NHS England Update

Debate between Jeremy Hunt and Wes Streeting

Thursday 13th March 2025 Commons Chamber

[Wes Streeting]

That is an excellent question. We are building an outstanding transformational team with Sir Jim Mackey, which will be announced very shortly. It will bring together some of the best leaders across the country, and expertise from outside the NHS, to drive the scale and pace of transformation that is necessary. My hon. Friend is right to say that it is existential, because we cannot allow the curve of cost and demand to continue to rise to the extent that it is. The NHS’s long-term workforce plan has one in nine people in our country working for the NHS. On the current trajectory, in 50 years’ time, 100% of the public would be working for the NHS. That is clearly not a sustainable position.

I tell people who resist this reform out of love for the NHS not to kill it with kindness. We have to bend the curve of cost and demand to ensure that our health services are sustainable for the long term on the equitable foundations of a public service, free at the point of use, that we will always defend. I also say to my hon. Friends on the Government Back Benches that if we do not get this right, goodness knows what will come next. The Leader of the Opposition says that she wants a debate on the funding model for the NHS. The leader of the Reform party—I am not sure whether he is the Leader of the Opposition yet—says that he is up for anything. I am sure he is. That should worry us.

To those who want to debate the funding model of our NHS and the equitable principle of it being a public service, free at the point of use, I say that we are happy to have that debate but the Government are unequivocal: under Labour, the NHS is not for sale. It will always be a public service, free at the point of use, so that when people fall ill, they never have to worry about the bill.

[Jeremy Hunt (Godalming and Ash) (Con)]

May I commend the boldness of today’s announcement? If the NHS is to be turned around, it will need radical reforms. If the result of today is to replace bureaucratic overcentralisation with political overcentralisation, it will fail. But if we move to the decentralised model that we have for the police and schools, it could be the start of a real transformation.

Will the Secretary of State give the House more detail about the changes he has in mind? Are we going to get rid of the central targets that make the NHS the most micromanaged system in the world and make it impossible for managers to deliver real change on the ground because they are working to about a hundred operational targets? If that is the case, and we are going to decentralise the NHS, does the Secretary of State agree that there remains a vital role for a reformed Care Quality Commission to call out poor care whenever it finds it?

[Wes Streeting]

I am grateful to the right hon. Gentleman for that thoughtful question. Let me say two things to him. First, democratic accountability matters, both in terms of patient outcomes and value for taxpayers’ money. One of the things that I, my Labour and many of my Conservative predecessors have reflected on a lot over many years is what the role of the Secretary of State, and Government, is in a national health service where clinical decisions should always be clinically led. It is the Secretary of State’s responsibility to be the champion for patients and for taxpayers and to ensure that the system as a whole delivers better outcomes for patients and better value for taxpayers.

The argument that I have started, however, which has ruffled some feathers within the NHS and even more so with some of our country’s most loved charities in recent months, is the fallacy that the Secretary of State can or should just fire endless instructions into the system, as if a Secretary of State or, for that matter, an NHS England could just pull some big levers and drive change in such a vast and complex system. That is a falsehood. Of course, we should set national strategic priorities on behalf of the public. We should ensure that there is more transparency and information so that patients, communities and staff can hold the system and themselves to account to improve performance. However, the overcentralisation has to stop.

In future, it will be for the Department and the NHS nationally to do the things that only the national health service can do, providing the enablers for the system as a whole. What we are presiding over and embarking on, however, is the biggest decentralisation of power in the history of our national health service. That will put more power into the hands of frontline leaders and clinicians, but even more fundamental and transformational, more power into the hands of patients. If we get that right, we will have an NHS that can truly be the envy of the world. If people continue to indulge in the fallacy that more targets from the centre or more—or indeed, less—political control is the answer, we will fail.

The right hon. Gentleman also mentioned the CQC. It has got itself into a terrible mess and I know that that is not what he intended when he rightly made the decision to create the Care Quality Commission. That is why Sir Julian Hartley knows that he has our full support, not just in turning around the CQC as it is, but in reforming it so that it can be the best guarantee and safeguard of quality that patients and the public deserve. Dr Penny Dash’s forthcoming review findings will also help to drive that reform agenda at pace.

Oral Answers to Questions

Debate between Jeremy Hunt and Wes Streeting

Tuesday 19th November 2024 Commons Chamber

[Wes Streeting]

I, too, pay tribute to Norman and to family carers like him, who play such a vital role supporting loved ones. Through the carer’s allowance uplift in the Budget, the Chancellor announced the largest increase to the weekly earnings limit since the introduction of carer’s allowance in 1976. As well as that investment, we will have a 10-year plan for social care, and I see the care workforce, care providers and family carers as all being important partners in building that plan.

[Jeremy Hunt (Godalming and Ash) (Con)]

I welcome the Secretary of State’s plans to reform the NHS, but may I caution against the idea that the answer is to fire more incompetent managers? The problem is not bad management: it is micromanagement from the centre that sees hospitals managed with more than 100 targets by NHS England, making ours one of the most micromanaged healthcare systems in the world. Will the Secretary of State’s plans allow managers more autonomy, helping them to innovate, save money and improve care for patients?

[Wes Streeting]

I am happy to confirm that it is my view that, when there are too many targets and everything is being measured, nothing ends up being measured. We need to give more freedom and autonomy to good leaders, including clinical leaders and managers in the NHS who are coming up with some of the best productivity gains in the system. That is why we have announced new support for, and investment in, the college of leadership for both clinical and executive leaders in the NHS. I would be delighted to meet the right hon. Gentleman to discuss those issues. He was a great Chair of the Health and Social Care Select Committee, but back in July, we saw a great example of how we can improve things by sacking bad managers.