(1 week, 4 days ago)
Commons ChamberIf hon. Members will bear with me, I will make a little bit more progress and then come back to them.
Many Liberal Democrat colleagues have made the argument that with hospitals in the state they are in, it is more important than ever to have a robust social care system in place. As the Minister for Care, I agree with them wholeheartedly, but it is simply not true to portray the Government as sitting on their hands while Baroness Casey gets cracking on her vital work. In fact, we have hit the ground running through a plethora of measures. We have legislated for the first ever fair pay agreement for social care in order to tackle the 130,000 vacancies we see today. We have delivered an extra 7,800 home adaptations through the disabled facilities grant to change the lives of thousands more disabled people for the better. In the Budget, the Chancellor provided the biggest increase in carer’s allowance since the 1970s, worth £2,000 a year to family carers and with an extra £3.7 billion for local authorities.
We are not hanging around on more structural reforms, either. We are introducing new standards to help people who use care, their families and providers to choose the most effective new technology as it comes on the market. We are joining up care and medical records, so that NHS and care staff have the full picture they need to provide the best possible care, and we are training more care workers to perform more health interventions, helping people to stay well and at home. Just two weeks ago, we announced a new qualification for social care staff, training them in artificial intelligence to automate routine tasks and motion sensors to detect falls. We are seizing the opportunities of care tech and harnessing it for the benefit of thousands who draw on care across our country.
We are desperate to help the Minister in this endeavour, and look forward to receiving our invitations to the cross-party talks, which have yet to be issued. However, the Health and Social Care Committee heard today from an organisation called Think Ahead, which is the only organisation in the country that trains mental health social care workers. I have just heard that the Department of Health and Social Care is not refunding that organisation. Can the Minister explain why?
I thank the hon. Lady for that intervention. Baroness Casey is working at pace to get the commission up and running, and that will be launched this month. On her point about Think Ahead, the fundamental challenge we had with that programme was its relatively high unit costs. We are aiming to ensure that we deliver value for money for the taxpayer—I am sure that the hon. Lady shares that objective. We have to ensure that we deliver a programme for mental health social care work that delivers not only the best possible outcomes for our communities, but the best possible value for taxpayer money.
A lot has been done in the nine months since the election, but there is a huge amount more to do, and this Government are getting on with the job. Alongside the work I have described, the Government are putting record levels of investment into healthcare, with capital spending rising to £13.6 billion over this year and the next. That includes £1.5 billion for new surgical hubs, diagnostic scanners and beds across the NHS estate, as well as new radiotherapy machines to improve cancer treatment; over £1 billion to tackle RAAC and make inroads into the backlog of critical maintenance, repairs and upgrades across the NHS estate; and over £2 billion to be invested in NHS technology and digital. We are also taking the pressure off our hospitals through care in the community, and I am sure the whole House will welcome the fact that we have recruited 1,500 extra GPs on to the frontline.
Lord Darzi’s independent investigation clearly set out the impact that “capital starvation” has had on the NHS in recent years, and the importance of capital spending to fixing the health service. The report highlighted substantial shortfalls in capital investment, combined with a tendency to raid capital budgets to cover in-year spending deficits, so I welcome today’s Liberal Democrat motion, which allows Parliament to highlight how important these issues are to the public. This is the second Liberal Democrat Opposition day, and it is the second time we have debated health and social care. It is because it is a priority for the country that it is a priority for us.
The Health and Social Care Committee has taken a keen interest in the new hospital programme. We have challenged the Government to maintain their capital spending and not fall into the traps of the past, when capital spending was redirected to fund day-to-day spending, so I was pleased to receive confirmation from the Department, and now from the Dispatch Box, that the Chancellor’s changes to the fiscal rules will stop future raids on the capital budget, or CDEL, to fund the day-to-day spending budget, or RDEL. That is hugely welcome. However, although the protection of capital budgets is reassuring, I remain concerned about the lack of transparency around how the funding is allocated by the Treasury.
The charge levelled at the Government is that funding is being funnelled into acute care to tackle waiting lists, at the expense of funding primary care, infrastructure and care in the community. Clearly, on current commitments, we will not see capital funding that is sufficient to meet anything close to the unfunded promises made by the Tories in 2020. Nevertheless, the principle of investing in our hospital infrastructure is good; money will be saved in the long run on maintenance and emergency repairs, as well as providing a better quality of care.
In the policy paper on the plan for implementing the new hospital programme, the Government stated that funding will reach only £3 billion in the early 2030s due to
“other key priorities in health spending, such as funding to enable the Secretary of State’s 3 shifts”.
That is good, but we need transparency around how decisions were made and which projects were chosen. In January, the Secretary of State provided the criteria by which the schemes were scored and funding was allocated, such as site constraints and maturity of planning permission, but it is disappointing that, as I understand it—I am willing to be corrected—the review was conducted without the involvement of the trust teams responsible for delivering the rebuilding programmes. As of last month, no trust with a new hospital programme scheme has been provided with the full details of how it scored specifically against the criteria.
The Health and Social Care Committee has asked how the Department is prioritising schemes and has not received a clear answer, so my question is very simple: in the interests of transparency, will the Secretary of State publish, for every single new hospital programme scheme that was subject to last year’s review, the details and findings of the Department’s assessment of them against each of the criteria that were published alongside his statement in the House of Commons on 20 January 2025? It is the very least that the schemes that felt deprioritised deserve, and we are hearing many examples of those from Members of different parties. I choose to believe that this outcome is inadvertent but, frankly, it just looks a bit shady. We have seen it happen before with the levelling-up money under the previous Government. The Public Accounts Committee, on which I know many Members have served, as have I, has a motto: sunlight is the best disinfectant. If the Government will not publish the detailed assessment, the Minister needs to explain why.
My local area, like so many others, has been affected by this issue. Last year I visited the John Radcliffe hospital, which serves much of Oxfordshire, and I saw at first hand how its capacity to deliver care is being severely constrained by the size and condition of the physical estate. We went to visit the old site of the neonatal intensive care unit, which had to be moved because the staff were worried about the ceiling literally coming down on sick children and on incubators. It was atrocious.
The John Radcliffe hospital wants to be world-leading. It is a specialist tertiary care hospital, which means it is able to perform very specialist surgery, and it wants a new building to do that in. When it put to the Government a bid for £28 million, it was rejected. Instead, it has gone out to seek private financing, and it will now cost the trust £46 million to deliver the exact same building. Would it not have made sense for the Government to allow the trust to borrow from the Government to build it, and then to pay the money back from its own reserves over time? Think what it could have done with that £18 million.
I know the John Radcliffe hospital, which serves some of my constituents. The hon. Lady has made a powerful case about the amount of money that has potentially been lost through this process. Would she, however, reflect on the role played by her party, particularly the right hon. Member for Kingston and Surbiton (Ed Davey), and the amount of money wasted on the disastrous top-down reorganisation of the NHS under the coalition Government?
I have to say that that was quite a segue. We are focusing on the capital estate. We all know that there were problems with the Lansley reform. In fact, I welcome the fact that it is being unravelled, and I was pretty vocal about it at the time.
The savings the John Radcliffe could have realised might have been spent on hospital at home services and other ways to divert people away from coming into A&E in the first place.
Across the wider Oxford university hospitals NHS foundation trust, £100 million of backlog is deemed as high or significant risk. Pausing or delaying plans to rebuild hospitals is a false economy, and hospitals around the country, including the John Radcliffe, are overspending on maintenance as a result. That is not limited to our hospitals; we are also seeing it in GP practices, many of which date from well before 1948. I will declare an interest in that my own surgery—the Summertown health centre—is one of those practices. It is doing incredibly well, despite working out of a very old Victorian building. It is desperate for a new site, and it was deemed one of the top priorities for the ICB. I note that the Minister mentioned a figure of £102 million, but, frankly, that does not touch the sides.
As in the case of the John Radcliffe, the Summertown health centre is now going out to seek private finance, which it will find a way to pay back slowly over time. The Exchequer would not even have to lay out this money in advance, and even with inflation, the amount it would get back is less than what the health centre has to pay to do this with private finance. I ask the Government to think about this innovatively. It is not the same as the PFI. It is the Government using their own borrowing rules to allow investment in vital public services, and it makes no sense that they cannot do it.
When it comes to mental health services, we have the incredible Warneford hospital in Oxfordshire, and Warneford Park in Oxford will provide a new cutting-edge mental health hospital surrounded by a research and innovation hub. Groundbreaking research is planned on understanding brain health and discovering new drug therapies and new forms of treatment. This is a great vision, but it will cost £500 million. We do have private benefactors, including local businesses, willing to feed into it, but where is the funding pot for mental health trusts? They were excluded from the new hospital programme, and it is not at all clear where that kind of money may be found.
I would like to share a story from a constituent who called me last night. Her daughter had psychosis and was locked in a room at the local hospital, with a mattress on the floor and two security guards outside. She was there for a week waiting for mental health provision in a setting outside the hospital. I would like the Minister to tell me what mental health provision will be in place.
I am so sorry to hear about the experience of my hon. Friend’s constituent. In Lord Darzi’s report, there are some stark pictures of him sitting in substandard accommodation for the very sickest in our society. The Health and Social Care Committee is currently undertaking an inquiry into severe mental ill health, because we know that mental health is so often forgotten in the NHS. It is good that the mental health investment standard has been continued, but it is sad that the overall spend as a proportion of NHS spend is going down this year for the first time in the last few years. We very much hope that this is not a trend, but a one-off, and that it will continue to rise from next year.
For the Warneford, we need to understand what new innovative funding pots we can put together. We understand that the Government are working across Departments, and this project would be as much of an advantage to the Department for Science, Innovation and Technology as to the Department of Health and Social Care. Where are these pots of money, because they are important?
I will end simply by saying that I completely agree with the thrust of the motion—and, indeed, with what the Government have themselves said—which is that if we invest in capital expenditure, we need to take an invest to save approach. We know that this matters to our constituents, and we know that they cannot get the services they so desperately need. If we are to achieve the three shifts, we should not be pitting them against each other. Investing in capital will help the three shifts to succeed, and we do will the Government and the NHS to succeed.
With an immediate four-minute time limit, I call Emily Darlington.
(1 month ago)
Commons ChamberI call the Chair of the Health and Social Care Committee.
I have to say that I am none the wiser about what exactly has happened. If we are to ensure that this will not happen again—that these deadlines will be met—we need to know how we got into this position. It may well be the fault of the previous Government. Will this Government commit to a full review of exactly how we got here, so that we can ensure that the published deadlines are met this time?
The Chair of the Health and Social Care Committee makes a good point, as she so often does, about what went on previously. This is an issue from the McCloud judgment that runs across many Departments. It was a problem under previous Governments, starting with the coalition Government. I know that the Public Accounts Committee, on which I served, and the Treasury Committee have looked at the matter over time. The Department will certainly co-operate with any inquiry and investigate what happened across Government. I am happy to get back to the hon. Lady on that point.
(1 month, 3 weeks ago)
Commons ChamberI call the Chair of the Health and Social Care Committee.
This is a bold change indeed. The job of my Committee is to help the Secretary of State to do it, so let me start by asking him to come in front of the Committee as quickly as possible—certainly before Easter—because there is a lot of detail that we need to drill down into.
On a more substantive point, the right hon. Member mentioned the financial reset that Sir Jim Mackey announced to integrated care boards just yesterday, which means that they need to cut their running costs by 50%. I am concerned that when my Buckinghamshire, Oxfordshire and Berkshire West ICB struggled with money, the first thing it cut were the place-based teams. If we are to deliver the neighbourhood NHS that the Secretary of State and I both want, those are not the teams to cut. Will he send a signal to ICBs that cost savings should not be at the expense of the broader shifts in the 10-year plan?
First, I give the Chair of the Select Committee my assurance that I would be delighted to appear in front of her Committee at the earliest opportunity —that means soon. I appreciate that it will want to scrutinise these changes in more detail, and I would welcome the constructive challenge that it offers. I also reassure her that the direction that we are giving to frontline leaders is to deliver the three big shifts in our 10-year plan, and to ensure that as we take immediate steps to bring the finances under control, we do so in a way that lays the firm foundations for the future of the NHS that we need to build.
My cautionary note to Members across the House is that when we ask frontline leaders to reform and to change ways of working, sometimes that requires not just changes to the bureaucracy as it were—the easier and lower hanging fruit—but service reconfiguration in the interests of patient outcomes and better use of taxpayers’ money. Sometimes, they get those changes wrong. I have successfully campaigned against closures of services such as the King George accident and emergency department, which should not have closed and where we won the case on clinical grounds.
Sometimes, let us be honest, the public can get anxious, and Members of Parliament feel duty bound to act as megaphones and amplifiers for public concerns. It is important that we support and engage with local NHS leaders. By all means, we should scrutinise, challenge and ask questions, but we must give local leaders the support to do the task that we are asking of them on behalf of patients and taxpayers. The powers that I have to intervene in those frontline service reconfigurations are ones that I will use only in the most exceptional and necessary cases, and that is why I have not used them once in the past eight months.
(1 month, 4 weeks ago)
Commons ChamberThank you, Madam Deputy Speaker, for granting us the opportunity to debate this supplementary estimate, which provides an opportunity for all Members of this House to look at the Public Accounts Committee’s report on health and discuss how the money might be spent on different priorities.
As the Chair of the Public Accounts Committee, I am honoured to introduce the first estimates debate on the supplementary estimate of the Department of Health and Social Care. I made this application jointly with the hon. Member for Oxford West and Abingdon (Layla Moran), the Chair of the Health and Social Care Committee, and my right hon. Friend the Member for Salisbury (John Glen).
As Members of this House will know, the Public Accounts Committee is one of the oldest Committees of this House. It exists to protect taxpayers’ money and ensure that their pound is being used effectively. It goes back, I think, to about 1867. Unlike other Committees, we do not take evidence from Ministers; instead, we take evidence directly from permanent secretaries and the most senior civil servants and public sector officials. The National Audit Office provides us with audited accounts and value for money reports, and we produce reports of our own with recommendations to Government to which they must formally respond as part of the Treasury minute.
At this point, I pay tribute to Amanda Pritchard, who has recently announced that she will be stepping down as chief executive of NHS England this summer. She oversaw the NHS at a time when it was under so much pressure post pandemic, and I wish her well in her future endeavours. I also congratulate Chris Wormald on his promotion to Cabinet Secretary. These vacancies at the head of NHS England and the Cabinet Office provide an opportunity for completely fresh thinking within the NHS.
I echo the hon. Gentleman’s thanks to Amanda Pritchard for her time at the head of NHS England. While I also welcome the appointment of Dr Penny Dash as its new chair, the hon. Gentleman is right to say this is a really important moment in the future of the national health service.
We are proving that estimates are not dull, although they have a terrible reputation for being so. Everything comes from the money, and if we do not follow the money, we do our constituents a disservice. The Government have announced an incredibly welcome £22.6 billion increase in day-to-day spend on health and social care, in addition to the further £3 billion in capital expenditure. It sounds like, and is, a huge amount of money. The only thing bigger than the uplift will be the disappointment of our constituents if the money is not spent wisely and does not lead to the change that they desperately want and need.
I will start with an example. My constituent was referred to her GP for an NHS-funded assessment for autism spectrum disorder. She took tests, and exceeded the threshold in all of them, and was told that she would be put on a waiting list, with an expected wait of 16 years to 18 years—yes, years. She is 34 with young children, and will be waiting for an appointment until she is 51. That is clearly ridiculous.
We welcome the three shifts, the 10-year plan and the long-term thinking, which hopefully will end stories like the one that I just told; I know Members from across the House will have similar stories. I was interested to hear the Secretary of State choose technology as his top pick when I pressed him to pick a favourite priority at our Committee hearing on 18 December. In recent correspondence with the Committee, which is now online, the Department credited technology with a 0.7% productivity contribution this year alone. I am concerned, though, that we do not have much detail about how exactly technology will achieve that, and we will press the Department on that figure.
Prevention is also incredibly important, and it is always in danger of being overlooked. I assure the Minister—I know she is responsible for prevention—that if the Government do not pursue it, we will press them to, as will the electorate, I am sure, because is a no-brainer.
If we want prevention, we have to invest in social care, but the Government are putting almost all the investment that the hon. Member talks about into the NHS, rather than social care. Surely there needs to be a rebalancing.
In our Committee hearing just this morning, we heard that all parts of the system want this. Acute care trusts recognise that they have the bulk of the investment, but they realise that unless they start pooling budgets and working in an integrated way, we will not achieve the productivity gains that we desperately need.
The Government’s policy is actually achieving the opposite for social care of what the hon. Member for Farnham and Bordon (Gregory Stafford) suggests. Peter runs a small domiciliary service in my constituency that is going bust. That means 35 people without a job, a loss of £100,000 in taxes every year, and all those patients now blocking beds in hospitals. Does my hon. Friend the Member for Oxford West and Abingdon (Layla Moran) agree that the Government’s policies are downgrading and trashing social care, rather than boosting it?
I share my hon. Friend’s frustration that we are not doing more faster. Indeed, the first inquiry that our Committee has launched is on social care and the cost of inaction, because there is a cost to doing nothing, and we need to quantify that as best we can.
On the three shifts, the shift to the community is incredibly important, not least because successive Secretaries of State have said that they want that shift, yet the money has flowed in the opposite direction.
In Cromer in my constituency, about 18 months ago, the Conservative-controlled county council closed down Benjamin Court reablement centre. That is exactly the sort of facility that we need to help bridge the gap between acute hospitals and community and primary care. Does my hon. Friend agree that we must work to reopen those facilities, which do not stand a chance until there is proper integration of NHS budgets and the budgets of adult social care providers?
We should be celebrating examples of where this works well, not shutting them down.
In Oxford, the Hospital at Home programme, run by Oxford University hospital ambulatory team, does incredible work. I visited 91-years-young Mavis the other day, who was receiving top-notch ultrasounds in her home—ultrasounds of better quality than those that she would have got in the hospital. That saves hundreds of pounds for the NHS and means no long trip for her and her family. That is definitely something that we should do more of.
Let me turn to the estimates, because they are why we are here. The supplementary estimates have been published. I will not hit anyone over the head with them—they are incredibly heavy. They are worth a read. They talk about a £198.5 billion day-to-day spending budget. At face value, that is an increase of £10.9 billion on the estimate from July, but £9.2 billion is for staff pay increases. Let us be clear: staff deserve that pay rise. It is long overdue. Retention and mental health are important, and we must invest in our workforce, but that does leave just £1.7 billion.
I will make progress, if I may, because the clock is ticking down. As for that £1.7 billion, once we add in national insurance contribution increases and inflationary costs, the NHS has had to ask for an additional £812 million on top, so it is already running a little behind. Next year, the increase is due to be £10.6 billion, but as the Committee heard in a hearing, the expected pressures are £11.7 billion. We can all do the maths. There is a problem. The way it will get solved, at least on paper, is through an enormous 4% productivity increase, combined with cost reduction. We need more detail about how exactly that will be done.
I echo the point made by my fellow Committee member, the hon. Member for Uxbridge and South Ruislip (Danny Beales), about capital expenditure. In these estimates, we see that there has already been a decrease in capital spend of £1 billion from the 2024-25 main estimate. It is explained away as a transfer to day-to-day spending, due to a reclassification of spending on technology and new hospitals as day-to-day spending. I do not know how others feel, but that does not sound quite right to me. I am concerned that the Government are falling into the same trap as previous Governments—perhaps understandably, because they have to pay for the day-to-day somehow. The Government gave an assurance to the Public Accounts Committee that they would stop making those sorts of changes. Is that still the case?
Finally, I want to do more of this; I want to undertake more scrutiny of the estimates, but it is quite hard to do, because there is a lack of detail. For example, in the document, £120 billion comes under the sub-heading, “NHS providers”, and there is absolutely no detail under that. Will the Minister commit to working with the Committee and the House of Commons scrutiny unit to provide Parliament with a meaningful breakdown, so we can have more wonderful debates just like these?
The Minister will have noted, on page 53 of the estimates, a £1 billion decrease in capital spending in the departmental accounts. Will that be explained, and can the Minister explain now how new hospitals constitute day-to-day spending?
I will be coming to that, but I thank the hon. Lady for raising it.
We have talked about productivity, an issue that has been raised by many Members including the Chair of the Public Accounts Committee. I am delighted that Members on both sides of the House, including Conservative Members, have now recognised and accepted the value of the Darzi report, which this Government commissioned.
We are committed to meeting a 2% productivity target by 2025-26. To help us to achieve that, there is a £2 billion investment in NHS technology, allocated to freeing up staff time, ensuring that trusts adopt electronic patient records—we have heard a great deal about old-fashioned paper today—and enhancing cyber-security measures, while also improving patient access to services via the NHS. The current measures of health productivity data do not capture all the outputs and outcomes adequately, and NHS England is working with the Office for National Statistics and the University of York to refine those metrics. Reform is at the heart of our 10-year plan.
We are rebuilding our capital-starved NHS through £1.6 billion of national capital funding in 2025-26, which will help us to achieve constitutional standards. The money will help to deliver more than 30,000 additional procedures and more than 1.25 million diagnostic tests as they come online through investment in new surgical hubs and diagnostic scanners, new beds across the estate, and a £70 million investment in new radiotherapy machines to improve cancer treatment. Questions have been asked about the shift from capital to revenue. Some of investment has met historic need, including capital funding for technology and new hospitals programmes, but because of the nature of the funding it needed to be defined as revenue. It is still being spent on those programmes. The autumn Budget included a commitment to ban shifting from capital to revenue, and I can confirm that no shifts of that nature have taken place since then. I will now give way.
(2 months, 3 weeks ago)
Commons ChamberI welcome the Under-Secretary of State for Health and Social Care, the hon. Member for West Lancashire (Ashley Dalton), to her place. I look forward to working with her, as I do with other Ministers.
As the Minister for Care will know, 20% of the burden on the NHS is due to mental health, yet only 10% of the budget is allocated towards it. The mental health investment standard has been a welcome maintenance under this Government. However, the Select Committee heard from Amanda Pritchard the other day that the standard is guaranteed for only the next two years. Does the Minister agree that the standard has had a positive effect on mental health community services, and would he commit to protecting it?
The Chair of the Committee will have seen that we have made an explicit commitment to the mental health investment standard—we are absolutely committed to that. In addition, we have to drive reform in the system so that it is about not just the amount of investment going in, but how we ensure that it is working properly. I am absolutely confident that the commitment to 8,500 new specialists, the Young Futures hubs and having a mental health specialist in every school will facilitate the delivery of services in a far more effective way than is currently the case.
(3 months, 2 weeks ago)
Commons ChamberI call the Chair of the Health and Social Care Committee.
May I press the Secretary of State on that data point? It is not just the Liberal Democrats making these representations; the Royal College of Nursing, the Royal College of Physicians, the Royal College of Emergency Medicine, HealthWatch, the British Medical Association, Age UK and many others also want the data. This matters, because the situation causes moral injury to staff and compromises patient safety—and the problem is not just corridor care; it encroaches on to other wards. Will the Secretary of State commit to releasing that data before the NHS England board meeting on 4 February? In addition, what assessment has he made of the impact of this winter on less urgent care, and on elective waiting lists?
I am grateful to the Chair of the Select Committee for her questions. I cannot give her a commitment to publish those statistics ahead of the next NHS England board, but I can give her an undertaking to go away and look carefully at the rhythm and pace at which we publish performance data, to make sure that we are being as transparent as we can, as fast as we can. That, I think, should be the principle that underpins our approach to the publication of data. She is right to talk about wider system pressures as a result of what we see in emergency departments. We will wait to review the performance of the NHS overall until we exit winter. I think we have seen some effective protection of elective activity throughout this winter, but that will of course vary from provider to provider.
The hon. Member mentioned a whole number of organisations calling for more data transparency. I, too, welcome the very public representations that we have heard from the Royal College of Emergency Medicine and others about the need to tackle corridor care. Let me assure her and all those who have made representations that we are absolutely determined to turn this situation around, and not just improve the performance of urgent and emergency care, but get a better system working. Ultimately, it is through ensuring better patient flows, and ensuring that people get the right care in the right place at the right time, that we will finally get this country out of the cycle, created by our Conservative predecessors, of winter crises.
(3 months, 3 weeks ago)
Commons ChamberFollowing the theme raised by my hon. Friend and neighbour, the hon. Member for Bicester and Woodstock (Calum Miller), may I make a plea for Summertown health centre? They are my doctors, by the way, so I declare an interest. They operate in an old Victorian building and are desperate to move to new premises. That health centre was at the top of the priority list, but the ICB says that there is no money, and the doctors say that there is no pot that they can bid into in order to get this seen to. Will the Secretary of State meet me as well? Clearly, £102 million spread across 50 projects in the country is not going to be sufficient. Can we get creative about how we can get new premises built for Summertown health centre?
Of course I will meet the hon. Lady. It would be daft of me to say no to the Chair of the Select Committee; otherwise, she will see me in less pleasant circumstances. In all seriousness, we are looking creatively at this issue. There are enormous capital pressures right across the NHS estate. We are regularly lobbied on new hospitals, for example, but we are also lobbied on general practice, the mental health estate and the rest. We will do as much as we can as fast as we can, thinking creatively about how we can get more capital investment in, and I would be happy to discuss that further with the hon. Lady.
(3 months, 4 weeks ago)
Commons ChamberGiven that the Health and Social Care Committee’s first inquiry is “Adult social care reform: the cost of inaction”, we welcome any action. As the name of the inquiry suggests, we are concerned about the length of time taken, because every year without reform costs money, not only to the NHS, but to the wider economy and in people’s lives. We have Andrew Dilnot in front of us on Wednesday, and it is 14 years since his report, which has been put into legislation twice. I ask the Secretary of State to be specific: what will stop the next iteration of the Committee having Louise Casey in front of it in 15 years’ time? What will be different this time, so that we get that cross-party consensus and it sticks?
That is a great question. First, I will put on my shin pads and crash helmet if Andrew Dilnot is in front of the hon. Lady’s Select Committee this week. I can well understand his frustration. He is a decent man who did an excellent piece of work. It must be frustrating to see one Government after the next not implementing something that was welcomed. The issue for us as an incoming Government is that the money was not there, and even if it had been, the system had not been set up to deliver for the October 2025 deadline. We chose to act on other immediate pressures in other areas, because we saw those needs as more pressing. That does not mean for a moment that I think Andrew Dilnot’s work is no longer valuable—I think it might well be. However, we have to consider the issues in the round and come up with a clear and sustainable plan that we can stick to.
On why the Casey commission will be different and will work, it is important to have as much political consensus around the House as possible. The national consensus and getting the public on board will be important. Anyone who has ever met Louise Casey will know she is a difficult woman to say no to. I have no doubt that if Louise Casey says something needs to be done, this Government and future Governments—whoever is in government—will make sure that it happens.
(4 months, 2 weeks ago)
Commons ChamberLast Friday, I visited Sherwood Pharmacy in Abingdon. Ben, who owns it, told me that local pharmacies stand ready to help. In fact, they are more than keen to help, but there are two things that he needs from the Government. First, there needs to be a real push for GPs to refer people to pharmacies, in particular for vaccinations, so that we are not collecting patients in one already overstretched part of the system and they can do what they do best. Secondly, there needs to be a general plea to the public that they can go to their pharmacies for those things. I note that in her statement the Minister did not mention pharmacies once. Let us be honest, this question is not going to do it either. How do we ensure that the message—“Go to your pharmacy and get vaccinated, you can do it faster there”—gets out there this winter?
I thank the Chair of the Select Committee for her point. She is right that I did not mention pharmacies, which was an omission on my part. We are running an advertising campaign, “Think Pharmacy First”, to ensure people use pharmacies. She is absolutely right that they stand ready. I will visit mine over the next few days to make sure I am vaccinated. Their support, working with primary care, is critical. Again, in some places relationships are working well and pharmacies support people in the community—that is apparent in the statistics. We are absolutely committed to ensuring that that works better, as part of our long-term reforms.
(5 months, 1 week ago)
Commons ChamberMy hon. Friend is absolutely right. I am really proud of the impact that the last Labour Government made in reducing smoking harms and the prevalence of smoking in our country.
That brings me on to the next point that I wanted to make. President Truman famously said that it is amazing what you can accomplish
“if you do not care who gets the credit.”
When I first sat down with Rachel Sylvester of The Times in January 2023 and flew a kite to start a debate that a Labour Government might introduce a ban on children and young people today ever buying cigarettes, of the type introduced by our sister party in New Zealand, I was not necessarily convinced my own side would buy it, but I thought it was a debate worth having. I never imagined, in a million years, that I would tune into a Conservative party conference speech by a Conservative Prime Minister announcing his intention to legislate for such a ban. I will do something I do not often do with Conservative party conference speeches and quote extensively—and approvingly—what the then Prime Minister said.
“As Prime Minister I have an obligation to do what I think is the right thing for our country in the long term. And as Conservatives, we have never shirked that responsibility.”
I say that bit through gritted teeth.
“We have always been at the front of society, leading it—”
Who wrote this?
“And when we have the tools at our disposal…to do for our children what we all, in our heart of hearts, know is right, we must act, we must lead…we must put the next generation first.”
In that spirit, I pay tribute to the former Prime Minister, the right hon. Member for Richmond and Northallerton (Rishi Sunak), for picking up the proposal and running with it despite opposition from his own party. That took courage. While we have taken steps to improve this Bill compared with the one put forward by the previous Government, I hope that hon. and right hon. Members on the Conservative Benches will follow his lead, showing that the one nation tradition still has a constituency in the modern Conservative party, and vote for this Bill in the national interest.
The Darzi investigation into the NHS set out the twin challenges facing me, my Department and this Government. The national health service is broken; it is going through the worst crisis in its history. At the point we came into office, waiting lists stood at 7.6 million. We had worse cancer survival rates than most comparable countries, ambulances not arriving on time, the number of GPs falling and dentistry deserts across the country.
Some of the most shocking findings in Lord Darzi’s report, however, were about not the sickness in our NHS, but the sickness in our nation. Children are less healthy today than they were a decade ago. Life expectancy was extended by three and a half years over the course of the last Labour Government, but in the past 14 years, it has grown by just four months. Brits now live shorter lives than people in any other country in western Europe, and we spend fewer years living in good health, becoming sicker sooner. Those are huge costs, borne by all of us as individuals. It means less time in which we are able to live our lives to the full, to do all the things we love and to spend time with the people we love. Sickness is forcing many of us out of work long before retirement age, leaving us dependent on welfare, ridding us of the purpose and belonging that work provides, and for everyone else, it means higher costs to us as taxpayers. Our sick society is holding back our economy, and that is why we should act.
I give way to the Chair of the Health and Social Care Committee.
In the spirit of cross-party working, I want to congratulate Members on the Conservative Benches for deciding, when the former Prime Minister put this policy forward, that it was a priority. It shows how important it is that No. 10 gets behind this kind of thing, and I hope we learn that lesson for the Government’s missions.
I gently say, however, that it is not just the evil tobacco lobby that has concerns about the age escalator. I completely agree with everything that the Secretary of State says, but if smoking is that much of an issue, why are we not just banning it for those under an age of, say, 25? That would have been another way to go. What is the thinking behind an age escalator, as opposed to a ban for those under a particular age so that people do not need new ID every time?
I recognise that there are people who have the freedom and the liberty to smoke today, the vast majority of whom, by the way, want to stop and struggle to do so. That is why we are announcing support to enable people to do that, with £70 million of investment in smoking cessation services. That is important, but for a future where people are no longer able to smoke, a phased approach is the right thing to do. It is also essential for the health of the individual, the nation and our economy.
Since 2018, our productivity has dropped by £25 billion due to worsening health alone. Some 900,000 more people are off work than would have been on pre-pandemic trends. That is more people than are employed by Tesco, Sainsbury’s and Asda put together. Smoking alone accounts for more than £18 billion in lost productivity. The rising tide of ill health, coupled with our ageing society, presents an existential challenge to our health service. If we do not act now, ever-increasing demands for healthcare threaten to overwhelm and bankrupt the NHS. That is the choice that we face.