(1 day, 15 hours ago)
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Sir Geoffrey Clifton-Brown (North Cotswolds) (Con)
Thank 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.
Layla Moran (Oxford West and Abingdon) (LD)
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.
Sir Geoffrey Clifton-Brown
I thank the Chair of the Health and Social Care Committee for her endorsements of the worthy work that all these individuals have put into the health service.
The Department of Health and Social Care is one of the highest spending Departments in the UK, with a total departmental expenditure limit standing at a huge £210.1 billion. I am not sure anybody believes that the NHS is working at optimal productivity. NHS England is the largest quango with the highest budget in Whitehall; however, when allocating funds, it is also one of the few Departments that is making life and death decisions that affect the lives of literally millions of patients and their families. I think it does, therefore, deserve the highest level of scrutiny, which is part of what we are doing today.
Before even getting on to the figures, the NAO confirmed that the level of productivity in the NHS has dropped by around 23% since the pandemic. I simply say that unless that is sorted, any reform that the Government announce will be sucked into the black hole of the NHS without commensurate value for money or results.
Sir Geoffrey Clifton-Brown
I do not want to give way to too many people; otherwise, you will reprimand me for taking too long, Madam Deputy Speaker. However, I am, of course, happy to give way to the hon. Lady.
Leigh Ingham
On that point specifically, I was at my local hospital—County hospital, in Stafford—a couple of weeks ago, where I noticed that staff were still using paper to make notes on patients. One of the biggest barriers to the NHS being more efficient is the inability to have effective digital systems. Does the hon. Gentleman agree that the investment that has been announced in the move from analogue to digital in the NHS is long overdue?
Sir Geoffrey Clifton-Brown
I agree entirely with the hon. Lady. She has obviously been reading my speech— I will cover the announcement later in my speech, at which point she will hear exactly what it says.
As I say, the NAO has confirmed that productivity levels have dropped by 23%. I welcome the Government’s commitment to a 10-year plan for the NHS. We have also repeatedly warned that, with an ageing and increasingly sick population, the NHS will struggle to cope with the ever-increasing multiple complex demands of our population.
I wish to split this speech into three sections: how productivity could be improved in the NHS; funding; and, as the hon. Member for Stafford alluded to, technical advancements and a shift into community care.
The Department of Health and Social Care’s day-to-day spending—RDEL—is set to increase by £10.9 billion—from £187.9 billion to the main estimate as produced today of £198.5 billion. The capital spending is, however, set to decrease by around £1 billion, from £12.5 billion to £11.5 billion—a decrease of 8%. That is worrying as it shows that more and more funds are being redirected from long-term investment—for example, in the new hospitals to which the previous Government had committed themselves. I welcome the new Treasury guidelines that have stopped the practice of the past few years of redirecting up to £1 billion from capital spending to day-to-day spending. That should help to make more money available.
The NHS estate, as we all know from our constituencies, is in desperate need of investment, and our capital investment programme is running behind schedule. The problems with reinforced autoclaved aerated concrete have only added to the necessity of upgrading our hospitals, and I hope the Minister will listen to this plea.
The latest NAO report on the DHSC annual report and accounts shows that local systems, such as integrated care boards and NHS providers, reported a year-end overspend of £1.4 billion. This has nearly doubled from £621 million in 2022-23. This was despite an extra £4.5 billion of additional funding during 2023-24, which was to support pay deals for non-medical staff, mitigate any impacts from industrial action and provide money to address the costs of new pay arrangements for doctors and dentists.
What I do not think is acceptable is the glacial pace of agreeing priorities and approving final budgets for the local systems. In November, our Committee was shocked to hear that, in the past two years, those local systems—ICBs and others—had not had their financial plans approved by the Department until June and May respectively. That is up to three months after the start of the financial year. How can our poor local systems plan efficiently when these final allocations and guidance are so late? If the Department’s own accounts were finalised much sooner, our local systems would be able to have the money allocated in a more timely way, making wastage and inefficient spending less likely.
I welcome the Secretary of State’s prognosis that the NHS is far too big and complicated. There should be a shift towards allowing NHS trusts more control of their own budgets, as clarified in the 2025-26 priorities and operational planning guidance published in January. Moving more funds directly to NHS trusts, ICBs and local systems will improve accountability and give them a level of flexibility about how their funds should be better spent, rather than just focusing on targets and directives. For example, if they were to run a surplus because they had run their operation so well, they could reinvest the money in desperately needed capital projects rather than returning it to Whitehall. That must also go hand in hand with a need to improve productivity. Between 1996 and 2019, the NHS averaged a measly 0.6% a year increase in productivity.
Since the pandemic, productivity has now fallen by 23%. In March 2024, the Conservative Government announced that the NHS would receive £3.4 billion of capital investment for digital improvements between 2025-26 and 2027-28, which begins to address the point that the hon. Member for Stafford mentioned. As part of that investment, NHS England committed to achieving ambitious average productivity improvements of 2% per year through to 2029-30. However, those digital improvements, presaged by that additional £3.4 billion, have not yet been fully actioned.
Chris Vince (Harlow) (Lab/Co-op)
I thank the hon. Gentleman for his speech and, importantly, for his scrutiny of the NHS. He reflected on the fact that productivity has worsened since the pandemic. Does he not think that is to do with the mental health of staff? To support our NHS professionals to be as productive as possible, should we not be considering looking after their health, including their mental health?
Sir Geoffrey Clifton-Brown
The hon. Gentleman is exactly right. The NHS employs an enormous number of staff—more than 1 million people, I think—and their conditions of work are really important if we are to retain them. That does mean that their mental health needs close attention, especially when they have problems. If the NHS cannot help with mental health issues, who can? The hon. Gentleman has hit on a really important point.
One reason that productivity is not improving more is that there are 19% more staff in the NHS, but they are seeing only 14% more patients. At our hearing, NHS officials stated that this was due to more complex and acute health needs, meaning longer stays in hospital. I also understand that it was due to staff sickness, absences and the then ongoing workforce industrial action that affected most patients last year, making targets more difficult to meet. I do not know about other hon. Members, but I am still getting emails from constituents whose appointments and operations were cancelled at the last minute due to that industrial action and who are still waiting for their procedures to be rearranged.
Along with staff, technology plays a big role in improving efficiency and productivity. The 2025-26 priorities and operational planning guidance stated that the NHS organisation
“will need to reduce their cost base by at least 1% and achieve 4% improvement in productivity.”
I understand that these figures are hard to pin down due to the NHS still negotiating with bodies such as the ONS on the definition of productivity and how it can be measured. I say to the Minister that, even if the numbers are disputed, we have still not seen a plan for how these productivity gains can be achieved, and the Committee believes that NHS England has produced unrealistic estimates. We need to have a realistic estimate from the Department of what productivity gains can be achieved over the next few years.
Without significant productivity gains, the NHS will not substantially reform waiting times and achieve the best value for the large amount of money that we spend on it. On average, there is a 4% real terms increase in our spending each year, when the economy is growing by only 1%, which is unsustainable in the long term. If we go back to 2013, the Health Secretary had set the NHS a challenge of going paperless by 2018. Clearly, as we all know, that has not happened, because the NHS is still using fax machines. In a digital age of AI, that lack of modernisation produces a risk to both patients and employees in the NHS. Investing in better technology would help with the Government’s ambition to shift more care into the community.
Community healthcare can take many forms, from GP surgeries and community hospitals to pharmacies, dentists and social care. I fear that when we talk about the NHS budget, we predominantly focus on hospital care, rather than the care that most of our constituents need every day. Indeed, Lord Darzi’s report, which was commissioned by the Government last year, said that
“the NHS budget is not being spent where it should be—too great a share is being spent in hospitals, too little in the community, and productivity is too low”
This is where I would like to pay tribute to our GPs and all their staff across the country, especially in the North Cotswolds. Our GP surgeries are usually the first point of contact with our NHS, from antenatal services to blood tests and vaccinations. They also offer a number of services that could be termed preventive care.
As a Committee, we questioned NHS officials on their prioritisation of preventing ill health rather than treating it, thus avoiding much more expensive hospital interventions in the future and a much better patient experience. Their reply was that they had little additional headroom to grow preventive services, yet the public health grant used by local authorities to commission preventive measures, such as health visitors and drug and alcohol services, is expected to fall in value next year by £193 million, despite the Government’s commitment to maintaining it in real terms. I cannot stress enough how I believe that we should be paying much more attention to prevention rather than cure; it is just so important.
NHS England said that, rather than moving funds, there should be a focus on the role of GPs and how they can advise their patients. However, according to the Royal College of General Practitioners, although more than 90% of patients’ direct experience of the NHS is through primary care and GP practices, less than 10% of the total budget is currently spent on primary care. I say gently to the Minister that we are getting our priorities wrong there.
As a Committee, we have recommended that the Government clearly define what counts as health prevention spending within the next six months and track that spending annually. ICBs should be given more flexibility in how they spend their money, which might include redirecting services to more community settings that are closer to patients. It might also include redirecting funds to help manage discharges from hospital. According to the House of Commons Library, the latest data shows that last year an average of 12,340 patients a day remained in hospital despite being clinically fit to be discharged. Even though there is a slight decrease of 1.2% from last year, more can be done to ensure that patients who are well enough can leave hospital for the community and be closer to their families. That will require better working between social care and hospitals.
Andrew George (St Ives) (LD)
The hon. Member is making a powerful case for reform and review. This morning, the Health and Social Care Committee was looking at the very issue of delayed discharge of medically fit patients. Does he not accept that we need more integration? If only a quarter of those delayed discharges are down to a lack of social care packages, that means many patients cannot be discharged because they have a primary healthcare condition that needs to be taken care of, so we need integration and not just social care reform.
Sir Geoffrey Clifton-Brown
The hon. Member makes an extremely powerful point. I am coming to the conclusion of my speech, which is on precisely that point.
The social care system is not working in this country. It is a political football that keeps being passed from one Government to another. I understand that the Government have committed to another review of adult social care and that we should not expect results until at least 2028; for many of our elderly patients, that will be too late. The funding of social care is rising exponentially. There needs to be more focused and joined-up thinking from the DHSC, NHS England and local authorities on how they can support those who need help to be discharged from hospital in a timely manner and live in their own homes for a longer period than they might otherwise be able to do. It should not be a postcode lottery, as exists now.
With more joined-up thinking between different parts of the NHS, the patient experience could be better. However, without substantial increases in productivity, increased spending on preventive care and public health, and a better functioning social care system, our NHS will never be able to operate at the optimal level with world-leading standards.
Several hon. Members rose—
Madam Deputy Speaker (Judith Cummins)
I want to try to get everybody in, so I will start with an immediate five-minute time limit.
Mr Clive Betts (Sheffield South East) (Lab)
It is a pleasure to follow the Chair of the Public Accounts Committee, the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown). Although we sit on opposite sides in the Chamber, we now spend most of our time in this place on the same side of the table in the Committee. I congratulate him on his appointment and the work he is doing as Chair.
The clear remit from the Secretary of State is to move to prevention, community care and digital services; that is how it is laid down. When we had the officials from the Department and NHS England before the Committee, we said that we thought they were complacent about the NHS’s finances. I thought that there was no sense of purpose or long-term strategy to deliver on the Secretary of State’s objectives; that was the worrying thing.
Let us look at the immediate problems. We have a service where trusts and others can run up deficits and seemingly there is no consequence. Unlike local government, which has to balance the books or go to the Government for approval to capitalise losses, that does not happen in the NHS. We have the problem in South Yorkshire that Doncaster hospital runs at a loss every year—I am not blaming the hospital, because it has an old building that needs massive refurbishment, or probably complete rebuilding, and it has not had the resources—and those losses go into the wider ICB system and put pressure on other hospitals and trusts not to distribute any surplus they might make to community services in Sheffield but to fund others’ losses. That is no way to incentivise a proper financial arrangement.
The hon. Member was absolutely right on moving towards community services, which is about not just getting people out of hospital but stopping them going into hospital in the first place. That certainly could be done. GPs hold 90% of appointments and get 10% of the funding. That is clearly wrong; we have got to switch that.
On social care, about eight years ago the Health and Social Care Committee and the Housing, Communities and Local Government Committee produced a joint report to which 22 Members of Parliament signed up, but we are still here talking about the funding. Louise Casey is a great appointment as she has a great “get up and go” attitude, but I am sure she could be asked to get up and go a bit before 2028, because that is a long time to wait for any response.
We should be looking a lot more at moving services out of hospitals. There is a proposal around—and I say “around” because the NHS does not tend to act quickly—a diagnostic centre at Crystal Peaks in my constituency. The south-east of Sheffield is a long way from the two teaching hospitals, so to put services such as MRI scans, ultrasound scans, X-rays and CT scans there and to have GPs working with consultants who come to see patients in their clinics in the community would save money and provide a better patient service. But that seems to get locked up in discussions about NHS financing and commissioning, and who gets paid what to see who and when. We have got to unravel that and recognise that services can be made to improve significantly.
On digitalisation, the example of fax machines is of course legendary, but the other week I had to change a hospital appointment a couple of times—the service was really helpful in changing it—and I got not merely three emails and three texts but three letters with a first-class stamp on them, all for one appointment. That is a complete waste of money. I have talked to the hospital in Sheffield, which is bringing in new IT systems to cover the whole of the hospital operation, but that does not link into the GP systems. It is just nonsense that in this day and age we have that sort of unjoined-up thinking.
I will raise a couple of other issues. The consultant who has been treating me for the last seven years—successfully at this stage—for my myeloma has got an idea. People have so much chemotherapy to go through—probably at least six different sessions, twice a week—and for those sessions they have to go into the day ward. That is all right for some people—my timetable was helpfully rearranged to suit me coming down here and going back—but for many that is not possible, particularly if they have to go to a specialist unit that is many miles away. He has developed an idea for home chemotherapy, which works and is good.
Sir Geoffrey Clifton-Brown
I am sorry to intervene on my deputy, who does an excellent job on the Public Accounts Committee. In the last Parliament, before he joined the Committee, we went to Denmark, where they do precisely what he is talking about: give chemotherapy treatment to people in their homes where they have a history of not reacting to it.
Mr Betts
Absolutely. Obviously, it is done with a clinician’s approval and with the patient’s agreement. The idea has been around for two years now, but again it is lost in the labyrinth of NHS discussions, boards and committees. Come on—let us do it now. It is a good idea, which is actually cheaper and benefits the patient. Why cannot these ideas be got up and moving much more quickly?
I absolutely agree with the comments made by the Chair of the Public Accounts Committee on public health. It is like an afterthought. The grant for public health comes out at least two, three or four months after the main grants for the NHS and local Government—it is like the money down the back of the sofa that the Treasury finds at the last minute—and over the years it has been cut significantly in real terms. Public health in Sheffield does an absolutely great job, working with NHS Sheffield Place. It has done some really good work in deprived communities to increase and improve community care in the north of Sheffield. That is the sort of initiative we ought to pursue, and we should give the ICB the wherewithal to support and engage with that.
Finally, we ought to build equality of treatment into our aspirations. In Sheffield, from one end of the city to another, life expectancy changes by 10 years. That is simply not acceptable. However, for child vaccinations, GPs get paid by the number of vaccinations they do, so those GPs with the easy patients to reach—probably those in the wealthier areas—get a lot more money for doing vaccinations than those struggling to engage with deprived communities. That sort of initiative from the NHS is wrong and we need to correct it.
John Glen (Salisbury) (Con)
It is a privilege to make a contribution in this important seasonal debate. I pay tribute to my hon. Friend the Member for North Cotswolds (Sir Geoffrey Clifton-Brown) for bringing the debate to the House and commend him on his work chairing the Public Accounts Committee. As he set out, the NHS faces a number of enduring challenges: productivity, the integration of different systems, the challenge of public health, and the enduring issue of social care and how local authorities can provide the space for the NHS to deliver some of the outcomes we all aspire to.
I spent some of my time prior to the election in the Treasury. At every fiscal event that I was part of, whether as Parliamentary Private Secretary to the Chancellor, Economic Secretary or Chief Secretary, more money was given to the NHS. An attempt was made before every fiscal event to ensure that all the relevant stakeholders made the right positive statements about the new commitments, yet six or 12 months later there would be another pressing financial challenge. I say that because it is frustrating—we all come to this place to try to find enduring solutions to problems that are complicated. I therefore want to make some observations about the challenges of multiple systems operating effectively in allocating resources.
I meet GPs in my constituency regularly, as I am sure we all do. One such person is Dan Henderson, who is a partner at Salisbury medical practice. Alongside Anna Morton, who is a practice manager, he explained to me the complicated dynamics with our ICB over how to ensure that the right allocations are made for the inputs that they are organising at GP practices. It is mindboggling how difficult that process of securing the right allocations is and the lack of ability to plan effective systems over one, two or three years and beyond because the budget cycle is so overwhelmed with managing the health system. If we are to tackle the productivity challenge, we have to come to terms with those connection points between ICBs, GPs and local authorities and with how we can embed behavioural shifts that lift productivity.
The second area I want to touch on, despite the record £200 billion of funding going into the NHS, is the problem of public health and coming to terms with how we consume health services as a country. Where something is free at the point of need, we can become very inefficient in the way we draw down that provision. I really think we have to work on pathways for informing and helping our constituents access health systems effectively.
We have seen an explosion of mental health challenges in recent years and the NHS has done a fantastic job of trying to deal with that. However, we should not tolerate the variable performance of the NHS across different trusts and across the country. One way in which we can raise productivity is by exposing those variances in performance so that those who are leading the NHS can be accountable for them. Those systems will be different for many reasons, with different demographic pressures and different challenges due to their capital estate. We must get those issues out in the open rather than always thinking that just ploughing more money into our NHS system is the way forward.
I welcome the greater investment, once again, in the NHS, but I recognise that we will need radical solutions if we are to change the productivity story. As a House, we need to unite in finding the right fixes and looking at the best ways of bringing them to fruition across our country.
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.
Gregory Stafford (Farnham and Bordon) (Con)
As a member of the Health and Social Care Committee, I know that there are serious challenges facing our health and social care system, particularly in the context of current and future funding. We all know that the NHS is under immense pressure. Our population is ageing, health needs are becoming more complex and the effects of the pandemic continue to be felt. If we want a system that works for everyone, we need to address these challenges with smart, strategic and effective solutions.
Before I became a Member of Parliament, I worked in healthcare, most recently as part of the NHS Getting it Right First Time programme. This programme focuses on improving patient care by studying what works best, comparing data and making practical changes. Through that work, I saw where the system was bogged down by excessive bureaucracy, poor organisation and feeble productivity improvements, leading to unacceptable and unwarranted variations in care. Those problems waste time and money instead of helping patients. We need to streamline processes, modernise services and focus on patient outcomes rather than bureaucracy.
When the last Government were in charge, we increased NHS funding to record levels. In 2023-24, the NHS’s day-to-day budget was nearly £180 billion, and there is even more being spent in the current budget. But the real question is: where is this extra money going? Despite this additional spending, NHS England’s chief financial officer admitted to the Health and Social Care Committee that almost all of this year’s £10.6 billion uplift will be consumed by pay settlements, increased national insurance contributions and rising costs of treatments and medicines, meaning that very little, or indeed none at all, will be left for improving patient care. The Government are pouring billions into the NHS, but without demanding productivity reforms the money is being absorbed by the system instead of reaching the frontline where it is needed the most.
In my constituency of Farnham and Bordon, which includes Haslemere, Liphook and the surrounding villages, we have challenges in ensuring fair access to services across our different areas. In Bordon, rapid housing developments continue, yet healthcare provision has failed to keep pace. The ICB is pushing ahead with proposals for a new health hub, but there are concerns that it will not meet the future demands of a growing population. Residents who rely on the Chase hospital need assurance that new facilities will provide long-term, sustainable care.
In Haslemere, the hospital has made great strides in expanding services, reducing pressure on nearby GP surgeries and major hospitals such as the Royal Surrey County hospital, but ongoing support is needed. Upgrading equipment, increasing staffing and ensuring continued investment will allow Haslemere hospital to remain a cornerstone of our local healthcare provision. Farnham, meanwhile, faces persistent issues with both healthcare and access to dental services. The shortage of NHS dentists is an escalating crisis, leaving many residents without the care they need. Too many people are forced to travel long distances or go without treatment entirely.
Indeed, across the constituency, transport links to places such as Frimley Park hospital remain a concern. As a regional hub, Frimley Park plays a vital role in serving Farnham and beyond. However, for many residents, particularly those in rural areas, accessing treatment there is a challenge. I have worked closely with the local authorities and Frimley Park to improve transport connections, including through the expansion of the Waverley Hoppa service. If the Government truly want to expand services, they need to look at this holistically: not just at the buildings but at how patients can access them.
Labour’s tax increases on GPs, pharmacies, care homes and social care providers are putting vital services at risk. The Royal College of General Practitioners has warned that these changes could force some surgeries to close or reduce their services. In my constituency, that was amply demonstrated to me when I visited Badgerswood GP surgery and pharmacy. I have also spoken to Dr Kabir from the Hampshire primary care network and Tim Corry from Guardian Angels. They told me that these changes are forcing small healthcare providers to cut staff hours, downsize operations and even lay off employees. Hospices are also struggling, with projected cost increases of £30 million. I am lucky that the Phyllis Tuckwell hospice in my constituency is currently going through a major rebuild, but others are not so lucky.
The Government need to focus on real reforms that improve productivity and modernise healthcare. If the Health Secretary is serious about making the NHS better, he must explain how he plans to integrate those innovations into his 10-year plan. The reality is that this Labour Government have failed to build the new hospital programme and to implement the Conservative Government’s cap on social care costs. Labour has no plans to fix the NHS. Instead of returning to the futile model of “Whitehall knows best”, the Government should be looking at actively devolving funding to local systems, with the provision of punishment if they fail. Ultimately, they must have an honest and open conversation with the public about how we deliver, provide and fund healthcare.
Jen Craft (Thurrock) (Lab)
Meeting my constituents in Thurrock serves as a constant reminder of the state of our NHS and the health of our nation. I regularly hear from residents who cannot access NHS services, who are stuck on a waiting list or who are unable to see their doctor. I see how the social determinants of health play out, putting people in parts of my constituency at a disadvantage from day one. Housing, unemployment and education drive health inequalities, and in our most deprived communities, people do not live to see their 80th birthday. That is representative of the immense task this Government have been set. The funding of the health service and the estimates we are discussing today are fundamental to turning the tide on these trends.
Fourteen years of neglect and failure, the highest waiting lists on record, an ageing population that is getting sicker and unmet need in communities across the country mean that the NHS is at a pivotal point in its history. It must fundamentally change how it operates in order to survive. The £22.6 billion of funding committed to revenue spending at the Budget was a welcome and much-needed cash injection, the impact of which is already being felt. The delivery of Labour’s manifesto commitment of 2 million more appointments a year is testament to that.
Gregory Stafford
I did mention this in my speech, but I think the hon. Lady was there in the Health and Social Care Committee when the chief financial officer of NHS England said that the extra £10.6 billion allocated for this year would be entirely eaten up by other costs, including national insurance rises, and that there would be almost no extra money for frontline patient care. Does she remember that?
Jen Craft
I was indeed at that Committee, and I also remember the reflection that NHS England was incredibly grateful for the amount of money that was being given. It was the highest amount of money given to any Department at the Budget, and it was much, much more than has been given in previous years.
Waiting lists have fallen for the fourth month in a row—I hope the hon. Gentleman and his colleagues will welcome that—with 160,000 fewer people waiting for treatment than when Labour took office. That includes a member of my own family, so I am very grateful to see that happening. Extending the opening hours of community diagnostic centres, such as the one set to open in my constituency this summer, will be key in catching conditions earlier.
While I welcome those measures, I would like to make the key point that funding alone is not enough to change and save how our NHS operates, and we must turbocharge the left shift to community and neighbourhood healthcare. In my constituency, it is often the front door to the NHS that lets local people down, which drives admissions to A&E when there is no available alternative. We have some of the most acute GP shortages in the country, with an average of 3,431 patients per GP. The neighbourhood health hubs promised by the previous Government have yet to be delivered. People in Tilbury, one of my most economically deprived areas, are still waiting for a long-promised facility, which currently looks like a hole in the ground, and I would welcome a discussion with the Minister about how we can work to deliver it.
The record funding uplift for general practice, with £889 million of investment, is again welcome news, but it highlights the fundamental tension between tackling the crisis in acute care and driving the vital left shift to community care that will be fundamental in turning the tide on the NHS. We must not lose sight of the goal of creating a healthier population in order to reduce pressure on acute services in this country, creating better, healthier lives and delivering the right care at the right time that puts the focus on the individual.
Thurrock community hospital in my constituency delivers excellent integrated community care that brings together social workers from the local authority and NHS staff to meet people where they are, intervening early and reducing pressures on acute care. That is partly thanks to a real partnership between the local authority and the integrated care board, and it has removed the need to focus on which public body benefits and which public body pays. I have to point out that our local authority has one of the lowest spends on adult social care, partly due to measures such as this.
The real focus is on how to deliver for individual patients—what do patients need and how do they get to that place? I welcome the bold move in the recent planning guidance to drastically reduce the strict targets placed on integrated care boards, allowing more of this work to take place by giving ICBs independence to make decisions that are relevant to their local population. However, I have heard from ICBs, including mine, that there is a risk that a focus on the elective care target may draw attention away from prevention.
I would like to point out the removal from the planning guidance of the targets for annual health checks for people with learning disabilities. That community historically has been under-represented and has not had its health needs fully met. This population dies younger and does not access preventive care at the point at which it would be most beneficial for them. Blanket prevention measures do not cover such populations. People in this community need specific intervention that allows them to access the healthcare that they need, when they need it. While a blanket annual health check is not necessarily the right way forward, it is absolutely critical that historically overlooked groups who are not served as well as others by our healthcare system are not overlooked when we shift to community and prevention work.
I very much welcome the strong investment that the Government are making in our NHS; it is vital in order to turn the NHS around and ensure that it is there for generations to come. I would welcome the Minister’s thoughts on how we can incentivise prevention as well as providing acute care.
Madam Deputy Speaker (Judith Cummins)
I call the Chair of the Select Committee.
Layla Moran (Oxford West and Abingdon) (LD)
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.
Gregory Stafford
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.
Layla Moran
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.
Mike Martin (Tunbridge Wells) (LD)
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?
Layla Moran
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.
Steff Aquarone (North Norfolk) (LD)
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?
Layla Moran
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.
Layla Moran
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?
Several hon. Members rose—
Madam Deputy Speaker (Judith Cummins)
I will start with an immediate four-minute time limit.
Neil Duncan-Jordan (Poole) (Lab)
I acknowledge the £25 billion of additional funding allocated to health and social care in the autumn Budget. We are already beginning to see improvements in waiting times, the number of dental appointments and access to treatment. That is absolutely what my Poole constituents wanted and needed to see from a Labour Government.
Neil Duncan-Jordan
I am afraid I will not.
Funding is more challenging in social care, and that is what I will focus my comments on. There is widespread acceptance that our social care system is neither sustainable nor fit for purpose. For far too long, it has been the Cinderella service of the welfare state, overlooked and underfunded, and it has suffered from a number of problems that started to emerge decades ago but have become critical as a result of severe cuts to funding and increasing demand.
Most people who have looked at the system recognise the huge cost to the NHS of keeping people in hospital when they could be discharged into the community. However, too often there are not the care packages in place to enable that discharge. That will be resolved only when we have a better understanding of the dynamics of social care and a more effective way of managing it. Addressing the crisis in the system requires us to reconsider the meaning of the term “social care,” and to abandon the false divisions between medical, nursing, personal and social care, and instead regard all those activities as part of a single care service.
A new national care service should seek to go further than the existing model of provision. As well as providing free domiciliary and residential care to all users who are self-funding, it should also have to: take account of the 2 million older people who have needs that are not being met by the system; improve terms and conditions for care staff; strengthen regulation and monitoring of services; and provide greater support for the country’s 5 million unpaid carers. There needs to be an immediate national debate about how a new national care service can be publicly funded and delivered, what it should include and who should be responsible for its delivery. The new Casey commission will only delay that debate further, in my view.
We have known about the problems for a long time. Over the last two decades, we have had at least 20 commissions, inquiries and reports analysing what is wrong with the system and what might be done to address the problems. However, successive Governments have all found the issue too difficult to tackle, and have instead favoured short-term answers that have largely left the system untouched. The issue that all politicians have avoided is the false division between health and social care, and the question of how such care should be funded.
No one should face personal costs simply because they are unlucky enough to suffer from conditions such as dementia. That undermines the very principle of our NHS. Society must share the burden, and those most able to contribute must pay their fair share. Our universalist principles must lead us to talk about correcting those inequalities and ensuring that wealth, resources and budgets are used to build a fairer and healthier society for all.
Joe Robertson (Isle of Wight East) (Con)
I commend my hon. Friend the Member for North Cotswolds (Sir Geoffrey Clifton-Brown) for his introduction to the debate. I agree with the majority of what I have heard so far.
We must understand the context of the large figures announced by the Government. In particular, the £10 billion for the NHS next year sounds like a big figure, but as my colleague and Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), was right to inform us, the vast majority of that money—around £8 billion to £9 billion—will be taken up by union pay deals, the national insurance increases brought about by the Chancellor, and inflation. When all the essential costs that the NHS must meet are taken into account, the £10 billion represents a shortfall. The NHS will be able to deliver only if it produces productivity gains. We must understand that £10 billion will not even meet the required costs of the NHS.
Joe Robertson
I agree with all those things, and I am happy that the hon. Lady and I agree with each other. I hope that she acknowledges that £10 billion does not cover the basic requirements of the NHS. It delivers nothing more; in fact, it delivers less. The NHS will be able to continue to grow only if it delivers productivity gains, and it should.
Gregory Stafford
Does my hon. Friend remember, as I do, that when the Secretary of State was in opposition, he was very clear that there would be no pay increases unless there were productivity gains and reforms to the way the NHS operates? Now that Labour is in government, that seems to have completely evaporated.
Joe Robertson
I remember that clearly. I would like the Minister to spell out how she will deliver those productivity gains through reform. We want to hear more detail so that we can be confident that the NHS is secure.
Let me turn to one area that the Minister might like to reflect on: the use of technology. Penny Dash, the candidate to take over as chair of NHS England, told the Health and Care Committee clearly that she would like technology to deliver and that she sees lots of opportunities. She herself remarked that basic technology in the NHS is not working. I recall that she used the example of nurses taking half an hour to turn on a computer system and having to use five passwords to access it. I said to her that it is hardly sensible to try delivering technology gains around artificial intelligence and all the opportunities that it might bring if we cannot deal with very basic, low-tech problems throughout the NHS. She agreed and accepted that is a challenge. I would like to see how the Secretary of State will, through the Minister, support NHS England in delivering that.
I would also like to see the dementia diagnosis target brought back into the planning guidance document for NHS England. It was taken out this year, in consultation with the Secretary of State—so he allowed that. Diagnosing dementia is the most important thing we can do for people living with dementia and their families. Taking that diagnosis rate target out is inexcusable. I accept the wider point that if everything is a target and a priority, then nothing is a priority, but I think we can all agree that dementia—the biggest killer in this country—must be a priority for the NHS. That target for diagnosis rates must come back into the planning guidance next year. Indeed, the word “dementia” does not even feature in the guidance, which is shameful, frankly.
Let me finish by talking about where the money is spent. We can have disagreements about how much is needed, but Lord Darzi was very clear that it is not being spent in the right places. Too much money in the NHS is being spent on hospitals, and not enough is being spent in the community. The Secretary of State will have to take some tough decisions, which he accepts, and one of them will have to be to reduce the proportion of money spent on hospitals. That is politically difficult, but across the House we are prepared to back him, if it is part of a plan to deliver meaningful change and to move more people out of hospitals and into communities, which is where they most want to be treated. Nobody wants to be in hospital if they have no medical reason to be there.
Finally, the Chancellor must understand that every decision she takes must be coherent and consistent with delivering the three shifts. When she came to the Dispatch Box to deliver the Budget in October, she recognised that national insurance increases were going to be crippling for healthcare. That is why she exempted the NHS from those increases. However, she failed to exempt other key providers of healthcare, particularly in primary care, such as GPs, so it is no good now saying that the GP pay deal is a record deal, because the money that they must pay in national insurance contributions represents more than 50% of the money that the Government have given them. The Chancellor must back up the left shift with the fiscal decisions she announced at the Dispatch Box.
Several hon. Members rose—
Madam Deputy Speaker (Judith Cummins)
Order. Before I call the next speaker, Members may wish to know that, given the time remaining for this debate and the number of Members who wish to speak, I will be unable to get everybody in, even with a four-minute time limit.
Josh Fenton-Glynn (Calder Valley) (Lab)
I am pleased to be called to speak in this important debate, Madam Deputy Speaker. When we talk about the NHS, we can argue either about specific investments or about general principles, and like many colleagues, I have received a great amount of correspondence highlighting no end of specific areas where investment is needed. I could also speak about the need to invest in urgent treatment centres in Todmorden, or to celebrate the work of Calderdale and Huddersfield NHS foundation trust—two things that I continue to raise with my right hon. Friend the Secretary of State for Health and Social Care. However, as I have the privilege, along with others, of sitting on the Health and Social Care Committee, I want to talk in more broad terms about some of the problems facing our health and social care system, and about how the proposed shifts in the NHS need a reprioritisation of resources.
I will focus on what I argue is the most important of those shifts—the so-called left shift of care from hospitals to the community. The hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown) outlined the need for that well—even if to hear him speak one might think that it had come from on high, and not as the result of 15 years of the previous Government. One in 10 people are stuck on waiting lists in a healthcare system that is becoming increasingly hospital-centric, and those lists will only grow if we continue on the same course. There is no solution to our crisis in emergency medicine without the left shift of solving problems earlier and closer to home.
Of course we need hospitals and to invest in them, but they should be where people go with acute and complex cases, not where they go for want of working services elsewhere. Despite the need to shift to community care being obvious to just about everyone, one of the most glaring revelations of the Darzi report was how poorly successive Governments have gone about achieving that. Meanwhile, we are not training or retaining enough GPs—that is where the renegotiation of the contracts is important.
In Calder Valley, the retention crisis has meant that Bankfield and Church Lane surgeries, Northolme practice, and Rastrick health centre all have a ratio of patients to fully qualified GPs that is far higher than the local, regional and national averages—averages that simply do not meet what is needed from our health service. More than a decade after the Dilnot report, social care remains the forgotten service—the Cinderella service, as my hon. Friend the Member for Poole (Neil Duncan-Jordan) artfully called it. With 1.4 million social care staff, our care system is the same size as the NHS workforce, but it receives nothing like the support or understanding of other areas of our health system. The consequence is that our Committee, week after week, hears about delayed discharge, with 20% of beds in my local hospital taken up by people who should be treated at home or closer to home. Meanwhile, carers are missing their appointments because they are delivering care to loved ones, and they end up with worse illnesses, adding to the strain on the NHS.
In less than a year, this Government have ended the industrial action in our NHS and delivered 2 million additional appointments, and they are now setting up a new deal with GPs. However, that cannot be the extent of our actions. The 10-year plan cannot continue down the same road that the last Government took us on, of trying to fix a crisis in the NHS by putting more money into hospitals and nothing else, because that tackles the symptoms but not the causes of the problem.
Therefore, when setting out the estimates, I urge the Minister to be mindful of the shifts we need to ensure that funding not only increases, but increases with a focus on community and social care. That is what we need for a sustainable system that will protect the rest of our health service in future, because a sustainable system is the only way to deliver better healthcare and better social care for people across the country.
Seamus Logan (Aberdeenshire North and Moray East) (SNP)
I commend the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown) for introducing the debate, and I pay tribute to the retiring interim chief executive of NHS Grampian, Adam Coldwells, an outstanding public servant who will be sadly missed when he departs his post.
The revised departmental expenditure limit for the Department of Health and Social Care in England sees an overall increase in the estimates of around £10 billion, and I want to comment on how that affects Scotland generally and my constituency in particular. Lest we get giddy about the numbers, let us think about where that expenditure might be going: salaries and wages, price increases—particularly for fuel and food—and certainly more taxes. It is a new definition of the circular economy as I understand it.
Let us also consider how the changes affect our partners in the enterprise of health and social care. GPs, hospices and charities are already facing huge financial pressures from rising energy costs, staff retention issues and labour shortages. Staff morale is already low and will be further impacted by funding cuts to the vital services they provide, as money is diverted to meet rising costs. Then along comes the increase in employer national insurance contributions for those partners. When we look across the border into England, we see additional GP contract funding of close to £1 billion, which will cushion much of those additional national insurance costs.
Let me share a local example from Aberdeenshire council, on which I was an elected member for more than two years. The cost to the council of the additional NIC changes is about £11 million. The council’s estimated allocation from the Scottish Government to mitigate those additional costs is around £5.5 million. The difference is stark and cannot simply be written off as a Scottish Government responsibility. Indeed, as Wes Streeting constantly reminds us, all roads lead to Westminster when it comes to funding. Our joint enterprise partners, such as GPs and third sector organisations such as Marie Curie—I see Members are wearing a daffodil today—or Chest Heart & Stroke Scotland, and local GP surgeries in places like Longhaven and Cruden Bay, are paying the price.
Turning to hospices, the Minister for Care, Stephen Kinnock, stated that there will be no additional Barnett consequentials—
Madam Deputy Speaker (Judith Cummins)
Order. I remind the hon. Gentleman to refer to Members not by name but by constituency.
Seamus Logan
Thank you, Madam Deputy Speaker.
There will be no additional Barnett consequentials arising for Scotland for hospices. The Scottish Government are investing an additional £4 million in the hospice sector, but that wider sector faces a £2.5 million bill from the additional employer national insurance contributions. A flat exemption would mean that they would not have to pay that cost.
Perhaps also not evident from the estimates are the eye watering costs of agency staff, which is felt no less in Scotland, partly because of the regressive immigration policies of the last Government, which are now pursued by this Government. We have asked for those powers to be devolved to Scotland, but if Ministers cannot do that, there is an alternative approach—that has already been pointed out by the right hon. Member for Salisbury (John Glen). The Royal College of Radiologists tells us that workforce shortfalls in radiology are around 30%, and around 15% in oncology. It states that the most urgent task facing the NHS is to manage its workforce crisis by investing in an increase of 150 radiology training places and 45 clinical oncology training places, rather than relying on outsourcing and international recruitment. Of course training has costs, and it is every bit as expensive in Scotland as it is here.
In conclusion, through the Minister I say this to the Treasury: do not treat Scottish citizens as if they live in some vassal state; they are taxpayers too. Rather than expecting us to give you thanks, just get your chequebook out because of the pressures that I have listed.
Nesil Caliskan (Barking) (Lab)
May I take this opportunity to thank the Chair of the Public Accounts Committee, the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown), for his work, as well as other Members who I sit on the Committee with?
The financial sustainability of our national health service will have an impact on patients now and in future. Given that such a huge amount of money is spent by the Government, it is imperative that they focus on value for money for the taxpayer so that, at a time when demand is going up but resources are limited, we can deliver the very best health service that the British people deserve and that my constituents in Barking can rely on.
For too long the Department and NHS England have taken a short-term approach to budgeting, relying on reallocating capital budgets to cover revenue shortfalls. Between 2014 and 2019, more than £4 billion was raided from the Department’s capital budgets to fund day-to-day spending. As a former council leader, that approach has always been curious to me, given that, as others have mentioned, local authorities are not permitted to have the same approach. Equally, councils are legally obliged to set annual balanced budgets, and even when they overspend because of demand-led statutory services, they cannot set deficit budgets.
Josh Fenton-Glynn
Another issue my hon. Friend may wish to reflect on is that the council tax base differs from place to place, so councils are even more disadvantaged than the NHS on funding.
Nesil Caliskan
My hon. Friend makes an important point, because health inequalities are determined by a multitude of factors and the work that local authorities do on public health is crucial too.
Compare the point I made about local authorities not being able to set deficit budgets with the situation in the NHS, where every year winter pressures mean that our NHS is at crumbling point and that despite the money poured in, the NHS overspends. Last year, that overspend was £1.4 billion, more than double the previous year. Those issues have not emerged in a silo; they are a result of years of mismanagement and failed leadership by former Ministers and by a Government who decided to allow the chaos of one year budget setting, hindering health leaders from being able to effectively plan for the future.
A lack of political commitment, coupled with a refusal to invest in the future, has led to awful consequences for patients. On the NHS estate, the National Audit Office report shows that since 2019, over 5,000 appointments, surgeries and other clinical incidences have had to be cancelled because of issues in buildings. That is absolutely shocking, so I take on board the points made by Members from across the House.
Nesil Caliskan
I will not take any interventions at this point—actually, I will.
Anna Dixon
I thank my hon. Friend for giving way. It is always a pleasure to serve with her on the Public Accounts Committee under the leadership of the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown). She makes an excellent point about the raising of capital budgets. In my constituency, we have the RAAC-infested Airedale hospital. Does she agree that it is only with the new Labour Government and a properly funded and deliverable plan for new hospitals that we will see that put right, following the decision made by the Chancellor to ringfence capital funding?
Nesil Caliskan
I am very pleased to have accepted my hon. Friend’s intervention and I entirely agree with her. If we want to see an improvement in the estate of the NHS, we need to have money allocated to it.
When the NHS was at breaking point, my constituents had to feel the pain of not being able to get appointments for their sicknesses. The population I represent already has some of the worst health inequalities in the country, exacerbated by the lack of primary healthcare provision. Some wards in my constituency have no GPs at all, so I welcome the remarks made by Members from all parties about the importance of primary healthcare provision.
Without reform, the NHS is simply not financially sustainable, but alongside reform there must be a culture of change in NHS England. The Public Accounts Committee report highlights that last year NHS England failed to approve ICB financial plans until months after the financial year had begun. Working with local NHS bodies, we have seen examples of ICBs, as other hon. Members have said, talking a good talk on prevention and public health, but we see a lack of action from many areas on commissioning in a way that has a positive impact on prevention.
Gregory Stafford
I entirely agree with the point the hon. Lady makes, but does the impetus not have to come from the top? Unless the Government are making strides to shift moneys from healthcare to social care, why on earth should any of the ICBs follow suit?
Nesil Caliskan
I do not disagree with that, which is why the Government commitment around reform will be so critical. I sit on the Public Accounts Committee that produced the report that highlighted some of those gaps. As a Committee, we will be looking closely at the reforms that have come forward from the Government, and I would welcome further reassurance from the Minister.
The Government are right to invest in the NHS to help to deal with the current critical waiting lists, but only alongside reform will the additional investment in the NHS be value for money. Only through reform can the NHS improve productivity to make it sustainable. I endorse comments made by Members from all parties about productivity because, without reform, the NHS cannot even meet its own productivity targets. That is why the estimates under discussion are so important. The 4.9% increase in investment is welcome because it will help to cover the pay review body’s recommended pay increase for NHS staff, stop the strikes, improve staff retention and keep more doctors and nurses at work. That is crucial if we want a properly functioning NHS.
The Secretary of State for Health and Ministers in his team have said time and again that the NHS is beaten but not broken. These estimates are important because they set the foundation and springboard for what is required to fix our NHS.
Sarah Bool (South Northamptonshire) (Con)
The Government came into office making all the right noises about tackling waiting lists and delivering a better healthcare service, which all our constituents want to see. However, since their election, I am concerned that Ministers are giving out more money—about £22.6 billion —for the day-to-day running of the NHS, without plans about how that may be spent to reform our health service, make it more efficient and support priority areas, such as dentistry, general practice or hospice care.
The Government are seemingly giving with one hand but taking with the other. No one should overestimate the impact of the increase of the employer national insurance contribution on our GP surgeries. Both Towcester and Brackley medical centres in my constituency have said that that increase will cost at least £40,000 to £50,000 and may result in redundancies, stopping the growth of their practices. Our surgeries are not here to make profit, but to deliver care, and attacks like this make care unsustainable.
The Darzi report said:
“The NHS budget is not being spent where it should be—too great a share is being spent in hospitals, too little in the community, and productivity is too low.”
Gregory Stafford
I agree entirely with what my hon. Friend says, but has she seen anything from this Government that suggests that there will be a significant shift from acute care in hospitals to community care, despite the rhetoric that we have heard from the Government Benches?
Sarah Bool
I concur that I have not seen anything, which is why today’s debate is so important. My GPs tell me that more attention needs to be given to GP practices: they are the praetorian guard who can ultimately protect the NHS. Access to timely appointments is crucial, as is rebuilding the key relationship and contact between a GP and their patient.
Josh Fenton-Glynn
Under the last Government, 20% of NHS doctors were thinking about moving overseas. Does the hon. Lady agree that solving GP contracts is a first step towards keeping GPs working in this country?
Sarah Bool
I want to encourage all our GPs to remain in the UK, giving back, so I am always fully supportive of anything we can do about that.
Ben Coleman (Chelsea and Fulham) (Lab)
On that point, will the hon. Lady give way?
Sarah Bool
I will make some progress.
That key relationship and contact between a GP and their patient was reinforced by the Public Accounts Committee report on NHS financial stability, published in January, which concluded that a reallocation of funds was needed to focus attention from sickness to prevention.
I am a massive advocate of prevention. Many hon. Members will know that I talk about being a type 1 diabetic; if they have not heard me talking about it, they may have heard one of my sensors going off for a low blood sugar. There is so much we could do in preventative measures in the treatment of diabetes. Treatments can be expensive as an initial outlay, but they will solve many long-term problems. We cannot prevent type 1 diabetes, but we could have earlier testing in children, for example, so that we could avoid them being diagnosed when in a state of diabetic ketoacidosis, which can be fatal. Families could be prepared and ready, and children could avoid hospitalisation, saving costs to the NHS while also saving lives.
We can also ensure access to technology that can avoid huge complications. Poor blood sugar control can result in loss of eyesight and limbs, alongside heart and other conditions. Making continuous glucose monitors and even insulin pumps available across the country can significantly help the patient and, again, in the long term save the NHS money. At the moment there is a very unfair postcode lottery, so I ask the Minister to consider ways to tip the funding balance, to ensure both prevention and community care measures are properly funded.
Finally, any reforms to the NHS must consider the computer operating systems in place. Many of my constituents must go out of the constituency for their hospital care, be it to Northampton general hospital, the John Radcliffe hospital, Horton general hospital, Milton Keynes university hospital or Kettering general hospital, but all those trusts operate on different systems, with the result that my constituents often cannot have their scans or medical notes shared easily. That is frustrating for residents, and potentially fatal. One resident noted that his wife was nearly given a drug that she was allergic to, because her notes had not been able to be shared correctly—it was only his presence that saved her.
We must ensure that money is spent to look at that and to change the systems, which my hon. Friend the Member for North Cotswolds (Sir Geoffrey Clifton-Brown) has explained very conclusively. We owe it to our constituents to work across the House to better our healthcare and to support the fantastic work of our doctors and nurses.
Madam Deputy Speaker (Judith Cummins)
I will start to call Front-Bench speakers at 3.15 pm.
Alex McIntyre (Gloucester) (Lab)
In my last career, prior to entering this House, I was incredibly proud to represent our NHS and other healthcare providers, and I will continue to fight for our NHS now that I sit here as an MP. I saw at first hand the impact that Tory mismanagement had on our NHS, which breached one of the fundamental principles of medical ethics: “first, do no harm”.
I saw that at first hand this week in my constituency when I visited Gloucestershire Royal hospital. I also met with Gloucestershire ICB this morning, and earlier this year I visited the surgery in Tuffley. The challenges that they face will not surprise anyone in this House, as they were set out in stark terms in the Darzi report, and they are replicated across the country in many constituencies—maintenance backlogs, lengthy ambulance waiting times, recruitment challenges and an ageing and sicker population. What struck me most about my visits this week was the resilience of our NHS staff, who are committed to people in our county and in my city of Gloucester.
What a difference a Labour Government are making with more investment in our NHS. Waiting lists locally are already coming down, and patients are now able to access emergency dental treatment, rather than pulling their teeth out at home. We have more midwives and dentists and a new GP contract that will help to bring back the family doctor. That is what we can do in eight months—imagine the impact that we could have if we had 14 years, as the Conservative party did.
From a personal perspective, I have seen how important that work is. I used to joke on the doorstep that I should be a poster boy for why prevention is better than cure—it will not surprise Members that I may have a few extra pounds that I could afford to lose. Sadly, the prevention piece came too late for me; I was diagnosed with type 2 diabetes earlier this year. The treatment I have received since then has been phenomenal. I am now on the path to remission programme—available in Gloucestershire, but not across the country—which has already brought my blood sugar levels down and helped me to lose 3½ stone. [Hon. Members: “Hear, hear!”] Thank you very much. It will help countless others across Gloucestershire and across the country. As we move to prevention work, it is so important that we also look at public health measures around diabetes; I echo the comments made by the hon. Member for South Northamptonshire (Sarah Bool).
I also thank all the staff who looked after my little boy last year when he was really sick. We need to ensure that when we look at investment in our NHS, we prioritise maternity services and services for the youngest in our society to ensure they get the healthcare they need.
We have talked about British values a lot in this place over the last few months. When people ask me what makes me proud to be British, I point them to our NHS—a system without comparison in the world that means that everyone can access healthcare, regardless of their wealth. I know that Reform Members are not in their places today, but they say that all options are on the table. I would like the Minister to make it clear in her remarks that standing against our NHS and its principles—being there for everyone, regardless of their wealth—is the opposite of being patriotic and that their options are not on the table.
I welcome the record investment in our NHS and the shift from analogue to digital and from cure to prevention. I would also welcome the Minister’s comments on how we can ensure that we deliver on the people’s priorities in Gloucester.
Madam Deputy Speaker (Judith Cummins)
I call the Liberal Democrat spokesperson.
Helen Morgan (North Shropshire) (LD)
I thank the Chair of the Public Accounts Committee, the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown), for securing this debate and for his excellent opening speech.
We all know that we have reached a crisis point across the NHS and care sectors, with more patients than ever waiting for treatment. That is affecting not just those in need of care and treatment, but those who work tirelessly across the NHS and care sectors, who are feeling the full brunt of the crisis. The Conservatives have a legacy of hours-long waits for ambulances, treatment in crowded hospital corridors—captured in horrifying detail by the “Dispatches” documentary, which looked into the hospital that serves my constituents in North Shropshire—and communities grinding to a halt under the weight of all sorts of waiting lists and backlogs. We urgently need to move forward.
The Secretary of State has repeatedly outlined the need to shift from treatment to prevention and from hospital to community, and the Liberal Democrats absolutely support him in that endeavour—indeed, we called for many measures that would achieve that shift in our own manifesto. Stronger primary care and community services were the strong recommendations of Lord Darzi’s report, which was commissioned by the Secretary of State and has been broadly welcomed.
There has been a great deal of consensus across the House today that we need to take those measures, but I fear that these estimates paint a picture of an NHS that continues to pour money into the previous, failing model in which capital budgets are drained to pay for day-to-day services and a huge proportion of increased spending goes on NHS staffing, while community care and primary care providers wrestle with the huge increase in employer national insurance contributions.
When that is combined with the decision to scrap targets on mental health and community services for the sake of prioritising targets on elective care, we must ask: when will the stated objectives of the Secretary of State really be matched by actions? The latest estimates are an indictment of the broken state of the NHS after years of Conservative neglect, but we urge the Government to go further and faster to address the failure.
Ben Coleman
Having heard the hon. Lady’s comments and the comments of those on the Conservative Benches, may I share with her my confusion? She seems surprised that she has not heard the full solution of what this Government are going to do with the NHS, when it is quite clear that there will be the three shifts, a 10-year plan and a huge amount of reform coming down the line. As that seems to have escaped the Opposition’s attention, has it also escaped hers?
Helen Morgan
There is clearly a point in the debate at which we need to urge the Government to go further and faster. As a constructive Opposition, that is exactly what we will do.
Primary care providers are on their knees, and I am afraid to say that that has been made worse by the national insurance hike announced in the Budget. They cannot meet demand for local appointments as things stand, and in many cases the constraining factor is the estate in which they operate. Prescott surgery in Baschurch in North Shropshire wants to provide additional services to the community and keep people away from hospital, but the surgery is physically not big enough. A local developer has provided land for a new surgery, and the local council has community infrastructure levy funding for that building, but it cannot be done because the ICB will not pay the notional rent, which everybody has agreed to forfeit. It is crazy. I hope that the Minister can commit to finding some kind of easy solution to that kind of nonsensical situation that we find ourselves in.
Nesil Caliskan
On the point about the inability of ICBs sometimes to get things going, in my constituency it has taken the ICB nine months to procure something very similar. Does the hon. Lady agree that it is about not just their ability to pay, but their procurement processes?
Helen Morgan
I fundamentally agree. There are many such instances, and I chose that one because I spoke to the providers there recently.
I will come on to community pharmacy, because I am particularly concerned about pharmacies, which are a key pillar of care in the community, dispensing prescriptions and providing over-the-counter medicines and advice. Critically, they also provide Pharmacy First, but they are closing at an alarming rate. Analysis by the National Pharmacy Association predicts that another 1,000 pharmacies will close—900 of them by the end of 2027—if the current rate of closures continues. That is because of a 40% real-terms cut in their funding since 2015.
In fact, community pharmacies are essentially subsidising the NHS by making a loss on many of the prescription drugs that they dispense. In a few weeks’ time, in April, they will be clobbered by not only the NICs hike, but the increase in business rates, which will affect high street retailers. Shamefully, they have not even had their funding rates for the current financial year confirmed—the one that ends in three weeks’ time.
Pharmacy First, the flagship plan to move care into the community, has not had its funding confirmed beyond the first week of April this year, which is in just a few weeks’ time, according to the National Pharmacy Association. In her remarks, will the Minister confirm the future of Pharmacy First? Is there a funded plan to deliver that service? What steps are being taken to keep our community pharmacies in business? If we want to see care in the community, it is essential that we support them.
I want to mention dentistry. In Shropshire, Telford and Wrekin, the number of NHS dentists fell by 12.3% from 2019-20 to 2023-24. Many of my constituents cannot access a dentist, and the Government have committed to improving the situation, so can the Minister confirm when the negotiations on the new dental contract will begin?
The crisis that the social care system faces is daunting, not least because of the additional national insurance hike that will take place in a couple of weeks’ time. Last week, caring organisations launched an unprecedented day of action, with thousands of people marching on Westminster to highlight the precarious state of the organisations that provide care. The Darzi review found that people waiting to access social care account for 13% of NHS hospital beds. We all understand the urgency of tackling social care, but the cross-party talks collapsed last week—they have not started. There is no date for a new meeting, and there are no published terms of reference. We think that 2028 is far too late to resolve this problem, so can the Government urgently reinstate those talks and act now to deal with the social care crisis?
Before I conclude, I will talk about mental health. As Lord Darzi has said,
“There is a fundamental problem in the distribution of resources between mental health and physical health. Mental health accounts for more than 20 per cent of the disease burden but less than 10 per cent of NHS expenditure. This is not new. But the combination of chronic underspending with low productivity results in a treatment gap that affects nearly every family and all communities across the country.”
He is dead right. By April 2024, about 1 million people were on a waiting list for NHS mental health services, of whom 340,000 were children. My casework is full of children who wait months and months for the diagnosis and treatment that they need. The Government have removed the targets for mental health waiting lists; I urge them to reinstate those targets, so that we have parity between mental and physical health in our health service.
I am very conscious of time, so in conclusion, I will just reiterate our asks. Those are to ensure that social care talks start immediately; to deal with the problems with pharmacies; and to make sure that mental health and social care receive parity.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I draw right hon. and hon. Members’ attention to my entry in the Register of Members’ Financial Interests, as I am a consultant paediatrician. I congratulate my hon. Friend the Member for North Cotswolds (Sir Geoffrey Clifton-Brown) on securing this important debate on the finances of the NHS.
Labour said that it had a plan to reform and improve our NHS. Unfortunately, it has become clear from the series of consultations—on the NHS plan, the 10-year plan, the patient safety review, leading the NHS and the independent commission to transform social care, to name just a few that are in progress—that Labour did not have a plan, other than to get into power and then consider what its plan should be. As my hon. Friend the Member for North Cotswolds has said, we need improvements in productivity, technology and long-term investment. I completely agree, and as a medic I could give many examples of wasteful spending, especially in relation to paperwork and increasingly inflexible guidance and procedures that are well-meaning but often unhelpful.
There is general talk of productivity improvements from Government Members, but few specifics. I would be grateful if the Minister could provide any specifics in her closing remarks, but let us see what the Government have said and done so far. In the autumn Budget, the Chancellor announced that overall NHS funding would be increased by £22.6 billion over two years—for this year, that is £10.6 billion. The Government are asking us to welcome that extra money. It sounds great, but is it extra or not?
Julian Kelly, NHS England’s chief financial officer, told the Health and Social Care Committee that the proposed 2.8% pay rise for 2025-26 would cost £3.8 billion. The NICs pressure is worth around £1.7 billion, alongside £1.9 billion in non-pay inflation, £0.8 billion for the GP settlement and £3.5 billion for basic demand growth in the NHS. Right hon. and hon. Members will note that those figures add up to more than £10.6 billion, and with the unions having threatened to strike again for even greater pay awards and with Labour’s propensity to capitulate to the unions, it is likely that that figure will increase. Can the Minister confirm whether the £10.6 billion that Labour talks about will really lead to an improvement in services, or will it merely cover inflation, tax rises and the pay rises given by the Labour Government to their union paymasters?
Several hon. Members rose—
Dr Johnson
I will give way in a moment; let us first look further at those tax rises. It is clear that the Chancellor had not properly considered the effects of the NICs rise on the wider healthcare system. For example, the Government have exempted the NHS from that tax rise, but that exemption does not cover general practice, hospices, charities, many social care providers—including many care homes—air ambulance charities, dental clinics, opticians, private healthcare providers, agency staff, local pharmacies and other suppliers and contractors, to name but a few.
Alex McIntyre
I am sure that the shadow Minister is about to come on to this in her speech, but given that she has just criticised this Government for lacking a plan —a plan that is about to come forward to the House later this year—surely she will now put forward her plan for how much extra the Conservatives propose to put forward for the NHS and how they would pay for it, and explain why they did not do that for the past 14 years.
Dr Johnson
If the hon. Gentleman looks back at the figures, he will see that there has been a substantial real-terms increase in NHS funding over the past 14 years. That cannot be said for this year, potentially, which is why I am asking the question.
Mr Betts
Perhaps I will ask the shadow Minister an easier question, then. She has just rejected the pay deals that this Government have agreed to give a proper reward to our nurses and doctors. By how much does she think that pay deal should be reduced to bring it in line with her policy? If she is opposed to the deal that has been agreed, she must have an alternative in mind.
Dr Johnson
One of the key things about the Government’s deal is that they have given in on money without asking for anything in return in terms of productivity. The Government needed to agree a pay deal that was sensible and affordable, not talk about the money that they are giving to the NHS while taking away with the other hand in taxes.
Let us hear what some healthcare providers have had to say about the implications of Labour’s NICs rises for their constituents’ healthcare. The Royal College of General Practitioners has warned that the NICs increase will force GP practices to choose between redundancies and closure. The hospice sector believes that the cost of national insurance rises could be £30 million a year. The Government have given that sector a capital grant worth £100 million, which is welcome and will improve facilities; however, if those facilities are empty and cannot be staffed, they will not deliver much in the way of improvement. Air ambulances are also under threat from the Chancellor’s rise in national insurance and taxes in last year’s autumn Budget, with the local service in my constituency, Lincolnshire and Nottinghamshire air ambulance—which is entirely charitably funded—needing to find another £70,000 just to pay for those national insurance rises.
The Independent Pharmacies Association estimates that the rises in employer national insurance contributions and the minimum wage will cost the average pharmacy over £12,000 a year, totalling more than £125 million for the sector as a whole. Nick Kaye, chairman of the National Pharmacy Association, has warned that
“Pharmacies face a financial cliff edge at the beginning of April, with a triple whammy of rising National Insurance, National Living Wage, and business rates all arriving at once.”
What impact will this have on our constituents’ health? The Government talk a good talk about bringing healthcare closer to the community, but actions speak louder than words, and putting extra pressure on community-delivered services is not a good way of delivering their aims.
The Nuffield Trust suggests that the national insurance rise alone will add a £900 million burden to the adult social care sector. With other new costs factored in, the care sector is believed to be facing a bill of an additional £2.8 billion, dwarfing the £600 million extra allocated to the local authorities responsible for providing social care. This will have a devastating knock-on effect: the amount of care that can be bought by local authorities will fall, the cost of private care will rise—so more people will be reliant on the state, rather than the private sector—and the waiting lists that the Government claim to prioritise will also rise. The Nuffield Trust warns that many small care providers will either have to increase prices, stop accepting council-funded patients, or go bust.
That will have a knock-on effect on the hospital sector, as people are unable to be discharged because there is not adequate social care for them. The Government talk about creating a new national care service, but they have managed to damage the existing one by hiking the costs borne by care homes through national insurance rises and other tax and wage increases.
In January, the Government announced a deal with private hospitals in an attempt to cut waiting lists. The deal, which sounded good to start with, would see private hospitals being paid for each patient that they treated, incentivising them to treat as many people as possible. However, The Times reported that NHS England has recently capped the amount that each hospital can be paid. The chief executive of the Independent Healthcare Providers Network has warned that the policy will actually lengthen waiting times. Will the Minister comment on that?
The Minister is focused on prevention, but when the Government announced that they would be cutting the overseas development aid budget by 40%, the Prime Minister said that the UK would continue to play a key humanitarian role on a range of issues, including global health and challenges such as vaccination. I would appreciate clarification from the Minister on whether the global health budget will be cut, or whether the cuts will be made from other aspects of the ODA budget.
Workforce is the key asset of the NHS, yet sickness levels are running at around 5.5%, which is a considerable cost to Government and drag on productivity. They vary considerably across trusts and professions, with consistently less than 2% of consultants off sick, but almost 8% of ambulance support staff. If those rates could be reduced, it would lead to improved productivity and patients being treated much faster. What is the Minister doing to look at that? Perhaps she will have another one of her reviews.
Josh Fenton-Glynn
The hon. Member has frequently been quick to criticise NHS pay rises. Will there be more or fewer sickness absences in the ambulance service if its staff are better paid?
Dr Johnson
Is the hon. Gentleman suggesting that whether someone becomes ill is entirely dependent on whether they get another 2% in their pay packet? I am not sure that it is.
The Government promised a great deal when they came into power last July. Since then, they have handed out inflation-busting pay rises, raised costs and abandoned election pledges. At the centre of the Government’s approach is a classic socialist trick—a sleight of hand, taking money away from NHS providers in taxes with one hand, and expecting praise when they give some of it back with the other. The public will see straight through it.
The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)
Let me begin by thanking the Chair of the Public Accounts Committee, the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown), for opening the debate. As a Public Accounts Committee alumna, it is my pleasure to have my first outing at the Dispatch Box for this debate.
I also thank all other colleagues for taking part. The number of right hon. and hon. Members who have contributed today speaks to the significant interest in our health and social care services not only in this House but in the country. The wide range of issues raised shows how broad and overarching our NHS and social care services are. I will try to cover as many of those issues as I can, and if I miss anything, I will happily pick it up with hon. Members afterwards. I will also attempt to respond to all hon. Members who have spoken, but if I miss anyone, I hope they will forgive me, because we have had so many contributions.
The Chair of the Public Accounts Committee, as well as the hon. Member for St Ives (Andrew George), my hon. Friends the Member for Poole (Neil Duncan-Jordan) and for Sheffield South East (Mr Betts) and many other Members, talked about social care. Productivity was a key point mentioned by the Chair of the Public Accounts Committee, as well as by the right hon. Member for Salisbury (John Glen), the hon. Member for Farnham and Bordon (Gregory Stafford) and my hon. Friend the Member for Barking (Nesil Caliskan). Prevention in public health was raised by many Members—as the Minister responsible for those areas, I am delighted to discuss that.
My hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) talked about dentistry, and shifts were mentioned by many hon. Members. My hon. Friend the Member for Barking talked about the work not only of public health but of local government, and the role of ICBs. It was great to hear my hon. Friend the Member for Gloucester (Alex McIntyre) talk about his pride in the NHS. This Government will always stand by our NHS and will always keep it free at the point of use.
In her autumn Budget, the Chancellor took the necessary decisions to put our NHS on the road to recovery, with an increase of more than £22.5 billion in day-to-day health spending and over £3 billion more in the capital budget over this year and the next. Thanks to her, we are taking the first steps towards fixing the foundations of our NHS and making it fit for the future. I say to the shadow Minister that yes, this will make a difference, because it is not just about the money but about making the right choices.
Gregory Stafford
I thank the Minister, and welcome her to her place. This, I think, is the fundamental point that Conservatives are making. We all accept that we want to see a shift from acute hospital provision to social care, but when the Chancellor’s Budget does not reflect that and when the national insurance rises hit the social care end of the spectrum, how can the public have faith that what the Minister says is anything more than rhetoric?
Ashley Dalton
I am coming to all of that.
Since coming into office, the Government have made choices. We have ended the resident doctors strike. We have published our elective reform plan, which will cut maximum waiting times from 18 months today to 18 weeks by the end of this Parliament. We have introduced investment and reform in general practice to fix the front door to the NHS and bring back the family doctor. We have started to get waiting lists falling, and we have kept the promise in our manifesto to deliver an extra 2 million appointments in our first year, a target that we have actually smashed in the first seven months. Anyone who thinks the Chancellor was wrong to make the necessary decisions and trade-offs must explain what they would cut from that list. Anyone who thinks they could have achieved everything we have done in less than a year without the autumn Budget is living in cloud cuckoo land.
Today we are setting out our supplementary estimates to the House. Funding will help the NHS to deliver 40,000 extra elective appointments a week, and to make progress on reducing the number of patients who wait longer than 18 weeks between referral and consultant-led treatment. We will publish our departmental budgets for the next financial year in the spring through phase 2 of the spending review.
Layla Moran
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?
Ashley Dalton
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.
Ben Coleman
I am most grateful to the Minister for giving way to me and not to an Opposition Member this time, splendid though they are.
The Minister probably shared my great disappointment when the last Government put no money into the new hospital programme and threw Charing Cross hospital, in my constituency, out of the programme. May I share with her my delight that the Government have put Charing Cross back into the programme and are funding it, with a timetable that the last Government failed to deliver?
Ashley Dalton
Everyone knows that the previous Government’s promise of 40 new hospitals was a fiction: there were not 40, they were not new, and many of them were not even hospitals. We have put the programme on a firm footing with sustainable funding, so all those projects will actually be delivered.
In response to the Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), I am more than happy to work with the Committee to clarify the funding for NHS providers. I understand that there is already quite of lot of information in the public domain, and I am more than happy to have that conversation with her.
On financial levers and incentivising prevention, the 10-year health plan is really the driver of all our shifts—from analogue to digital, from hospital to community, and from sickness to prevention. It will set out how we achieve transformational change. As part of that, the plan’s working groups are looking at how payment mechanisms, funding flows and contracting will need to change to build a health system that is fit for the future.
On ENICs, we have been here before. The Government will provide support to Departments for additional ENICs for public sector employees, and commissioned services are all subject to local negotiation with providers.
I want to move on to public health, in which I take a particular interest. I agree with hon. Members on the importance of public health investment. In 2025-26, through the public health grant and the 100% retained business rates arrangements for local authorities in Greater Manchester, we are increasing funding to £3.858 billion—a 5.4% cash increase, and 3% in real terms. It is a priority for this Government to confirm future year allocations as early as possible, and we will seek to do that. It is a priority of mine.
We have talked a lot about social care. Louise Casey commands great respect across political parties, the Government and the NHS, which is why she will lead the independent commission on adult social care as part of our critical first steps towards delivering a national care service. She will begin her work in April, drawing on people who need care and their families, staff, politicians, and the public, private and third sectors to inform the recommendations on how we rebuild adult social care.
Anna Dixon
I welcome the Minister to her place and congratulate her on her new role. On building a national care service and the Casey review, will she reassure me and other Members of the House that there will be a first-phase report in 2026 to inform the spending review, and that we will have action sooner than the 2028 final report?
Ashley Dalton
I can confirm that, as has already been stated, those interim reports will take place, with a view to informing spending reviews.
I want to pick up on the point made by the hon. Member for North Shropshire (Helen Morgan) about the cross-party talks. My right hon. Friend the Secretary of State wrote to colleagues from all the UK-wide parties to invite them to joint cross-party talks in February. Not everybody was able to take part—a significant number of people were not—and we think it is really important to have a wide range of views at such talks. We have taken the decision to reschedule them, but we will make sure that they take place. We are seeking to reorganise those talks at the earliest opportunity, and I can confirm that the intention is to go ahead with them.
We have committed to look at how we can further expand the role of pharmacies and better utilise the clinical skills of pharmacists, and we have now resumed our consultation with Community Pharmacy England regarding the funding arrangements for 2024-25 and 2025-26. I am unable to say any more on that until the consultation has finished.
To wrap up, we are undertaking the largest capital investment in our national health service since Labour was last in office, but if we are to deliver our promises to the British people, we must deliver faster improvement than even the last Labour Government achieved. Investment and reform are what we promised before the election, and investment and reform are what we are delivering. We will ensure that the NHS is there for people when they need it; we will tackle the big killers, such as cancer; and we will create a fairer Britain, where everyone lives well for longer, while making sure that every penny of taxpayer money is well spent. I commend the estimates to the House.
Sir Geoffrey Clifton-Brown
I shall be brief. I thank the Minister for her very comprehensive reply, and I congratulate her on her new role. I also congratulate everybody who spoke in this debate; there were some excellent speeches. Can I ask the Minister to thank her officials for appearing before my Committee? It is very much appreciated. I also thank the members of the PAC, a very hard-working Committee that produces two major reports a week, and in particular my deputy, the hon. Member for Sheffield South East (Mr Betts).
To sum up, as I said in my speech, productivity is the key to long-term reform of the NHS. Increasing funds at 4% per year in real terms when the economy is growing at only 1% in the long term is unsustainable, so something has to be reformed in the health service. As I did in my speech, I ask the Minister to consider producing a productivity plan, so that, without all the arguments with the Office for National Statistics and everybody else, we can see the DHSC’s best estimate for productivity gains over the next five to 10 years, and can start to see how such goals will be met. In such a productivity plan, modern digital technology will be really important. The Minister skated over one word that I am really concerned about, which is “cyber”. We had a wake-up call with WannaCry two or three years ago. The NHS has some very important personal data, so it is vital that we move towards modern machines that can withstand cyber-attacks better than some of the analogue equipment in the NHS.
It has been a great debate, and I am sure that the Minister will have plenty to think about.
Question deferred (Standing Order No. 54).