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Steve Darling (Torbay) (LD)
I beg to move,
That this House has considered NHS funding in the South West.
It is a pleasure to serve under your chairmanship, Dr Huq. For me, the NHS is a family affair, as my wife has served it for more decades than she would want me to admit and my son is a registrar at Torbay hospital.
This time last year, many of us were out pounding the streets at the general election, and the NHS was a big plank of what many of us talked about. It was one of the key themes on which the Liberal Democrats fought the election. We knew the NHS was a shambles, but we did not know the challenge that would face the new Government when they came to power. The Minister for Care highlighted that the money for the new hospital programme ran out in the March just gone, and there was a £6.6 billion hole in the programme’s budget. It was a real challenge for the new Government, but equally, their “waves” approach has caused real concerns in hospitals across the south-west and in our communities. It would be extremely helpful if the Minister for Secondary Care could address that today.
I will focus on Torbay hospital as a useful example of the challenges we face across the south-west. It is the third oldest hospital in the UK, with only 6% of the estate up to standard. Some bits are very good, such as the endoscopy and out-patient units, but those constitute an extremely small proportion. Someone suffering from cancer has to go to a number of locations across the hospital where there are real challenges. That is not the offer we want for those suffering from that disease. There have been almost 700 sewage leaks on the site, often infecting clinical areas, resulting in closures and delays of service to our community. The tower block of the hospital is swathed in scaffolding—not for a rebuild, but to stop clumps of it falling off and braining passers-by. There are some massive challenges, which have impacted our world.
Wave 2 mitigation bids went in in February from affected trusts. Torbay bid for £183 million to collapse the tower block and ensure that we have four fit-for-purpose wards built. I understand that the white smoke from the Government is yet to appear. So far, we have had only £7 million to help tackle some of the challenges, which hardly touches the sides.
Gideon Amos (Taunton and Wellington) (LD)
I congratulate my hon. Friend on bringing the NHS in the south-west into the spotlight. Does he agree that the pressures on Musgrove Park hospital, due to the closure of the Yeovil maternity unit, put staff in an almost impossible position, with 30° heat in summer and leaking roofs and walls with holes in them in winter?
Steve Darling
I agree that staff are the NHS’s most important asset and what makes it tick, which my hon. Friend is right to highlight.
Jim Shannon (Strangford) (DUP)
I am here to support the hon. Gentleman; I congratulate him on bringing this subject forward for debate. He is right to highlight issues with cancer care. It is the same for us back home: only a third of those referred by GPs begin treatment within the target time. Does he feel that there is money to be saved through the administration in the south-west trust area? If there is, perhaps that could help.
Steve Darling
That is very insightful. After being around medics for many years, I know the concern about the increase in managers. Equally, I know that integrated care boards, which I will come on to now, have real challenges with the savings that they are making. There is talk of merging ICBs, including, in the far south-west, a merger in Cornwall and Devon. Both ICBs are relatively challenged, and I fear that it could be a marriage of two bankrupts. Perhaps it would be better to look at a bigger footprint, including Somerset.
Noah Law (St Austell and Newquay) (Lab)
I welcome and echo the hon. Member’s comment about an inappropriate marriage in respect of the Devon and Cornwall ICBs. They have quite different issues. I commend the work of Cornwall’s ICB, of course, but we have to recognise the specificities of the peninsula penalty and the unique challenges facing both our areas.
Steve Darling
That is also very insightful. There are lots of good staff throughout the NHS, including in ICBs. It is about unlocking their potential, which I hope the Minister can do.
I was suggesting a bigger footprint, which could include Somerset and maybe even Dorset, as well as Devon and Cornwall, to give greater corporate capacity. I hope the Minister will reflect on that. Perhaps she will give some guidance on when we will hear about the ICB merger. A larger ICB could reflect the footprint of a mayoral authority; I fear that we could be poorer country cousins if we have only two county mayors in the west of England.
The real challenge with our ICB is that we are looking at a quarter of a billion pounds in cuts to services for Devon. The Exeter trust faces £69 million in cuts. The way to save money is mostly by not filling posts, so that is a real challenge. In Torbay, the figure is £42 million. We have an integrated care organisation, as a result of the merger of NHS acute and social care services, and people often say that is the direction in which we should be going. It saves 60 beds in the hospital by ensuring that we get people out of hospital sooner and into their own homes, where they want to be. However, I worry that the organisation is threatened by the quarter of a billion pounds-worth of cuts to services in Devon coming down the line; I fear for its future. I know that the Government actually want to move in the direction of services working together—it is so important.
The last area I want to touch on is Getting It Right First Time. I have heard from a number of professional sources that they feel that is a metropolitan approach that does not always work well in areas with significant rurality, such as Devon, mostly because it does not take into account some of the deprivation we have, our coastal communities, rural communities and the need for travel, or the fact that our population is older than those in metropolitan areas. We have older folk who are perhaps more digitally excluded. The approach does not always work.
We have seen that in respect of a procedure called PPCI—I will not share what that stands for, but it is an intervention used when someone is having a heart attack. They have a balloon inserted through their groin that goes up to the artery, and a stent is inserted to prevent a blockage in the system. A proposed merger in the offer will see people from south Devon drive past Torbay hospital and go 24 miles up the road to Exeter. That was originally the out-of-hours service, but it is now the emergency service, so when someone is thrown in the back of an ambulance, assessed and told, “You need this intervention,” they will go up to Exeter.
As my son says to me, “Time is tissue.” A consultant told me that if we push forward with this approach, it could result in greater debilitation and deaths. As a result of campaigning, the can has been kicked down the road on two occasions, and the ICB is due to return to the issue again at the end of July. I thank the medics who stood up and shared their concerns about the issue, as well as the thousands of people who signed our petitions on it. This situation shows how, because of the challenges in more rural areas, Getting It Right First Time does not always lead to the right solutions.
I would welcome the Minister’s reflections on wave 2 mitigation, on the challenges in relation to ICBs and, finally, on coronary care issues in south Devon and how we can ensure that we are providing an appropriate service for our communities.
Several hon. Members rose—
Dr Rupa Huq (in the Chair)
Order. Given how many people wish to speak, we will start with a two and a half minute limit.
Jayne Kirkham (Truro and Falmouth) (Lab/Co-op)
I was not expecting to be called first, but thank you very much, Dr Huq.
Each year, Cornwall, which has a population of 650,000, welcomes around 4 million visitors, drawn by our beautiful beaches and coastline. Tourism is a key part of our economy and provides a livelihood for many, but the downside is the pressure on our public services. Some areas in Cornwall treble in population, and that has a profound impact on our NHS and our only hospital, the Royal Cornwall hospital in my constituency.
In 2021, our hospital was on black alert all summer, and 30% of those attending A&E were not registered with a Cornish GP; the August bank holiday saw almost 700 people go to the emergency department. Hospitals in other parts of the country tend to see reduced pressure in the summer, but the Royal Cornwall is under pressure all year—winter and summer. We also have a super-ageing population—that is not my term, but the NHS’s—because many pensioners choose to retire down in Cornwall.
The current health funding formula does not reflect that seasonal reality or sufficiently account for factors such as population sparsity, rurality or poor transport links, all of which make healthcare much more expensive to provide and all of which affect Cornwall. Our health services are therefore very much overstretched.
The South Western Ambulance Service is the worst-performing ambulance trust in England, and its performance is worst in Cornwall. An April 2025 SWAS performance report showed that Cornwall had the worst category 1 mean response time—nearly 11 minutes, compared with the national target of seven minutes. It is the same for category 2, and the handover time is high as well.
Those ambulance delays have serious consequences. We have ambulances waiting outside our hospital, and in December 2023 two of our coroners wrote to the Secretary of State with a concern about avoidable deaths as a result. They were keen to stress that the challenges are systemic; they are not the fault of the trusts, and they are too big for a single doctor, nurse or paramedic to fix, and too big for the hospital trust or ambulance trust to fix on its own.
The waiting times have actually reduced well over the past year, partly because of the Government’s focus on health and partly because of the work of local health partners and the granular work of the voluntary sector down in Cornwall, including organisations such as the CHAOS Group, Volunteer Cornwall and Age UK. Our foundation trust struggles with large numbers of legacy buildings that have been taken over by NHS Property Services, and it is being charged for rent and maintenance that has not been delivered. Giving control of those buildings back to the trust would help. Our mental health funding is also low, with many patients having to go out of county to be treated.
In summary, our health system is at breaking point. To tackle the systemic issues, we need to recognise that rural and coastal areas face higher costs and additional pressures for care, and we need a fairer formula that truly reflects seasonal demand and rurality.
Rebecca Smith (South West Devon) (Con)
It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Torbay (Steve Darling) for securing this debate.
I am here to focus specifically on fertility treatment in Devon, which is one of the costs we have because of the atrocious funding situation to which the hon. Member referred. The Devon integrated care board is not currently funding fertility care for local patients in line with Department of Health and Social Care expectations, and is not following National Institute for Health and Care Excellence guidelines in their entirety. Its policy is not based entirely on the clinical factors recommended by NICE, but is based instead on previous clinical commissioning group policy, economic factors and additional non-clinical factors, which are all understandable, but that is not good enough for local patients.
NICE states:
“Commissioners…should commission sufficient capacity within specialist fertility services to provide 3 full cycles…for women aged under 40 years who meet the criteria for IVF…A full cycle should include 1 episode of ovarian stimulation and the transfer of any resultant fresh and frozen embryo(s)”,
and that any previous cycle counts towards that total. NICE guidelines also state that women under 40 who meet the criteria for IVF treatment
“should be offered 3 full cycles of IVF”
with a cycle defined as including one episode, as I have said. A full cycle ends either when every available but viable embryo has been transferred, or when one results in a pregnancy.
Devon ICB incompletely funds only a portion of one cycle. It has made up a different definition of a cycle, and, in the commissioning policy, defines a cycle as
“one…fresh and one…frozen implantation of embryos. A frozen embryo transfer episode will only be available if there are embryos generated from the fresh cycle suitable for freezing.”
That does not include any remaining embryos from the first cycle of stimulation, nor the remaining two cycles recommended by NICE. Devon should be funding three full cycles, and it is not.
That means that we are living in a legitimate postcode lottery: people with a PL, TQ or EX postcode are being completely sold short. I believe we need to treat this, and we need to see what the Government can do to mitigate the problem and to encourage ICBs such as Devon to ensure that just living within their health authority should not mean that people cannot access the treatment that others in other parts of the country can access, particularly those under 40 years old.
Tom Hayes (Bournemouth East) (Lab)
In less than a year, this Government have recruited 1,700 new GPs, delivered 3.5 million new appointments and cut waiting lists by more than 200,000. Just today, we heard in the Chamber the good news from the spending review: a record cash investment increase, in real terms, of 3% every year up to 2029, the equivalent of £29 billion extra a year. That will help to put our NHS back on the road to recovery.
In Dorset, we are already seeing the impacts of the investment. Dorset ICB has seen 13,600 extra urgent dental appointments. The public health grant for Bournemouth, Christchurch and Poole council is up from £22 million in 2024-25 to £23.3 million in 2025-26. There have been four surgeries identified for enhancement in Bournemouth, one of which is in my constituency, and the waiting list for University Hospitals Dorset trust is down by 1,715 between July and now.
Lloyd Hatton (South Dorset) (Lab)
I thank my hon. Friend for giving way, and for setting out so clearly the work this Labour Government are doing to fix our NHS. Will he take the opportunity to welcome the investment of some £100 million being delivered by this Labour Government that will totally rebuild the emergency department and critical care unit at Dorset county hospital? Does he share my belief that fixing the front door of our national health service is essential for driving down waiting lists in Dorset?
Tom Hayes
My hon. Friend makes a powerful point. I, of course, welcome that investment and it will benefit both his constituents and mine.
We are also seeing significant investments in the Royal Bournemouth hospital. Just yesterday, I was standing on top of the Coast building at the hospital, at the topping-out ceremony. The Coast building will feature 110 new beds across four floors, a larger kitchen and a catering facility. If we look across from the top of that building, we will see the new £91 million Beach building that houses the emergency department from the Royal Bournemouth. Services moved into that building in May, and it will also contain a maternity unit, critical care and a children’s unit, which will be moving in next year.
These developments are all part of a £500 million transformation of University Hospitals Dorset sites, which is much needed and will have a critical impact. These investments across hospitals, and across Dorset, will improve care for the people of our region—for my constituents—and will support our staff, who have been really looking for light at the end of the tunnel after 14 difficult years of Conservative rule, so that they can care for patients in modern, purpose-built facilities.
I would like more. Despite all the investment and the upcoming reform, I would like the funding formula to be changed so that it reflects the age profile of our local area. The south-west and especially areas such as BCP have a much higher older population, but not the funding to match. Our house prices are high but, unlike in Hampshire, UHD staff do not get pay weighting. I would also like to register concerns about proposals to create new subsidiary companies in Dorset and Newcastle. I have called for a pause in those processes, because I have concerns about the terms and conditions. Existing staff who are TUPE-ed into a subco have their existing terms and conditions protected, but I am concerned that when new staff are recruited into subcos, they do not have existing NHS terms and conditions. That could particularly affect lower-paid roles.
In conclusion, I thank the Government for their prioritisation of our NHS. I feel that the NHS is firmly on the path to renewal and is in safe hands.
Wera Hobhouse (Bath) (LD)
Across Bath, people wait far too long for the NHS care that they urgently need. There are proven ways to bring down waiting times and boost NHS capacity, but they are not always used to their full potential. I recently visited Bath Clinic, an independent sector provider with the infrastructure, staff and capacity to deliver high-quality secondary acute care. Bath Clinic ringfences slots for NHS patients. If the slots are not filled, they simply sit empty. Valuable appointments are wasted while my constituents in Bath linger on waiting lists without any good explanation. I understand that, across England, ICBs are planning to commission between 5% and 20% less activity from private hospitals this year, while the latest data—from March—shows that NHS waiting lists are getting longer.
The longer patients wait, the more complex and costly their care becomes. Using independent sector capacity in the limited way that I have described gets people the treatment that they need when they need it, and helps them to return to work and to their lives. Everyone suffers when those slots are not used. This is not a criticism of the NHS or its dedicated staff. It is a call to make full use of every available resource to support them. The independent sector is not a replacement, but the capacity is there and it could make a real difference. This is also an issue of choice. The NHS constitution enshrines patient choice, so there is no excuse for not offering it.
I have one question for the Minister: can she help me to understand why independent sector healthcare providers are not being used? Services such as Bath Clinic are ready to help and they have capacity that otherwise will simply go to waste.
Andrew George (St Ives) (LD)
It is a pleasure to serve under your chairmanship, Dr Huq. I congratulate my hon. Friend the Member for Torbay (Steve Darling) on the debate. I will try, in my remaining two minutes, to cover four subjects very quickly. The first is about the fair funding question or whether the funding to an area is sufficient. The hon. Member for Truro and Falmouth (Jayne Kirkham) rightly referred to the seasonality of the pressures and the rural nature of the geography, but in Cornwall there is also the issue of the peninsularity of the geography. People cannot call on an emergency service to the north, south or west in a place such as Cornwall and therefore we need to make provision for services so that they can cover all eventualities. Also, this year, during the settlement process, people are talking about cost improvements within the ICB spending programme over the future year. In Cornwall, it is a cost improvement—the rest of us might describe it as a cut in services—of £108 million, which is about 7% of the budget overall. That will create tremendous pressure in areas such as ours.
The second issue is value for money estimates. I visited a brilliant project very recently: the Helston Gateway project, which has created a new GP surgery across 20 consultation rooms, and achieved that on the basis of a building cost of just £1,400 a square metre, which is half the cost that people would get if they went to private sector contractors doing it through NHS development programmes and certainly significantly less than in the private finance initiative programmes of the past. I strongly urge Ministers to look at such brilliant initiatives as a brilliant way to provide services.
The third issue is stopping private sector organisations cherry-picking the profitable parts of the NHS and therefore undermining acute sector trusts. Finally, I would welcome clarity as to why the acute trust in Cornwall is not having its debt written off, unlike other provider trusts and ICBs.
Dr Rupa Huq (in the Chair)
The aim is to take the three Front Benchers from 5.09 pm, which means that the time limit is dropping down to two minutes each.
Martin Wrigley (Newton Abbot) (LD)
It is a pleasure to serve under your chairship, Dr Huq, and I congratulate my hon. Friend the Member for Torbay (Steve Darling) on securing the debate.
GP funding is in crisis. I have met representatives of individual practices in my Newton Abbot constituency, as well as the 28 practice managers from around the district. They all have a funding crisis. The recent GP settlement was described to me as unsafe, unsustainable and unfunded.
GP funding is complex, but in essence it has two parts: the global sum and the quality outcomes framework. The global sum is meant to cover basic costs, including salaries, facilities, and so on, and the QOF extra services, but it does not cover any of it. Practice managers across south Devon have told me that the global sum is £121.79 per patient per year. That works out as less than paying to take a dog to the vet for an annual check-up, or about a third of the cost of servicing a modest car, such as a Renault Megane. That sum is also then modified by the Carr-Hill formula, which, perversely, can reduce the sum in areas of deprivation. The Royal College of General Practitioners wrote in an open letter to Government last year that this formula is no longer fit for purpose and has contributed to the widening health inequalities across the country.
Practices in the areas of greatest deprivation have patients with more complex needs, yet they do not receive proportional funding to address those needs. For example, Buckland surgery in my constituency has 4,000 patients, but the Carr-Hill formula reduces the funding to the equivalent for 3,200 patients. Practice managers are juggling numbers to make things work. Some surgeries are short of a full-time GP; just imagine the impact that has on patients. No wonder it is difficult to get an appointment. That is unsafe. The Government have said that from October GPs must offer an open access service; that means that all available slots are booked, so emergency appointments cannot be seen. That is not sustainable.
Adam Dance (Yeovil) (LD)
It is a pleasure to serve under your chairmanship, Dr Huq, and I thank my hon. Friend the Member for Torbay (Steve Darling) for securing this vital debate.
I start by thanking the amazing NHS staff across Yeovil. The NHS makes me so proud to be British, but our NHS in Somerset has been left on its knees, particularly Yeovil hospital. First, we had the closure of the hyper-acute stroke unit and now we have had the temporary closure of the maternity services. As I have said before, I am worried that the decisions made to protect patient safety in Yeovil may undermine it. That is why we continue to push for the safe reopening of maternity services as soon as possible. It is also why I will soon submit a second call-in request on the decision to close the hyper-acute stroke unit at Yeovil. I again urge the Minister to join local health leaders in committing to fund and maintain a general district hospital in Yeovil.
Without enough properly supported and funded staff, the NHS cannot function. That is partly why Yeovil hospital is in the state it is in. What steps is the Department taking to encourage people to work in the NHS in the south-west, and what future guidance and support will the NHS in Somerset get to maintain staff, and to improve working culture and staff mental health?
Our GP practices and our dentistry desperately need support, too. I am really pleased to have received confirmation from the Minister that Crewkerne health centre and Church View medical centre in Neroche are set to receive a share of the £102 million for GPs to deliver upgrades to their practices. It is a shame that our other practices have not been so successful.
More must be done. The Government must get on with fixing the NHS dental contract and I am worried about the implications of the cuts and mergers faced by the ICBs. Although we are taking steps in the right direction, more must be done to fund our NHS, so that people in Yeovil get the safe and local healthcare they deserve.
Several hon. Members rose—
Dr Rupa Huq (in the Chair)
Order. I think that someone will probably end up falling off the call list; there are people standing to speak who were not on the list and who were not standing at the beginning of the debate. Let us see how we go.
Sir Ashley Fox (Bridgwater) (Con)
It is a pleasure to serve under your chairmanship, Dr Huq. The NHS is a vital service. I pay tribute to the doctors, nurses and many other health professionals who look after my constituents. Bridgwater community hospital, Burnham-on-Sea War Memorial hospital and GP practices across the constituency provide the health services that people need.
Hon. Members will know that during the five years of coalition Government and nine years of Conservative Government, spending on the NHS rose in real terms every year. However, increased spending alone will not fix the problems in our region. NHS productivity fell during the pandemic and, despite recovering, is still lower than it was in 2019. We need improvements in both productivity and service quality.
My constituents have raised the difficulty of getting GP appointments when they need them. Last year, the Government announced a large pay rise for junior doctors with no strings attached. What is the result of that? Less than a year later, junior doctors are back asking for more and threatening to go on strike unless they get another above-inflation pay increase. I want to see our NHS staff paid more—they do vital work in our community—but those increases must come with improved productivity and service for our constituents. How does the Minister propose to provide more GP appointments? My constituents also find it difficult, if not impossible, to find an NHS dentist. What steps will the Minister take to improve dental care in the south-west?
The Government have announced that they will abolish NHS England. I sincerely hope that will reduce bureaucracy and lead to improved services and shorter waiting lists, but if it results in the same people being shuffled around and given different job titles, few savings will be made. I wish the Minister well as she endeavours to improve healthcare across our region.
Ben Maguire (North Cornwall) (LD)
It is a pleasure to serve under your chairmanship, Dr Huq. I congratulate my hon. Friend the Member for Torbay (Steve Darling) on securing this debate. Following the Chancellor’s spending review announced in the House today, I am appalled that Cornwall and the wider south-west have been seemingly overlooked yet again, with Swindon the closest place to get a mention. Hospitals such as North Devon district hospital in Barnstaple, which serves thousands of my constituents, are crumbling before our eyes, as is the Camelford GP surgery.
Our constituents deserve to get appropriate care when they need it and, crucially for those living in rural areas, where they need it. With the recent cuts to bus routes such as the numbers 11 and 12 by the previous Tory-run council, residents of Bude, Launceston, Padstow and many other towns do not have a direct public transport route to their cancer appointments at Derriford hospital. Those routes urgently need Government funding.
Our Liberal Democrat policy aims for every cancer patient to start their treatment within 62 days of an urgent referral, but for many cancer patients in Cornwall, disruptions to vital transport links make that much more difficult. All the while, the number of cancer patients waiting over four months for treatment more than doubled between 2020 and 2023 under the previous Tory Government.
In comparison with the plans laid out today in the spending review, the Liberal Democrats would invest in a rural fund for our GPs, dentists and pharmacists so that, for example, my nine-year-old constituent Sophie would not need to wait 12 hours at A&E in Treliske with a tooth infection. That sort of investment would significantly reduce the number of visits to our hospitals in the first place. At the same time, we would tackle the fundamental issues that hold back our social care system; solve the care crisis with cross-party talks; introduce a fair deal for our carers, with a higher wage and a new royal college of care workers; and, finally, get our NHS back on track. We owe it to our brilliant NHS staff and our patients across the south-west.
Rachel Gilmour (Tiverton and Minehead) (LD)
My constituency, which straddles the Devon-Somerset border, has a disproportionately elderly population. We have perhaps even greater and more regular healthcare needs than some other parts of the country, but significant funding shortfalls have hit GP practices particularly hard.
In the coastal west Somerset area, we have what are termed dental deserts. The percentage of adults in my constituency seen in the last two years by a dentist falls well under the national average. A&E departments see the effects of that down the line. The failure to treat ailments at an earlier stage often leads to conditions deteriorating and to serious complications, leaving A&E departments overwhelmed.
Let us not kid ourselves: the strains on A&E capacity are downstream from the insufficiency of GP and dental services, whose raison d’être is to provide routine and preventive care. We need a systemic overhaul to shore up GP and dental services so that they are fit to tackle the problems at their onset and remove some of the pressure on accident and emergency.
I am all too aware that healthcare professionals tend to practise where they trained, so we want to swell the ranks of our nurses, doctors and dentists in Tiverton and Minehead by providing locally based training colleges. In Tiverton and Minehead, we also have a shortage of pharmacies. Let us be clear: this is about essential medication. Finally, I have often talked about the lack of transport facilities in my constituency. The paucity of healthcare provision across my constituency coupled with the significant shortcomings in public transport creates a bleak picture indeed.
John Glen (Salisbury) (Con)
It is a pleasure to contribute to the debate, Dr Huq. In every Budget that I have seen over the past 15 years, either as a Treasury Minister or as a constituency MP, more money—whether it is 1%, 2% or 3% more—has gone into the NHS, yet there is still a demand for even more money at the next fiscal event. In the south-west, there are 5.7 million people, 30% of whom live in rural areas. We will always have limited resources, so we have to be radical in organising them differently. I urge the Minister to look at not just how we deal with care based on the physical location of acute hospitals, but how we deliver more localised digital care and investment in relevant digital infrastructure.
The chief executive of the Bath, Swindon and Wiltshire hospitals group tells me that a national approach to AI would be hugely welcome to unlock the delivery of radiology, pathology, clinical administration and risk stratification in a much more effective way. We have to level with our constituents that services cannot all be delivered at the local hospital if we are going to have the best service and the appropriate aggregation.
I urge the Minister to address the issue of digital systems. How can we bring them to a different level and deal with demand management? Demand is outstripping supply, and we have to look at investment in public health. To that end, I urge her not to move most of the Porton Down campus to Harlow, which would save a considerable sum of money that we could use in the south-west.
Edward Morello (West Dorset) (LD)
I congratulate my hon. Friend the Member for Torbay (Steve Darling) on securing the debate. I will be as brief as I can. I would love to talk about the lack of NHS dentist appointments in West Dorset or the problem with the funding model for community pharmacies, but instead I will just make the point that integrated care boards such as NHS Dorset are being asked to cut their staff by 50% on top of previous cuts of 30%. These are the people who ensure that frontline services run smoothly, and I am concerned that gutting their capacity in such numbers so quickly risks destabilising the very system that we are trying to fix.
Although NHS Dorset has a plan in place to break even, it is reliant on delivering £190 million in savings. The trust has requested £14 million in additional financial support, but remains £22 million short of its funding target. There is also a pressing need for capital investment in digital infrastructure to help modernise hospital estates, such as Dorset county hospital, to streamline services.
The closure of the maternity unit at Yeovil means that Dorset county hospital in Dorchester is picking up much of the slack; it is looking after more patients with no additional cash. The fact is that delivering services in rural communities in the south-west is more expensive than it is in urban areas. What steps are the Government taking to ensure that rural communities are no longer left behind?
Several hon. Members rose—
Dr Rupa Huq (in the Chair)
Order. I am afraid that we will now move on to the Front Benchers, starting with the Liberal Democrat spokesperson.
Alison Bennett (Mid Sussex) (LD)
It is a pleasure to serve under your chairship, Dr Huq. I thank my hon. Friend the Member for Torbay (Steve Darling) for bringing forward this important debate.
We have been reminded by hon. Members that the Conservative legacy is pensioners left in agony, waiting for hours for an ambulance that may not come in time; women forced to give birth in unsafe, overstretched conditions; and people having to pull out their own teeth—in the 21st century—because they cannot find an NHS dentist. We have heard from hon. Members that the south-west has some of the longest ambulance waits in the country, some of the worst repair backlogs, and waiting times for GPs and dentists that are simply unacceptable. That is not just a strain on our health services but a daily struggle for families, carers and patients across our region.
The Liberal Democrats believe that people deserve better, and that they should be in control of their own lives and health. That means people getting the care that they need, when they need it and where they need it, without them having to fight every step of the way. Instead of lurching from one crisis to the next, as previous Governments have done, we have a plan. It starts with early investment in community health—in GPs, pharmacists and dentists—so that fewer people end up in hospital to begin with. We will finally fix the crisis in social care, so that people are not left stuck in hospital beds with nowhere to go.
If we expect to rely on our NHS in future, we simply must invest in it. We need not just big grand schemes but investment in the simplest yet most important things. For example, in my own patch in Mid Sussex, the Princess Royal hospital recently had only one of its four lifts working over a weekend.
Caroline Voaden (South Devon) (LD)
Does my hon. Friend agree that it is much more expensive to provide services in rural areas than in urban areas? An example is the pharmacy funding model, which relies on footfall. On a recent visit to Modbury pharmacy, staff told me that they are really struggling to stay afloat because they do not have enough footfall, and they cannot reach the national payment threshold that would enable them to survive. Does she agree that we need to look at rural exceptions for critical services such as community pharmacies?
Alison Bennett
My hon. Friend makes an excellent point about rurality, which is obviously a big issue in the south-west. It is also a serious issue in Sussex where we have things in common with the south-west, such as having an older than average population and all the challenges that come with that, as hon. Members have mentioned.
Hospitals want to be able to sort those issues out, but they are left juggling priorities, barely scraping by with the current levels of funding. Things do not work if we do not look after them, and if we do not look after our health system, it will not be able to look after us or our loved ones. Although I am sure that the Minister will make the point about capital investment in the NHS, which is welcome, the future looks very uncertain and precarious for our ICBs, as a number of hon. Members have said.
Soon after ICBs were first created, they had to cut their budgets by 30%. They have now been asked to cut their budgets by 50% on average. Indeed, for Sussex, the cut is more than 50%—it is 53%. It is no surprise that Sussex and Surrey have formally proposed merging their ICBs, which, by running at the same time as local government reorganisation and the creation of a mayoralty, means we will end up with an ICB that does not have the same footprint as the new incoming mayor.
Richard Foord (Honiton and Sidmouth) (LD)
What does my hon. Friend think about how ICB funding is weighted? I contend that the formula overemphasises the size of each ICB and the size of the registered population, but does not account sufficiently for age, given that older people require more funding spent on them.
Alison Bennett
My hon. Friend makes a really good point. It is vital that when we look at per head of population funding, we think about the different factors that actually drive up the true cost of delivering healthcare across the country, which obviously varies by region.
On ICBs, I will press the Minister on three points. First, on the timescale for cuts to be delivered by ICBs, they have to be completed by the end of 2025. The Sussex ICB had about three weeks to make that initial submission to the Department. Does the Minister think that those timescales are realistic and achievable? Secondly, what will the cost of the redundancies be for ICBs? Has that calculation been done? For Sussex, we are looking at more than half the workforce losing their jobs. Thirdly, what is the impact assessment for patients and the service that they will receive as a result of cuts to ICBs?
For too long, social care has been treated like the back door of our public services. It has been overlooked, underfunded and taken for granted. That must change. That is why we must once again ask for more urgency on social care reform. I believe that personal care should be free at the point of use, just like the NHS—
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Dr Huq, and a privilege to contribute to this important debate. I congratulate the hon. Member for Torbay (Steve Darling) on securing the debate at such a timely point, following today’s spending review.
The focus on NHS funding, particularly in underserved regions such as the south-west, is welcome, so that every area of the UK is properly equipped to meet the healthcare needs of all communities. I, too, represent a predominantly rural constituency, so I am keenly aware of the unique challenges in healthcare provision facing remote areas. Geography should not be a barrier to treatment, but for many in the south-west and beyond, it still is.
We heard in the spending review today that the NHS will receive a substantial cash uplift. We must ensure this money is spent in the most effective way possible. We do not have the allocations yet, but can the Minister enlighten us on whether there will be an amount allocated particularly for rural healthcare. The spending review document talks about efficiencies of £9 billion to be achieved by the Department of Health and Social Care. Can the Minister elaborate on how those efficiencies will be achieved?
Much has been said already about the financial pressures facing integrated care boards. The Government’s proposal to restructure NHS clusters in the south-west into larger conglomerates is presented as a move towards greater efficiency, but care must be taken that this does not come at the expense of local responsiveness or patient outcomes. NHS England is legally required to assess the performance of each ICB annually and publish its findings. However, the Government have decided at the same time to abolish NHS England—a decision they took without a proper impact assessment.
Fred Thomas (Plymouth Moor View) (Lab)
The hon. Member mentions patient outcomes, but in Plymouth we have patients awaiting assessments for attention deficit hyperactivity disorder being left in limbo and unable to move forwards. Does she agree that the current refusal by some GPs to enter into shared care agreements is effectively blocking access to a diagnosis for adults pursuing ADHD assessments through the right to choose?
Dr Johnson
I would need to look at that separately and come back to the hon. Member on it, although he should perhaps direct his question to the Minister, as she has control at the Department at the moment.
The problem with cutting both the ICBs and NHS England is that it risks destabilising the very structures that are designed to deliver care simultaneously. The chief executive of NHS England has stated that legislation will be required to change the duties on ICBs. When do the Government intend to introduce the health Bill and, when they do so, can the Minister rule out the removal of the duty in the Health and Care Act 2022 requiring integrated care systems to commission dental services?
In paragraph 5.12 of the spending review, the Government say that 92% of patients will start consultant-led treatment for non-urgent health conditions within 18 weeks, but The Times has reported that the figure is closer to 80%. Can the Minister please clarify where the 92% figure has come from, and if she is unable to do so today, will she write to me?
Much of this debate has been about infrastructure. Since the last general election, Ministers have pledged to deliver the new hospitals programme in full, without caveats or conditions. However, in Torbay, for example, the rebuilding has been pushed back, with construction now expected to begin between 2033 and 2035. Thanks to the efforts of my hon. Friend the Member for South West Devon (Rebecca Smith), Ministers have given the greenlight to rebuilding Derriford hospital’s new accident and emergency facility. Can the Minister confirm if there are plans to bring any of the other projects forward?
Let me turn to national insurance contributions. The Royal College of General Practitioners has described the national insurance increase as,
“the straw that breaks the camel’s back, forcing them to make tough decisions on redundancies or even closing their practice”.
The Government’s promise to recruit more GPs is welcome, but hiking national insurance puts that pledge in jeopardy, as GPs will have no choice but to cut staff numbers. This is a false economy, so will the Minister use any of the money allocated today to help those services, such as GPs, air ambulances, hospices, pharmacies and others, that are affected by the national insurance contribution rise?
It will not have escaped Members’ notice that, despite the Chancellor promising that the NHS plan would arrive by spring, we are now at the start of summer—indeed, the Government promised that they had one before the election last year. Will the Minister provide some clarity on when we can expect this long-awaited plan?
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Torbay (Steve Darling) for securing the debate. We could have had more time, as this is an important issue for us all across the whole south-west. I thank colleagues for taking part.
The hon. Gentleman is right that the system has real challenges receiving deficit funding in our part of the NHS recovery support programme. He will rightly be following that closely. In the autumn Budget, which I think virtually everyone in this room disagreed with, the Chancellor took the necessary decisions to put our NHS on the road to recovery, with a more than £22.5 billion increase in day-to-day health spending and over £3 billion more in the capital budget over this year and the last. Today, the Chancellor has announced the conclusion of the spending review, with £29 billion more day-to-day funding in real terms than in 2023-24. There is a £2.3 billion real-terms increase in capital spending over the spending review period—something I hope everyone welcomes.
The SR puts the NHS on a sustainable footing by cutting waiting lists so that by the end of this Parliament 92% of patients will start consultant-led treatment for non-urgent health conditions at 18 weeks, delivering on the Prime Minister’s plan for change commitment and prioritising people’s health. To respond to the hon. Member for Bath (Wera Hobhouse), we do encourage use of the independent sector for capacity, and that is a decision for ICBs to make sure they achieve those standards. The settlement also supports the shift from analogue to digital, with a total investment of up to £10 billion in NHS technology and transformation between ’26-27 and ’28-29, and an almost 50% increase from ’25-26. I agree with the right hon. Member for Salisbury (John Glen) that technology offers huge opportunities in geographies like ours.
Thanks to the Chancellor, we are taking the necessary steps towards fixing the foundations of our NHS and making it fit for the future. Since coming into office, the Government have published our urgent and emergency care plan, which will support the NHS across England to improve the timeliness and delivery of care to patients requiring urgent and emergency care over the next year, including for next winter. We are delivering on our plan for change through the accelerated roll-out of the NHS app. We will create an NHS fit for the future and continue to invest in the latest technology, shifting healthcare from analogue to digital.
Our investment and reform in general practice, to fix the front door to the NHS and bring back the family doctor, includes an additional investment of £889 million. We have published our elective reform plan, which will cut waiting times from 18 months to 18 weeks. We have exceeded our pledge to deliver an additional 2 million appointments, tests and operations—we have delivered over 3 million more. Waiting lists have fallen for the sixth month in a row and have now been cut by over 219,000 since we came to office. The Government have committed to a10-year health plan that will lead the NHS to meet the challenges set out in the plan for change to build the NHS for the future, and it will be coming very soon.
I know that hon. Members across the House share the concerns of the hon. Member for Torbay about the crumbling NHS estate after years of neglect. I wish to assure Members that my right hon. Friend the Chancellor has given us the funding to begin reversing the trend of decline in the south-west and nationwide, with health capital spending rising to £13.6 billion this year.
In the south-west region, allocations have been made totalling £448 million in operational capital, empowering systems to allocate funding to local priorities; over £238 million from our constitutional standards recovery fund to support NHS performance across secondary and emergency care; and £83 million from the £750 million estates safety fund to deliver vital safety improvements, enhance patient and staff environments and support NHS productivity. This includes £7.3 million for Torbay hospital in the constituency of the hon. Member for Torbay; £10 million from our primary care utilisation fund for improvements in the primary care estate; and almost £5 million to help to reduce inappropriate out-of-area placements for mental health patients in the south-west.
ICB allocations have been talked about a lot today. For the south-west, they have been confirmed as totalling £11.5 billion out of a total of £116.7 billion allocated for England. The regional allocation per capita for the south-west is above the national average. We heard from my hon. Friends the Members for South Dorset (Lloyd Hatton) and for Bournemouth East (Tom Hayes) that the signs are being seen in their constituencies.
Karin Smyth
I am going to just complete these points, so that I can try to address as many points as possible.
In the constituency of the hon. Member for Torbay, the local ICB, NHS Devon, receives £2.5 billion of the £11.5 billion for the south-west. The allocation per capita for Devon is higher still, and above the south-west regional average. Likewise, NHS Cornwall and the Isles of Scilly ICB received just over £1.2 billion of that £11.5 billion total. The allocation per capita for Cornwall and the Isles of Scilly is above the south-west regional average and national average.
To respond to the hon. Member for St Ives (Andrew George), I understand from NHS England that the ICB has had the debt written off, so that might be something he wants to follow up. My hon. Friend the Member for Truro and Falmouth (Jayne Kirkham) and others talked about funding allocations—we could talk about this for a very long time. They are difficult things to get right, and are controversial, but the funding formulation does account for older people and for rural populations.
The latest financial performance position publicly available is for quarter three of last year. It showed an overall deficit position of £51.7 million against the year-to-date plans, of which Dorset ICS had the largest variance of £27.7 million. Final end-of-year positions are still being finalised and will be made publicly available in due course. For ’25-26, NHS systems overall have received £2.2 billion of deficit support funding in their allocations. All systems in the south-west have now agreed a balanced plan for ’25-26. The position on deficit support for ’26-27 will follow the spending review settlement for individual organisations agreed as part of the planning guidance process.
NHS England will continue to support all organisations to deliver financially sustainable healthcare through a range of improvement measures, some of which we have heard about today. Devon integrated care board, and three trusts within the ICB, are currently part of the recovery support programme, which provides intensive support to challenged organisations. Where organisations are struggling significantly, the Department of Health and Social Care provides cash support to support the continuity of patient services—obviously, that is critically important. So that colleagues are aware, I am personally meeting with finance colleagues from NHS England and the Department of Health every week to support that work. We are clear as a Government that we need to be certain that every pound of taxpayers’ money is used to best effect, and that best practice is followed in this region and across the entire NHS.
The hon. Member for Torbay asked about coronary services, and that is a local decision. NHS Devon and Torbay Foundation Trust have proposed undertaking a test-and-learn process for out-of-hours primary percutaneous coronary intervention. That service will be provided in Torbay and Exeter, which would involve a temporary change to provide out-of-hours services at Exeter only. Members will be aware that the ICB was due to make a decision on the pilot at its board meeting in May. However, following significant local feedback, the ICB has decided to reflect on those issues raised, and I am sure the hon. Member for Torbay will be following up on that. The ICB will be providing an update at its board meeting in July.
In conclusion, the Government are taking the necessary steps to fix the NHS, and the Chancellor’s spending review settlement puts the NHS further on the road to recovery. I assure Members that we will write back to them on any other individual points raised.
Steve Darling
I thank all colleagues for coming and joining this debate, however short people’s interventions may have been. I also thank the Minister for casting at least some light on this subject, but what we have heard from other colleagues from all over the south-west has been very enlightening. I am sure that there is much more for us to go away and campaign on, but this has been truly debated.
Question put and agreed to.
Resolved,
That this House has considered NHS funding in the South West.