Department of Health and Social Care

Andrew George Excerpts

Tuesday 24th June 2025 Commons Chamber

[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.

--- Later in debate ---

[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.