health is more likely to push people onto welfare. Do you accept that basic logic?
10:17
Jen Craft
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Jen Craft
So it's definitely the case that the NHS should be working with other bits of the system to prevent people needing to go on welfare, and whether that is because of treatment, whether that is because of mental health needs and so on. I think it's just it's also it's not the only bit of the system because there's also support in employment as well that can help improve your mental health.
10:17
10:18
Ben Coleman
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Ben Coleman
Thank you, Permanent Secretary. According to the Guardian. And picking up on what the Secretary of State just talked about in terms of regulating private ADHD testing companies, according to The Guardian, you had significant commercial interests in a major provider of ADHD testing. ADHD 360 was the name of it until a month after your appointment as permanent secretary. Given this, may I ask, will you consider recusing yourself from the work to tighten regulation of these companies?
10:18
Speaker 1
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Speaker 1
Thank you very much to give me the opportunity to discuss this here today at the committee. I think I've previously offered to do this in private, so can I just be very clear , all interests were appropriately declared as a non-executive director as I was previously, and as a prior to my appointment and subsequently to my appointment as Permanent Secretary, which is also subject to outside of the department overview and oversight in terms of individual permanent secretaries specifically, I did not have and was not part of any involvement in any commercial arrangements around ADHD 360 or indeed any of those services, including any commercial or private interests either.
10:19
10:19
Gregory Stafford
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Gregory Stafford
Thank you very much. Thank you, Secretary of State, I was very pleased to see at the PAC on Monday, the permanent Secretary say the reason that girth is getting it right first time programme works so well is that it's clinically led. And then she went on to put some words in your mouth, which were the the Secretary of State is very clear with us about the importance of clinical leadership. Now, assuming that you do agree with what the Permanent Secretary said on your behalf, can you let me know what's happening with the clinical leads? Because in your letter to both to us and to the staff in the reorganisation, there was no mention of those in their contracts expire in March of next year.
Will they all be rehired in the new system?
Will they all be rehired in the new system?
10:19
Jen Craft
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Jen Craft
So pass on to Sir Jim to follow up. But I have made clear within the Department that sort of two things. First of all, that we actually need to strengthen clinical leadership across the board. It's one of the things that feels different to me compared to last time I was in the health department 25 years ago. It actually feels like in some areas, some of that clinical leadership has been lost compared to what we had back in the day, and I want to strengthen that. And it's why I've talked about having a clinicians council, a clinical council being set up so that we've got that strengthened voice.
And I want to see that in different parts of the NHS. I've also been clear that I do not want a situation where we have a whole series of clinical leads being terminated in the spring. I do not want that to happen. I don't think that would be appropriate. Of course, there may be areas where roles should evolve or roles should be strengthened or changed and so on. But I have made that clear because that would be a sort of an accidental consequence of the timings of the change and the NHS England moving into the department.
And so we need to be clear about all of that critical work and that clinical work continuing.
And I want to see that in different parts of the NHS. I've also been clear that I do not want a situation where we have a whole series of clinical leads being terminated in the spring. I do not want that to happen. I don't think that would be appropriate. Of course, there may be areas where roles should evolve or roles should be strengthened or changed and so on. But I have made that clear because that would be a sort of an accidental consequence of the timings of the change and the NHS England moving into the department.
And so we need to be clear about all of that critical work and that clinical work continuing.
10:20
Gregory Stafford
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Gregory Stafford
And I accept that Sir Jim is about to give me some more detail. But obviously all of these clinical leads are employed directly by their trusts. And as we get closer to that point, the trusts will think, well, actually, we'll just have them all back and you'll lose 200 plus clinical leads, over 70 specialties who are doing some great work. But sir. Jim.
10:21
Speaker 3
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Speaker 3
Yeah, so just, just to, to flesh this out a little bit, there was an interpretation as part of the change programme that all fixed term contracts and secondments needed to end on the date of abolition that affected some of these Girthed leads. Secretary of state and I discussed this. We discussed it on Monday, and I've asked the medical director, doctor Frank swords , and her deputy, Ramani Singh, to communicate with all of the clinical leads involved and assure them that that will not be the case in their employment will continue beyond April. There's normal reviews going on all the time about who does what and stuff, but there's no cliff edge in application, and everybody who's involved will be assured on that.
Might have been hopefully have been this week, but certainly through the rest of this week.
Might have been hopefully have been this week, but certainly through the rest of this week.
10:22
Gregory Stafford
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Gregory Stafford
Okay. That's reassuring. Thank you. I may come back to some more NHS restructuring in a second, but obviously having clinical expertise at the top of the organisation is very important. But having the right clinical expertise at the bottom is also, I think, vitally important. Now, your predecessor, about one, the Secretary of State, the right hon. Gentleman for Ilford North, both prior to the election and at the despatch box on the 15th of October 2024, said the government was committed to doubling the number of medical school places, then the now Welsh Secretary in April of last year tried to row back on that.
So I just want to get clearly from you, as the new Secretary of State, is your intention to carry out the commitment you made before the general election and your predecessor did, at the despatch box, to double the number of medical school places by the end of the parliament.
So I just want to get clearly from you, as the new Secretary of State, is your intention to carry out the commitment you made before the general election and your predecessor did, at the despatch box, to double the number of medical school places by the end of the parliament.
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10:23
10:23
Jen Craft
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Jen Craft
Excellent. We are currently expected to do so in the new year, and it's worth me setting out just so. Some of the uncertainties are that have led to some of the delays in doing this. I think there is there's a kind of level of uncertainty, probably around what the future staffing needs and specialism needs are for the NHS. That is probably greater than at any time in its history for a series of reasons. First of all, we know that there is a sort of unmet need in a series of areas. I would highlight, for example, speech and language therapists, for example, as an area that we need to increase.
We're also keen to shift areas into community services, increasing GP community services. But just to.
We're also keen to shift areas into community services, increasing GP community services. But just to.
10:23
Gregory Stafford
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Gregory Stafford
Finish, this is not new stuff. Your predecessor and the last predecessor, I questioned him back in July on this, and he said it was almost there that the permanent secretary said, and I'm slightly paraphrasing here, that it was just being held up by the sign off processes that the Cabinet Office needed to do. You're now saying that it's going to be at least another six months since I asked him. Things haven't changed so significantly since July that you now pushing this to to the new year, whenever that might be.
10:24
Jen Craft
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Jen Craft
So and just to finish the previous sentence, the other area that I think is changing things substantially is around AI, and that will lead to us wanting to increase certain areas, but also to potentially reduce certain areas as well. Now, I think part of what we need to do is have some humility around the idea that a ten year plan, the idea that we can predict what we're going to need in ten years is actually just so much harder now than it was even just 2 or 3 years ago as a result of technology changing.
And therefore, we just need to be to recognise that in what we do, of course, because the training of doctors takes seven years, actually, you have to do that long term planning. But the uncertainty around the areas that we need, I think, has become much greater than previously. So, look, I recognise that means that there are challenges around the workforce planning as a result of this. One of the things that we have been looking at is whether rather than us try and keep continually focus on precise modelling, we also look at what are the areas in which we can give indications to the training providers.
These are the areas we know that we need to significantly increase alongside. Take the get it doing the further modelling as well. So look, the.
And therefore, we just need to be to recognise that in what we do, of course, because the training of doctors takes seven years, actually, you have to do that long term planning. But the uncertainty around the areas that we need, I think, has become much greater than previously. So, look, I recognise that means that there are challenges around the workforce planning as a result of this. One of the things that we have been looking at is whether rather than us try and keep continually focus on precise modelling, we also look at what are the areas in which we can give indications to the training providers.
These are the areas we know that we need to significantly increase alongside. Take the get it doing the further modelling as well. So look, the.
10:25
10:25
Jen Craft
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Jen Craft
I would just say to you in the new year, I understand, I understand you have asked this to many different health secretaries. I also would just say to you as the Health Secretary for three months, after 25 years, you will appreciate that I am going to look at this properly and carefully, because this is about the consequences of the workforce. Planning is so important to the whole of the system, and I am concerned that some of the planning assumptions actually do need to be looked at.
10:26
Gregory Stafford
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Gregory Stafford
10:26
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10:27
10:27
Gregory Stafford
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Gregory Stafford
Yes, by that period. Okay. Given that you are now realised that the organisation can't happen, you know, in totality from on the on the 1st of April next year, and you've now created a new special health authority or going to create a new special health authority and NHS group. When will those happen? By what's the date the special Health authority will arrive.
10:27
Jen Craft
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Jen Craft
A special health authority will be also set up for the 1st of April. Right. So and the reason for doing this is that the all the national functions would transfer Right. So and the reason for doing this is that the all the national functions would transfer into the. department and into an NHS group within the department. So the model that we've set out is, to be honest, broadly similar to the one that operated before 2012 and before what I think were deeply reforms that were brought in by Andrew Lansley, and is also similar to the model that.
operated when I was the health minister 25 years ago, where you have an NHS group, a strong NHS group, but within the Department of Health. So you have an NHS chief. executive and also the. ability for teams to work much more effectively together on things like social care. The reason that we have a different arrangement for the regions, because we have seven regional teams across the country who do performance management, very close to. trusts and health. organisations across the country. We think it's better for them to stay close to the NHS locally rather than be brought into the centre.
And we also recognise we've got this devolution process underway, led by the Prime Minister at the moment. And so the precise arrangements around regions, around.
operated when I was the health minister 25 years ago, where you have an NHS group, a strong NHS group, but within the Department of Health. So you have an NHS chief. executive and also the. ability for teams to work much more effectively together on things like social care. The reason that we have a different arrangement for the regions, because we have seven regional teams across the country who do performance management, very close to. trusts and health. organisations across the country. We think it's better for them to stay close to the NHS locally rather than be brought into the centre.
And we also recognise we've got this devolution process underway, led by the Prime Minister at the moment. And so the precise arrangements around regions, around.
10:28
10:28
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10:28
Gregory Stafford
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Gregory Stafford
Special health. authority in order for those regions to be able to get on with the work. I would entirely agree with you, Secretary of State, which is why I think perhaps more thought should have been given before, before we got down to this route. Last question. Someone else may pick up on more NHS ones. The autumn budget confirmed that the capital spending on health projects would be lower in each year, 29 to 30, compared with last year's projection projections.
Can you. explain what will it be effective? Will it be? I don't know.
Can you. explain what will it be effective? Will it be? I don't know.
10:29
Jen Craft
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Jen Craft
Neighborhood health centers, new hospital program. What? Who's going to lose out with these cuts? So we have a capital budget increasing from around 11 billion before the election to nearly. 14 billion this year, rising to 15 billion by the end of the spending review. We have a 1% saving we're finding this year, and then 2% next year and the year after. We believe we can manage those savings without it having any impact on things like the new hospital programme on the major.
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10:30
Josh Fenton-Glynn
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Josh Fenton-Glynn
Which the capital budget is managed. Thank you very much. Thank you. I'm primarily going to pick up on some of those points and look at medical training and training pathways. It's interesting. In the last set of questions you said it takes seven years to train a doctor. Does that mean you consider a doctor kind of trained by .
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10:31
10:31
Josh Fenton-Glynn
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Josh Fenton-Glynn
That was not me changing policy on the training of the medical profession. So I, I was yeah, it's just just just tingled at the back of my head when you said that. So the BMA. estimates that. 20,000 doctors could miss out on specialty training this year. How did we get to the point where the. bottleneck in workforce planning .
10:31
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10:31
Jen Craft
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Jen Craft
In terms of how things are operating through the NHS at the moment. I mean, look, obviously we the result of a lot of the work we've done, we have got a substantial increase in the number of consultants. We're also funding as a result of the additional funding that we have put into the NHS. That is also funding additional consultants places, and we will be expanding the work in terms of things like NHS.
10:32
Speaker 2
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Speaker 2
Online as well. But let me pass to Sir Jim on the training point. Goes back to your point earlier on, Secretary of State, about how complicated it is to plan these things. So the my. interpretation of the problems we we felt last year, the year before, and are still partly. experiencing much reduced was a long time ago when they'd been. expansion in medical school. placements that hadn't. The. The follow up placements in the training system at every level haven't hadn't been either fully muddled through, or there were inaccuracies in the way that they were followed through.
Add into that international recruitment. As you'd be aware a few years ago, there's a lot of international recruitment that created extra competition for places. So we ended up with this unhealthy situation that was a key part of the resident doctors dispute. So we're working our way through that now. We've expanded places again to try and ease the to ease the problem, which .
Add into that international recruitment. As you'd be aware a few years ago, there's a lot of international recruitment that created extra competition for places. So we ended up with this unhealthy situation that was a key part of the resident doctors dispute. So we're working our way through that now. We've expanded places again to try and ease the to ease the problem, which .
10:33
Josh Fenton-Glynn
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Josh Fenton-Glynn
Is all part of the resident doctor deal. But we're not out of the woods yet. Okay. I mean, so we were talking about mental health earlier. So I did a bit of a quick bit of research into what the mental health training backlog is. The BMA globally say that there's in 2019, there were 1.9. applications per specialty training post.
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Jen Craft
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Jen Craft
Overseas or from the profession if they can't find a training pathway? A lot of work has been done to make sure that we have as many specialist training posts as possible, and also as many different jobs in the. NHS as possible. I think that is really important. But I think, look, there is always a time lag between the numbers going into training and what's needed in five years time, seven years time, ten years time. So that is just a. reality of how you manage a service with a big workforce. And I think the I mean, the overall, we've got about.
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Speaker 2
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Speaker 2
Equivalent five years of this government? The increase to be that will be worked through in the in the workforce plan. What we're keen to do is, Secretary of State said, is to try not to make similar. mistakes or create more similar problems to the past and try and get the planning right. But it's got to work at every stage. As you've described medical school places, foundation programme, core training, specialty training, and then into the consultant and the GP workforce as well.
So that and .
So that and .
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Jen Craft
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Jen Craft
Time that was here. Again, it will be dealt with in the yeah, I mean, the the plans as part of the spending review. And these may be the figures that Mr. Stafford was also asking for earlier is the postgraduate medical training. places should be up to. 4500 over the. next three years, also increasing the numbers going into GP training by. 750 over the period to. 5000 by 2829. So those are the sort of training places we have set out as part of the spending review. I, I think the the thing we need to ensure as part of the workforce plan is if we are serious about shifting to greater.
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Josh Fenton-Glynn
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Josh Fenton-Glynn
And over. 130 are intending to retire in the next five years. We don't actually have a recruitment problem, though, do we? We've got a training problem. So how are we going to fix it and in what time scale, and how are we going to make sure that these areas that we keep telling, you know, I've heard from three secretaries of state now that we are prioritising palliative care and mental .
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Jen Craft
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Jen Craft
And yet these numbers remain the same, how are we going to fix it? And I think part of what we'll need to do in the palliative care is that's the reason for me for having a modern services framework, because the point of having the modern services framework is to give the sense of the standards that need to be met, but also the sort of. holistic approach that looks through at everything through from the. workforce to the. standards and what it is that you want to achieve. I also think the the work that Ali McGovern is currently looking at about how palliative care becomes some of the first steps towards the National Care.
Service also requires an increase in this. But look, in order to get the training places in the system, it's not just about the training decisions, it's also about what trusts. themselves and what NHS. institutions also think they need and can. support in the system as well. And so that's why sending the clear signal about the importance of things like .
Service also requires an increase in this. But look, in order to get the training places in the system, it's not just about the training decisions, it's also about what trusts. themselves and what NHS. institutions also think they need and can. support in the system as well. And so that's why sending the clear signal about the importance of things like .
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Speaker 2
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Speaker 2
NHS needs. They have a long term responsibility, which I think they do recognise. Is that a. No. It's not just the trusts either, it's the colleges. And you know, the whole thing has to be agreed together. It's just it made me think Josh more as a trust chief exec rather than a national position. I would generally be confident. overall in aggregate, that I'd have more candidates than I had jobs to fill. But there'd be specific specialties that were always worry. You've pointed to a couple of those specialties, and if you're you're running a mental health service.
So you've got pediatric pathology or you've got some of the very highly specialist areas where the training system is very small, the numbers of trainees, and you're very reliant on very small numbers of people. So there's the medical training review that CMO kicked off a couple of .
So you've got pediatric pathology or you've got some of the very highly specialist areas where the training system is very small, the numbers of trainees, and you're very reliant on very small numbers of people. So there's the medical training review that CMO kicked off a couple of .
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Josh Fenton-Glynn
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Josh Fenton-Glynn
Years ago. Jane is carrying that through now. Hopefully that will address these issues. You said the medical. Sorry. Just very quickly, you said the medical royal colleges needed to buy in. These are all all press. My numbers are from press releases from the medical royal colleges. But we do need to see that trusts are .
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Speaker 2
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Speaker 2
Going to be in some way supported to provide those places, rather than just. And on the. expansion in the conversion from locally employed doctors to formal training positions as part of the resident doctor deal. That was all done in. collaboration with trusts. Glenn Burley's led that work. It's been pretty. successful so far, but it hasn't resolved the problem entirely.
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Paulette Hamilton
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Paulette Hamilton
Hasn't completely made it go away. Thank you, Paul Hamilton. Mine is a really quick question. Secretary of state, it's relating to consultants. Now, you. highlighted all of you have highlighted that we have enough of these people and what have you. But the problem is many of the. consultants are saying now, if we don't sort out the issues around the pay and other.
conditions that they will be leaving, and if you don't have them to. train your junior doctors and others. surely going down the line, you're going .
conditions that they will be leaving, and if you don't have them to. train your junior doctors and others. surely going down the line, you're going .
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Jen Craft
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Jen Craft
The things I think that we need to improve and to do better is actually. strengthening the the role of consultants and the voice that clinical voice, both at local level within trusts and organisations. I think there is a sense for some. consultants that actually their their voice has been lost on the kinds of innovations, the care improvement service improvements that they want to see and how we strengthen that, and also how we make sure that that is strengthened at. national level as well. I also want to work with consultants on some of the areas about how I think we can.
It is in everybody's interest for consultants to be able to do more.
It is in everybody's interest for consultants to be able to do more.
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Jen Craft
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Jen Craft
As a committee that this is in the workforce plan? So that is, I think, not only does it need to be part of the workforce plan, it's also part of setting up the clinical council. I actually think this is different from pay, because obviously you have consultants I think have had around on average, about. £25,000 pay rises over the last four years. I don't think this is a pay issue. I think this is about how we work with.
consultants on training .
consultants on training .
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Andrew George
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Andrew George
Consultants on their role within hospitals. Thank you very much. Thank you very much, Andrew. George, thank you very much. So we're not to get the workforce plan until the new year. The new year is 12 months long. It could be another year waiting for the workforce plan. It doesn't prevent you from from addressing some of the issues like those have been raised already, like the that of safe, safe staffing, recruitment and, and retention of staff. So surely you can, you can still be issuing policy statements, clear guidance and instructions to, to those on the ground as to .
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Jen Craft
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Jen Craft
Community over the over the plan period? And how that how is that going to be done? So this is an area where I think we've not done enough yet. And the plans were set out as part of the the ten year plan, but I don't think we have yet done enough to make this real, to turn this into something substantial. So I'm hoping over the next few weeks to say something more about our approach to neighborhood health, for example, and the way we need to bring services together to deliver more services in the community. What I would like Neighborhood Health very much to focus on.
initially is on frailty, on the frail elderly, and how you can have primary care, community services and acute services working.
initially is on frailty, on the frail elderly, and how you can have primary care, community services and acute services working.
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Jen Craft
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Jen Craft
I don't think we're going far enough on that yet. That is something we're going to have to shift and develop over time. I think we're just we're not we're not yet at a position to be able to do that. And as you know, look, in the end, we also have to make sure that things like the accident and emergency .
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Speaker 2
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Speaker 2
Give us the detail in writing. It would be very helpful. Yes, Jim, I was just going to say when when we set off on this last year, we did consider do we do we set out an overt upfront reduction in acute spend overall. If you remember, we had we had to get rid of a. 6.7 billion deficit last year. And largely that was in the acute sector. So the view was if we just make a cut there in an investment in community services without shifting flow, that would probably be a risk that we couldn't manage.
So the approach we've been following since then is we want people to develop neighborhood care and new pathways that move.
So the approach we've been following since then is we want people to develop neighborhood care and new pathways that move.
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Speaker 2
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Speaker 2
Allow patients to be treated somewhere else, and. incentivize that so that the workload drops in the acute setting, and then then funding drops in the acute setting as well. We're trying we're having discussions about various ways of incentivisation. I've got a discussion coming up with a group of GPS who want to own the outpatient budget, for.
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Andrew George
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Andrew George
Not remove the money, but not the work and causing more financial distress. Okay. And you'll you'll send us a written note about the quantification question. Just moving on to the, the changes which you've made since since you've arrived, Secretary of State amongst them, we, we certainly oppose and I certainly oppose the the, the merger of the Health services safety and investigation body Ahcip and many were campaigning against the the the scrapping of Health Watch, both of which have happened since your arrival. ICB mergers have been paused. I mean, this is quite a lot of chaos, isn't it?
As well as obviously making the right decisions, in my view. But but for those people that
As well as obviously making the right decisions, in my view. But but for those people that