Department of Health and Social Care
Andrew George Excerpts(1 week, 5 days ago)
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Paulette Hamilton
Hear, hear. My hon. Friend makes some valuable points, and I agree with every one of them.
Underpinning the settlement I have described, however, is the Government’s pledge to generate £17 billion in efficiency savings over three years, with a staggering £9.1 billion expected in the final year of this Parliament. Critically, those savings have already been factored into the settlement—in effect, they have been spent before they have been delivered. In the light of that, we need absolute confidence that there is a clear and robust plan to generate those savings. The Government are assuming an annual productivity improvement in the NHS of 2%, more than triple the long-term average of 0.6%. They appear to be relying on digital transformation to unlock the bulk of those savings, which is risky, given the history of digital change programmes in the NHS.
Another source of savings is the plan to cut reliance on temporary staff by reducing sickness absence and overhauling staff policies, including limits on agency spending and eliminating the use of agencies for entry-level roles. Again, this is a welcome ambition, but delivering it will be a significant challenge, one that will require meaningful, sustained improvements to staff wellbeing and working conditions. We cannot build a sustainable workforce on good will alone. Therefore, will the Minister say when we can expect an updated and fully costed workforce plan to deliver on these ambitions?
Delivering the reforming elective care for patients plan is also central to achieving those efficiencies. It proposes reforms such as optimising surgical pathways through hubs, streamlining referrals, expanding remote monitoring and reducing unnecessary procedures. The plan assumes a rapid transformation of services, with significant improvements in productivity and patient flow expected within just a few years. That is ambitious, especially given the context of ongoing workforce shortages, ageing infrastructure and rising demand. Reform is essential, but it must be realistic, properly resourced and paced to succeed. We cannot afford to set targets that look good on paper but falter in practice, damaging morale and patient care. What steps is the Minister taking to ensure that the projected £17 billion in savings will materialise and be delivered on time? What happens to those additional resources for frontline delivery if those savings are delayed or fall short?
I will also touch on adult social care, which is in desperate need of reform. The Casey commission has an important job to do, but the terms of reference for the first phase of Casey’s work state clearly:
“The commission’s recommendations must remain affordable, operating within the fiscal constraints of Spending Review settlements for the remainder of this Parliament.”
Now that those settlements have been reached, can the Minister provide clarity to the House about precisely what fiscal constraints Baroness Casey’s recommendations will have to conform to? The £4 billion for adult social care announced in the spending review includes an increase to the NHS minimum contributions to the better care fund.
Andrew George (St Ives) (LD)
I thank my fellow member of the Select Committee and stand-in Chair for giving way, and I congratulate her on how she is introducing the issues today. Does she agree that the length of time set for the Casey review to report does not give us a sense of confidence that the Government have injected sufficient urgency to address the serious problems of ensuring that we have a robust social care system that can stand up to the pressures that lie ahead?
Paulette Hamilton
I thank the hon. Member for that deep and thoughtful point. He is absolutely right. Timescales are an issue, and that is why, as a Select Committee, we are asking the Government a number of questions so that we can scrutinise what is happening and get the information.
My Committee considered the better care fund in our inquiry into adult social care. It was introduced with the aim of driving better integration between health and social care, and shifts resources upstream from NHS acute services. However, the evidence we heard was stark. These resources have been overwhelmingly focused on hospital discharge. While timely discharge is important, that does not match the fund’s original objectives. How will the Government ensure that this increase in funding leads to a greater focus on prevention? The Chancellor referred to the Government’s plan for an adult social care fair pay agreement. Reaching such an agreement is not just desirable but essential. Staff working in care homes are far more likely to live in poverty and deprivation than the average British worker.
Andrew George (St Ives) (LD)
It is a pleasure to follow the hon. Member for Altrincham and Sale West (Mr Rand). Of course, in this debate we have to reflect on the fact that the Government inherited the NHS in the very worst state in its 77-year history, which the hon. Member for Chelsea and Fulham (Ben Coleman) reminded us of. The Government must pick up the NHS and try to restore it to the state that we would all like to see.
I approve of the three shifts the Government are proposing—no one could argue against prevention rather than ill health. Obviously we want to see advances in prevention, technology and delivery of services into the community, with better integration and improvements in the workforce plan. With that, however, I would like to see the Government advance the case for safe staffing. When I was last in this place, I was part of a campaign on that, which sought to achieve, for example, a ratio of never more than seven on acute wards—seven acutely ill patients to every registered nurse on acute wards. We should be aiming to try to support staff on the frontline, rather than leaving them under the pressures they currently face where they are seriously understaffed.
There are incredible pressures within the service itself. I know that, at the weekend, the A&E department of the Royal Cornwall hospital had more than 100 patients waiting to be treated, with ambulances often waiting outside. Our ambulance service is currently proposing to cut co-responders from some of our rural areas—where fire service staff support the ambulance service—which is a matter of great concern. The Royal Cornwall Hospitals Trust is also facing a £50 million cost improvement programme this year, and many other trusts on the frontline are also facing similar pressures.
The Government must look at the capacity of the nursing home sector, as there are often many unused beds. We talk about the difficulty of discharging patients from a hospital, but there is also the risk of the independent sector cherry-picking the profitable bits of the NHS. We need, above all, to back up our NHS. As the hon. Member for Birmingham Erdington (Paulette Hamilton), the temporary Chair of the Health and Social Care Committee, pointed out, social care is vital. If one in four social care workers are leaving the sector every year, we know that we have a serious crisis. The Casey review cannot come soon enough.
NHS Funding: South-west
Andrew George Excerpts(3 weeks, 4 days ago)
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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.
Oral Answers to Questions
Andrew George Excerpts(3 months, 1 week ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)
I commend my hon. Friend’s constituent for her work with the Brain Tumour Charity, and I wish Lily well with her treatment. The Government have launched the brain tumour research consortium, which will support efforts to speed up the diagnosis of tumours and aid the recovery of patients, and the national cancer plan will ensure that we include brain tumour patients. We know that everyone’s cancer is as unique as they are, and this will be reflected in the plan.
Andrew George (St Ives) (LD)
Wes Streeting
The Chancellor took almost immediate action to deliver the uplift in pay for NHS staff that they deserve. We are working closely with the Royal College of Nursing, Unison and others ensure that we tackle the challenges of low pay in the nursing profession that the hon. Member describes.
Department of Health and Social Care
Andrew George Excerpts(4 months ago)
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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.
New Hospital Programme Review
Andrew George Excerpts(5 months, 2 weeks ago)
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Wes Streeting
I am grateful to my hon. Friend for her question. We are very fortunate to have in the House someone with her experience of social care and health issues. She has already done an outstanding job representing her constituents, who I know will not only welcome the news that Airedale general hospital will begin construction in 2027-28 but will be appalled that, as a RAAC hospital, work could have been well under way had the Department’s request for funding not been denied by the woman who is now the leader of the Conservative party.
Andrew George (St Ives) (LD)
I sympathise with the Secretary of State for having to pull these projects out of the fire of non-funding, and I thank him for the announcement on the women and children’s hospital in Cornwall. I know that all my parliamentary colleagues in Cornwall will be delighted at today’s news. I sympathise with colleagues who find themselves in waves 2 and 3. What can the Secretary of State do to crack on with the enabling work to ensure that this project is delivered in double-quick time? It is desperately needed, and a 2030 finish date will be challenging for Cornwall. It would be much appreciated if it could be brought forward.
Wes Streeting
I am grateful for the way in which the hon. Gentleman poses his question. I can confirm that pre-construction work is ongoing, with construction due to start between 2027 and 2029.
A lot has been said about what my party said before the election, and I will give Opposition Members a role model in how to do honesty ahead of an election. I stood outside the Royal Cornwall hospital and was asked by local media whether I would commit to a specific timetable, and I said, “We have committed to the new hospitals programme. We are committed to seeing through the new women and children’s hospital at the Royal Cornwall, and I know that enabling work is under way. Beyond that, we are going to take an honest look at the books.” That is the approach I took as shadow Health and Social Care Secretary, and that is how to do it—to under-promise and then over-deliver.
Health and Social Care: Winter Update
Andrew George Excerpts(5 months, 3 weeks ago)
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Wes Streeting
I strongly agree with my hon. Friend. The way that Conservative Members continue to behave should send a message to every resident doctor, and indeed every member of health and social care staff, in the country. Every single one of them will know that thanks to the decision the country took back in July, we have a Government who are committed to the NHS and social care. Had the Conservatives remained in power, we would be going even deeper into the already deep hole that they left the country in. We must never go back there again.
Andrew George (St Ives) (LD)
I accept that the Government are clearly not the architect of the current unacceptable state of affairs. However, may I encourage the Secretary of State to reflect again on our exchange at the Health and Social Care Committee just a month ago, when he resisted the recommendation of the president of the Royal College of Emergency Medicine that we invest in more beds to accommodate additional admissions to hospital? That would ease a return to normality, reduce the need for corridor care, and ease the pressures in emergency departments.
Wes Streeting
Throughout the winter, NHS providers have continued to flex bed capacity to meet demand. The important thing is that our approach to investment and reform delivers the system-wide improvements that help us to break out of the annual cycle of winter crises. There has been criticism of the Government’s focus on elective recovery—for example, people have asked if that is at the expense of urgent and emergency care—but I will not allow a status quo to settle in which the NHS is in effect reduced to a blue-light, emergency service. The Government will improve urgent and emergency care, elective recovery, primary care, community services and social care, because that is what we need to meet the health and care needs of people in this century, and that is what we will deliver.
Winter Preparedness
Andrew George Excerpts(6 months, 2 weeks ago)
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Madam Deputy Speaker
I call Andrew George, a member of the Select Committee.
Andrew George (St Ives) (LD)
In the far west of Cornwall, in a medical emergency we cannot look for additional support from the north, west or south, because it is sea. The urgent treatment centre at Penzance hospital was closed two and a half years ago, under the Conservatives, adding pressure to the only emergency department for the next 100 miles, which is in Truro, and the out-of-hours doctor service has no doctors. The Minister mentioned in her statement that the NHS urgent and emergency care tiering programme is able to help. Will she use her influence to reopen the urgent treatment centre so that we can have a 24/7 emergency service in the far west of Cornwall?
Karin Smyth
The hon. Gentleman tempts me to make commitments from the Dispatch Box, which I am not going to do. He makes a very serious point. The sea is an issue for many hon. Members—beautiful though it is, it has an impact on the ability of the system to manage different areas. Looking at different solutions for populations such as those he represents—be that 111, hear and treat systems, more use of technology, and pharmacies and community out-of-hospital care—is exactly what we think is the right way to go in the next few years, as part of the long-term plan. That may or may not be a building with services. We need to look at that in the round and learn from what works well in different sorts of systems.
Community Pharmacies: Devon and the South-west
Andrew George Excerpts(6 months, 2 weeks ago)
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Rachel Gilmour
I will come on to Pharmacy First at the end of the debate, because I see it as the solution, rather than the problem.
The sector is trying its hardest, but without a fundamental overhaul of the system these NHS services, which are much-needed by patients and the public, may fall by the wayside into one of the following pits. There are the hours lost. When the money is not there, pharmacies cannot operate. As we see in many areas across the south-west and the UK, including in Tiverton and Minehead, hundreds of hours have been lost to temporary closures of pharmacies. According to the Company Chemists’ Association, pharmacies across the south-west have cut opening hours to the tune of 130,400 hours over just more than a year and a half by reducing their opening hours. According to Community Pharmacy England, from October 2021 to May 2024, in my constituency alone, more than 520 hours of pharmacy time were lost due to temporary pharmacy closures.
Although pharmacies operate all the services that I mentioned in the first part of my speech—and more, but I do not have time to go through them all—the closures take a toll on the GPs and A&E staff who might be someone’s next port of call if they cannot see their pharmacist. They take a toll on the NHS 111 line if the individual calls in, and they take a toll on the people who might not have any other free time in that day to take care of their health needs. Those lost hours add up. When pharmacies cannot provide those appointments or other services, it leads to bottlenecks elsewhere in the system.
Over the first three months of Pharmacy First, to which I will come shortly, pharmacies took 234 appointments out of the GP system simply by offering consultations for the seven applicable conditions. Pharmacies have fantastic potential to relieve pressure and provide new ways for people to access medical services, receive advice and so much more. Pharmacies cannot fulfil their potential if they are closed. The prospect of local pharmacies closing really does scare people. In a recent poll, 83% of respondents reported that they would be concerned about their local pharmacy closing. Data shows that closures are disproportionately taking place in the most deprived areas, with 50% of the pharmacy closures recorded in areas in the lowest three deciles of deprivation.
Andrew George (St Ives) (LD)
Further to the point made by the hon. Member for Exeter (Steve Race), is that not the nub of the argument? If the Government are to make the three shifts—including, importantly, the shift from hospital to community—they must not only stem the loss of pharmacies, but build them up.
Rachel Gilmour
I see it as a pyramid, with pharmacies at the bottom, right up to operations and A&E at the top.
According to the CCA, between September 2022 and June 2024 nearly 200,000 hours of pharmacy time was lost due to pharmacies closing their doors permanently. Over 1,000 pharmacies have closed since 2016, with a net loss of 136 pharmacies in the south-west over the last decade—including in Tiverton and Minehead, where we did not have many pharmacies to begin with. The number of pharmacies operating in England is now the lowest since 2008-09. There are reports across the sector of sustained difficulties in even staffing the pharmacies that remain open. The sector cannot sustain these exits, nor can communities where pharmacies are so vital. Pharmacies across the south-west and Devon need proper investment to safeguard and fix our broken pharmacy system, and to ensure that our health system is up to scratch and our social care system is supported.
Oral Answers to Questions
Andrew George Excerpts(7 months, 2 weeks ago)
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Wes Streeting
Of course we need to deliver both new homes and GP surgeries, but the previous Conservative Government delivered neither. We have a housing crisis and an NHS crisis in this country; I would have thought Conservative Members might have shown some humility and responsibility for those facts before challenging a Government who have been in office for only four months.
Andrew George (St Ives) (LD)
In Cornwall, only 25% of delayed discharges from hospital are because of lack of social care packages, with the remainder involving the significant degree of support needed from primary and community NHS services. The Royal College of Nursing has pointed out that there has been a 45% reduction in district nurses in the last decade, so what can the Government do to replace those essential roles at a primary care level?
Wes Streeting
The hon. Gentleman is right. Last weekend, I was up in Middlesbrough with local Members, where we saw a great example of hospital at home delivered by the community nursing team and the community health trust. We have to do a lot more in that space to ensure we provide care closer to peoples’ homes—indeed, often in the home—keeping them out of hospital and close to home, which is better for them and better value for the taxpayer.
NHS Dentistry: Rural Areas
Andrew George Excerpts(8 months ago)
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Sarah Gibson
I agree with the hon. Gentleman. It is disappointing that those who have failed to address this issue over many years still do not seem to see it as important. Although the dental contract was introduced under a Labour Government, it was clear that, after a length of time, there was an obvious moment when it should have been reformed but was not. That is disappointing and noticeable.
Andrew George (St Ives) (LD)
To reinforce the points made by the hon. Members for Truro and Falmouth (Jayne Kirkham) and for Camborne and Redruth (Perran Moon), and by my hon. Friend, this is not purely down to money. Indeed, there is an underspend in the dentistry contracts of many ICBs, and not just in Cornwall. Fundamentally, we know that it is the nature of the contract itself that means we end up in situations such as that in Cornwall, where children can expect never to see an NHS dentist until adulthood.
Sarah Gibson
I agree with my hon. Friend. As I have mentioned, the ICB that represents my constituency has quite a significant underspend in its dental budget. That is quite often because dental practices do not wish to take up the contract as they find that the payments system, and its use of units of dental activity, fails to support them in a way that allows them to make a living. As we said earlier, small businesses are struggling across the country. They find that they are subsidising their NHS dentistry with private dentistry, to the point that it is no longer sustainable.
Another issue that is prevalent in most rural areas, and certainly in the south-west, is recruitment. While NHS dentistry does not pay, it is extremely difficult for dental practices to find dentists who will take on NHS contracts. Many of the dentists who took on NHS contracts have left—some were European citizens—or are simply no longer prepared to spend that many hours in a dental surgery and have decided either to retire or to take on easier work elsewhere. This ongoing problem will continue unless the dental contract is reformed quickly.