Department of Health and Social Care

Gregory Stafford Excerpts

Wednesday 5th March 2025 Commons Chamber

[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.

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[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.

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[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.

[Gregory Stafford]

Will the hon. Gentleman give way?

[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.

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[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.

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[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.

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[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]

Will the Minister give way?

[Ashley Dalton]

I will, but very briefly, because we have very little time.

[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.