Urgent Care Centres: Hillingdon

Danny Beales Excerpts

Wednesday 10th September 2025 Commons Chamber

[David Simmonds]

I am grateful to the hon. Member. What he described is similar to the concerns outlined by my hon. Friends the Members for Beaconsfield (Joy Morrissey) and for South West Hertfordshire (Mr Mohindra) and others across the wider area, as well as by many people who have been in touch with me directly.

We know that minor injuries units in general, and the one at Mount Vernon in particular, are valued by people for whom A&E is not always the best place to seek treatment. Many local schools have been in touch to say that if there is an injury during the school day, minor injuries units are the ideal place for a child to get the treatment that they need. For older residents, particularly if they are not in the best of health and perhaps not up to the journey to an A&E department—many of which are under significant pressure—a minor injuries unit is the place to be. I know the Secretary of State and Ministers have responded very positively to the pleas of a number of Members across the House who have asked for the prospect of a minor injuries unit opening to serve their constituencies as part of the 10-year plan, so to see one lost that is already providing a good service seems to me a great shame.

The Minister will know that the Hillingdon hospitals NHS foundation trust has been financially challenged for many years; indeed, during my days as a non-executive director of the Hillingdon primary care trust, in the days of the last Labour Government, the overspend was significant. It is a challenge that has persisted to this day under Governments of all parties, despite numerous initiatives to try to resolve it. That is reflected in the poor state of the main hospital building, which is pending a rebuild. I should declare for the record that my wife is a doctor in that building. I know the Minister and the Government have accepted the programme of works set in place previously, which was granted planning permission by the local authority and announced under the last Government, to provide a new district general hospital at Hillingdon.

I am sure the Minister will know, because of her local knowledge, that we need to recognise that Hillingdon serves Heathrow airport as well as the normal district hospital population. The airport has a very large population of transitory people coming through it, many of whom are taken ill and add to the pressure on A&E. In addition, we have the largest number of asylum seekers per capita of any local authority in the country and a significant number of people in immigration detention, pending deportation. This is not just a hospital serving the normal day-to-day needs of the population area; it has particular and unique pressures, and a minor injuries unit is a means of beginning to take off some of that pressure for the benefit of local residents.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

My constituency neighbour perfectly describes the very difficult situation in Hillingdon inherited by the trust leadership and this Government, such as the hotels opened under the Conservatives putting pressure on the local system. I am pleased that the Government have committed to close hotels across the country and deal with this issue and are reviewing the fair funding of local authorities. That is much overdue in Hillingdon.

The hon. Gentleman describes the situation in Hillingdon hospital, with the need for a rebuild after 14 years with no funding. Again, I am pleased that the Minister, who knows Hillingdon very well—I am sure that did not influence the decision—finally provided the almost £1.4 billion that the hospital needs. Does the hon. Gentleman agree that those are positive steps forward? I agree that the decision on Mount Vernon hospital is concerning, and I have raised those concerns with the trust’s executive leadership myself. Does he agree that there have been positive steps forward on those long-term issues and that we need to continue to work together to improve neighbourhood healthcare?

[David Simmonds]

I am grateful that my constituency neighbour is here. Had he the same degree of history in Hillingdon as myself and the right hon. Member for Hayes and Harlington, I am sure he would recall that the hotels were set up and opened as part of a dispersal programme started under the Labour Government in the mid-2000s and led by Andy Burnham, who is now the Mayor of Greater Manchester. I know that has placed ongoing pressure on the local area, but the number of people put into that initial accommodation who are now stuck locally is very large.

I am sure the hon. Member for Uxbridge and South Ruislip (Danny Beales) shares my concern that, under the recent announcements about local authority funding, Hillingdon remains broadly the same as it always has been, but I welcome his commitment to carry on the work started under the previous Government for the rebuild of Hillingdon hospital. I know the right hon. Member for Hayes and Harlington will be very aware that the work undertaken on sewerage and electronics for that new build over the last few years has presented a significant challenge to residents in accessing the hospital—I am sure his constituents complain about it as much as mine have done.

Indeed, the challenges that will come during the rebuilding process of the hospital on what is currently its car park are a further argument for why a minor injuries unit is important in this period. It creates a bit of additional capacity to help with potentially challenging times at A&E and the difficult logistical challenge of accessing a hospital whose car park is already constrained and will be the building site for a new hospital. All those are additional reasons why a minor injuries unit remains important.

It is noteworthy in this context that the move away from an open access unit to appointment-only, which took place following covid, has significantly reduced the footfall at the Mount Vernon unit and has driven up the cost per visit compared with the previous position. This is part of a pattern that we have also seen in the Harrow part of my constituency at the Pinn medical centre, where the loss of a walk-in facility has led to more patients attending the local A&E, to longer waits and, ultimately, to increased cost to the NHS, because A&E attendances are more expensive than nurse-led walk-in services such as that which is available at Mount Vernon.

The Minister knows all this personally. She knows how much value the local community—not just in Hillingdon, not just in Ruislip, Northwood and Pinner, but across north-west London and into neighbouring Buckinghamshire and Hertfordshire—places on that service and how often Members of Parliament representing places like Watford and the Harrow constituencies have been in touch to share their concerns about the delays and challenges faced by patients attending A&Es in Watford, Hillingdon or Northwick Park, which are the main destinations for alternative treatment.

--- Later in debate ---

[Karin Smyth]

I will comment on that later. I understand that there is a meeting on Friday, to which I will allude.

In preparing for the debate, I met representatives of the trust, and I am grateful to those in the local NHS for their time in giving some further background. The trust is clear that it would be more efficient for urgent care services to be consolidated at the site in Hillingdon, bringing forward the urgent care nurse practitioner service at Mount Vernon into the urgent treatment centre at Hillingdon hospital. The rationale for having urgent treatment centres alongside A&E is well established clinically.

The hon. Gentleman referenced the 10-year plan—I am pleased he is such a fan—and the direction of travel. I am pleased to say that the trust also believes that people are better served by primary care hubs, so that more responsive care can be delivered closer to where people live. Three such hubs are being developed in Hillingdon, one of which will be in Ruislip. I am sure that he welcomed the announcement this week of the roll-out of the first of the 43 hubs, including the one in Hillingdon, which will deliver the neighbourhood health services model.

[Danny Beales]

Despite some of the heat in the debate, the misquoting of things that have been said and the unfortunate politicisation of this important local issue, about which there is general agreement among Members of all parties and in the community, the consensus that I hear is that people want more accessible services, more locally. There is a need for three hubs—the system wants that—and I am pleased that the Government have announced funding and prioritised Hillingdon. I have also heard that there is a potentially greater role for community pharmacies in providing urgent services and care. Does the Minister agree that more can be done by primary care providers across the board in Hillingdon and elsewhere?

[Karin Smyth]

I agree with my hon. Friend that that is the direction of travel that we want to see in all of our constituencies across the country.

The long-promised rebuild of Hillingdon hospital will be delivered by this Government as part of wave 1 of the new hospital programme. The money is guaranteed and construction will start between 2027 and 2028. We are already helping the trust to prepare for when we get spades in the ground, and it was a pleasure to visit the trust recently with my hon. Friend the Member for Uxbridge and South Ruislip.

The hon. Member for Ruislip, Northwood and Pinner raised the issue of consultation. I understand that there is a meeting with the trust, the integrated care board and the local authority on Friday, and I am sure that he and other hon. Members will be part of that. It is entirely proper for a Member of Parliament to raise issues about changes in their area—that is part of our democracy and democratic accountability. Now that this Government have put the new hospital programme in order, it is also proper for the House to hold us to account on its progress.

Defibrillators

Danny Beales Excerpts

Tuesday 2nd September 2025 Westminster Hall

[John Slinger (Rugby) (Lab)]

It is a pleasure to serve under your chairship, Mr Stringer. I thank my hon. Friend the Member for Bishop Auckland (Sam Rushworth) for securing this important debate. There can be no overstating the importance of publicly accessible defibrillators. If used within the first three to five minutes of a cardiac arrest, as hon. Members have said, they can increase the chance of survival by up to 70%. For a device that costs only a few thousand pounds, that is a truly remarkable statistic. I was told that stat by a remarkable constituent of mine, Naomi Rees-Issitt, at a defibrillator and CPR training session that she had arranged for the community. She knows more about the critical importance of defibrillators than most people, because she set up the OurJay Foundation after the tragic death of her son Jamie, who suffered a cardiac arrest. Although a defibrillator was nearby, it was inaccessible.

It is clear that a lack of accessible devices continues to hinder lifesaving intervention, but thanks to the incredible work of Naomi, her family and the OurJay Foundation, Rugby now has a significant number of accessible defibrillators. But it should not fall solely to charities and grieving families to bear the cost of this vital equipment. When the OurJay Foundation was established, Rugby had just seven 24/7 defibrillators for a town of 80,000 people. Today, thanks to its efforts, the number has risen to more than 170. They are triggered six to seven times a week. I welcome the Government’s commitment to improving access to automated external defibrillators, as hon. Members have referred to, so I will not rehearse that. The Government have also committed to providing a defibrillator in every state-funded school in England. Sadly, there remains no legal requirement for organisations to make AEDs available on their premises, although many have done so voluntarily. Could the Minister comment on whether the Government are considering this?

Naomi and the OurJay Foundation are also campaigning for AEDs to be put in every police car. Recent Home Office funding, which was very welcome, has enabled additional defibs for every force. Warwickshire police has secured 30 new defibs, which it is putting in specialist operations vehicles. I saw that for myself, alongside Naomi, and met the officers whose dedication to the public I commend. The urgency is underlined by recent figures from the Resuscitation Council, which show that out-of-hospital cardiac arrests in the UK have risen to 40,000 each year. The survival rate remains a devastating one in 10.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend the Member for Bishop Auckland (Sam Rushworth) for bringing this important discussion. My hon. Friend the Member for Rugby (John Slinger) rightly points out the survival challenge. We know that survival is improved with quick access to these vital devices. Many Members have described deserts of access to these devices in their constituencies. In my own constituency there are only four devices per 10,000 people, so 70% of people do not have access in the three to five-minute timescale that my hon. Friend recommended. Does he agree that to improve that stat, it is vital that we get more devices in the community and, fundamentally, that we make it cheaper to access these devices for community groups, local and national Government and the police forces that he mentions?

[John Slinger]

I agree entirely. Obviously, there is not an unlimited amount of money, but we—whether Government, hon. Members, charities or businesses—must do everything we can to ensure more devices in our communities.

I will conclude by saying that Naomi is calling for Jamie’s law. This would make it mandatory for all police vehicles to carry defibrillators. I am sure that hon. Members in and beyond this room would agree that across our country we should do everything we can to increase the number of defibrillators, and am sure that I am not alone in having lost a friend who died young from a heart attack. I pay tribute to Naomi Rees-Issitt for her effort and her dedication to saving lives in the community in memory of her son. She is an example to all of us of taking action to save lives.

Services for Adults with Learning Difficulties: Hillingdon

Danny Beales Excerpts

Friday 4th July 2025 Commons Chamber

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I rise to discuss services for adults with learning difficulties and disabilities in Hillingdon. Approximately 1.3 million people in England have a learning disability. If we include those with learning difficulties, that figure is even higher. Yet too often our services, education system, NHS, workplaces and society as a whole are not inclusive of their needs, and they are often seen as an afterthought.

I was motivated to bring forward this Adjournment debate having recently had the privilege of meeting many adults with learning disabilities and difficulties and their families in the borough of Hillingdon. They expressed to me that, again, they feel like an afterthought, as they were appalled by the council’s recent decision to close another vital service for adults; many other services have been closed, moved or cut in recent years.

Before turning to the specific important services that have been lost or are under threat, it is important to note that, of course, many good organisations are working hard in challenging circumstances to provide support. In the NHS, the Hillingdon community team for people with learning disabilities provides specialist support for adults with learning disabilities in the community and across primary and secondary care. Those services, however, are largely around diagnosis and access to medical support—just one aspect of an adult’s needs.

DASH, a voluntary sector group, offers a range of sporting and recreational activities for people with a disability, all focused on encouraging people to socialise, but it too has struggled with decreasing funding in recent years. Hillingdon Autistic Care and Support provides an autism hub, advice and social activities for adults in the London borough of Hillingdon, but the slashing of its budget in 2023 led to the closure of the popular tea rooms—a café open to the public that offered training and work support to adults with autism. Unfortunately, that was a sign of even more damaging cuts to come. Following those proposals, an e-petition signed by 3,330 people called on the council not to withdraw the funding for the tea rooms. Despite that, the council pressed ahead, claiming that 20 people benefiting from training and support was not good value for money—a disappointing sign of things to come, with a council knowing the price of everything, but the value of nothing.

More broadly in the area of education, the Park View centre, part of the Orchard Hill college group near Uxbridge, has a range of on-site vocational opportunities. The college does excellent work in challenging facilities that were not purpose-built. I recently had the privilege of meeting a number of their learners and staff, and they showed me at first hand how much they have to offer our community and workplaces. As well as insisting I attend their next disco, their overwhelming message was that they love their job coach Holly, but unfortunately, there was only one Holly in the whole of the college. They wanted more work coaches, placements, internships and job coach support. Yes, learning is vital, but they wanted it to lead somewhere in adult life. They wanted real workplace experience and, ideally, a full-time or part-time role.

The Government’s commitment to invest more than £1 billion into workplace support for those with disabilities is a welcome step forward. I hope that the Department of Health and Social Care and the Department for Work and Pensions will work together to ensure that this investment is also targeted to help adults with learning difficulties get the support they desperately need.

Data suggests that the employment gap for people with a learning disability is still far too wide. Of the people accessing long-term social care, only 5% of those with a learning disability are in paid work, which is a shame on our society. Charities have previously called on the Government to set a new ambitious target for reducing the disability employment gap with strategic actions behind it. A previous Secretary of State for Work and Pensions said in March 2023 that he would set a new disability employment goal, but progress has been slow, and I hope the two Departments can work together to progress that. Such a gap is why supporting work placements, centres for training and volunteering is vital.

Following the closure of the Hillingdon tea rooms, another such facility is now under threat. There is a strong community-led campaign to save the Rural Activities Garden Centre, which provides employment opportunities, skills, lifelong relationships and a connection to our community for adults with learning difficulties across west London. Conservative-led Hillingdon council took the decision just last week to slash that vital service.

I have been shocked and saddened to see how the voices of adults with learning difficulties and their families have been silenced in this discussion, not even being allowed to speak or question the decision at the civic centre. We are now in this Chamber, and we can ensure that their voices and stories are heard; a number of them are in the Gallery with their families.

George is 28. He was separated from his parents at birth due to their inability to care for him at that time. He has spent years unable to eat without a feeding tube and has battled self-harm throughout his life. After decades of struggle for specialist support, four years ago George found something precious: a community at the Rural Activities Garden Centre, where he feels valued and understood. Since the announcement, and as a result of the fear that that vital support system may be stripped away, George’s challenges have again become overwhelming.

Oliver has been attending the RAGC for 10 years and has complex health needs. He is partially sighted and has severe learning difficulties and chronic kidney disease. More recently, he has suffered from post-traumatic stress disorder. Oliver’s battle with mental health impacted on his ability to do day-to-day tasks and the usual activities that brought him joy, but one comfort remained: the RAGC.

There is also Doug, who I have had the pleasure to meet. He is an adult with learning disabilities that impact on his ability to read, write and count. Where the private sector was unable to provide support to Doug with his additional needs, the RAGC saw past what he could not do and nurtured what he could. It watched him transform from a shy young man into a confident 32-year-old with purpose. After the closure meeting, Doug asked a simple but heartbreaking question: “Where do the staff go? What happens to me and my mates?”

I was also told of Georgia’s story. Before joining RAGC, she struggled with anxiety and undiagnosed autism, leaving her imprisoned in her own home. The garden centre helped her to develop skills and build confidence, and she even went on to compete in a wreath-making competition. It was the service now under threat that transformed her from someone who could not leave the house to someone who could confidently serve customers—what a transformation. She fears the closure will reignite those same issues that she has worked so hard to manage.

The difficulties of day-to-day life are often felt more acutely by adults with learning difficulties. It is the sanctuary that places such as the RAGC provide that makes it imperative we continue to fight for their survival. The Rural Activities Garden Centre makes employment opportunities, personal development and skills curation accessible for those who are often isolated. I have met so many people from right across the community who have volunteered there, gained skills and even moved into permanent jobs as a result. Families feel that their loved ones are cared for, safe and nurtured in this space, and it has given carers and families their own ability to have respite and time to care for themselves.

[John McDonnell (Hayes and Harlington) (Ind)]

I congratulate the hon. Member on securing this debate. He will know that the garden centre also provides an essential service to my constituents. I have visited the place for either 20 or 30 years—I am not clear—and it was commended by the former Conservative leader of Hillingdon council, who called it a jewel in the crown. That is why it has come as such a shock that this Conservative administration is now willing to close it with such brutality. Does the hon. Member agree that the council should, even at this late stage, think again and consult properly—including all those volunteers and parents as well as the people who use the centre—to look at a wider range of options? This does not have to happen now: the council just needs to listen to us.

[Danny Beales]

I concur completely with my right hon. Friend. We have both met those affected, their loved ones and their families, and we can really hear and see the value. Unfortunately, that value was not considered in the rushed decision made by the councillors—I will turn to the lack of consultation very soon, and I completely agree with him about that. It is not too late and, like him, I hope that the council thinks again.

The Rural Activities Garden Centre is another in a long list of closures at the hands of the local council. Following years of financial mismanagement by the leadership, the modus operandi has become to cut through its crisis. While the council’s cabinet sees nothing more than a line on a spreadsheet, behind this move are adults with learning difficulties, whose lives have been transformed by this service and who risk losing it all as a result of the council’s decision. By its own admission, it views the decision of the closure through the lens of profit. Failure to turn a profit means inevitable closure to Hillingdon council. That was the reason quoted at the recent decision-making meeting, but should social services have to make a profit to survive? To me, it defeats the objective of those services. By that logic, one wonders what will be cut next by Hillingdon council? What other social services or schools will it have in its sights?

This heartless approach to community services aside, Hillingdon council’s binary decision making in relation to profit is economically flawed. These services are not costs; they are investments in the future. The National Audit Office calculated that supporting someone with moderate learning disabilities in residential care costs £4.7 million over their lifetime. With proper community support such as the RAGC, that drops by £1 million. We save money while giving people the dignity, purpose and independence they deserve.

Perhaps the council’s inability to understand this basic economic principle of investment and returns sheds some light on why it is about to go bankrupt, receiving damning reports from its own chief financial officers. Still, Hillingdon council dismisses the RAGC as merely a “retail service”. Tell that to George, Doug, Oliver or Georgia. Tell the families who have watched their loved ones transform from isolation to independence that this is a “retail service”.

I recognise that there are similar stories across the country, unfortunately, scattering services, breaking up communities and destroying what works for short-term savings that create long-term costs, with our most vulnerable communities always the first to feel the brunt. The Rural Activities Garden Centre works. Its clients thrive. Their families are supported. The evidence is overwhelming, but evidence means nothing without political will, and political will means nothing without adequate funding.

We are not asking for the impossible. We are asking the council and this Government to back choice and independence for adults with learning difficulties and care packages and to recognise that supported employment is not a luxury to be cut when times are tough; it is a vital investment that pays dividends in human dignity and economic returns for national and local government.

The Rural Activities Garden Centre must be saved. Services like it across England must be protected. The people who depend on them deserve nothing less than our absolute commitment to their dignity, their potential and their right to belong. I appreciate the Minister giving up her time to be here today, with so many pressing issues across the health and care system. There are some specific issues I hope she will take away for further consideration.

First, I and local families would like to welcome the Minister to Hillingdon to meet disabled adults and those with learning difficulties, to hear their experience of a fragmented system and a council and NHS not working together as well as they could and should, which I hope could inform the broader review of social care taking place nationally.

Secondly, the Women and Equalities Committee report in 2023 on inequalities for people with learning disabilities outlined clearly that people with a learning disability, and those who care for them, are the real experts when it comes to their health and care needs. However, aside from the occasional opportunity to feed into consultations, far too often their voices are missing when it comes to decision making at both a local and national level. Their lived experience should be better reflected in efforts to reduce health inequalities and improve outcomes.

I hope the Government will look at how they can embed co-production and meaningful engagement in decision making on care packages and services and ensure that those with care packages and support are genuinely consulted and engaged in any service changes. There must also be clearer guidance for providers and commissioners of services about consultations and full equality impact assessments being conducted before services are changed, which has been woefully lacking in this case.

Thirdly, the NHS 10-year plan, launched yesterday, included welcome announcements about supporting people with health budgets, giving people personal health plans and a shift to prevention and community-based working for the NHS. Will the Minister address whether we can and should expect the same principles to lead work on adult social care support, too?

Fourthly, on enabling joint working, the Public Accounts Committee report in 2017, “Local support for people with a learning disability”, found that people with a learning disability who live in the community have patchy access to healthcare and limited opportunities to participate in the community—for example, by having a job. While the Department has the policy lead for people with a learning disability and care plans, responsibility for their support spans across Government. We even found that to be the case when discussing which Department should respond to this debate. Responsibilities cross the Department of Health and Social Care, the Department for Education, the Department for Work and Pensions and the Ministry of Housing, Communities and Local Government.

In its report, the Public Accounts Committee recommended that Government should

“set out a cross-government strategy for improving access to health care and opportunities”

for adults with learning disabilities to

“participate in the community, including employment, as well as how it will measure the effectiveness of this strategy.”

I hope we can return to this in future, because clearly all these Departments bear some oversight and responsibility for this important group of the population.

Lastly, I hope the Minister will join me in thanking Oliver, Doug, George and Georgia, as well as all the service users and their families, for building this project from scratch, many decades ago, planting the first trees, building the first planters, volunteering to keep it going in difficult times and creating this amazing life-changing project, and now also for their campaign to fight for its survival. I hope that Hillingdon council will think again, take the time to genuinely listen and get the decision right, working with the community. In the absence of that, I hope the Government will prioritise adults with learning difficulties in services like this one.

We were elected a year ago today on a manifesto of change, investing in people, transforming life chances and providing everyone with opportunity. These are the things that the Rural Activities Garden Centre, and so many other services in Hillingdon, have done, and can continue to do, for countless people in the borough of Hillingdon.

Department of Health and Social Care

Danny Beales Excerpts

Tuesday 24th June 2025 Commons Chamber

[Paulette Hamilton (Birmingham Erdington) (Lab)]

I am delighted to open this debate on the Department of Health and Social Care’s main estimate. My remarks will focus on the recent spending review, which includes some welcome funding increases and sets out some ambitious reform objectives. However, it also raises questions about deliverability, particularly of objectives to do with capital investment, efficiency savings and the role of social care.

Let me begin with capital investment. The Government have rightly emphasised the need to shift from analogue to digital systems across the NHS. The increase of nearly 50% in technology and transformation funding will mean that it reaches up to £10 billion by 2028-29, which is a welcome and substantial commitment. However, the NHS has a poor track record on digital transformation. The National Audit Office has highlighted the risks around fragmented delivery, unclear governance and unrealistic timelines, and those lessons remain highly relevant. Its 2020 report on digital transformation in the NHS found that despite £4.7 billion in national funding, many trusts were still reliant on systems that were outdated and not integrated.

The capital budget is being asked to do a great deal more than achieve digital transformation. The Government have committed to the new hospital programme, and to addressing critical infrastructure risks, such as those posed by reinforced autoclaved aerated concrete. Over five years, £30 billion is allocated for maintenance and repair, and £5 billion is allocated for critical risk. However, by the end of the decade, there will be no real-terms uplift in the capital allocations, compared with this year. In fact, in 2027-28, the funding settlement actually falls to £13.5 billion from £14 billion the previous year, meaning that inflation in construction costs and materials will significantly erode its purchasing power. The British Medical Association has warned that current funding cannot cover both the new hospital programme and essential maintenance, and now that programme must also compete for funding with the vital digital transformation. Can the Minister explain how the Department will choose its priorities from those competing essential demands on the capital budget?

Turning to resource spending, the Department’s day-to-day budget will grow by an average of 2.7% per year in real terms. That funding will be used to deliver several welcome commitments, including investment in elective recovery and urgent and emergency care; a £4 billion increase in adult social care funding; 700,000 additional urgent dental appointments annually; 8,500 more mental health staff; and £80 million a year for tobacco cessation programmes. Those are all positive steps.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend for giving way, as well as for her excellent chairing of the Health Select Committee at the moment and for opening today’s debate. Does she agree that this Government’s record investment in our health service will be vital to turning around the health service after 14 years of under-investment and a lack of reform? As my hon. Friend has touched on, that investment also needs to be targeted to enable the three shifts that the 10-year plan talks about. In particular, we need to reverse the trend of more spending going towards secondary care while less goes to primary care. We need a big uplift in dentistry, which my hon. Friend has mentioned, but also in primary care—in GPs—and in pharmacy.

[Paulette Hamilton]

Hear, hear. My hon. Friend makes some valuable points, and I agree with every one of them.

Underpinning the settlement I have described, however, is the Government’s pledge to generate £17 billion in efficiency savings over three years, with a staggering £9.1 billion expected in the final year of this Parliament. Critically, those savings have already been factored into the settlement—in effect, they have been spent before they have been delivered. In the light of that, we need absolute confidence that there is a clear and robust plan to generate those savings. The Government are assuming an annual productivity improvement in the NHS of 2%, more than triple the long-term average of 0.6%. They appear to be relying on digital transformation to unlock the bulk of those savings, which is risky, given the history of digital change programmes in the NHS.

Another source of savings is the plan to cut reliance on temporary staff by reducing sickness absence and overhauling staff policies, including limits on agency spending and eliminating the use of agencies for entry-level roles. Again, this is a welcome ambition, but delivering it will be a significant challenge, one that will require meaningful, sustained improvements to staff wellbeing and working conditions. We cannot build a sustainable workforce on good will alone. Therefore, will the Minister say when we can expect an updated and fully costed workforce plan to deliver on these ambitions?

Delivering the reforming elective care for patients plan is also central to achieving those efficiencies. It proposes reforms such as optimising surgical pathways through hubs, streamlining referrals, expanding remote monitoring and reducing unnecessary procedures. The plan assumes a rapid transformation of services, with significant improvements in productivity and patient flow expected within just a few years. That is ambitious, especially given the context of ongoing workforce shortages, ageing infrastructure and rising demand. Reform is essential, but it must be realistic, properly resourced and paced to succeed. We cannot afford to set targets that look good on paper but falter in practice, damaging morale and patient care. What steps is the Minister taking to ensure that the projected £17 billion in savings will materialise and be delivered on time? What happens to those additional resources for frontline delivery if those savings are delayed or fall short?

I will also touch on adult social care, which is in desperate need of reform. The Casey commission has an important job to do, but the terms of reference for the first phase of Casey’s work state clearly:

“The commission’s recommendations must remain affordable, operating within the fiscal constraints of Spending Review settlements for the remainder of this Parliament.”

Now that those settlements have been reached, can the Minister provide clarity to the House about precisely what fiscal constraints Baroness Casey’s recommendations will have to conform to? The £4 billion for adult social care announced in the spending review includes an increase to the NHS minimum contributions to the better care fund.

Prostate Cancer Treatment

Danny Beales Excerpts

Tuesday 17th June 2025 Commons Chamber

[Dr Huq]

I completely agree with the hon. Gentleman that access should be based not on how deep somebody’s pockets are, but on need.

Abiraterone halves the risk of relapse. Each relapse literally costs the NHS millions—the definition of lose-lose. As many Members have pointed out, it is already successfully available on the NHS and routinely funded for use in metastatic cases in England, but sadly there is a catch: abiraterone is not available on the NHS for men with non-metastatic prostate cancer living in England.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend for bringing forward this very important debate for her constituents, my constituents and people in the UK. Does she agree that since this issue was last assessed by the National Institute for Health and Care Excellence, there have been significant developments, as has been mentioned by other colleagues, both in the provision of the drug in other nations and the fact that it is now available off-patent, so it is much cheaper to access? That will fundamentally change the cost-benefit analysis that NICE did previously. Does she agree that her constituents and my constituents need this drug just as much as patients in Scotland and Wales who are benefiting from it?

[Dr Huq]

I totally agree. West London needs the same as the west of Scotland, the west of Wales, and all the other bits of those other nations. Men can access abiraterone on the NHS in Scotland and Wales, but not in England, even with an identical diagnosis. It seems at best anomalous that their postcode, not their prognosis, is determining their treatment, and we all know that the NHS is meant to be free at the point of need.

I would give anything to have had longer with my dad. I was reminded of him when, like the hon. Member for Harrogate and Knaresborough (Tom Gordon), I had someone come to see me: Peter Treadgold, who came to my advice surgery and pointed out that he is falling between the cracks. He had a long-standing diagnosis, with remission, and he diligently followed all the advice. He was under NHS monitoring for 20 years because he had heightened prostate-specific antigen levels, although he was never actually offered an MRI or ultrasound scan. Last year, his cancer came back, and he was told that he would need hormone and radiation therapy; abiraterone was not offered. Peter is one of the one in three people who get the devastating news that their cancer has come back, and has been denied access to a treatment that could save or extend his life.

The first time I heard of abiraterone was when I met Peter, because as my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) said, in my dad’s day, it would not have been cost-efficient. However, it is now a generic drug—it has gone off patent—but it is licensed only for metastatic cases. As my hon. Friend the Minister knows well, there is a complicated, convoluted process involved in getting it approved for non-metastatic cases. There is no question about the effectiveness of abiraterone. It has had one of the biggest trials known to mankind, a genuinely world-beating trial. When NHS England’s own clinical priorities advisory group plotted the clinical benefit against the net cost, abiraterone scored highest in that tabulation. It is calculated that two years of abiraterone treatment would halve the death rate for men with locally advanced prostate cancer, but we hear about budgetary challenges. I have written to the Minister and tabled questions, and have been told that NHS England has not identified the recurrent budget to support provision of the drug.

We should look long-term, at the remissions, and at the cost of chemotherapy, hospital appointments and other associated things. Those costs add up. University College London found that abiraterone would pay for itself if it were £11 a day. Do Members know what the NHS is actually paying? Does anyone want to hazard a guess? Oh, we are not doing call and response. Abiraterone costs £2.75 a day, now that it is off patent and has come down in price. That is less than three measly quid to avoid costly relapses, scans, chemo, hospital appointments and everything else—less than three little round ones to improve lives and reduce deaths. As we have heard, only people who can fork out up front for private treatment or private medical insurance currently have that option, and again, our NHS was not meant to be for private profiteering or big pharma drug pushers. People are seeing their pensions and life savings evaporate, and we are in a cost of living crisis. This drug should be universally available.

It took less than one year for abiraterone to be approved for men with non-metastatic prostate cancer in Scotland and Wales. In England, it is now three years and counting, and we still have not had a concrete resolution. Right now, abiraterone is the cheapest and most cost-effective it has ever been, and as the excellent Prostate Cancer UK put it, the postcode lottery must end. Lord Darzi’s independent investigations into the NHS found that the UK had higher cancer mortality rates than other comparable countries, and sadly, progress in diagnosing cancer at stages 1 and 2 is flatlining. Just over half of prostate cancers are caught at an early stage. That falls well short of the NHS target of 75%. I appreciate that Labour has just come into power after 14 years of the Conservative party, so it will take time to fix our health system, but we need it to be more responsive—to act early and rapidly, to use all the tools it can, and to offer preventive rather than after-the-fact care in every case. Abiraterone exemplifies all those things.

I welcome the Chancellor’s 3% real-terms increase in NHS spending to deliver the exciting plan to build an NHS fit for the future. With the 10-year plan coming soon and the national cancer strategy due this autumn, we have a real chance to deliver significant improvements for people living with cancer, so as is customary, I have a list of questions for the Minister. I will incorporate those of my hon. Friends—I think we are all friends here, even if we sit on opposite sides of the Chamber.

First, will the Minister commit to exploring ways of ensuring that additional NHS funding is used to make abiraterone available to all men who need it in England—and in Northern Ireland, as the hon. Member for Strangford (Jim Shannon) has pointed out? Secondly, will the Minister support the introduction of a national programme of screening for prostate cancer, like those that we have for comparable cancers in the United Kingdom? Thirdly, given the complexity of NHS England’s decision-making processes in relation to the availability of abiraterone—which sound like a right old bureaucratic nightmare—as the functions of NHS England are transferred back to the Department of Health and Social Care, will the Minister take steps to ensure that all decisions about access to medicine, including abiraterone, are timely and transparent? I know that she has had a long career in the NHS, and as I have said, she is on the side of the angels.

Fourthly, will the Minister commit to publishing an equality impact assessment, given the disturbingly disproportionate effect that prostate cancer is having on black men, who are more likely to develop it and to receive a late diagnosis, and less likely to receive the right treatment? I am doing this partly for Dad, who is watching from somewhere up above, but also for the black and minority ethnic men who are implicated here and now. This is the second time that you have been in the Chair, Madam Deputy Speaker, when I have been talking about health inequalities since Friday, when we discussed assisted dying. You have chaired both debates excellently.

Fifthly, in the light of the lengthy approval process, will the Minister assess the adequacy of the funding formula model—we have NICE and we have the Medicines and Healthcare products Regulatory Agency, and it all seems a bit knotty—and consider whether novel pharmaceutical treatments could be produced cost-effectively, especially, as my hon. Friend the Member for Uxbridge and South Ruislip said, when they come off-patent. I am arguing for simplification in cases in which drugs are already prescribed for limited use and there is a credible case for expanding their application to a generic treatment. We are halfway there; we just need to go that little bit further.

Prostate Cancer UK estimates that 672 men die prematurely each year because we have no access to abiraterone. Each week that this continues, 13 men in England will die from a cancer that could have been treated cheaply had they lived in Scotland or Wales. Labour is the party of the NHS, and a Labour Government introduced the UK’s first dedicated cancer strategy; so let us go for this win-win for all, end the iniquitous, unjust postcode lottery, celebrate the best of British science, and widen access to abiraterone for all those who need it, not just those who can afford it.

Hospitals

Danny Beales Excerpts

Wednesday 23rd April 2025 Commons Chamber

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I am glad that we are taking the time today to discuss the immensely important issue of the state of our NHS hospitals. Nowhere is it more obvious that our NHS has been broken over the past 14 years than in our crumbling NHS estate. Our NHS has been starved of capital funding, and the backlog maintenance bill now stands at more than £11 billion. Research from the NHS Confederation shows that nine in 10 NHS leaders believe that the crumbling NHS estate is undermining their ability to tackle the elective backlog. This is devastating. It is apparent in my constituency, with Hillingdon hospital plagued by flooding, sewage overflows, failing lifts and outdated equipment.

The need for a new hospital in Hillingdon is not new—my predecessor’s predecessor described the hospital as no longer fit for purpose many years ago, and pledged at the time to replace it. The Lib Dems are right today in their condemnation of the previous Government’s record, with their fantasy hospital programme that seemed to exist only in the mind of Boris Johnson, and never in the reality of the Treasury’s decisions. Residents in Uxbridge have been led up the garden path time and again, with false promises upon false promises, a funding package that was never approved and building works that never began—to this day, not a stone has been laid and no ground has been broken. At the election, no business case had been agreed, the hospital design was still being tweaked, and no contractor had been appointed. Rather than being fully funded, only £70 million of £1 billion had ever been provided.

I am glad, therefore, that the Labour Government have prioritised capital investment, with capital spending increasing by £13.6 billion in the Budget, and I am grateful for the progress we are now making with a realistic, honest and deliverable timescale for the programme. After years of broken promises, people are fed up and need action, delivery and credible commitments. That is why it is disappointing that the Lib Dem motion today, if approved, risks leading again to unfunded commitments, promising to deliver all the hospitals simply through a new taskforce. That is not how hospitals are built or paid for. It does not feel to me like a credible funded programme; instead, it is a recipe for more talk, more delay and more inaction.

I know that the community in Uxbridge and South Ruislip are now reassured that Hillingdon hospital has been included in wave 1, with a capital envelope agreed in recent weeks of nearly £1.4 billion. Instead of more words or a taskforce, we have delivered solid agreements and funded commitments—a real plan for change. The hospital is now finalising its business case and design. A contractor will be appointed and on site in 2027, and construction work will start in 2028. It is essential that the new hospital programme continues to work at pace to provide my constituents and all residents in this country with the quality of care they deserve. I am sure the Minister would expect all Members to hold the Government to account for the delivery of the programme.

Turning to the concrete actions we could take to deliver the hospital programme more quickly, long-term revenue funding for new wave 1 teams is much needed so that they can work at pace, as well as a simplified planning process for new hospitals. I welcome the Government’s planning reforms and Planning and Infrastructure Bill. I hope that Lib Dem Members will support the Bill, which seeks to speed up the delivery of critical national infrastructure.

As well as investment in hospitals, we need investment right across our NHS estate, as has been discussed today. I have met GPs who are using store cupboards as consulting spaces and heard from pharmacies that want to do more but are desperately lacking the space to deliver Pharmacy First services in privacy. The Wakley centre, which provides sexual health services in my constituency, is crammed into an outdated building, using every inch of space, and is desperate for more modern space to do preventive work.

[Edward Morello (West Dorset) (LD)]

I agree entirely with the hon. Gentleman on the need for investment outside of hospitals, but does he agree that we also need smarter investment? Dorset NHS foundation trust, along with Somerset NHS foundation trust and university hospitals Dorset, has submitted a business case for an integrated electronic health record system that would allow them to work together, share information and, ultimately, save the NHS money. Does he agree that this is exactly the kind of technological advancement the NHS should be funding?

[Danny Beales]

We need to think not just about buildings, but about digital infrastructure and investment in a whole range of capital investment needs for the NHS for it to be a modern, fit-for-purpose service. It sounds like the measures the hon. Gentleman suggests are sensible.

There is a strong desire in the emerging 10-year plan to shift to neighbourhood health services, which would also require capital investment. Three neighbourhood hubs are planned in Hillingdon, but there are still no clear sites and no capital investment to make them a reality. We need a long-term infrastructure strategy for the NHS, alongside our 10-year health plan. I welcome the significant increase in capital spending for the NHS at the Budget. I also think the Government’s new commitment to protect capital budgets in the NHS is vital. Far too often, under the previous Government, those budgets were raided for short-term investment to plug revenue-based gaps; now that has come to an end, which is very welcome.

My constituents have waited long enough for Hillingdon hospital. We do not need more taskforces or reviews, but concrete funded plans of action. At last, we have from this new Labour Government a fully funded new hospital programme ready to be delivered. I look forward to construction starting and working with this Government to deliver health services that are fit for the future.

NHS England Update

Danny Beales Excerpts

Thursday 13th March 2025 Commons Chamber

[Wes Streeting]

And my friends at DCMS with their considerable spending power. No, I will stick with the Treasury in my order of favourites, thank you very much. I know where my bread is buttered.

To return to the point made by the right hon. Member for Salisbury (John Glen), I thank Dame Jenny Harries for her leadership of UKHSA. We are recruiting for an outstanding replacement and successor, and that is an opportunity to look in the wider context at some of the first principles. The right hon. Gentleman mentioned the specific, traditional Porton Down versus Harlow decision, which has been running around the system so long that is now used in a case study for senior civil servant recruitment. The worst decision is indecision. It has plagued us for too long and I hope we can soon report back to the House with a decision on that for everyone’s benefit.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I welcome the statement today from the Secretary of State. Clearly, there is massive duplication of functions across the many regulatory, national, local and regional NHS bodies and huge room for efficiency.

I want to press the Secretary of State on two points. First, will he assure me that the bonfire of bureaucracy will not stop effective local management of NHS trusts and community settings, as IPPR has found that locally the NHS is poorly and under-managed and clinical staff are backfilling admin and management roles? Secondly, as he mentioned, the roll-out of digital technology has been far too slow, with NHS Digital’s move into NHS England not directing change fast enough, so how will the change ensure that the Department of Health and Social Care grips the digital roll-out, accelerates it and ensures the proper integration of NHS digital functions?

[Wes Streeting]

That is a great question from my hon. Friend. We have to give people the tools to do the job. The Prime Minister set me and my hon. Friends in the Department an enormous challenge on behalf of the public. In turn, I am setting an enormous challenge for NHS leaders at every level, but particularly for frontline NHS leaders. We have to give them the tools to do the job in terms of data platforms and the technology that they are given to work with, ensuring that they have access not just to cutting-edge treatments and medical technology, but to the back-office productivity support that can drive efficiency and improvement and, frankly, liberate managers and frontline staff from the arcane systems they are working with.

Some of the very best people I have met in the last few years, shadowing this portfolio and now holding it in government, are NHS leaders, especially on the frontline. It is my responsibility to give them the tools to do the job. That is not just about financial resources; it means bulldozing through some of the regulatory barriers and overcentralised instructions that stop them making decisions in the best interests of patients, in terms of clinical pathways and value for taxpayers. I have given them an undertaking that I will have their backs, both on the decisions that they will have to take on the frontline and on bulldozing through the national bureaucracy that is tying them up in knots when we need to set them free.

Department of Health and Social Care

Danny Beales Excerpts

Wednesday 5th March 2025 Commons Chamber

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

When the Labour Government came into office last year, the NHS was in a critical state. Its fundamental promise to be there when we need it had been broken. The uplifted funding package is the first step on the road to making good that promise once again, but the pressures facing our health and care system are not over. Our system needs fundamental reform as well as investment, and achieving the ambitious 4% efficiency targets on which the Budget is premised will be challenging and will require change.

It is vital that we secure additional capital investment. We saw the previous Government continually raid the capital budgets of the NHS to balance the books, leaving the long-term productivity issues that we face today. I have seen in my own constituency hospital wards closed and unable to do procedures, and pharmacy and sexual health services desperate to do more but without the clinical space to expand. The £3 billion uplift in the future capital budget is therefore very good news. In her response, will the Minister outline that commitment to protecting capital budgets and maximising them to deliver the change that we need to see?

Through my work on the Health and Social Care Committee over the past few months, I have heard time and again, and it has become increasingly apparent, that to achieve the three shifts that the 10-year plan addresses we will have to bring together health and social care budgets and change financial flows to provide long-term funding settlements for both sectors. We will also have to fix the front door of our NHS, which is primary care, to which I will address the rest of my comments.

Primary care is best placed to provide preventive advice that keeps people well and deliver community-based healthcare that keeps people out of hospital. Yet it is precisely those primary care services—GPs, dentists, pharmacists and optometrists—that faced some of the harshest underfunding and neglect over the last 14 years of Conservative mismanagement. The Government’s new deal for GPs, announced last week, is a welcome first step in improving primary care provision, but GPs cannot do it alone. Primary care is much more than just general practice, and other components of primary care are still in a state of crisis.

Community pharmacies are on the same flat funding contract that expired in late 2024, and that funding model is clearly inadequate. Healthwatch has estimated that 400 pharmacies were forced to close permanently in the last 12 months. I recently visited Boots pharmacy in my constituency and saw the great work that it is doing on vaccinations, health advice and so much more, and it is desperate to expand the range of services it offers.

On optometry, having recently met the team at Uxbridge Specsavers, it is clear to me that optometry is much more than just glasses and contact lenses. Through advanced testing, they have recently diagnosed people with a range of conditions, such as high blood pressure and even brain tumours. On dentistry, the dental contract is no longer fit for purpose, with many practices no longer delivering NHS appointments and those that are doing so at a financial loss. In Uxbridge and South Ruislip, the majority of practices are now closed to new NHS patients—both adults and children—and that clearly cannot go on. With that in mind, the provision of 700,000 extra urgent dental care appointments on the NHS, announced last month by the new Government, is a vital and desperately needed action. But clearly, more is needed.

Will the Minister confirm whether the dental budget will continue to be ringfenced? Will we ensure that, unlike the last Government, we will not underdeliver and underspend on the vitally needed dentistry budget? Will she also confirm that negotiations for the new dentistry contract will begin in earnest this year to permanently fix the dentistry crisis?

The mental health investment standard has been crucial in protecting mental health spending, as part of a vital shift to giving mental health parity of esteem. As we shift to neighbourhood health, I hope the Government can explore how to better track community-based health and preventive spending, ideally protecting and growing the share of the NHS budget seen by primary care.

The task of rebuilding our health estate and our primary care system is an immense challenge. However, it is not insurmountable. Labour has turned around the NHS before, and I am confident that this Government will do it again, creating a genuine community-based health and care system.

New Hospital Programme

Danny Beales Excerpts

Wednesday 22nd January 2025 Westminster Hall

[Karin Smyth]

I thank the hon. Gentleman for his intervention. We had a good discussion yesterday about North Devon; I understand the rurality of that location, as it is fairly close to my Bristol constituency. Obviously, however we manage it, there are a lot of schemes represented by a lot of MPs. I am open to suggestions about how we go forward. I hope hon. Members feel that we have tried to give as much information as we can to them and the trusts in the announcement and the meetings yesterday. That is the spirit in which we will continue.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I welcome the spirit of openness and transparency that the new leadership of the programme has demonstrated. Previously, and frustratingly, residents in Hillingdon were—to be frank—led up the garden path. We were left with all but an IOU note for £750 million for a new hospital. The revenue funding for the new hospital ran out this year. We were pleased to see it renewed, and to be in wave 1; a significant capital investment of more than £1 billion has been committed to.

This is complicated: it is hard to deliver projects at this scale. With the best will in the world, if another £20 billion were to appear, despite the Conservative party opposing any methods that would raise money, the construction sector would struggle to build all these hospitals at once. Is it not the case that it is challenging to deliver this project at scale? Will the spirit of openness and transparency continue?

[Karin Smyth]

I thank my hon. Friend for his continued campaigning on behalf of the residents of Hillingdon; I used to be one of them. Talking to people is really important, and we have learned a lot from it. In case I have not outlined this enough, let me be clear that all our constituents who are on the programme are in severe need. The programme has looked at clinical need and deliverability. We understand how difficult these choices are, so I thank my hon. Friend for that intervention.

New Hospital Programme Review

Danny Beales Excerpts

Monday 20th January 2025 Commons Chamber

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

Today’s announcement is welcome for my constituents. It confirms that we are keeping the promises we made in 2023 to deliver Hillingdon hospital in the first term of a Labour Government. I thank my right hon. Friend for that commitment. We also know that, shamefully, my predecessor and his predecessor misled my constituents. My predecessor stood here, almost where I am standing today, and told my constituents that Hillingdon hospital was fully funded and that construction had started. We now know that that simply was not true. Does my right hon. Friend agree that it is vital that today’s statement outlines a fully funded programme that is deliverable and an honest assessment of when hospitals will be delivered? Can he confirm that that is the case?

[Wes Streeting]

First, I thank my hon. Friend for his strong representations on behalf of his constituents, not just since his election, but before it. Between the by-election and his election to this place, he did not give up; he continued to fight for his community.

I stood outside Hillingdon hospital, having had a good look around at the state of the hospital and the plans for the reconstruction of the site. I am delighted to have kept my promise and this Government’s promise, so that construction at Hillingdon hospital will begin in 2027-28. My hon. Friend is quite right to say that his predecessor and his predecessor’s predecessor made claims about Hillingdon hospital that were not true. This Government will not make those mistakes. We will keep our promise. What we have set out for all schemes in the new hospital programme is a credible, realistic, funded timetable that this Government, for as long as there is a Labour Government, will actually deliver.