18:57 - The House divided: - Ayes: 80 / Noes: 337 - Question accordingly negatived.
Helen Morgan
I thank the hon. Gentleman for his intervention. That is an important point and I apologise for not making it in my speech. Optometry is really important, and as somebody who spends their whole life looking for their other glasses, I can absolutely appreciate his point.
The Minister for Care (Stephen Kinnock)
Should’ve gone to Specsavers! [Laughter.]
The Minister for Secondary Care (Karin Smyth)
I beg to move an amendment, to leave out from “Parliament” to the end of the Question and add:
“; welcomes the urgency with which the new Government commissioned Lord Darzi to conduct an independent investigation of the NHS in England; recognises that within weeks of taking office the Government invested £82 million to recruit 1,000 newly qualified GPs; notes the Government commitment to tackle the dental crisis by providing 700,000 urgent dental appointments and recruiting new dentists to the areas that need them; approves the Government’s commitment to expand the role of pharmacies and better utilise the skills of pharmacists and pharmacy technicians; and welcomes the Government’s commitment to further reduce unnecessary bureaucracy as care shifts from hospital to community.”
I recognise that many people want to speak, so I will be as brief as possible. I begin by thanking the hon. Member for North Shropshire (Helen Morgan) for starting this debate. I think she spoke for us all when she said that she spent a lot of time looking for her glasses— I recently decided to go for the varifocal option just to avoid that problem. She also spoke for us all when she said that we all know how great it is when primary care is there for us. I am proud to have worked with primary care across the piece in south Bristol for many years. Although the hon. Lady and I are on opposite sides of the Chamber, I think we can agree that the last Government broke primary care at the same time as they were breaking the NHS.
Throughout my time in opposition, and in my first three months in government, I simply have not met or spoken to a GP, a pharmacist, a dentist or, indeed, anyone else working in primary care who has said, “Everything is going swimmingly. My patients are happy, and this is exactly what I signed up for.” Lord Darzi’s review tells the same story and sets out an enormous charge sheet, and we still have not heard whether the Conservative party agrees or, indeed, whether it will apologise. The list is far too long to repeat in full. Hospital workforces and budgets have shot up, yet full-time equivalent GP numbers have been allowed to shrink by over 1,500 over the last seven years.
Promises to shift resources to the community have been repeatedly broken, and our primary care estate is not fit for purpose. Shockingly, one in five general practice buildings is older than the NHS itself.
Daisy Cooper (St Albans) (LD)
The Minister may be aware that I lobbied Health and Treasury Ministers in the previous Government for the best part of a year and a half to review outdated Treasury rules that prevent GP practices that want to move from staying within a city centre—the outdated rules force them to move to ring-road locations, away from the populations they serve. Will the Minister look at this issue with fresh eyes, with her new glasses, and work with Treasury colleagues to review these outdated rules?
Karin Smyth
I thank the hon. Lady for her assiduous work in opposition. Looking at the capital estate is one of my favourite new responsibilities, and our commitment to a neighbourhood service means that we need to bring services together. We need to look at this across the piece, to make sure that primary care is provided where it is needed. We often hear about hard-to-reach groups, but I do not think they are that hard to reach. Frankly, services are sometimes located in the wrong area. One of our key commitments is to shift services into communities, and the neighbourhood service programme is part of that.
Just three in 10 NHS dentists are accepting new adult patients, and geographical inequalities are vast. More than 1,200 pharmacies have shut their doors for good since 2017. Again, the record speaks for itself: public satisfaction with general practice has fallen from 80% in 2009 to just 35% last year. If there is any reason why the Conservative Benches are empty, it is because dissatisfaction with access to primary care is so stark, as we learned in July’s general election.
It is absolutely clear that primary care is broken, but NHS staff working in primary care did not break it; the last Government did. They cut funding for the community pharmacy contract, they failed to incentivise enough dentists to perform NHS work, and they pursued a disastrous top-down reorganisation of the NHS, with which we are still living.
The last Government might have broken the NHS, but it is not beaten. NHS staff remain as passionate, dedicated and skilful as ever, and this Government will work in lockstep with them, their counterparts in social care and local partners across the country to fix the NHS.
Karin Smyth
I am tempted, but I know that many of the hon. Lady’s colleagues want to speak, and I am sure she is on the list.
Fixing the NHS will take years of discipline and hard work, and we are in this for the long haul. However, we must first clean up the mess we inherited, and that work has begun in earnest. We have found the funding to recruit an extra 1,000 GPs this year as our first step towards fixing the NHS’s front door and making the system more flexible.
Dr Evans
One of the keys to delivery is the GP partnership model, which is the mechanism by which they are set up. The Secretary of State, who is now in his place, said in 2023 that he wanted to phase out the GP partnership model, although he later reneged on that position. It would be interesting to hear what the Government now perceive to be the best model for delivering primary care, as that is really important for GP partners.
Karin Smyth
I wish the hon. Gentleman well with his own access to a GP at the moment. We are committed to working with the profession on the best way to organise primary care. The critical point is that primary care, however it is organised in neighbourhoods, is there for our constituents when they need it. It is not there now. The model is not working and has not worked over a period of time. It has merits, as we have said, and we are continuing to talk to people. I have worked in the sector for a number of years, so I understand the point the hon. Gentleman makes.
Karin Smyth
No, I want to move on. I will take one more intervention from the Government Benches at some point and then it is all fair, but I want to allow time for hon. Members to speak.
In our first week, we pledged to increase the proportion of NHS resources going into primary care, and in our first month, the Government made a down payment on that pledge, providing GP practices with their biggest funding increase in years. But we are not just increasing funding; we are also cutting the red tape that stops many staff doing their jobs.
Some GP practices currently have to fill in more than 150 different forms to refer patients into secondary care services. They are spending as much as 20% of their time on work created by poor communications with their secondary care colleagues. That is totally nonsensical in 2024 and it has to change.
Time spent doing needless paperwork and bureaucracy means appointments lost for patients, which is why we have launched a red tape challenge to bulldoze bureaucracy and free up GPs to deliver more appointments. It will be led by Claire Fuller and Stella Vig, established leaders in primary and secondary care. They will check with staff what is working well and what needs to change, so we can take the best of the NHS to the rest of the NHS.
Initiatives like Consultant Connect in south London allow GPs to talk to mental health consultants in real time, reducing the number of referrals they have to make by 40%. Delivered across the country, such schemes could save thousands of hours of time and create thousands of new appointments—that is what our red tape challenge is all about.
We want to help patients see specialists faster. Starting in November, 111 online will pilot directly referring women with a worrying lump to a breast clinic. That means faster diagnosis for cancer patients and more GP appointments freed up, which is better for patients and better for GPs.
On dentistry, as the hon. Member for North Shropshire outlined, we inherited an NHS dentistry system in disrepair thanks to 14 years of chaos, failure and neglect. As we have to keep reminding Conservative Members, it is a national scandal that tooth decay is the leading cause of hospital admission for five to nine-year-olds. We all see that in our constituencies. The last Government broke their relationship with the British Dental Association, as they broke so many relationships. During the election campaign, we pledged to meet the BDA immediately upon taking office to start rebuilding the relationship, and that is exactly what we did.
The BDA is right that the last Government’s dentistry recovery plan did not go far enough. We are keeping parts of it that are the right solutions, including the golden hello and some other measures, but we want to go further to deliver an NHS rescue plan that gets dentistry back on its feet. We are working around the clock to end the truly Dickensian tooth decay that is blighting our children. As well as our additional urgent appointments for all ages, we will work with local authorities to introduce supervised tooth brushing for three to five-year-olds in our most deprived communities. We will see the difference getting them into healthy habits can make, protecting their teeth from decay and ending the national scandal the last Government presided over.
On pharmacy, previous Governments dithered and delayed, failing to find a sustainable and long-term funding solution. NHS England is working with the sector to assess the cost of providing pharmaceutical services, and we look forward to seeing its outcome. Consultation around this year’s funding and contractual arrangements with Community Pharmacy England did not make it over the line before the election was called, so we are looking at that as a matter of urgency.
We want to continue to make it easier for pharmacists to take referrals and support people with common conditions, using prescribing skills to treat a wider range of conditions and patients. Pharmacists are highly skilled people in our communities. Allowing patients to get the care they need in the community, saving time and freeing up GP appointments by using the skills of pharmacists, will be really helpful for the wider system.
Those are our first steps. Primary care is central to the three big shifts that underpin our ten-year plan to make the NHS fit for the future, taking it from analogue to digital, from sickness to prevention, and from hospital to community.
We will soon begin a public consultation that will be the biggest listening exercise in NHS history. I look forward to taking part in that and I urge all right hon. and hon. Members, their constituents, and staff across primary care to tell us what is working and what needs to change. We will use their responses to take the best of the NHS to the rest of the NHS and build a neighbourhood health service.
Technology will help doctors, dentists and pharmacists meet demand for same-day appointments, giving patients a digital front door to end the 8 am scramble. Big data will end the cruel postcode lottery of health inequality, so that we can take screening, checks and care directly to the communities that need it most, intervening early to prevent ill health and deterioration. We want colleagues from across primary care to come together with their partners in social care and mental health to work in lockstep, as one team, to treat patients in the comfort of their own homes, which is where those patients want to be. That is the neighbourhood health service that we want to build. That is the future that our constituents want to see.
In the interests of time, Madam Deputy Speaker, I will conclude. Our constituents were let down by the previous Government. They were let down by broken promises, underfunding and a failure to listen to patients and staff. We will repair the damage. We have already begun investing in GPs and pharmacies to fix what is broken. We will cut the red tape, speed up treatment, and build a neighbourhood health service that works for everyone. The NHS may be broken, but it is not beaten. We are determined to rebuild it for our people, our communities and our country.
Dr Johnson
I thank the hon. Gentleman for his intervention. I have talked about the challenges the NHS faces. I will come shortly to the achievements of the Labour Government so far in the Department of Health and Social Care.
Turning back to technology, I was saying that I agree with the Secretary of State on how technology can improve NHS services. Over the last few years, in my professional capacity, I have seen improvements in making communication between primary and secondary care and within secondary care much more efficient. As a patient, I have used the askmyGP service, which is an excellent way to communicate with a GP, particularly for working people. I have also used the NHS app, which millions of people have downloaded and which has huge potential. I hope he intends to build on that potential and harness the benefit of AI for diagnostics in particular.
The Secretary of State and I also agree on the importance of prevention. It is vital to make the NHS accessible to those who need it, but it is even better if people stay healthy in the first place. Before the election, he was supportive of measures to protect children from the dangers of vaping—measures I campaigned for actively. In fact, he was quite critical that it had not been done sooner, as in some respects was I. Given that the legislation has already been written and that it passed both Second Reading and Committee stage with the support of his friends on the Labour Benches, why is it taking him so long to produce a tobacco and vapes Bill? Can he guarantee that he will deliver it, like a present, in time for Christmas—for clarity, I am hoping for this Christmas?
The Secretary of State for Health and Social Care (Wes Streeting)
Have you been naughty or nice?
Dr Johnson
I have been a good girl, thank you, Secretary of State.
Furthermore, can the Secretary of State explain how cancelling dozens of new hospitals will reduce pressure on general practice? Can he explain how cutting the winter fuel payment for millions of pensioners will help the NHS? The End Fuel Poverty Coalition predicts that Labour’s winter fuel payment cut will result in an additional 262,000 pensioners needing NHS treatment because they are cold, resulting in a great deal of suffering and millions of pounds of additional cost to the NHS. Does he agree with that assessment? I have asked repeatedly, in both oral and written questions, if the Government will conduct a proper impact assessment of the policy on the NHS and on the wellbeing of vulnerable older people. Will he commit to producing and publishing such as report?
Further on the issue of prevention, the right hon. Gentleman will know that folic acid supplementation can prevent neural tube disorders, such as spina bifida and anencephaly. The previous Government brought forward regulations on the matter. What conversations has the Secretary of State had with the Department for Environment, Food and Rural Affairs about ensuring that that work is continued?
Our approach to dentistry was also underlined by prevention. We introduced the Health and Care Act 2022, which gave the Secretary of State the power to introduce water fluoridation schemes. Those powers have since been used to extend existing schemes, particularly in the north-east of England. Does the Secretary of State intend to continue that work and exercise the powers the previous Government gave him? He knows that I am passionate about dentistry. I have raised the issue many times in the House, including by securing an Adjournment debate on dentistry in Lincolnshire. It troubles me greatly that children are coming to hospital for multiple dental extractions due to rotten teeth. It is worth noting that the issue is not a shortage of dentists overall or, as the hon. Member for North Shropshire (Helen Morgan) says, a shortage of money, but a shortage of dentists doing NHS work rather than private work specifically.
The previous Government were encouraging dentists to take up NHS work with a range of measures, including golden hellos for dentists in underserved areas, dental vans going out to rural communities, and tie-ins for new dental graduates. We were also in the process of broader contract reform after a small change in the units of dental activity rate when we went into the election. Let us look at Labour-run Wales in comparison. Wales is delivering only 58% of pre-pandemic dental activity. It is burdened with the highest proportion of NHS dental practices not accepting adult patients and the longest waiting lists in the UK. One in four Welsh residents is currently on a waiting list. The new Secretary of State for Wales has said that the Government “will take inspiration from” Labour-run Wales on dentistry. Given their woeful record in office, I sincerely hope that that is not the case.
Before the election, when I listened to the Secretary of State for Health and Social Care say that Labour had a plan to reform and modernise the NHS, I believed him, but in Monday’s debate on the Lord Darzi report, we uncovered that his plan was not really a plan at all, but a list of desired outcomes and a proposal to make a plan if he got into office. It is unclear how long this plan will take to develop. The Minister for Secondary Care said that it is a listening exercise like we have never seen before, but how much will that cost, and had Labour not been listening already?
The Minister for Care (Stephen Kinnock)
This really has been a vibrant and powerful debate. I thank the Liberal Democrats for using their Opposition day constructively to shine a searing spotlight on the challenges that our constituents face. Hon. Members made a series of outstanding contributions, but I thank in particular my hon. Friends the Members for Aylesbury (Laura Kyrke-Smith), for Bury North (Mr Frith), for Calder Valley (Josh Fenton-Glynn), for Ealing Southall (Deirdre Costigan), for Welwyn Hatfield (Andrew Lewin), for Croydon East (Natasha Irons), for Lichfield (Dave Robertson), for Norwich North (Alice Macdonald), for Worthing West (Dr Cooper), for Uxbridge and South Ruislip (Danny Beales), for Thurrock (Jen Craft), for Gloucester (Alex McIntyre), for Bury St Edmunds and Stowmarket (Peter Prinsley), for Blackpool South (Chris Webb) and for Hexham (Joe Morris) for demonstrating why our party always has been, and always will be, the champion of the NHS.
I also congratulate the hon. Members for North Devon (Ian Roome), for Newton Abbot (Martin Wrigley) and for Harrogate and Knaresborough (Tom Gordon) on their excellent maiden speeches. It is quite shocking to note, however, that in spite of the vital importance of this debate to our constituents, there was not a single contribution from the Conservative Back Benches. [Hon. Members: “Shame!”] Not only do the Conservatives refuse to apologise for the last 14 years, but they have run for the hills. Their silence truly speaks volumes.
Labour Members deal with facts and the unvarnished truth. On the subject of today’s debate, the list of facts illustrating the appalling neglect and incompetence of the last 14 years is truly as long as my arm. If I were to pick out just one statistic to summarise the last 14 years, I might choose that the most common reason for children aged five to nine being admitted to hospital is tooth decay. It is a truly Dickensian state of affairs. I could also point to the UK’s decreasing GP numbers, as there are 1,500 fewer compared with seven years ago, against the backdrop of a rising population. Or I could pick the collapse in patient satisfaction from 80% in 2009 to a shocking 35% last year. Or I could single out the fact that more than 1,000 pharmacies have shut their doors since 2017, and that almost six pharmacies a week have left the market in the last year.
The charge sheet is so long that a month of debates in this Chamber could not cover the profound damage that has been done by 14 years of short-termism and sticking-plaster politics, and by the botched top-down reorganisation in 2012. The reality is that the Tories doused the house in petrol and covid lit the match.
John Slinger (Rugby) (Lab)
The reaction to a proposed ward closure in my local St Cross hospital in Rugby shows how concerned the public are about the health system after 14 years of underinvestment by the last Government. In this case, however, the closure is because patients are being cared for closer to home. Does my hon. Friend agree that bringing more services into the community, and into smaller hospitals such as the one in my constituency, is integral to managing present and future demand, and to putting our NHS on a sustainable footing?
Stephen Kinnock
My hon. Friend is absolutely right. This strategic shift from hospitals into the community will be vital and central to our 10-year plan for the future of our health and care system.
Primary care is the NHS’s front door, but the Tories spent 14 years bricking it over. Now it is walled off to millions of people across our country, so it falls to this Labour Government to tear down that wall. We know that there is not a second to waste, not least on mental health. It is unacceptable that so many children, young people and adults are not receiving the mental health care they need. We know that waits for mental health services are far too long, and we are determined to change that. We will recruit 8,500 additional mental health workers across child and adult mental health services, we will introduce a specialist mental health professional in every school, and we will roll out Young Futures hubs in every community.
We will reopen the front door to the NHS by rebuilding general practice on the firm foundations it needs to get the service back on its feet and fit for the future.
Munira Wilson (Twickenham) (LD)
As well as needing more GPs, our GPs need decent premises from which to deliver high-quality care to patients. Park Road surgery in my constituency has been looking for new premises for more than a decade—it serves 13,000 patients out of an old Victorian house—but there simply is not the budget, and the processes are too complex. Will the Minister commit to both looking at the bureaucracy and pressing the Chancellor for more capital investment in primary care?
Stephen Kinnock
As the Darzi review shows, one of the most egregious examples of the neglect and incompetence of the past 14 years is the underspend on capital. We are clear that a number of premises across the country can be repurposed, and that the bureaucracy needs to be cleared out of its way. As the Prime Minister said earlier this week, we will have a mission about smart regulation and clearing the bureaucratic barriers to change.
We are also cutting red tape so that GPs spend less time pushing paper and more time face-to-face with the patients they serve. We are working to bring back the family doctors and to end the 8 am scramble. We have done more for primary care in the last 14 weeks than that lot did in the last 14 years.
On dentistry, we will introduce supervised tooth brushing for three to five-year-olds in deprived areas, ending the national scandal of tooth decay. And we are rebuilding the bridges that the Conservatives burned with the British Dental Association. I have already met the BDA, and we will deliver a rescue plan that gets NHS dentistry back on its feet, with 700,000 additional urgent appointments, starting as soon as possible, in those parts of our country that need them most.
Amanda Martin (Portsmouth North) (Lab)
Given the shocking state the last Government left us in, is it not good that the grown-ups are now in the building and that we have seen the urgency needed in the NHS, commissioning the Darzi report and investing £82 million, alongside making our commitment to tackle dentistry, use pharmacies and reduce the unnecessary burden?
Stephen Kinnock
I thank my hon. Friend for her intervention. I pay tribute to my right hon. Friend the Secretary of State for getting the strikes sorted within a week of us taking power—what a change that has made. We will reform the dentistry contract to make NHS work more attractive, boost retention and deliver a shift to prevention.
On pharmacies, as my hon. Friend the Member for Bristol South (Karin Smyth) made clear, we will shift the focus of our NHS out of hospital and into the community, empowering more pharmacists to prescribe independently, and freeing up GP appointments for those who need them most. That shift from hospital to community is vital for demand management in the primary and acute sectors.
On the whole, this has been an excellent debate, but I find it absolutely extraordinary that not a single word of humility or contrition was uttered by the official Opposition. Where was the apology for the fact that they spent 14 years bringing our NHS to its knees? Where was the mea culpa for the way in which they spent 14 years scapegoating the workforce, dodging the tough questions and passing the buck? Where was the acknowledgment of the fact that they called the election and ran away from their £22 billion black hole and from the multiple crises in our public services?
While the Conservative party continues to live in a parallel universe, we on the Government Benches are living in the real world. We are honest about the scale of the challenge, and we are up for the fight. While the mountain before us is daunting, we are not daunted. Instead, we are focused on the future, reform and rebuilding, and on shifting from hospital to community, from sickness to prevention, and from analogue to digital. Let us roll up our sleeves and get to work.
Question put (Standing Order No. 31(2)), That the original words stand part of the Question.