Hospitals

Karin Smyth Excerpts

Wednesday 23rd April 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

It really is a pleasure to close this debate on behalf of the Government. I think there have been 33 contributions from hon. Members from across the House.

Nowhere is it more apparent that the NHS is broken than in our crumbling hospitals. Over 14 years, the NHS was starved of capital and the capital budget was repeatedly raided to plug the holes in day-to-day spending. Lord Darzi’s investigation into the NHS in England made it clear that we have crumbling buildings and IT, mental health patients sharing showers in Victorian-era cells infested with vermin, and parts of the NHS operating in decrepit portacabins. Some 20% of the primary care estate predates the founding of the health service in 1948.

I thank the Liberal Democrats for bringing forward this debate. We broadly agree on the disgrace that the backlog of repairs, the decades-long cannibalisation of capital budgets and the unfunded fantasy of the new hospital programme had become. Where we disagree is on the cause and the solution. As we have heard today, the Liberal Democrats are completely silent on the part they played as members of the coalition Government. They were active and enthusiastic partners in the decision to impose austerity, and our NHS was starved of funding on their watch. The practice of raiding capital budgets to keep things afloat started in 2014, on their watch. The disastrous top-down NHS reorganisation, which wasted billions of pounds and contributed to record-high waiting lists, happened on their watch.

As for the solution, the Liberal Democrats are silent on how they would pay for and accelerate the new hospital programme. They are playing the same cynical game that we saw from the Conservative party: they are dangling the prospect of a new hospital while being unable to explain where the funding would come from or how the construction industry could deliver it within the timeframe. It is indeed opportunism, as my hon. Friend the Member for Gateshead Central and Whickham (Mark Ferguson) said. We all remember the Rose Garden, as my hon. Friend the Member for Watford (Matt Turmaine) said. The Liberal Democrats opposed the autumn 2024 Budget, which delivered record investment in our NHS. In sharp contrast, this Government are prepared to take the decisions needed to back up our promises with the funding needed to deliver them, and we are determined to rebuild confidence and trust in politics by promising only what we can deliver.

I have met many hon. Members in person and heard them in the Chamber today, and I know others are not here who would have wanted to contribute. As the Minister, let me say plainly that I agree with everyone’s anger. I share that anger because, when I tour hospitals up and down the country—I did so recently in Doncaster and in Oxfordshire, where I visited the Warneford hospital—I often see equipment and infrastructure that was procured 20 years ago when I was working for the NHS in Bristol. Seeing these physical reminders of the past when I tour hospitals fills me with a mixture of pride and shame. I feel pride because I was part of a generation of leaders who delivered hospitals fit for patients in the biggest hospital programme in NHS history delivered under the last Labour Government, and I feel shame because our legacy was squandered and patients have paid the price. We understand the legacy, and Lord Darzi was very clear that the task for us is to take action. That is why the Chancellor took the necessary decisions in her Budget to meet this challenge, and why we have put the programme on a firm financial footing.

As my hon. Friend the Minister for Care said, we are not just writing the wrong; we are taking pressures off hospitals, shifting the focus of our NHS from hospital to community, recruiting over 1,500 more GPs to take the pressure off A&E and harnessing the power of AI to help people who depend on care to stay at home. That point was well made by my hon. Friends the Members for Stroud (Dr Opher), for Aylesbury (Laura Kyrke-Smith), for Milton Keynes Central (Emily Darlington) and for Calder Valley (Josh Fenton-Glynn). As he made me sponsor him, may I wish my hon. Friend the Member for Calder Valley good luck in the marathon this weekend? The challenge before us is immense, but every member of this Government is up for the fight.

Members made a number of points, and I will try to get through them in the time available. I could not agree more with those who made the point that we have to break out of the vicious cycle of false economy. This Government were elected on a manifesto to end short-termism, easy answers and sticking-plaster politics. When we came into government we were saddled with a bill of almost £14 billion in backlog maintenance. My right hon. Friend the Chancellor has given us the funding this year to back NHS systems with over £4 billion of operational capital. A lifesaving cash injection of £750 million for targeted estate safety funding is a vital first step towards fixing our crumbling estate. That is crucial not only for patients, but for staff morale, as my hon. Friend the Member for Carlisle (Ms Minns) said. There is also £440 million to tackle crumbling RAAC concrete, keeping patients and their families safe. We are opening new mental health facilities, with more in construction, and that state-of-the-art provision will give the best possible care outcomes.

Furthermore, I assure Members that, unlike the previous Government, we will never raid capital budgets to plug day-to-day spending, and the Treasury has updated its fiscal rules to make that impossible. My hon. Friend the Member for Crewe and Nantwich (Connor Naismith) said that big promises with no plans are what got us into this mess, and that was echoed by my hon. Friend the Member for Mid Cheshire (Andrew Cooper), who talked about the false hope and the waste of the past. My hon. Friend the Member for Banbury (Sean Woodcock) echoed that point and reiterated the point about trust, which was almost shared by the hon. Member for South Devon (Caroline Voaden).

Members have called on the Government to reverse course and commit to a timeline that is unfunded, unrealistic and undeliverable. That has been recognised by a National Audit Office report, which stated that

“some schemes publicly promised in 2020 now face substantial delays and will not be completed by 2030…with implications for patients and clinicians.”

The delivery of these hospitals existed only as a figment of Boris Johnson’s imagination and this Government are doing the hard yards of putting the new hospital programme back on track. The NHP previously received a red rating from the Infrastructure and Projects Authority, now known as the National Infrastructure and Service Transformation Authority. Its latest review, which it carried out in January, rated the NHP as amber. That reflects the measures that we took to put the programme on a firm footing, as my hon. Friend the Member for Harlow (Chris Vince) rightly said.

Some Members, including the Chair of the Select Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), have asked us to publish the individual scores of each scheme following the outcome of the review, but may I just take issue with the hon. Lady’s use of the word “shady”? The Secretary of State and the Department will continue to co-operate with her Committee, but to be clear, as part of our analysis, schemes were prioritised into upper, middle and lower thirds, which gave a delivery schedule for the programme to align with the funding envelope, and there was no final individual score for each scheme. There is no formal delineation among schemes in wave 2, and schemes remain scheduled to start construction as outlined in our plan for implementation.

I briefly say to my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) that it was a pleasure to meet Councillors McCabe and Garrod from her constituency and to understand their passion about the loss of resources. That is echoed in many low-income areas, and we have to reverse that loss of resources as we go forward with our 10-year plan.

We are taking a systematic approach to building the next generation of hospitals, known as Hospital 2.0, allowing trusts to benefit from economies of scale, provide excellent patient care and facilities, and ensure that staff are supported with technology for decent working environments. It contributes to our growth mission, putting more money in people’s pockets and supporting our supply chains. In response to my hon. Friend the Member for Milton Keynes North (Chris Curtis), we do abide by the Hospital 2.0 scheme. It is a systematic and centralised approach that will save taxpayer money, while driving innovation and laying the foundations for a new relationship between Government and industry. I am disappointed if it is official Liberal Democrat policy to oppose that approach.

I know the clock is against me but I want to end by saying that I completely understand why colleagues are so concerned about the plans, when previous Governments have so badly let them and their constituents down. I also hear the point made by the hon. Member for South Antrim (Robin Swann) about Northern Ireland. Northern Ireland benefits from the Barnett consequentials for revenue and capital. It is devolved and it can look at alternative means. The Department will continue to work with all devolved Administrations across all issues, but they do have particular problems.

Staff and patients deserve better, so I want to offer them some reassurance about our record since July. We promised to sit down with resident doctors and end the damaging strike action—promise made, promise kept. In October, we said we would recruit more GPs by April and we recruited more than we said—promise made, promise kept. We promised 2 million extra appointments in our manifesto and we smashed that target seven months early—promise made, promise kept. Last month, over 80% of patients in England referred for cancer had it ruled out or diagnosed within 28 days, the first time that target has been met for years, and waiting lists are now consistently falling.

We have gripped this critical issue since July, from day one with the review. The Secretary of State and I met MPs and the NHP team before the completion of the review. I met all colleagues the day after the announcement in January and I have had individual meetings. I will keep my promises to visit, when the diary allows. I am really looking forward to North Devon. I am also visiting Hillingdon, where I grew up, with my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales), and possibly visiting some old haunts. I have committed to visiting Basingstoke, with my hon. Friend the Member for Basingstoke (Luke Murphy). We will progress at pace on RAAC and wave 1. I am committed to holding more meetings with wave 2 and wave 3 MPs in the coming weeks and months to keep colleagues abreast of updates and to provide them with the opportunity to ask questions directly of the team. That is how I will work with colleagues across the House to make sure the programme happens.

Finally, the hon. Member for Sleaford and North Hykeham (Dr Johnson) talked about her experience of the PFI scheme she worked under and the nonsense she had to deal with. Her Government could have changed that at any point. My experience of a PFI scheme in Bristol was waking up about a year ago after I had had my melanoma removed, in an almost brand new hospital with fantastic facilities in a single, individual ward with my husband beside me. Maybe it was the drugs that made me feel a little bit bleary-eyed, but what I thought then was how proud I was to have been part of the development team, as part of the primary care trust board, bringing forward a fantastic hospital for north Bristol that serves patients so well. That would never have happened under another Administration. We rebuilt the hospitals under the previous Labour Government. I am proud of that record. We did it before; we are going to do it again. That is what a Labour Government do.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

--- Later in debate ---

That this House regrets the appalling state of repair of NHS hospitals across the country; notes that the NHS maintenance backlog rose to £13.8 billion in 2023-24; further notes the sustained pattern of cannibalising NHS capital budgets to keep day-to-day services running; condemns the previous Government’s record of starved repair budgets and exploding maintenance backlogs, which made sewage leaks, cracked walls, crumbling ceilings and sinking floors commonplace; further condemns the previous Government for launching the New Hospitals Programme with no realistic plan to fund or deliver it; also notes that the Chancellor has announced new fiscal rules to ensure capital budgets can no longer be cannibalised, with transfers from capital to resource budgets not permitted; recognises that the previous Government left a New Hospital Programme which was unfunded, unrealistic and undeliverable; welcomes that the Government has taken action to review that Programme and has published the New Hospital Programme Plan for Implementation, to put the Programme on a sustainable footing; supports the Government’s investment in the Plan, which will increase to up to £15 billion over each consecutive five-year wave, averaging around £3 billion a year from 2030; and further supports the work being done to bring forward construction of the reinforced autoclaved aerated concrete replacement schemes wherever possible, to ensure that patient and staff safety is prioritised.

[Karin Smyth]

On a point of order, Madam Deputy Speaker, could you advise me whether it is in order that the hon. Member for Sleaford and North Hykeham (Dr Johnson), who opened the debate for the Conservatives, was not in her place for the close of the debate? I think that is discourteous to the House, and I would like your advice on how we rectify this matter.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

The point of order is most definitely on the record. It is a point of courtesy to be here for the close of a debate if you are here for the opening. No doubt, Opposition Front Benchers will make that very clear to the Member.