Hospice Funding

Karin Smyth Excerpts

Thursday 19th December 2024 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on hospice funding.

[The Minister for Secondary Care (Karin Smyth)]

I am grateful to the hon. Member for Sleaford and North Hykeham (Dr Johnson) for asking that important question. This Government want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life. We will shift care out of hospitals into the community to ensure that patients and their families receive personalised care in the most appropriate settings. Palliative end of life care services, including hospices, will have a big role to play in that shift. Most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. The amount of funding that each charitable hospice receives varies both within and between integrated care board areas.

On children and young people’s hospice funding, the Minister for Care met representatives from NHS England and Together for Short Lives and one of the chairs of the all-party parliamentary group for children who need palliative care to discuss children’s palliative and end of life care, and that funding stream was discussed at length at that meeting.

This Government recognise the range of cost pressures that the hospice sector has been facing over a number of years, so today I am delighted to announce the biggest investment in hospices and end of life care in a generation. We are supporting the hospice sector with a £100 million boost for adult and children’s hospices, to ensure that those hospices have the best physical environment for care, and with £26 million in revenue to support children and young people’s hospices. The funding will support hospices and deliver much needed funding for improvements, including refurbishment, overhaul of IT systems and improved security for patients and visitors. It will help hospices in this year and next year in providing the best end of life care for patients and their families in a supportive and dignified physical environment.

Hospices for children and young people will receive that further £26 million in funding for 2025-26 through what was, until recently, known as the children’s hospice grant. We will set out the details of the funding allocation and dissemination in the new year.

We completely understand the pressures that people are under. To govern is to choose, and the Chancellor chose to support health and social care in the Budget. The alternative is not to fund. The sector has suffered from 14 years of underfunding, and we are righting that historic wrong. This Government are committed to ensuring that every person has access to high-quality palliative and end of life care as part of our plan for change. We are taking immediate action to make our healthcare fit for the future. I am sure that the hon. Member for Sleaford and North Hykeham and everyone in the House will welcome this announcement. I thank her for giving me the opportunity to give the House an early Christmas present.

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[Dr Caroline Johnson]

After the confusion of yesterday, I welcome the fact that further details on hospice funding have been announced, albeit by our dragging them out of the Government on the very last day of Parliament before the recess.

On 30 October, the Chancellor decided to break her election promise by increasing employers national insurance contributions and reducing the threshold at which employer contributions are payable. It was later confirmed that hospices would not be exempt from the increase in costs. Now the Government have announced new funding for the sector, which they have the audacity to call

“the biggest investment in a generation”.

Let us be clear about what is going on: the Government are taking millions of pounds off hospices and palliative care charities, and then think those hospices and palliative care charities should be grateful when the Government give them some of that back. That is socialism at its finest.

We will look more closely at the funding announced today, but despite many questions from right hon. and hon. Members, to date the Government have refused to give any clear answers on how much their tax rises will cost hospices. I will try again: will the Minister please tell us how much the Government estimate they will raise from taxing hospices more? Was an impact assessment ever produced on how hospices will be hit, and how that will affect the care that they provide? Do the Government expect the funding that they have announced today to cover the additional costs in their entirety?

At the heart of this discussion are charities that provide compassionate care to terminally ill people in their final days, weeks and months. While hospices were left without information, Hospice UK reported that 300 beds have already closed, with many more closures to come. Does the Minister accept any responsibility for that? Ultimately, it is patients who will pay the price.

While we welcome this update for hospices, when will the Health Secretary come forward with more details on the many other health providers who have been hit by Labour’s tax increases, including GPs, community pharmacies and dentists? Will they be expected to be similarly grateful for getting back some of the money that the Government have taken from them?

[Karin Smyth]

To govern is, indeed, to choose. The Conservative party chose neither this sector nor any other health sector and it refused to govern. Within five months, we have not only increased the funding to the health sector to stabilise it but made today’s announcement.

Beneath all that, there might have been a welcome for the announcement—I am not entirely sure—whereas the sector is pleased to have the money. The chief executive of Hospice UK said:

“This funding will allow hospices to continue to reach hundreds of thousands of people every year with high-quality, compassionate care. We look forward to working with the government to make sure everyone approaching the end of life gets the care and support they need”.

The chief executive of Haven House children’s hospice said that it is

“very positive to hear about the government’s plan to invest significantly in the wider hospice sector; we hope that there will be as much flexibility as possible to determine locally how this new money is spent.”

This is an important issue for many hon. Members, and we look forward to working with the sector in the new year on the specifics of the announcement.

[Clive Efford (Eltham and Chislehurst) (Lab)]

This is a very welcome announcement and I am sure the hospices are breathing a sigh of relief after the level of funding they endured for 14 years under the Tories. If we are to move palliative care out of hospitals and into care situations or people’s homes, the money needs to be passported to the hospice sector for it to play its part. Integrated care boards have been charged under the Health and Care Act 2022 to provide that funding. Will the money go through ICBs or will it be passported straight to the hospice sector?

[Karin Smyth]

My hon. Friend makes an important point about the need for more people to be treated at home. That is absolutely the direction of travel that we want to see. This money will help, for example, with technology to support more people to be treated at home. ICBs are responsible for commissioning and allocating funding, so that will be done in the normal way.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I wish you and the whole team a very merry Christmas, Mr Speaker.

Last week, I visited Hope House in my constituency, where I met beautiful young Esmay, one of hundreds of children cared for by the hospice every single year. She is nearly three and has a life-threatening heart condition. Esmay’s family do not know what the future holds for her, but they know that Hope House will be there to support them, as it has since before she was born.

There are 300,000 people like Esmay treated in hospices every year, and just one third of their funding comes from the NHS. That leaves institutions such as Hope House and nearby Severn hospice reliant on generosity and unable to plan as they wait for confirmation of the funding they will receive from the NHS. That situation has been made more difficult this year because of the increase to national insurance contributions, which Hope House estimates will cost £177,000.

Funding is welcome, and I welcome the Minister’s commitment today. Will she explain whether the increase that she has announced today will cover the NIC hike for hospices and the increase in the living wage that was announced at the Budget? Will she also commit to providing future settlements in a timely manner so that hospice managers can budget effectively for the coming year?

[Karin Smyth]

I thank the hon. Lady for her questions and for welcoming the announcement. She will know that, in the past 14 years, the sector has been neglected, like the rest of the NHS and social care system. As we have repeatedly said, to govern is to choose. We have improved the settlement for the sector this year. Today’s welcome announcement can be used by the sector to manage some of those pressures and deliver the sorts of services it wants for the future.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

Does the Minister agree that the amazing staff at Overgate hospice in my constituency should be focused this Christmas on caring for their patients and not on funding? Will she confirm that this funding allows them to do so? Also, in April I will be running the London marathon for the Overgate hospice’s big build appeal. Will the Minister sponsor me?

[Karin Smyth]

That is possibly one of the cheekiest questions I have ever heard asked here, and I am obviously going to have to say yes. Frankly, rather him than me, but good luck to my hon. Friend on doing that. I know that many hon. Members raise money for their local constituencies and that the marathon is an important part of that.

We understand how different hospices are funded differently throughout the country. We want to make sure that end of life care, with all the different options that people have in their local systems, is well supported. It is really important for people to have some of that security, and I know that this announcement will be welcomed by my hon. Friend’s local hospice, as it is by the sector today.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

Merry Christmas, Mr Speaker.

The St Helena Hospice in Colchester, which serves my constituency and that of the Labour hon. Member for Colchester (Pam Cox), estimates that the national insurance increase will cost it £300,000 in a full year. Can the Minister now give a guarantee that the hospice will be compensated by the Government in full?

[Karin Smyth]

It is good to hear the hon. Gentleman supporting his local hospice with his neighbour, my hon. Friend the Member for Colchester (Pam Cox). We will announce allocations for the whole sector and the NHS in the usual way in the new year.

[Sarah Edwards (Tamworth) (Lab)]

St Giles Hospice in my constituency has funding challenges like any other. One thing that staff mentioned to me was the sustainability of when they are contracted to do things. Is the Department considering the timing and not just the funding, to enable better planning and better staff planning?

[Karin Smyth]

Yes, stability and understanding longer-term planning is important for this sector as well as for many others. Certainly, we want to make sure that we work with the sector and the wider NHS, so that we deliver our longer-term 10-year plan, but get to that process in the next few years.

[Bob Blackman (Harrow East) (Con)]

Merry Christmas, Mr Speaker.

St Luke’s Hospice in my constituency covers the whole of Brent and Harrow. I helped to form it back in the 1980s. The staff tell me that the biggest problem they face is that, every time there is an increase in nurses or doctors’ pay, it is never passed on to them, so they have to find the money from charitable giving. The Minister’s announcement of extra money is of course welcome, but she has failed to answer the question: will it cover the national insurance increase, or not?

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[Karin Smyth]

All hon. Members support their local hospices, which I know is important, but I have to remind the House of the parlous state of the sector that we inherited after 14 years of the previous Government. If Conservative Members, many of whom were part of that Government, had wanted to rectify the way in which hospice funding was allocated, or indeed that end of life care was managed, they had plenty of opportunity to do so. This Government have hit the ground running. We have fast-tracked these measures, and this announcement today is clearly a part of that. I hope that they all welcome it; it is just a shame that they did not do it themselves.

[Helena Dollimore (Hastings and Rye) (Lab/Co-op)]

Merry Christmas, Mr Speaker.

May I welcome this record investment in our hospices from the Labour Government? The Conservative Government had 14 years to do that, but they shirked that responsibility. Will the Minister join me in thanking the amazing staff and volunteers at Saint Michael’s Hospice and Demelza hospice in my constituency who do such amazing work all year round to support families and children who need amazing care?

[Karin Smyth]

I am delighted to support my hon. Friend in the work that she has been doing with St Michael’s and Demelza hospices. She is absolutely right to highlight that, and I hope that she will be able to meet the staff in the new year and discuss how they can best use some of this funding.

[Caroline Voaden (South Devon) (LD)]

I wish you, Mr Speaker, and all the House staff, a very merry Christmas.

Following on from the hon. Member for Calder Valley (Josh Fenton-Glynn), next year I will be taking part in a strictly dancing competition for my local Rowcroft Hospice. However, I am pretty sure that, even if all the Members in this House sponsored me, I would not be able to raise the £225,000 needed by Rowcroft to cover the additional national insurance contribution payments that it will have to make. Will this extra funding, which is very welcome, be additional funding, or will it be just enough to cover the extra costs that have been imposed on the hospice sector through the increase in national insurance contributions in the recent Budget?

[Karin Smyth]

I have to say that dancing is more my style than marathon running, so I wish the hon. Lady luck with that. At least she did not ask me for any money. I refer her to my earlier answer: this is additional money to support the hospice sector. It is a £100 million boost for adult and children’s hospices to ensure that they have the best physical environment for care, and £26 million in revenue to support children and young people’s hospices. We look forward to working with the sector in order to best deploy that in the New Year.

[Melanie Ward (Cowdenbeath and Kirkcaldy) (Lab)]

Merry Christmas to you and your team, Mr Speaker.

Our hospices do an amazing job, and I look forward to visiting my local hospice in the next few days, but Scottish hospices have warned that they might have to turn patients away because of the funding crisis that they face under the SNP. Does the Minister agree that the Scottish Government must at least match the level of investment that she has announced today? They must have a similar level of ambition for Scottish hospices, and provide fresh investment for our hospices, which do an amazing job in Scotland.

[Karin Smyth]

As my hon. Friend highlights, this is a devolved issue for the Scottish Government. We hope that they match our ambition, as she rightly puts it. I wish her well with her local hospice, and I hope that the Scottish Government take note of what we are doing here in England.

[Neil O'Brien (Harborough, Oadby and Wigston) (Con)]

Over 7,000 charities and voluntary groups have written an open letter to the Chancellor warning that the national insurance increase will cost them £1.4 billion and have a devastating impact. At this time of the year, ahead of Christmas, many charities, including hospices, are trying to raise funds. I know that the Chancellor did not go into politics to be the Grinch who stole Christmas for charities, so will the Minister please look at this again, and exempt charities and voluntary groups, including hospices, from this cruel tax increase, which is sucking up good will and donations and really hurting valuable charities?

[Karin Smyth]

The hon. Gentleman was a Government Minister, so he had plenty of opportunities to change the system, had he wanted to do so at the time.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

I thank the Minister for her announcement of a huge funding boost for the hospice sector. Will she join me in thanking all the brilliant staff at Keech hospice, which serves Luton South and South Bedfordshire, and especially all the volunteers who are out fundraising with Smiley Sam and Santa’s train across the streets of Luton, including Farley Hill tomorrow and Wardown Crescent on Saturday?

[Karin Smyth]

I thank my hon. Friend for making that point, and wish the volunteers well in their weekend activities. She is right to highlight not only staff but the hundreds of thousands of volunteers across the country who work to support the hospice sector and others with end of life care. That support is so important for people receiving end of life care and their families. It is something that I have experienced; my father died over the Christmas period a number of years ago. It is a hard time of the year to have a death, and I warmly support what those volunteers are doing this weekend.

[Paul Holmes (Hamble Valley) (Con)]

The fact that the Minister has come here expecting us to welcome her announcement and congratulate her on giving money that her Government took away in the first place really beggars belief. Mountbatten hospice in my constituency needs an extra £1 million because of the NICs increase that her Government have brought forward. Will she guarantee to Mountbatten and the charitable sector, including hospices—which the last Government increased funding for, before she comes back to me with that answer —that today’s announcement will cover the £1 million that her Government have taken away in NICs?

[Karin Smyth]

What beggars belief is that person after person—man after man—on the Opposition Benches still feels able to get up and defend their record in government. Not once have we heard that they agree with Lord Darzi’s diagnosis, or that they welcome the extra investment that the Chancellor found by choosing to support the health sector in the Budget. I am afraid that, until they reach that conclusion, they are destined to be on the Opposition Benches for a very long time.

[Warinder Juss (Wolverhampton West) (Lab)]

Merry Christmas to you and your team, Mr Speaker.

Compton Care hospice in my constituency provides specialist palliative and bereavement care, 24 hours a day, 365 days a year. Having previously discussed the lack of funding with the hospice, I am sure that it will welcome the extra funding that has been announced today. Will the Minister please join me in thanking Compton Care hospice and its incredible staff for the care that they will continue to provide throughout the Christmas period?

[Karin Smyth]

I welcome my hon. Friend’s comments, and I am very pleased to thank Compton Care hospice for all its work. He is right to highlight that the care is 365 days a year, around the clock.

[Lisa Smart (Hazel Grove) (LD)]

Hospices such as St Ann’s in Stockport provide really high-quality care to my constituents and others at what is often the toughest point in their lives, but they are struggling in a system that is no longer fit for purpose. It is of course welcome that the Government are providing additional funding for them. One of the challenges that the hospice sector faces is a really high rate of staff vacancies, so I would be grateful if the Minister would confirm whether the 10-year plan for the NHS includes a specific workforce plan for our hospice sector, so that it continues to care for our constituents at the toughest point in their lives.

[Karin Smyth]

The hon. Lady makes an excellent point about the stability of the workforce across the piece, from diagnosis to the end of life. We absolutely need to consider support for all parts of that through the 10-year plan. I encourage hon. Members and others to ensure that they keep making those points. We are getting excellent contributions from the public, patients and staff, and we look forward to developing the plan over the next few months and years.

[Matthew Patrick (Wirral West) (Lab)]

I welcome the largest funding increase for hospices in a generation. If that cannot bring some Christmas cheer to the Conservative Benches, it will in my constituency of Wirral West where Claire House hospice does such important work all year round. I was there just last week for their Christmas carols. Will the Minister take the opportunity to thank them for the important work they do in my constituency of Wirral West?

[Karin Smyth]

I thank my hon. Friend for his contribution and, indeed, for his singing. Those events bring joy to people at a particularly difficult point in their life, and they are very welcome.

[Martin Vickers (Brigg and Immingham) (Con)]

Any increase in funding for the hospice movement is of course welcome, but let us be honest: it is giving with one hand and taking with the other. The two excellent hospices that serve my constituency—St Andrew’s in Grimsby and Lindsey Lodge in Scunthorpe—tell me they want certainty. The Minister says they will be told early in the new year. Can the Minister give a categorical assurance that in the first half of January hospices will be told how much extra they are getting from the £100 million she mentioned?

[Karin Smyth]

I thank the hon. Gentleman for welcoming the announcement. As I said, we will be working with the sector in the new year and then we will make allocations accordingly.

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

Stoke-on-Trent is wonderfully served by the Dougie Mac and Donna Louise hospices. They are part of a healthcare system in Staffordshire and Stoke-on-Trent that the Minister knows has a £90 million projected deficit. What oversight will there be to ensure that the money that goes to the ICBs reaches the hospices and that the team in Staffordshire and Stoke-on-Trent do not try to use some of this welcome new money to fill holes elsewhere?

[Karin Smyth]

My hon. Friend makes an excellent point —one that was raised earlier. It is vital that ICBs work with all providers to understand the needs and how they are best met. I know he will be diligent, as he already has been, in pursuing what is happening with the funding with his local ICB. We will work with Hospice UK to ensure that that happens across the piece.

[Seamus Logan (Aberdeenshire North and Moray East) (SNP)]

The hon. Member for Cowdenbeath and Kirkcaldy (Melanie Ward) calls for a fresh approach by the SNP Government in Holyrood, but she clearly expects us to do that with fresh air, because part of the £750 million additional cost from the national insurance contributions will fall on hospices. On Tuesday, she had the opportunity to vote against that cost. Will the Minister confirm that there will be Barnett consequentials for Scotland? How will she address the problems that Marie Curie in Scotland faces?

[Karin Smyth]

I admire the hon. Gentleman for keeping on the same wicket. In the Budget, this Government made the greatest allocation to the health sector. What the Scottish Government do with their consequentials and how they manage that is entirely a matter for them, and if they are not doing a good job, the public need to vote for someone else.

[Harpreet Uppal (Huddersfield) (Lab)]

I wish you, the team and all the wonderful staff on the parliamentary estate a merry Christmas. I very much welcome this big investment into local hospices, and I know it will be welcomed by my local children’s hospice Forget Me Not and Kirkwood hospice, which do invaluable work in my constituency. What assessment has the Minister carried out on long-term sustainable funding for the sector, particularly in relation to statutory funding and the increasing role that hospices play in the community and in people’s homes?

[Karin Smyth]

My hon. Friend is absolutely right to highlight that need. As I said earlier, end of life care and its stability as part of the wider system, which is a commissioning role for ICBs, was not addressed by the last Government over 14 years. As part of our 10-year plan, that will be important to do.

[Sir John Hayes (South Holland and The Deepings) (Con)]

We can all agree that hospices, such as St Barnabas in Lincolnshire, do vital and valued work. I hope we can also all agree that every Government—Labour and Tory—have increased national health spending, for that is simply a matter of fact. I ask the Minister to show a little wisdom in contrition in acknowledging that the national insurance increase that was imposed on charities and hospices has done immense damage. We welcome the funding today—of course we do—but she needs to be straightforward: was she, or any of the Health team, consulted before the Budget about the impact of the NI increase on hospices, health charities, pharmacies and so on? May I advise her to put down the folder and tell us what she really thinks?

[Karin Smyth]

I have scribbled my own note—the right hon. Gentleman says that he “agrees”— but the issue is that his Government did nothing over 14 years to support or make a change. That is why the announcement we are making is so important. I reiterate my earlier point, which I will repeat every time I am at the Dispatch Box: the Conservatives have not read the Darzi report; if they do not agree with the diagnosis, they cannot agree with the solution. That is their fundamental problem.

[Amanda Martin (Portsmouth North) (Lab)]

I welcome the announcement of additional funding, as will many families across the country. Although it is not in my constituency, Rowans Hospice is used by people in Pompey. Indeed, my nan Pearl and my very dear friend Fiona spent their last few weeks in the hospice’s care, and what a wonderful place it is. At a city council meeting this week, concerns were raised about the future of that amazing service. Will the Minister confirm that the Government are committed to ensuring that every person has access to high-quality end of life care?

[Karin Smyth]

That is absolutely what we want to do, and today’s announcement is a step towards it. As my hon. Friend highlights, hospices are very special places, but most people want to die at home with their loved ones, in the place they know well, and many parts of the sector will be able to use this money to help more people to die peacefully at home.

[Tim Farron (Westmorland and Lonsdale) (LD)]

This additional funding will benefit hospices serving Westmorland communities—St Mary’s, St John’s, Eden Valley and the children’s hospice, Jigsaw—only if two things happen. First, the Government must provide additional funding to match the national insurance increases that those hospices will have to bear, and secondly, the Government must ensure that the integrated care boards in south Cumbria and north Cumbria pass on that money in full and on time. Will the Minister press them to do so? On the Morecambe bay end, will she press them on the closure of the Abbey View ward at Barrow hospital? The trust is planning to close that end of life ward, which will put additional pressure on our local hospices but without any additional funding to support them.

--- Later in debate ---

[Karin Smyth]

The commissioning of those services is the responsibility of the ICBs, and we expect them to do that. They are responsible from diagnosis to end of life. In the past few months, I have met many hon. Members from across political parties to discuss issues in their ICBs. I know that he will, like others, be assiduous in pursuing the ICB to ensure that funding goes to the right place.

[Alistair Strathern (Hitchin) (Lab)]

I wish you, Mr Speaker, and the fantastic staff across the estate a happy Christmas.

I thank the Minister for the way in which she and her team have listened to me and colleagues, who arrived in this place with real concern about the state of palliative care after years of under-investment by the previous Government. The funding announced today will be welcomed by Keech hospice and Garden House hospice, which provide fantastic palliative care for constituents in and around my area. Will she join me in thanking them for the fantastic work that their staff and volunteers do all year round to support people in incredibly difficult moments in their lives? Will she also assure them that palliative care will remain at the front and centre of the Government’s mind in the difficult work of getting health services working again?

[Karin Smyth]

I am happy to support my hon. Friend, who makes an excellent point, in his work with local providers. He congratulates me, but the work has been done mainly by the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), and by the Secretary of State, who have personally taken on this issue. They are visiting hospices today, so they could not be here even though they wanted to. We are committed to supporting people throughout their life, from diagnosis to end of life.

[Robbie Moore (Keighley and Ilkley) (Con)]

I have been contacted by vast numbers of families and relatives of those who have been wonderfully cared for by Sue Ryder Manorlands hospice in Oxenhope in the Worth valley. They are all concerned about the impact that the rise in employer national insurance will have on them. Those at Manorlands are deeply concerned that it will cost them hundreds of thousands of pounds. In answering the urgent question, the Minister has announced additional funding, but can she confirm whether it will cover the cost of those rises to Sue Ryder Manorlands hospice in my constituency? Did the Government carry out an impact assessment of the negative impacts that the Budget would have on those in the charitable and hospice sectors?

[Karin Smyth]

The hon. Gentleman asks the same question again. Through the Budget, this Government have allocated more money to the health service than the previous Government—a record announcement—and we have announced money again this morning. To govern is to choose. The last Government neither governed well nor chose to support the health sector from diagnosis to end of life; this Government have, and will continue to do so.

[Alison Bennett (Mid Sussex) (LD)]

Some weeks before the Budget, I visited both St Catherine’s hospice and St Peter and St James hospice, which serve my constituents. I had not expected how quiet and empty those hospices were, because of the empty beds and mothballed wings that had been closed due to a lack of funding. Evidently, the funding crisis in the hospice sector was very deep before the Budget, but the Budget has only made it worse through the NIC increases. As such, I will try again: will the welcome funding announced today cover the cost of those NIC increases?

[Karin Smyth]

As Lord Darzi’s report announced, the entire sector has been under pressure and struggling since the disastrous Lansley reforms—they were part of the coalition Government—through to when we took over in July. We will fix the NHS and rebuild it to make it more sustainable and fit for the future. That includes everything from diagnosis to end of life care.

[Blake Stephenson (Mid Bedfordshire) (Con)]

For my sins, I too will be running the London marathon next year. I will be running to raise money for Keech hospice; I know, as do other hon. Members who represent constituencies in Bedfordshire, what fantastic work that hospice does and the care it provides to our county. The Minister has been asked lots of times to comment on the impact of the NIC increases, which are going to hurt hospices in constituencies all around the country, so may I ask the question in a slightly different way? Does the Minister think that Keech hospice, taken in the round, will be financially better off or worse off next year as a result of both the Budget and this announcement that she has been dragged to the House to make?

[Karin Smyth]

I have not been dragged—I am very happy to be here. The reality is that the health sector in its entirety, from diagnosis to end of life care, will be better off this year than it was last year or the year before under the hon. Gentleman’s Government.

[Gideon Amos (Taunton and Wellington) (LD)]

I place on record my thanks to all those in my constituency who will be caring for others over Christmas, whether they are unpaid family carers or paid care providers. That includes the registered nurses and registered care providers who have written to me to say that there will be an extra cost of £615 per employee as a result of the changes in the Budget. I will not attempt to ask whether the money announced today will cover national insurance contributions, but I will ask what the Government will do to help registered care providers. Where will the money come from to enable them to meet their increased national insurance contributions?

[Karin Smyth]

As the hon. Gentleman knows, this Government have allocated an extra £12 billion in this year for the health and care sector. The full allocation to cover the entire area of health and social care will be announced in the new year.

[Jim Shannon (Strangford) (DUP)]

It would be churlish of anybody in this Chamber not to welcome the money that the Government are setting aside. I thank the Minister and the Government for that announcement, but what discussions has the Minister had with Cabinet colleagues to secure exemptions from national insurance contribution hikes for hospice workers? I think of Marie Curie—I spoke about that charity yesterday in Westminster Hall, and the Minister probably has a Marie Curie in her constituency. We know what that charity does. Unlike the mainstream NHS, it will not be exempted, yet it carries out the end of life care that the NHS simply cannot provide. Further, what help will be provided to carers in the community? The withdrawal of their service would leave the care system decimated.

[Karin Smyth]

The hon. Member makes an excellent point about carers and their support. We made announcements about that in the Budget, and we will make more general announcements about allocations in the new year.

[Mr Speaker]

May I gently say that I know you welcome being here, Minister, but it would have been easier if the announcement had come as a statement rather than through having to grant an urgent question? When Ministers are going out—quite rightly—to visit hospices, we should be told at the same time. It would be nicer and easier for us all to do it that way, but I thank the Minister for coming.

I would also say to all of us that our hospices matter. In the case of those hospices that serve my constituency—the children’s hospice of Derian House and St Catherine’s— I wish them all the best for Christmas. I thank all hospices for the duty they carry out on behalf of our constituents.

Winter Preparedness

Karin Smyth Excerpts

Wednesday 18th December 2024 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

With permission, Madam Deputy Speaker, I would like to make a statement on winter preparedness. Before I begin, I want to say a very special thank you to all the staff who will be keeping our NHS going over the Christmas holidays and into the new year. When I was a manager in the NHS, I worked on winter planning, so, if I may, I will say an additional thank you to all the people who are often unseen: the managers and admin staff who also keep the system going. I know how hard it is for people to work in the system with the challenges that winter can bring through increased demand and higher rates of infection.

There are things that we cannot predict. Storms Bert and Darragh have added pressure, and we might have a cold snap. I know that many people like a winter cold snap of snow and ice, but it is not something that the NHS ever wants to see. The NHS has excellent people who have done this before and, unlike last year, thanks to the new Government, many of them will not be on strike. While we cannot control the weather, we can plan, prepare and pull together, so today I want to update colleagues with the current picture before moving on to the things that we are doing.

NHS England and the UK Health Security Agency will publish the latest statistics tomorrow morning as usual, but we do know that levels of seasonal illness are high. The most recent figures show that last week there was a 350% increase in flu cases compared with the same week last year, but that is comparable to levels we saw two years ago. Norovirus cases are high, but covid rates are low, and although rates of RSV—respiratory syncytial virus—have been high, we expect them to start coming down over the next few weeks.

I want to make it clear that the current rates for both bed occupancy and ambulance delays are unacceptably high. I will shortly come to measures about how we are dealing with that capacity.

I will not rehearse the Darzi investigation and his findings, except on one thing. I remind the House that he found “a perpetual bed crisis”, particularly during peak periods like winter cold snaps. That means that every winter our staff have been wasting precious time solving process problems, ringing round wards to find beds and desperately trying to hold the system together. We can see that in the figures.

On an average evening in 2009, a patient would have been 39th in the queue when they arrived at a typical accident and emergency department. In 2024, they are 100th. The four-hour A&E standard has not been met for nearly a decade and ambulance response times have not been consistently achieved since their introduction in 2017. In November, the average ambulance response time stood at 42 minutes, which is more than double the NHS constitutional standard. A third of the 2.3 million people who attended A&E last month waited more than four hours, and one in 10 of those people—more than 150,000—waited for more than 12 hours.

Those life and death delays are the result of deep structural issues in the NHS that cannot be fixed overnight. But this winter, NHS staff will be on the frontline, not the picket line, because we took a different approach on how to work with staff and the unions. To resolve the resident doctors’ dispute, we spoke to them on day one, we met them in week one, and by week four we had negotiated a deal to end their strikes. That is why, for the first time in three years, the Government are fully focused on winter and not on planning for strikes.

This is what we are doing. First, the NHS is managing extra demand by strengthening same-day emergency care and offering more falls services for older people, with upgraded 24-hour live data centres. Secondly, we are continuing to support systems that are struggling with direct intervention through the NHS urgent and emergency care tiering programme.

Thirdly, the Secretary of State is chairing weekly meetings with me and senior leaders to ensure that we are managing pressures across the entire system. Last week, he specially convened with trusts and told them to prioritise patient safety by focusing on key metrics, including improving emergency ambulance response times, addressing handover delays and tackling the longest waits in A&E. We have made it crystal clear that we do not want trusts to prioritise patients who can be seen and discharged more quickly over those with the greatest clinical need, because this Government will always prioritise people, not performance. This morning, the NHS published a letter outlining how it is prioritising patient safety.

Fourthly, I am taking steps to ensure that we get a clear picture of what is happening on the ground. I recently visited Newham hospital’s A&E, Bristol Southmead hospital and the head offices of NHS England to see the aforementioned operational control centre, where it receives data in real time and responds to problems as they emerge. Fifthly, we launched a national communication campaign in the autumn to encourage people across the country to take their winter vaccines, with a particular focus on people who are less likely to come forward.

That last point is essential, because the best and easiest way to keep people out of hospital this Christmas is to encourage them to come forward and get vaccinated. Last year, people who received a covid vaccine were half as likely to be admitted to hospital than those who did not. So far, we have delivered over 17 million flu jabs and 9.5 million covid jabs, and we have introduced the first ever public vaccination campaign for RSV, with over a million and counting vaccinations delivered to protect young babies and the elderly. In total, we have delivered nearly 28 million vaccinations for this winter, and I thank every person who has come forward to protect themselves and the vulnerable.

Now, I would like to speak directly to anyone who has not yet been vaccinated. No one wants to be separated from their family and stuck in hospital this Christmas, and there is a real risk that people may inadvertently take flu home to loved ones this year. Please protect yourself, your family and the NHS, and book that appointment today, because tomorrow is the last day you can book a vaccine through the NHS app or website, although after tomorrow there will be local solutions.

While we tackle winter pressures in the short term, we are fixing the foundations of our NHS with long-term reform. Two weeks ago, the Prime Minister spoke to the nation about our plan for change, and set out our ambitions for the health service over this Parliament. We will get a grip on waiting lists and return to 92% of patients waiting no longer than 18 weeks from referral to treatment by the end of this Parliament. We are also taking action on social care, introducing the largest increase in the carer’s allowance weekly earnings limit since 1976. We will ensure that carer’s allowance meets its objectives, while reviewing unpaid carer’s leave and looking at the benefits of introducing paid carer’s leave.

We will publish an improved better care fund framework, using £9 billion of funding to provide better, more integrated health and social care for patients and people who draw on care. We are helping disabled people on low incomes adapt their homes through the disabled facilities grant. The Employment Rights Bill is already in Committee, laying the foundations for the first ever pay agreement for care workers as a first step towards building consensus on the long-term reform needed to create a national care service. By the end of our first year in government, we will deliver an extra 2 million operations, scans and appointments through innovation, investment in additional capacity and productivity gains.

We are sharing the best of the NHS with the rest of the NHS, with our Further Faster teams. These are teams of experts that are supporting 20 trusts with long waits to tackle waiting lists and increase productivity. They have been deployed to five trusts so far, and we are already seeing improvements—for example, in theatres. For this financial year, the Government have committed £12 billion more in everyday spending on health and social care than was planned by the last Government in the spring Budget.

We are giving our capital-starved NHS the funding it so badly lacked over the past decade, setting aside at least £1.5 billion next year, which will create additional capacity, including new surgical hubs and diagnostic scanners, and new beds across the estate. That will enable 30,000 additional procedures and over a million diagnostic tests as they come online. That is the difference that a Government of service make. We have also been clear that investment must come with reform. Lord Darzi has given us the diagnosis, and the cure can be found in shifting the NHS from treatment to prevention, hospital to home, and analogue to digital.

Harold Wilson once called himself an optimist who carries a raincoat. As someone who has worked in our NHS at this critical time, I am fully aware of the challenges we face and the effort required. I am making sure that we have a firm hold on problems in the short term, while we do the work of fixing the foundations of our NHS with long-term reform. Over the past 14 years, we have limped from one crisis to the next, improvising and making do with sticking plasters. It cannot go on. It is bad for patient care and it is totally demoralising for staff.

We are building a health service that is fit for the future, ready to face every winter with confidence, and we will publish our 10-year plan for health in the spring. Anyone who thinks that we cannot do it should remember: we have fixed the NHS before, and we will fix it again. The public rightly expect us to put an end to the annual winter crisis, and that is what we will deliver. I commend this statement to the House.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Secretary of State.

[Edward Argar (Melton and Syston) (Con)]

I am grateful to the Minister for early sight of her statement—as I have said before, it is typically courteous of her. I echo the gratitude that she expressed to those in our NHS, and also those in the social care workforce who will be working hard throughout the festive period. As she alluded to, the NHS is already feeling the pressure this winter. We know that winter is always tough for the NHS, irrespective of who is in government, but services are feeling the strain even earlier than in previous years. A tidal wave of flu infections has led to a 70% increase in hospital cases in just seven days, and the national medical director of the NHS has warned of a “quad-demic” of health emergencies as cases of covid, norovirus, RSV and winter flu are all on the rise.

Meanwhile, in October, the longest A&E waits of over 12 hours increased by over a quarter in just one month, reaching the third highest monthly figure since comparable records began in 2010. Of course, all that has come before the cold weather really hits and before more vulnerable pensioners are left in freezing homes, unable to put the heating on after the winter fuel payment was scrapped for a large number. What assessment has the Minister and the Department made of the potential impact of that on hospital admissions this winter?

In government, we recognised that the NHS faces unique challenges in winter. We also recognised, as I know the Minister does from our previous discussions, the importance of flow in the NHS, with all parts of the system working together. That is why last year we provided £200 million to boost NHS resilience specifically during the peak winter months, which was accompanied by £40 million to bolster social care capacity and improve discharges from hospital. That followed the £1 billion announced earlier that year to boost capacity by delivering 5,000 additional beds, 800 new ambulances and 10,000 virtual ward places.

The Secretary of State himself has admitted that there will almost certainly be a winter crisis. There have been warnings from the Royal College of Emergency Medicine, the Royal College of Nursing and directors at NHS England. Yet in today’s statement, in contrast to the steps we took, we heard a lot about data, meetings and co-ordination, but very little in concrete terms to increase capacity specifically over the winter period. That will give scant reassurance to those working in the system or patients needing the system. In fact, earlier this year, the Secretary of State suggested that there would not be any specific new funding for the NHS to cope with winter pressures.

The Minister will know that I have tabled a number of written questions in recent days, met in many cases by what seems to be the standard DHSC response for named day questions of a holding answer. As the pressure continues to grow, I have a number of specific questions for the Minister while she is at the Dispatch Box. Will the NHS receive more resources specifically to increase bed and A&E capacity this winter? Are there enough hospital beds and ambulances for this winter, or is she taking steps to increase them? As of the 1st of the month, how many people who were medically fit to be discharged had not been, for a variety of other reasons?

I am grateful for the update that the Minister provided on winter vaccinations. What assessment has she made of the supply of the flu vaccine? There are some suggestions that pharmacies and others have run out and are waiting for more deliveries. How many additional 111 and 999 call handlers have been recruited specifically for this winter?

We talked briefly about the need for the system to work as a whole. In that context, what is the impact of national insurance contributions on hospices, social care and GPs? The Secretary of State told the Health and Social Care Committee this morning that hospices would get an update from him before Christmas, but at Prime Minister’s questions in response to the Leader of the Opposition, the Prime Minister appeared to say that it will be after Christmas. Can the Minister clarify that for the House, because it is an important point?

Finally, what meetings has the Secretary of State personally had with Julian Redhead and Sarah-Jane Marsh, the NHS winter leads, and when was the first of those meetings specifically on this subject? I am very happy for him to write to me if that is easier, given the complexity.

As seasonal flu piles yet more pressure on NHS systems, it is more important than ever that it gets the resources and support that it needs. There are many promises of reform, but the NHS needs an immediate capacity boost in beds over winter. So far, the Government have kicked reform into the long grass in favour of yet more consultation, and their preparations for winter have lacked the urgency and focus that patients and NHS staff demand. In government, the Conservatives always put extra support in place to keep the NHS going through the tough winter period, boosting capacity and increasing support. This Government need to get a grip and do the same.

[Karin Smyth]

I will do my best to address that range of questions. First, as even a stopped clock is right once—[Interruption.] Yes, twice. On that basis, I agree with the right hon. Gentleman. On correspondence and answers to parliamentary questions, again, the situation we inherited is not satisfactory. I apologise to all Members who are waiting for correspondence—it is something we are taking a grip of. We want to respond positively to questions. The Conservatives did not; we will make sure that starts to happen.

On capacity in the system, again, I remind Members that we came into office in July, which is one quarter of the way through the planning and financial year. We very rapidly looked at the plans that were baked in by the previous Government—I appreciate that the right hon. Gentleman was in the Ministry of Justice at the time, not the Health and Social Care Department—to see whether they were fit for purpose. We wanted to make sure we brought stability to the system. There are, in fact, more beds currently available in the system than last year. If there is a need to increase capacity due to a likely cold snap, the system is absolutely ready to respond in its usual way. That is why we are meeting weekly.

On meetings with clinical and managerial colleagues at NHS England—who, frankly, I see more often than many members of my own family—I can tell the right hon. Gentleman that we started those meetings immediately. I would have to check the exact date, but it was certainly in the summer. I have had fortnightly meetings since September, which, as I said, we can move to monthly meetings, chaired by the Secretary of State. We began getting a grip from day one, knowing that winter was coming, which is why I am monitoring the situation weekly. It is also why we visited the operational centre, to understand in real time what is happening across every single system and every single trust—be that ambulance issues or problems at the front end and in A&E. The one question I do not directly have the answer to is what the daily figures are; I will try to get those figures to the right hon. Gentleman later.

We all know that waiting for discharge to assess is a massive problem. That is why, as I said in my statement, we want to take a grip of the better care fund, to ensure it works better and to stabilise the social care system. I am not particularly versed in issues on supply, so I apologise if that is wrong. We will certainly get back to the right hon. Gentleman on that matter, because we want people to be taking the vaccinations where necessary.

I can confirm that we want an announcement on hospices before Christmas. On winter fuel and its impact, as Opposition Members know, we will continue to monitor the impact of all situations on individuals to ensure they are supported in the community. We urge people to make sure they access pension credit. [Interruption.] I have just addressed that, but if I have missed anything, I will come back to it.

[Rachael Maskell (York Central) (Lab/Co-op)]

Despite York’s new emergency department, a consultant has described to me the situation in emergency medicine, where patients are waiting for days to be discharged and 50 patients are waiting to be placed on wards. We know we have inherited a broken NHS. Will the Minister say what she is doing first to enable primary care to pull more patients out of emergency medicine, in order to see people in the community, and secondly to invest in social care, which will clearly address some of the backlog and the logjam in patient flows?

[Karin Smyth]

My hon. Friend’s comments reinforce how much pressure, we understand, is front facing. A&E is demonstrative of the overall pressure in the system, not just at discharge but, as she rightly says, in primary care. We took action in the summer to improve primary care, increasing the number of GPs available in the system. It is absolutely critical that primary care community services are integral to winter planning at a local level. That is what we expect from every single system. We will continue to monitor that over the winter period and into the spring. If those services are not involved in planning for any particular systems, enabling them to monitor the surge and flow of people, we very much want to understand how that is working.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I express my thanks and those of my Lib Dem colleagues to everyone working over the Christmas period to keep people healthy and safe. Preparedness for winter is absolutely critical for our health and care system, and a quick look at what happened last year shows us why. Ambulances across England collectively spent a total of 112 years waiting outside hospitals to hand patients over, and a quarter of a million people waited more than 12 hours to be seen. Every winter we are warned of a winter crisis. Under the Conservatives, crisis became the norm not just in winter but all year round.

This year is very concerning so far. A&Es have overflowed through spring, summer and autumn. At my local hospital trust, Shrewsbury and Telford, one in three ambulances have had to wait more than an hour to hand over patients, while patients with devastating cancer diagnoses have had to wait months for crucial scan results. Across England, more than 7 million people are on waiting lists. Meanwhile, I am afraid, we have not heard enough from the Government on fixing one of the root causes of this crisis, which is our broken social care system.

The scale of the crisis is demonstrated by the challenges facing ambulance services across the country at the moment. October—before the winter—was the third worst month ever for handover delays at West Midlands ambulance service, which covers my constituency. The equivalent of 130 ambulance crews are out of action, waiting every single day. Now these overstretched ambulance services are formally changing their advice to reflect the pressure they are under. At times of peak demand, even category 2 patients—those suffering a heart attack or a stroke—will be asked to make their own way to a hospital. People in North Shropshire have long had to put up with some of the worst ambulance waits in the country, and they have come to harm as a result. It may no longer be the case that they can rely on an ambulance arriving.

Action is urgently needed to prevent more preventable deaths this winter. I am sure the Minister shares my alarm that ambulances may not be reaching people facing life-threatening situations. If she does, will she commit today to the Government tackling the handover delays paralysing the ambulance service by accepting Liberal Democrat proposals to make a £1.5 billion fund to provide more staffed beds, and by agreeing to urgent cross-party talks to fix the crisis in social care?

[Karin Smyth]

I think I have addressed the Government’s plans on social care. The hon. Lady makes an excellent point on ambulance delays, which we know to be a problem, and particularly so in the west midlands. That is one of the things I have asked the system to look at particularly, so that the Government and hon. Members can better understand the particular problems in their particular systems. We know that ambulance and handover delays are a particular problem in some systems. We are making sure that clinical and managerial leads from NHS England are visiting those systems and that they are understanding in depth the process issues in some places, where they may not be adopting the best practice that can be learned from others.

We need to roll out best practice across the country. When the Secretary of State and I visited the operational centre of the London ambulance service, we sat in on some hear-and-treat calls; in dealing with people in mental health crises, in particular, some places are doing that better than others. Those are the sorts of examples we want to learn from. I absolutely hear what the hon. Lady says about the unacceptable delays in particular parts of the country. That is very much on our priority list.

[Madam Deputy Speaker]

I call a member of the Health and Social Care Committee.

[Jen Craft (Thurrock) (Lab)]

Last week, I visited Basildon hospital, which is relied on by my constituents and people across Essex. Staff in the emergency department told me that they were operating under intense pressure all year round, and that it is indeed winter all year for them. That is due to a lack of beds, the terrible condition of parts of the estate and inadequate primary care services, meaning that people turn up at the ED when they should be somewhere more appropriate. What steps is the Minister taking to turn the page on 14 years of decline, and to ensure that Basildon and hospitals across the country have the resources and structures they need to better manage seasonal and year-round pressure?

[Karin Smyth]

My hon. Friend has already been a fantastic advocate for her local NHS services. Like the hon. Member for North Shropshire (Helen Morgan), my hon. Friend is absolutely right to highlight the acute pressures all year round. We did not always have winter crises under the last Labour Government. It was tough; I worked during some of that time, and it did happen, but getting used to such levels of bed occupancy and pressure in the system all year round is a direct legacy of the Conservatives and what they did to the NHS, particularly with the Lansley reforms, and their refusal to take a grip of it. This matter of a summer crisis going into a winter crisis is a real problem. That is why we are committed to these short-term measures to stabilise and support the system over the winter. However, as I said in my statement, we will also look at medium and longer-term reform so that we do not have to revisit this scenario year on year.

[Madam Deputy Speaker]

I call the Chair of the Health Committee.

[Layla Moran (Oxford West and Abingdon) (LD)]

Last Friday, I visited Sherwood Pharmacy in Abingdon. Ben, who owns it, told me that local pharmacies stand ready to help. In fact, they are more than keen to help, but there are two things that he needs from the Government. First, there needs to be a real push for GPs to refer people to pharmacies, in particular for vaccinations, so that we are not collecting patients in one already overstretched part of the system and they can do what they do best. Secondly, there needs to be a general plea to the public that they can go to their pharmacies for those things. I note that in her statement the Minister did not mention pharmacies once. Let us be honest, this question is not going to do it either. How do we ensure that the message—“Go to your pharmacy and get vaccinated, you can do it faster there”—gets out there this winter?

[Karin Smyth]

I thank the Chair of the Select Committee for her point. She is right that I did not mention pharmacies, which was an omission on my part. We are running an advertising campaign, “Think Pharmacy First”, to ensure people use pharmacies. She is absolutely right that they stand ready. I will visit mine over the next few days to make sure I am vaccinated. Their support, working with primary care, is critical. Again, in some places relationships are working well and pharmacies support people in the community—that is apparent in the statistics. We are absolutely committed to ensuring that that works better, as part of our long-term reforms.

[Madam Deputy Speaker]

I call a member of the Select Committee.

--- Later in debate ---

[Josh Fenton-Glynn (Calder Valley) (Lab)]

Last week, Calderdale and Huddersfield NHS foundation trust’s bed occupancy was at 99.6%. Some 20.1% of those beds, because of the failure of social healthcare and community care, were taken up by people who could be treated elsewhere. All I want for Christmas is a reassurance that, next Christmas and next winter, social care will be on a more secure footing.

[Karin Smyth]

My hon. Friend is absolutely right to highlight those shocking levels of bed occupancy. As I said earlier, running consistently at that high level of occupancy is something we should never have got used to. That discharge rate is demoralising for staff, very bad for patients and a sign of the pressure in the system. We absolutely must ensure the system is incentivised and works properly to make our hospital-to-community commitment, one of our three shifts, operate in practice. People do not want to be in hospital when they do not need to be and it is not the best place for them to be. We will be saying more about that in the new year.

[Wendy Morton (Aldridge-Brownhills) (Con)]

We hear today about a massive backlog at the Department for Work and Pensions in processing pension credit and winter fuel payment claims. Bearing in mind that cold homes increase winter deaths and hospital admissions, and that we are debating winter preparedness today, what discussions has the Minister had with the DWP to ensure that those in my constituency who are waiting for their winter fuel payments will receive them before the Christmas break? Will she commit to publishing a full impact assessment of that decision on the NHS?

[Karin Smyth]

I thank the right hon. Lady for her question. We have discussed this issue a number of times in this place. We absolutely understand the impact of cold and heat on the system and on people. It is something we need to address more generally. She will be aware that discussions on this issue are continuing with the DWP. If there are specific examples she wants to raise with me or the Department, I am very happy to look at them.

[Chris Vince (Harlow) (Lab/Co-op)]

I welcome today’s statement and take a moment to thank emergency services in Harlow and across the country who are giving up spending time with their families at Christmas to keep us all safe. East of England ambulance service has set up a new process to support paramedics and Princess Alexandra hospital, which will give them a direct line to a GP who can triage patients and send them to the right department straight away. What is the Department of Health and Social Care doing to work with ambulance services across the country to learn from that and share good practice?

[Karin Smyth]

Again, my hon. Friend is already representing the people of his constituency so well by getting to the heart of what is happening on the ground, learning it for himself and bringing such examples to the House. He is absolutely right that there are such examples across the country, working differently in different systems, which are challenging other systems to look at that practice. That is why we say we want to bring the best of the NHS to the rest of the NHS. That is exactly what we mean. I am confident in the work happening centrally at NHS England. It is learning from such examples and wants to go around the country to ensure that we spread those sorts of ideas to other places. We are looking at them all very closely.

[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.

[Several hon. Members rose—]

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

When I started working in public health, winter pressures were just that: seasonal flu and extra hip fractures. Under the Conservatives, winters started getting longer and longer. How will our 10-year plan ensure that seasonal pressures actually become seasonal and manageable again?

[Karin Smyth]

My hon. Friend makes an excellent point. We need to get back to normal and we need to recognise that there are different things happening to the system at different times of the year, much of which is predictable. We need to ensure that the system is strong enough to be able to cope with those differences.

[Dr Neil Hudson (Epping Forest) (Con)]

As we come into the height of winter, will the Minister join me in thanking all the amazing people on the frontline who are diagnosing, treating and caring for people right across the country? With multiple infectious disease challenges, the impact of cold and extreme weather, and the risk of falls and accidents, will the Government please now rethink their policies on winter fuel cuts and national insurance rises, which will exacerbate the situation and compromise the delivery of primary healthcare, social care and hospice care?

--- Later in debate ---

[Karin Smyth]

I join the hon. Gentleman in thanking everyone who works in the system. As I said, the NHS is getting £12 billion more this year from this Government than it had from the previous Government in the spring Budget. We are now focused on ensuring that money is used properly.

[Peter Swallow (Bracknell) (Lab)]

Let me take this opportunity to thank healthcare workers in Bracknell Forest, who will be working so hard across the Christmas period to keep patients safe this winter. Does the Minister agree that we must ensure that we have not only the right investment in our health services but the right reforms, so that we can fix the broken NHS and get it back on its feet?

[Karin Smyth]

My hon. Friend is absolutely right. We want to make sure that taxpayers’ money is used efficiently and effectively in the right places for the right treatment at the right time. That is why we are looking at our long-term plan. That is why we want to stabilise the system, so we do not have to keep coming back here year after year with a so-called winter crisis.

[Mike Martin (Tunbridge Wells) (LD)]

I note that the Minister thinks that the absence of the word “pharmacy” from her statement was an omission. I wonder whether she also thinks that the absence of the words “general practice” was an omission. I have been visiting some of my local GP surgeries, and one told me that, as a result of the NIC rises, it is facing charges of £40,000. That equates to a staff member, so it will have to consider laying off a member of staff. Will the Minister please explain how GPs laying off staff will help them to cope with the winter crisis?

[Karin Smyth]

As I think the hon. Gentleman knows, I cannot talk about individual cases from the Dispatch Box, but we will be making announcements on that subject very shortly.

[Lewis Atkinson (Sunderland Central) (Lab)]

I thank the Minister for her statement, and also thank my recent former NHS colleagues, especially those in Sunderland, for what they will be doing over the winter. The Minister has rightly highlighted unacceptable levels of bed occupancy as we go into winter; we know that as bed occupancy increases to unacceptable levels, there is a rise in patient safety risks. What assessment has she made of the patient safety monitoring regime over the winter, linked to those risks?

[Karin Smyth]

We have made it absolutely clear, as did the NHS in its letter today, that patient safety is the watchword this winter. We have targets in relation to monitoring the performance of the system, but we absolutely want to ensure that patients are kept safe as we go through the next few months.

[Lincoln Jopp (Spelthorne) (Con)]

Yesterday I spoke to an elderly gentleman who was taking himself off to his local pharmacy to receive the RSV jab, but because he was over 80 he was going to pay more than £200 for it. Will the Minister please tell us how much the RSV jab costs the Department when it is free for 75 to 80-year-olds, and how much guidance or limitation it places on the profit that can be taken by chemists who give it to people who are over 80?

--- Later in debate ---

[Karin Smyth]

I think the hon. Gentleman knows that I cannot do that from the Dispatch Box, but my officials will have heard his request and what he has said about that specific case, and I will ensure that he receives an answer.

[Alice Macdonald (Norwich North) (Lab/Co-op)]

I pay tribute to the hard-working NHS staff in Norwich and in Norfolk as a whole. Norfolk County Council has used artificial intelligence to identify more than 1,000 people who are risk of being admitted to hospital because of falls this Christmas. Does the Minister welcome that use of AI, and will she expand on how we are using technology, now and in the future, to help alleviate winter pressures?

[Karin Smyth]

I do not wish to test your patience, Madam Deputy Speaker, but good falls practice has not been prioritised over the past decade, and the failure to prioritise it and continue the work that I know was being done many years ago is yet another testament to the failure of the Conservative party. My hon. Friend is right to refer to the way we can use AI to help the system to improve, so that this hugely preventable problem, which is so damaging to the elderly in particular, no longer occurs.

[Greg Smith (Mid Buckinghamshire) (Con)]

Winter pressures come around every year for all sorts of reasons. The difference this year was the political choice to take the winter fuel payment away from millions of pensioners. Worse still, the 44,000 pensioners living with a terminal illness will lose that payment. I cannot believe that a Minister as diligent as the hon. Lady has not carried out an impact assessment of the cost to the NHS of people being left in cold homes. My right hon. Friend the Member for Melton and Syston (Edward Argar)—the shadow Secretary of State—and my right hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) asked for such an assessment. May I give the Minister another chance to commit to publishing it?

[Karin Smyth]

The hon. Gentleman is wholly wrong to say that winter crises happen under every Government in every year. They happened, and became a fact of the NHS, under his party’s Government. The key difference this year, which the Conservatives will still not address, is the fact that doctors are not on strike. Doctors are working in the system, caring for patients and doing their job, because this Government, on day one and week one and week four, delivered the negotiated settlement with the doctors. We cannot run the NHS and we cannot manage a winter crisis without doctors in the frontline, and that is where they are. That is what the difference is.

[Laura Kyrke-Smith (Aylesbury) (Lab)]

It is great to be going into the winter for the first time in four years without doctors being on strike. Last week I visited the new emergency medical receiving unit at Stoke Mandeville hospital, a 21-bed facility to provide quicker care for patients who come in from ambulances and as a result of GP referrals but require only short admissions. The early results look very promising. Does the Minister agree that we must take these pockets of good practice from across the NHS and ensure that other parts of the NHS learn from and adopt them to help us get through this winter and future winters?

--- Later in debate ---

[Karin Smyth]

I commend my hon. Friend for, as a new MP, getting to grips in detail with what is happening in her local system and challenging that system, while also giving us those examples of good practice so that we can all learn from them. As she says, many parts of the NHS across the country want to learn from them, and we want to ensure that they are mainstreamed where possible. There are different solutions for different systems, but she is absolutely right to highlight that one.

[Manuela Perteghella (Stratford-on-Avon) (LD)]

I refer the House to my entry in the Register of Members’ Financial Interests as a member of the University College London Hospitals NHS Foundation Trust.

The upcoming rise in national insurance contributions could cost our GP surgeries the equivalent of more than 2 million appointments a year. General practice is the cornerstone of the NHS; it is our front door. Many GPs in my constituency have written to me to express their serious concerns. Does the Minister recognise that hiking costs for family doctors will only worsen pressures on our hospitals, pushing more people towards A&E and preventing many from receiving the care they need?

[Karin Smyth]

We recognise all the costs to GPs, as contractors, and to many other parts of the system, as we have said many times in the House. We also recognise the improvements that we have made to the system by improving the number of GPs and funding the NHS by more than the last Government did. We will continue to look at that in the round to ensure that we have a sustainable system.

[Paul Waugh (Rochdale) (Lab/Co-op)]

One of the main reasons I became a politician was the fact that my wife is a midwife. She would come home night after night complaining bitterly about staff shortages on the wards. Can the Minister reassure me that maternity services will receive all the funds they need over the winter, and will she join me in thanking all those maternity staff who work so hard over Christmas, over the new year, and all year round?

[Karin Smyth]

My hon. Friend is absolutely right. Many tragedies happen over the Christmas period—my own father died on 23 December. Those staff members go above and beyond to help people at difficult times, but also at times of great joy—babies do not wait for Father Christmas, do they?—and my hon. Friend is right to commend midwives and everyone else who is working at this time. We know that maternity services are particularly stretched across most of the country. Those midwives are doing a tremendous job in keeping the system working, and doing the critically important job of supporting women at a mostly joyous but sometimes very difficult time.

[Alison Bennett (Mid Sussex) (LD)]

At the start of this week, 300 patients were ready to go home from my local NHS hospital trust in Sussex. That bears out the statistic in Lord Darzi’s report that 13% of patients are medically fit for discharge. I am really concerned that we have now reached a point with winter pressures where corridor waits are normalised, not only in A&E departments but in the case of initiatives such as continuous flow models, with corridor trolley waits being pushed into regular wards. It is unacceptable that this has become normalised. Will the Minister expand on her comments about the national care service? When will the plans be published? Will the Government work with us on a cross-party basis, and why did this work not begin sooner?

[Karin Smyth]

As I said in my statement, we have begun plans to stabilise the workforce and the employment Bill is going through the House, so I do not agree with the hon. Lady on that point. We know that it will take a long time, and we will of course be working with colleagues to ensure that we do develop that national care service.

[Amanda Martin (Portsmouth North) (Lab)]

Let me begin by echoing the Minister’s words and thanking the fantastic NHS workers and those in the wraparound service who provide a vital service in Portsmouth all year round, but particularly in winter. Let me also thank all the Members who turned up for the joint NHS consultation with me and with the Under-Secretary of State for Education, my hon. Friend the Member for Portsmouth South (Stephen Morgan).

Unfortunately, owing to the scale of the damage done to the NHS by the last Government, our NHS providers have to make very difficult decisions at this time. Can the Minister reassure me and my constituents, that patient safety, and emergency services in particular, will be this Government’s first priority during the winter?

[Karin Smyth]

I am very pleased to reiterate that safety is the watchword for winter, as it is all year round, and to stress that that is why NHS England wrote about it today. I commend my hon. Friend for meeting her constituents locally, and I urge all Members to do the same. We are getting some fantastic ideas from staff and from patients about how to reform and change the system for the long term.

[Jess Brown-Fuller (Chichester) (LD)]

One in four people trying to contact their GPs last month were unable to get a same-day appointment, and one in 20 could not get through to their GPs at all. We know that these people end up in A&Es up and down the country, and that hospitals are already buckling under the strain. What is the Minister doing to improve support for GPs and frontline services during this winter crisis, especially while they navigate the challenges of the employer NICs rises?

[Karin Smyth]

I refer back to what I said in my statement about how we are supporting the system. We absolutely understand the importance of primary care, and of using 111 to make sure that people are directed towards getting the right care in the right place. We know that the system is under pressure, and we will continue to do all we can to support it in the longer term, as well as in the short term.

[Emma Foody (Cramlington and Killingworth) (Lab/Co-op)]

I recently visited Northumbria specialist emergency care hospital in Cramlington in my constituency. I met the staff there, who shared their concerns about winter pressures. Every year, they closely track the flu seasons in Australia, given that the patterns that emerge there are often what follows here. They are extremely concerned about what we are going into this winter. What steps has the Department taken to ensure that as many people as possible are vaccinated this winter?

--- Later in debate ---

[Karin Smyth]

I am working very closely with the UK Health Security Agency to make sure that, week on week, we are aware of the movement of different diseases and viruses through the system, and we will continue to publicise the campaign to get people vaccinated. Anything that hon. Members can do to support that campaign, and to make sure that people support themselves and their loved ones, will be gratefully received by the entire system. The campaign is something that everyone can get behind.

[Dr Danny Chambers (Winchester) (LD)]

While we all pay tribute to the NHS staff who work over Christmas, we should remember that they are not only missing Christmas with their families, but putting their own health at risk in caring for us.

On Monday, Winchester hospital declared a critical incident, saying that it could admit no more patients and asking people to seek treatment elsewhere. For years, the chief executive officer of the hospital has been requesting 160 extra social care packages, because the lack of social care is stopping the flow of patients through the hospital. She said that providing such packages is the single biggest thing that would help deal with the winter crisis. In September, Winchester hospital applied for winter crisis funding to put an urgent treatment centre on the front of its A&E department to help deal with the anticipated extra caseload. It is now December, and the hospital has still not heard whether it will get the funding. Given the number of critical incidents being declared, will the Minister meet me and the CEO to discuss how we can support the hospital through this situation, and how we can avoid having a planned crisis next winter?

[Karin Smyth]

As I said earlier, different systems have different issues. Funding has been allocated in advance to the NHS so that it understands which systems require funding, and that has now been baked in for this year. I cannot address the hon. Gentleman’s points directly from the Dispatch Box, but I am very happy for officials to take note of them and to check with the system on what is happening in his particular community. Obviously, it is important that Winchester hospital works closely with its local authority with regard to discharge. We want to improve the better care fund, and I am sure that he will work with the local authority and his hospital to make sure that it works better.

[Clive Jones (Wokingham) (LD)]

I declare an interest: I am a governor of the Royal Berkshire hospital, and I have a family member who has shares in a medical company.

The Royal Berkshire hospital has experienced its highest increase in emergency department attendances as we head into the winter period, yet the estate of the Royal Berks is crumbling, out of date and not fit for purpose. People with infectious diseases, such as flu, covid and norovirus, cannot easily be isolated due to poor air circulation, which only makes the situation worse. When will the Royal Berkshire hospital be rebuilt, and will the Minister visit it to see the full extent of our challenges?

Finally, may I wish the Secretary of State and the Minister a merry Christmas? They should take a short break but come back quickly to continue to clear up the Conservatives’ massive failures on the NHS.

--- Later in debate ---

[Karin Smyth]

Hopefully, we will make announcements on the Royal Berkshire hospital and others as soon as possible in the new year, as I know that this issue is of great concern to all hon. Members. We know that the system will be under pressure, and we thank everyone working in it. We want to make sure that everyone keeps well, and I will take this opportunity to thank the hon. Gentleman for his comments. I am looking forward to returning here in January, hopefully to answer more questions. I thank hon. Members for their questions this afternoon.

Healthcare Incidents: Suspected Criminal Activity Contributing to Death or Serious Harm

Karin Smyth Excerpts

Tuesday 17th December 2024 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I am pleased to announce that the memorandum of understanding (MoU), “Investigating healthcare incidents where suspected criminal activity may have contributed to death or serious life-changing harm”, was published today on www.gov.uk.

This MoU was recommended by Professor Sir Norman Williams’ rapid policy review into gross negligence manslaughter in 2018. The Williams review was set up to look at the wider impact of concerns among healthcare professionals that simple errors could result in prosecution for gross negligence manslaughter, even if they happen in the context of broader organisation and system failings.

Following this recommendation, the Department of Health and Social Care consulted with regulatory, investigatory and prosecutorial bodies to develop the new MoU, “Investigating healthcare incidents where suspected criminal activity may have contributed to death or serious life-changing harm”.

The MoU applies in England and has been formally signed by:

NHS England

National Police Chiefs’ Council

Health and Safety Executive

Crown Prosecution Service

Care Quality Commission

General Medical Council

Nursing and Midwifery Council

General Dental Council

Health and Care Professions Council

General Pharmaceutical Council

General Optical Council

General Chiropractic Council

General Osteopathic Council

The MoU will be used by signatories to help deliver early, co-ordinated and effective action following incidents where there is reasonable suspicion that a patient/service user’s death or serious life-changing harm occurred as a result of suspected criminal activity in the course of healthcare delivery.

The MoU specifically delivers on the following recommendations from the Williams review:

Updates and replaces the previous MoU from 2006;

sets out the roles and responsibilities of the signatories providing a framework for how organisations should work together to ensure a co-ordinated approach;

provides advice on communication including liaising with families and the public; and

supports the development of a “just culture” in healthcare which recognises the impact of wider systems on the provision of clinical care or care decision making. This includes considering the wider systems in place at the time of the incident, to support a fair and consistent evaluation of the actions of individuals and ensuring expert witnesses consider the effects of the wider systems in place during an incident.

[HCWS330]

Lobular Breast Cancer

Karin Smyth Excerpts

Tuesday 10th December 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a real pleasure to serve under your chairship, Ms Vaz. I add my thanks to all hon. Members for their contributions and to my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes). First let me say how sorry I am to hear about her friend. Those are very precious friendships and I think my hon. Friend articulated that well today. My deepest sympathies to Heather’s loved ones who are with us today and to her wider family group. It is a really difficult time and this is a very recent bereavement to be talking about. My hon. Friend has used her voice as a parliamentarian to good effect, as she always does, and I congratulate her on doing that. I hope I can go some way to answering the questions she raised at the end of her speech. If I do not and she is not satisfied, I will make sure officials get back to her on the specifics.

I also echo the words of the hon. Member for Hinckley and Bosworth (Dr Evans) about hon. Members raising their personal experiences and the importance of support from partners and wider family members for people who are going through diagnosis, treatment and sadly, often, death.

We know that too many cancer patients are being failed. They are waiting too long for life-saving treatments and receiving a diagnosis too late. As my right hon. and learned Friend the Prime Minister reiterated last week, we have inherited a broken NHS but it is not beyond repair. We know it needs to be fixed and there is not a single solution. To ensure that more people survive cancer, including lobular breast cancer, we have to take a multi-pronged approach—catching it earlier so more treatments are available, raising awareness of its specific symptoms, and investing in equipment and research, as many hon. Members have raised today. All those actions are part of our plan to put the NHS on the road to recovery.

As we have heard today, according to Cancer Research UK lobular breast cancer is the second most common type of breast cancer. Also known as lobular carcinoma, it impacts the lives of many—around 15 in every 100 breast cancers are invasive lobular. Treatments for lobular breast cancer are broadly similar to those for other breast cancers. Surgery and radiotherapy are effective for most patients with primary invasive types, meaning those which have not spread to other parts of the body. Systemic therapy such as chemotherapy, hormonal treatment, targeted therapy or immunotherapy are usually offered based on the stage at which the NHS catches that cancer.

Another factor which can determine clinicians’ decisions on the best treatment option is how the cancer has spread or developed in each patient’s case and we understand that is different for different patients. Sadly my understanding is that when cancer is growing in more than one location, as is more common in lobular breast cancer, treatment is more challenging. The same is true when a cancer has spread to other parts of the body. To improve outcomes in such challenging cases, NHS England funded an audit into both primary and metastatic breast cancer that has spread. The scoping for this audit began in October 2022 and the results were published in September this year. NHS England are hopeful that the results will help to improve the consistency of treatments offered, as well as stimulate improvements.

We know that for far too many women, lobular breast cancer is diagnosed at a later stage, which means that treatment options are more limited. The key to improving survival must lie in raising awareness, and early detection and diagnosis. I am not sure I can do it as well as the shadow Minister, but I want to use this opportunity to raise awareness of the fact that not all breast cancers form a firm lump. I think he articulated really well what women should be looking for. Lobular breast cancer patients are more likely to have thickened areas of breast tissue. Possible symptoms include an area of swelling, a change in the nipple or a change in the skin, such as dimpling. I encourage everyone to check their breasts regularly and to consult their GP straightaway if they have any concerns. While more people are surviving breast cancer than ever before, we know that lobular breast cancers can be particularly hard to detect.

Another measure to support earlier diagnosis of breast cancer is screening before people notice symptoms. Our screening programme sends women their first invitation at the age of 50. To support detection, the NHS carries out approximately 2.1 million breast cancer screens each year in hospitals and mobile screening vans, usually in convenient community locations, but—this is a really shocking figure that I learned recently in another debate in Westminster Hall, which shows how important it is that Members raise these issues—take-up of breast cancer screening is currently below 70%. That is worryingly low, and we are determined to improve it. Every effort that hon. Members here and people listening to this debate can make to improve that take-up rate will help save lives. If someone is eligible for screening, they should come forward and take up that important offer.

Unfortunately, even for those women who come forward for a mammogram, we know that lobular breast cancer can be more difficult to catch than other types of breast cancer. We have heard some shocking stories and examples today. To ensure that women survive, we need to be relentless in researching every possible avenue of treatment and diagnosis. Examples of innovation supported by my Department include £1.3 million invested in a Bristol-based FAST MRI project, which will determine whether different types of scans can help detect cancer in a cost-effective manner. The FAST MRI project focuses on an abbreviated MRI, which is a shortened version of a breast MRI. This type of imaging can help to detect the most aggressive forms of breast cancer sometimes missed by screening through mammography, including lobular breast cancer.

My Department is also working closely with UK Research and Innovation and the Medical Research Council. These bodies are responsible for studies that look to understand the basic mechanisms of disease. Combined, they spend £125 million on cancer research each year. My officials also meet regularly with partners to discuss a wide range of our research investments and ways to stimulate new proposals. These include those for lobular breast cancers.

Through the National Institute for Health and Care Research, my Department will continue to encourage and welcome applications for new research in this area. I hope this addresses the shadow Minister’s point, but funds for research are still available through the NIHR. Funds are awarded through open competition informed by expert peer review, with active involvement of patients and the public. The Department and NIHR also advise the campaign on the Lobular Moon Shot Project. It has already contracted £29 million, which I think is the figure the shadow Minister referred to, to the Institute of Cancer Research and its partner at the Royal Marsden. This proposal included work on lobular breast cancer. I hope I have addressed that point, but if I have not, then please let me know.

We know that we must do more to rise to the growing challenge that cancers including lobular breast cancer represent, but for our efforts in detecting and understanding this complicated disease to be effective, we need to back fundamental reform in the health service. That is why we have launched the biggest national conversation about the future of the NHS since its birth to shape the 10-year plan. We need suggestions from hon. Members on how to go further in preventing cancer where we can. I urge everyone to visit the website change.nhs.uk to do so.

[Jess Brown-Fuller (Chichester) (LD)]

The risk of all breast cancers in women is reduced by 4.3% for every 12 months of breastfeeding, but the UK has one of the lowest breastfeeding rates in the western world: only 1% of children are still exclusively breastfed at six months. Does the Minister agree that community initiatives to encourage women to breastfeed for longer support the Government’s mission to reduce the risk of breast cancers and improve health outcomes overall?

[Karin Smyth]

I thank the hon. Lady for that really important point. She highlights another important issue affecting the health of women and children, and I agree with her.

My hon. Friend the Member for Dulwich and West Norwood spoke about women’s health overall, which is an important priority for this Government, as are these forms of cancer and the wider preventive agenda. That is another point that can be made on the change.nhs.uk website, which I will keep plugging. The issues that have been raised on it by the public and staff are really interesting and informative.

My right hon. Friend the Secretary of State has been clear that there should be a national cancer plan. The hon. Member for Wokingham (Clive Jones) made helpful points about that opportunity. I will not take up his invitation for a meeting; his point would be better made by being inputted into the process with the organisations he is in touch with. That would help to shape the national cancer plan, which we can all buy into as a country. The plan will include more details about how to improve outcomes for all tumour types, including lobular breast cancer, and ensure that patients have access to the latest treatments and technology. We are now in discussions about what form that plan should take and what its relationship with the 10-year health plan and the Government’s wider health missions should be. We will provide updates on that in due course.

I thank my hon. Friend the Member for Dulwich and West Norwood for bringing this important matter to the House.

[Dr Evans]

I want to draw the Minister’s attention to the point about guidelines. Will she consider speaking to the devolved nations and, in England, to NICE, about guidance on lobular breast cancer?

[Karin Smyth]

I was going to come to that. I am not fully au fait with the change in guidelines that the hon. Gentleman referred to, so I will happily take that point away. He made a wider point about aligning across the devolved regions. Obviously, some of these issues are devolved and we have to respect the devolution arrangements. On the wider research, we should learn from each other, understanding that we have similar patient cohorts. There is lots of good medical work going on, and the Government are determined to work respectfully across the devolved nations. I will ensure that the hon. Gentleman gets a written answer on the specifics of his question.

Heartbreaking stories such as Heather’s remind us that diseases such as lobular breast cancer are complex. They are hard to catch, and therefore treat. Such tragic losses are a wake-up call for us all, and I commend all hon. Members for raising those stories. For people listening in, as well as those who have attended the debate, they are an important way to raise awareness. We are grateful to those who have shared their personal stories, which help us get the NHS back on its feet so that we can better serve the people who need it.

Improving cancer survival requires a multi-pronged approach to ensure that patients have timely access to effective treatments, built on the foundations of world-class research. We have already taken immediate steps to allow cancer patients to benefit from the most up-to-date technology. Through the recent Budget, we committed to surgical hubs and scanners to allow for 30,000 more procedures each year, and we are increasing capacity for tests. We have also committed another £70 million for radiotherapy machines. Lots of hon. Members have raised those points. I have outlined several measures today, and I assure Members that improving outcomes for cancer patients, including those with lobular breast cancer, remains a top priority for this Government.

Draft Human Medicines (Amendment) (Modular Manufacture and Point of Care) Regulations 2024

Karin Smyth Excerpts

Wednesday 27th November 2024 General Committees

[The Minister for Secondary Care (Karin Smyth)]

I beg to move,

That the Committee has considered the draft Human Medicines (Amendment) (Modular Manufacture and Point of Care) Regulations 2024.

It is a pleasure to serve under your chairmanship this morning, Mr Betts. I am grateful to be debating this important amendment to establish a tailored regulatory framework to support decentralised methods of medicine manufacture, moving innovative medicines closer to the patient.

The draft regulations will amend the Human Medicines Regulations 2012 and the Medicines for Human Use (Clinical Trials) Regulations 2004. The regulations create an enabling pathway for innovative manufacturing from early-stage development in clinical trials through to the administration of medicines to patients. The UK is leading the way as the first country to introduce a framework for these groundbreaking, decentralised methods of medicine manufacturing. We are taking action to support medical advancements that are on the cutting edge of technology to benefit patients across the country.

The new framework is being brought forward pre-emptively to encourage increased manufacture and supply of innovative medicines that can only be manufactured at or close to the point of care or by modular manufacturing, where products are manufactured in relocatable units. The framework will help to develop a new sector of medicines manufacturing, enabling safe innovation and development of highly specialised treatments. It will provide the flexibility to deliver medicines directly where patients most need them, whether that is a hospital ward, an operating theatre, a community health centre or even a patient’s home. These products are currently in early development. An example of a point-of-care product is a diabetic foot ulcer treatment using products derived from blood obtained from the patient and manufactured at their bedside. Modular manufacture offers significant advantages to support the faster roll-out of vaccines, for example, by allowing vaccines to be filled and finished on a local or district basis to supply mass vaccination centres.

I will highlight why the change is needed. Advancing health technology increasingly means that new medicines are being developed that need to be manufactured close to the healthcare setting. Our traditional regulatory models need to change to support the new technologies. The current regulations are suited to centralised, factory-based manufacture at a small number of fixed manufacturing sites that are named on manufacturing licences and marketing authorisations. Point-of-care and modular manufacture products may be manufactured at hundreds of different sites for specific patients, when those patients need them.

It would be extremely challenging for these innovative products to be regulated within the currently legislation, and it would cause significant regulatory and financial burden. The products are often developed to meet the unique needs of individual patients, using the patient’s own cells or blood, and they may need to be administered within an hour or even minutes of being manufactured. The urgency and specificity of the products cannot easily be accommodated by traditional manufacturing or by the current regulations.

We need to adapt our regulatory approach to be suitable for manufacturing medicines at many different sites across the country, while maintaining regulatory oversight to ensure that manufacture is safe and consistent. The new framework will provide regulatory clarity to encourage new products and innovative approaches to support the future supply of treatments that are emerging in early-development stages and that may be life-changing for patients.

Patient safety is central to the new legislation. We need to provide a regulatory framework that is flexible for new innovations but does not compromise the safety of patients who receive innovative medicines. I will set out how the UK medicines regulator, the Medicines and Healthcare products Regulatory Agency, will ensure that point-of-care and modular manufacturing products meet the necessary standards of safety, efficacy and quality.

The new framework is centred on a hub-and-spoke model, with a single control site as the hub for each product, overseeing all aspects of the point-of-care and modular manufacturing system, including the spokes—individual manufacturing locations—and their activities. The control site will be the only named manufacturing site on manufacturing licence, clinical trial and marketing authorisation applications. The holder of the control site will, as the name signifies, be responsible for notifying the MHRA of reportable issues and ensuring product quality across all the manufacturing sites, the spokes.

The diligence of the control site in overseeing the manufacturing locations will be scrutinised at routine MHRA inspections of the site; arrangements for that oversight will be scrutinised as part of the licensing process. A number of manufacturing spoke locations will be sampled and will be subject to inspections to ensure that the oversight claimed by the control site is independently supported by inspection findings.

The new framework is a modified form of the current system for evaluation of regulatory compliance at manufacturing sites and safety monitoring. There will be no change in the expected standards that must be met for the safety, quality and efficacy of the product. As the MHRA is retaining regulatory oversight, there will be no increased risk to patient safety.

I turn to the benefits. First, patients and carers will benefit from access to new and more personalised treatments in a timely and more convenient manner. There is even the potential for some patients to be treated with medicines manufactured at home, which aligns with our wider ambition to move care from hospitals to communities and reduce the need for patients to stay in hospital. Secondly, healthcare professionals will see a greater range of more effective treatment options for their patients, which will help to improve patients’ response to treatment. Lastly, innovators and industry will have clear regulatory expectations suited to innovation. The new framework will remove regulatory barriers, enabling speedier product development. Companies of all sizes—large, small and medium-sized enterprises—will benefit from that.

The new framework will allow us to use effective regulation to support the development of medicines at the forefront of technology. I am pleased to bring forward the draft regulations, using powers under the Medicines and Medical Devices Act 2021, to move innovative treatments closer to the patient and support patients’ access to pioneering medicines. That work that has been ongoing for some time within the agency. I hope that hon. Members will join me in supporting these important regulatory changes. I commend the draft regulations to the Committee.

--- Later in debate ---

[Karin Smyth]

I thank the hon. Member for Sleaford and North Hykeham for her comments. As I say, this is work that was long in progress under the previous Administration; I am pleased that colleagues from the MHRA are here today to see that work come to fruition. We are leading the world in this work.

We are highly committed to encouraging our life sciences sector to take innovations directly to patients. I am pleased to have cross-party support for the draft regulations. I look forward to working with the hon. Lady and others to ensure that we make this a reality for patients.

Question put and agreed to.

Radioisotope Shortage

Karin Smyth Excerpts

Tuesday 26th November 2024 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I am today updating the House that the temporary reduction in the production of radioisotopes has been resolved and that the supply of affected radioisotopes has returned to normal.

Throughout the shortage, my Department worked with industry, the NHS, in particular the radiopharmacy community, and the devolved Governments to make best use of available stock, ensuring critical patients were prioritised. Suppliers and NHS trusts and hospitals displayed great flexibility throughout this incident. Thanks to this collaborative approach from all parts of the system, we were able to manage the unique challenges presented by radioisotope shortages and help ensure fair and equitable access for UK patients.

This will have been a challenging time for patients and their loved ones as well as healthcare professionals. Services are returning to normal, and the NHS is working to book in patients who have had scans delayed, while continuing to ensure patients with the most critical needs are prioritised.

My Department will continue to monitor supplies of the affected radioisotope.

[HCWS248]

Eradicating Modern Slavery: NHS Supply Chains

Karin Smyth Excerpts

Thursday 21st November 2024 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

An estimated 50 million people live in modern slavery across the world. Modern slavery exists in every country, including the UK, with instances of forced and child labour documented within the supply chain of the health and social care sector.

The UK Government are committed to eradicating modern slavery both domestically and abroad and are clear that the NHS should not be purchasing goods or services which have been tainted by slavery or human trafficking.

DHSC, supported by NHS England, delivered a review in December 2023 into the risk of modern slavery within NHS supply chains. The review showed a significant amount of commitment from our suppliers to tackling modern slavery in their supply chains, and confirmed the important role that regulation would play in this area.

As such, I am pleased to announce that we will be introducing robust regulations to ensure the eradication of modern slavery in NHS supply chains in England.

As required by the NHS Act 2006, we are creating regulations which will place legal duties on public bodies to assess modern slavery risk in procurement and contract activities and take reasonable steps to address, and where possible, eliminate that risk.

These regulations will impose legal obligations on public bodies to assess and address modern slavery risks in their supply chains when procuring goods and services for the purpose of the NHS. Public bodies will be required to first evaluate the level of modern slavery risk associated with a procurement, then take appropriate and proportionate actions to mitigate and, where possible, eliminate that risk. Reasonable actions include ensuring robust selection and award criteria is built into their tenders to respond to identified risks; and introducing specific contract terms to monitor and require mitigation where instances of modern slavery are discovered.

The Department is pleased to announce that public consultation on our draft regulations has now been launched. This marks an important step in our commitment to eradicate modern slavery from our healthcare system. A collaborative approach is necessary, and as such we are inviting the views and contributions from a wide range of stakeholders including public bodies, suppliers, trade associates, interest groups and the public. Subject to the outcome of the consultation we intend to lay draft regulations before Parliament in due course.

Efforts to reform procurement rules in the UK are ongoing. The Procurement Act 2023, scheduled to take effect on 24 February 2025, will establish the new legal framework that the public sector must adhere to for applicable procurements. In January 2024, the Health Care Services (Provider Selection Regime) Regulations 2023 came into forces, outlining procurement regulations for clinical services.

Modern slavery is an abhorrent crime which requires a collective international response. DHSC has a duty to eradicate the use of goods and services tainted by modern slavery in NHS supply chains. This is not something that impacts only the health sector; modern slavery impacts everyone, everywhere. This Government will work to ensure a collaborative Government and cross-sector approach to tackling modern slavery within our regulatory framework.

[HCWS245]

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 19th November 2024 Commons Chamber

[Tessa Munt (Wells and Mendip Hills) (LD)]

2. What recent assessment he has made of the adequacy of the condition of NHS hospital equipment.

[The Minister for Secondary Care (Karin Smyth)]

The Darzi review made it absolutely clear that the NHS has been starved of capital. It is 15 years behind the private sector in its use of technology and we have fewer scanners per person than in comparable countries. That is why at the Budget the Chancellor announced an investment of £1.5 billion for capital funding, which will include investment for new artificial intelligence-enabled scanners, which will help tackle that backlog.

[Tessa Munt]

Residents in Somerset, and in North Somerset, my part of the world, recognise the £70 million that has been granted for new radiotherapy machines, as announced in the Budget, which will fund up to 30 machines. However, 70 machines will pass their sell-by date—their 10-year recommended life—by the end of this year. Will the Secretary of State and the Minister agree to meet Radiotherapy UK, which wants to highlight the huge cost benefits of having a more consistent, rolling programme of machine maintenance and replacement in the NHS 10-year plan?

[Karin Smyth]

The hon. Lady highlights the important matter of the lifetime of some of the machines, which we are finally addressing after the last 14 years of not addressing issues that include providing support to ensure that the machines work properly. Officials regularly meet Radiotherapy UK and the Department values its input. If there are specific incidents that the hon. Lady wishes to highlight, I am happy to respond to her.

[Deirdre Costigan (Ealing Southall) (Lab)]

Does the Minister agree that the NHS cannot continue to rely on outdated and obsolete equipment? It is ridiculous that GPs still use pagers and hospitals communicate with each other using fax machines. After 14 years of decline under the previous Government, will she commit to bringing our NHS into the 21st century?

[Karin Smyth]

My hon. Friend lays bare an important issue. We all know, and critically, staff know, that we are asking them to do the most incredible job with outdated technology. It is bad for staff and it is bad for patients. That is why moving from an analogue to a digital system is crucial. I was fortunate to visit colleagues at NHS England offices up in Leeds last week to see some of the fantastic work they are doing on the app. We will ensure that the NHS comes into the 21st century.

[Abtisam Mohamed (Sheffield Central) (Lab)]

3. What steps he is taking to improve mental health support services.

--- Later in debate ---

[Dr Lauren Sullivan (Gravesham) (Lab)]

T2. What steps are Ministers taking to address the ongoing shortages of medications for attention deficit hyperactivity disorder, which have been going on for 18 months?

[The Minister for Secondary Care (Karin Smyth)]

The Department has been working with suppliers of medicines used to treat ADHD to seek commitments from them to address the issues, expedite deliveries and boost supplies. We are working with NHS England to approve the modelling for industry and communications regarding ADHD medicine supply issues. We will continue to engage with industry to address the remaining issues as quickly as possible.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

--- Later in debate ---

[Karin Smyth]

My hon. Friend makes an excellent point on behalf of Rachel and many other women suffering from this disease. We are looking urgently at gynaecological waiting lists. They are far too high, including for endometriosis. I welcome the new National Institute for Health and Care Excellence guidelines. We will be looking at women’s health hubs and how they work, and future guidelines will help women to get a diagnosis more quickly and help with situations like Rachel’s.

[Wera Hobhouse (Bath) (LD)]

Respiratory health conditions are one of the main drivers of NHS winter pressures, yet only 32% of asthma sufferers in Bath and across the country can access the most basic level of care. What will the Government do to improve access to basic levels of care for the 68% of asthma sufferers who are currently missing out?

[Andy McDonald (Middlesbrough and Thornaby East) (Lab)]

Women with spinal cord injuries face significant challenges in accessing core health services, including breast screening, cervical screening and gynaecological care. Research shows that women with disabilities, including spinal cord issues, are 30% less likely to attend routine breast screening appointments, in significant part due to the physical inaccessibility of the screening equipment. Will the Minister meet me and representatives of the all-party parliamentary group on spinal cord injury to discuss these unacceptable disparities and ensure that women receive the equitable and accessible care they deserve?

[Karin Smyth]

My hon. Friend highlights a shocking example of inaccessibility in these important services. I will make sure that the Department responds to him and that either me or a ministerial colleague meets him.

[Stuart Anderson (South Shropshire) (Con)]

Ludlow community hospital in my constituency provides a great service for the local community, but it is restricted by its location and its building. There is a business model that would be more cost-effective in the long term that involves moving the facility to the eco park. Will the Secretary of State meet me, healthcare stakeholders and the league of friends in Ludlow to take that forward?

Respiratory Health

Karin Smyth Excerpts

Thursday 14th November 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Rosindell, for the first time in my new role. I thank the hon. Member for Strangford (Jim Shannon) for securing this debate on an important issue, and I thank other Members for their contributions.

As the hon. Member for Hinckley and Bosworth (Dr Evans) said, I am covering for my hon. Friend the Member for Gorton and Denton (Andrew Gwynne). I am pleased to do so. We had an outing this morning, and I was able to talk to the hon. Member for Hinckley and Bosworth earlier, whose first ward area was in this area as a medic. I must say that he is getting his money’s worth out of the NHS at the moment—I hope he does not have to do that again.

One of my jobs as a manager some 15 years ago was with the British Thoracic Society and primary care leading physicians on COPD. It was a project about living and dying with COPD and helping people to understand the disease and navigate it. I learned an awful lot about respiratory disease at that time and how people live and die with it. I commend that work.

I am shocked at some of what we have heard this afternoon and what I found in preparing for this debate about quite how poor things are, and that some basic preventive measures we were talking about 15, 16 or 17 years ago are still not in place. I am really happy to be responding this afternoon. I am not sure I will be able to satisfy everyone’s requests, but I can say on behalf of the Minister for Public Health and Prevention, my hon. Friend the Member for Gorton and Denton, that he will be happy to accept the invitation to the roundtable that the hon. Member for Strangford talks about, and his expertise will be better there than mine. We are keen to pursue that conversation with the hon. Gentleman and the all-party parliamentary group.

As we have heard, one in five of us will be affected by a chronic respiratory disease at some point in our life. These conditions are, sadly, the third biggest contributor to years of life lost in England. Many people out and about using public transport will know the symptoms of poor respiratory health. They might associate a wheezing or raking cough with being indicative of a smoker, but not all ill health is about personal choice. In fact, this common symptom belies a huge range of conditions, only some of them related to smoking and each requiring different interventions. On all those conditions, we are taking forward a combination of immediate bold actions and long-term reforms.

The Government are taking radical action to create the first smoke-free generation. We are clamping down on kids getting hooked on vapes and protecting children and vulnerable people from second-hand smoke. Tobacco is a uniquely harmful product and smoking is the No. 1 preventable cause of death, disability and ill health. The statistics are stark: smoking claims the lives of about 80,000 people a year in the UK and kills up to two thirds of its long-term users. Second-hand or passive smoke is extremely harmful to health. There is no safe level of exposure to smoke: if we can smell cigarette smoke, we are inhaling it. Smoke is harmful, particularly to children, pregnant women or people with pre-existing health conditions such as asthma or heart disease, which may not be visible to the smoker.

Our Tobacco and Vapes Bill, which we introduced last week, will be the single biggest public health intervention since the last Labour Government banned smoking in indoor public spaces. The Bill’s primary aim is to create a smoke-free generation by gradually ending the sale of tobacco products throughout the country and breaking the cycle of addiction and disadvantage, so that someone born after 2009 will never be able to legally buy tobacco. This landmark legislation will also enable the Government to strengthen the existing ban on smoking in public places and to reduce the harms of passive smoking in certain outdoor settings. It will ban vapes and nicotine products from being promoted and advertised, to prevent the next generation from being hooked on nicotine.

We will hear all sorts of arguments against these sorts of policies, with people saying it is the nanny state or that they are anti-growth. However, most smokers—myself included—always wish they had never started. They have had their choice taken away by addiction induced at a young age by the tobacco industry. I remind Members present that smoking costs the economy and wider society some £21.8 billion a year through lost productivity, smoking-related lost earnings, unemployment and early death, as well as the cost to the NHS and social care of over £3 billion. Our action will save thousands of lives and protect the NHS. I pay tribute to charities such as Action on Smoking and Health and Asthma and Lung UK, which have supported our work. Through our changes we will create a healthier society and, in doing so, boost the economy.

As we have heard this afternoon, smoking is only one example of how our respiratory health is influenced by our environment. Even though it has been almost 70 years since the first Clean Air Act was passed, what we breathe remains one of the greatest risks to public health in the UK. As the chief medical officer’s 2022 annual report on air pollution sets out, there is clear evidence that outdoor air pollution contributes to the initiation and development of respiratory diseases such as lung cancer. That is why the Government are committed to a preventive approach in this policy area. I assure people that we are taking a mission-led approach, working across Departments to improve air quality. We want to address the inequalities in the quality of the air that people breathe simply because of where they live.

The Department of Health and Social Care will support the Department for Environment, Food and Rural Affairs to deliver a comprehensive and ambitious clean air strategy. This will include a series of interventions to reduce emissions so that everyone’s exposure to air pollution is reduced. The UK Health Security Agency, which has been talked about this afternoon, is working closely with DEFRA to review how we communicate air-quality information to ensure that members of the public, and vulnerable groups in particular, have what they need to protect themselves.

I commend my hon. Friend the Member for Newcastle-under-Lyme (Adam Jogee) for his work in support of his constituents with regard to Walleys Quarry. The Minister for Public Health and Prevention visited Newcastle-under-Lyme recently and will pursue those discussions with the Environment Agency.

The Government are also taking steps to reduce risks to respiratory health in people’s homes—a point addressed well by the Liberal Democrat spokesperson, the hon. Member for Winchester (Dr Chambers). Living in a home with damp and mould increases the risk of respiratory illness and conditions such as asthma and COPD. It also affects symptom severity and the risk of death for individuals with existing respiratory conditions. We are therefore putting forward an initial £3.4 billion towards heat decarbonisation and household energy efficiency over the next three years, and £1.8 billion to support fuel poverty schemes. That means that over 225,000 households will receive help to reduce their energy bills by more than £200.

The hon. Members for Winchester, for Strangford and for Hinckley and Bosworth made excellent points about vaccinations. We want to encourage everyone, including ourselves—I look around the room, even at myself; I am slightly behind on my flu vaccine—to do all we can ourselves and to encourage others to take up vaccines and prevent some of the related problems.

We recognise, however, that not all ill health can be prevented, so we need to act to help those who need treatment. I assure the hon. Member for Strangford and other contributors that respiratory disease remains a clinical priority.

The NHS long-term plan under the last Government set a series of objectives for improving outcomes for people with respiratory disease through early diagnosis and increased access to treatments. As we have heard, and as I have said, it is quite shocking that that basic objective is not being achieved everywhere. Access to checks and basic preventive care needs to be much better spread across the country. That is why we say that we want to take the best of the NHS to the rest of the NHS. NHS England has 13 respiratory clinical networks across the country, which are vital in providing clinical leadership across primary and secondary care for respiratory services and supporting services in primary care, where of course most patient contact is.

I commend my hon. Friend the Member for Sherwood Forest (Michelle Welsh) for highlighting pulmonary fibrosis. I wish her father and her family well. She is absolutely right that early and accurate diagnosis is a priority for NHS England. Work to make improvements is under way, and that should have an impact on reducing delayed diagnoses of pulmonary fibrosis. As I understand it, access to these treatments has recently been expanded to patients with non-idiopathic pulmonary fibrosis, following the publication of the NICE technology appraisal for treating progressive fibrosing lung diseases. I hope that that goes some way towards reassuring my hon. Friend, who spoke so eloquently today.

As the hon. Member for Strangford and my hon. Friends the Members for Newcastle-under-Lyme, for Blaydon and Consett (Liz Twist) and for Sherwood Forest highlighted, COPD is a major contributor to inequalities in life expectancy and in healthy life expectancy. People living in the most deprived parts of the country are five times more likely to die from COPD than those in the least deprived. I have seen that both in my previous work with those working in the NHS and since becoming the Member of Parliament for Bristol South in 2015. My constituency was home to the Wills tobacco company, a huge employer in the area over many decades. Its legacy can be seen in many different ways, but particularly in the very high rates of smoking in my constituency—up to 32% in some parts. The reduced lives lived in good health, and those shocking early deaths, are things that I see every day. The impact is still very apparent in the shocking statistics on health inequality across my home city of Bristol.

Let me assure hon. Members that this issue remains a priority for all of us in this Government. Reducing health inequalities is a key part of our mission. That requires us to work across Government, and it runs across all parts of Government. In NHS England, Core20PLUS5 is a national approach to inform action to reduce healthcare inequalities at both national and local system level. The approach provides a vehicle for targeted interventions to detect and treat the diseases that are major contributors to life expectancy as well as pressures on the NHS.

We know that there is a particular risk of condition exacerbation around the winter, leading to emergency treatment in hospital and in-patient care. That is why the focus of the Core20PLUS5 action on respiratory health this year has been to increase vaccination uptake, including covid-19, flu and pneumovax, which can protect against serious illnesses such as pneumonia and meningitis.

NHS England is leading on the development of an approach for COPD management. This will support proactive identification and management of risk in patients in winter, to reduce demand on primary and secondary care. My hon. Friend the Member for Blaydon and Consett was absolutely right to highlight the low levels of diagnosis, the number of people living with COPD and other respiratory diseases, and the impact on children that we might not even know about. The plan is to test and evaluate this approach in four sites this winter to help inform decisions on winter planning in the future.

On severe asthma and access to biologic treatment, significant work has been undertaken through the NHS England severe asthma collaborative to develop the capacity of the severe asthma centres. That important work includes streamlining patient pathways to biologic therapy and reducing variation in prescribing and patient management. Patient outcomes are now submitted to the UK severe asthma registry. That has led to improved identification of patients with potential severe asthma in primary and secondary care, resulting in referral to severe asthma centres for consideration of eligibility for biologic therapy.

Action to address avoidable deaths from asthma has not gone far enough. That is why we are working to ensure that asthma care has a higher prioritisation within systems, for example through the national bundle of care for children and young people with asthma workstream, which is intended to improve outcomes for children and young people with asthma.

Looking further forward, a central mission of the Government is to build healthcare that is fit for the future. As hon. Members have noted, our 10-year health plan will focus on the three shifts needed to deliver a modern NHS: from hospital to community, from analogue to digital and from sickness to prevention. That is a long-term challenge and those shifts will take time to deliver, so the plan will consider what immediate actions are needed to get the NHS back on its feet and bring waiting lists down, as well as the longer-term changes needed to make the health service fit for the future.

I thank the hon. Member for Strangford for his commitment to respond to our engagement exercise. I encourage all organisations and individuals to contribute to the 10-year plan at change.nhs.uk. We are keen to work with the public, patients and our partners in all the organisations that support this work. We will listen and co-design the plan with them.

Disease-specific and more general long-term conditions that affect people’s health are a very live issue. Given the level of comorbidities with which people currently live, it is important to look at the person as well as the diseases. We will continue to look at that as part of the development of the 10-year plan; I know that all hon. Members will take an active part in that process. The hon. Gentleman will tell me if there is anything to which I have not responded.

The hon. Member for Hinckley and Bosworth asked for an update on the RSV vaccine. As part of my portfolio working on urgent and emergency care, we are looking closely at a vaccine update, as well as at the presentation of very young children with respiratory disease in the emergency care system; I am sure that he is aware of that issue. If there is anything else that he would like to know, I will ensure that he is written to. On spirometry and fractional exhaled nitric oxide tests, a look at the NICE guidelines is long overdue, so I hope that we see some more progress on that. If I have missed something, Members may write to the Minister for Public Health and Prevention and he will respond very promptly.

I thank the hon. Member for Strangford and the APPG for raising the issue. I am genuinely very pleased to see it being raised. As a contributor to admissions and inequalities, it is a very serious disease and we need to highlight it. I thank him for the invitation to take part in a discussion with healthcare professionals on the way ahead for respiratory health. My ministerial colleagues look forward to discussing that further.

National Insurance Contributions: Healthcare

Karin Smyth Excerpts

Thursday 14th November 2024 Commons Chamber

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the impact of changes to employer national insurance contributions on primary care providers, hospices and care homes.

[The Minister for Secondary Care (Karin Smyth)]

I am grateful to the hon. Member for asking this important question. It gives me the opportunity to say to GPs, dentists, hospices and every part of the health and care system that will be affected by changes to employer national insurance contributions that this Government understand the pressures they face and take their representations seriously. The Chancellor took into account the impact of changes to national insurance when she allocated an extra £26 billion to the Department of Health and Social Care. There are well-established processes for agreeing funding allocations across the system, and we are going through those processes now with this issue in mind.

This Government inherited a £22 billion black hole in the public finances, broken public services and a stagnant economy. Upon taking office we were told that the deficit the previous Government recklessly ran up in my Department alone would mean delivering 20,000 fewer appointments a week instead of the 40,000 more we promised. The Chancellor and my right hon. Friend the Secretary of State were not prepared to see further decline in our NHS. That is why we put in an extra £1.8 billion to stop the NHS going into reverse this year.

We built on that at the Budget, delivering the significant investment that the NHS needs to get back on its feet, backing staff with investment in modern technology, new scanners and new surgical hubs, and rebuilding our crumbling primary and secondary care estate. Alongside that, we delivered a real-terms increase in core local government spending power of around 3.2%, which will help to address the range of pressures facing the adult social care sector, including £600 million in new grant funding for social care. We are now working through exactly how that money will be allocated, as per normal processes. As the Secretary of State set out yesterday, we will ensure that every pound is invested wisely to deliver the Government’s priorities and provide value to taxpayers.

The Department will set out further details on the allocation of funding in due course, including through NHS planning guidance and the usual consultations, including on the general practice contract. As part of these processes, we will consider the impact of changes announced to employer national insurance contributions in a fair and open way over the next five months, before the changes come into force in April 2025.

[Dr Evans]

I draw the House’s attention to my declaration of interests.

Many in the health sector will have been pleased to hear the announcement of the extra funding for the NHS, only for their joy to be struck down by the realisation that a manifesto promise not to raise national insurance contributions had been broken. That was compounded further by the discovery that a raft of frontline care providers—care homes, hospices, care charities, pharmacies and GPs, to name but a few—will not be exempt from the NI rise, leaving them with crippling staff bills and the threat of closures and redundancies. The hospice sector expects the cost to be £30 million—closures and redundancies. The initial assessment of the cost to GPs is £260 million—closures and redundancies, at the expense of 2.2 million appointments. For the care sector, the changes will cost £2.4 billion, dwarfing the £600 million in social care support that was announced. Does the Minister accept that it is inevitable that council tax will have to rise to support the increase in NICs?

For the first time, the National Pharmacy Association has announced collective action. Its chair said:

“The sense of anger among pharmacy owners has been intensified exponentially by the Budget, with its hike in national insurance employers’ contributions and the unfunded national living wage increase, which has tipped even more pharmacies to the brink.”

Will the Minister clarify who is exempt from NI? Will the Government admit that they got it wrong and make a change? The Prime Minister, Health Secretary and Chancellor have all said that allocations will be made “in the usual way”. Will the Minister clarify what the usual way is? Will mitigations be put in black and white to the House and the public? Is this part of the £20 billion, or new funding?

More importantly, will the Minister lay out a concrete timetable for hospices, care homes, GPs, pharmacists and all other allied health professionals, who are making decisions now? This seems to be another example of a big headline from the Labour party but no detail.

[Karin Smyth]

Well, really. I am quite dumbfounded by the hon. Gentleman’s response. I respect him for his professional practice, and he knows the state of the NHS that we inherited from the previous Government, as reported in Lord Darzi’s report. He talks about joy, but there was no joy when we inherited the mess they left back in July. He talks about people being tipped to the brink, and they absolutely were, as Lord Darzi made clear.

As I said, we will go through the allocation of additional funding in the normal process, which will be faster than under the previous Government because we are committed to giving the sector much more certainty. The normal process, as the hon. Gentleman should know from his time in government, is to go through the mandate and the planning guidance and to talk to the sector about the allocations due next April, as I said in my opening statement.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

Does my hon. Friend join me in welcoming the Opposition’s new interest in social care? Does she further agree that the problems that social care faces owe more to the previous Government’s failure to do anything with Andrew Dilnot’s 2011 report than they do to anything that is happening now with national insurance?

[Karin Smyth]

My hon. Friend makes an excellent point. When I joined this House in 2015, I remember that the first act of the new, non-coalition Conservative Government was to take the legs from underneath that social care commitment by postponing the Care Act 2014. They cynically said at the time that they would bring it forward by 2020, which they thought would coincide with the next general election. We all saw how that went.

--- Later in debate ---

[Alison Bennett (Mid Sussex) (LD)]

The increase in employer national insurance contributions will erode the very investment in the NHS that the Budget sought to prioritise. Katie, a GP from Lindfield in Mid Sussex, wrote to me saying that the NICs increases

“serve to directly undermine access and patient care.”

The Government have promised to recruit more GPs, but hiking national insurance puts that pledge in jeopardy. Surgeries are set to see eye-watering increases in staff costs, equivalent to 26,786 appointments in West Sussex alone. GPs will have no choice but to cut services and staff numbers, and patients will pay the price.

Does the Minister agree that stronger primary care, with faster appointments and fewer people having to go to hospital, is better for both the NHS and patients? If so, will she protect services and press the Chancellor to end this GP penalty?

[Karin Smyth]

The hon. Lady makes an excellent point about the importance of GPs and primary care to the wider sector. Immediately after taking office this summer, we freed up the system to employ 1,000 extra GPs through the additional roles reimbursement scheme—which the previous Government refused to implement—because we recognised the need for that extra capacity. We will be talking to general practice as part of the contract reforms over the next few months, following the normal process, to determine allocations for next year.

[Rachael Maskell (York Central) (Lab/Co-op)]

If this Government’s ambition, stemming from Lord Darzi’s report, is to be realised, significant investment is required not only in primary care but in third sector organisations. However, these organisations are concerned about the increased cost pressures on their services. Will the Minister ensure that there is sufficient support within the trickle-down approach, which the Department will now have to apply, to maintain current service levels and facilitate the urgently needed transition across health services?

[Karin Smyth]

I respect my hon. Friend’s expertise in this area. She is right, and we understand that the pressures are real, which is why we have committed to supporting the NHS and the social care system with the additional funding that my right hon. Friend the Secretary of State for Health and Social Care secured as part of the Budget settlement.

We are also working closely with the NHS, in a new relationship, to understand its needs. That is a dynamic conversation, because we want to understand what is happening in local systems as we continue to invest in them.

[Mr Speaker]

I call the Father of the House.

--- Later in debate ---

[Karin Smyth]

I understand the right hon. Gentleman’s point. As I have said, we will continue our conversations with all affected providers in the normal way.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

Does the Minister agree that the support that we will put in place for general practice and, in particular, the community health hubs that were recently announced, will be crucial to the improvement in the health service that we urgently need?

[Karin Smyth]

I respect my hon. Friend’s expertise and service to the national health service. He will understand the need to make the shift into neighbourhood health services. We have been clear that we will ensure the NHS spends all its allocations in the most effective way to enable that shift, as part of our 10-year plan.

[Mr Richard Holden (Basildon and Billericay) (Con)]

A trustee of the Hamelin Trust, a not-for-profit provider of care and support across Essex, has contacted me because he is concerned about the £92,650 rise in national insurance that Hamelin will have to pay because of the measures introduced by the Government. He said:

“This will affect what they can do to support our communities and subsequently put more pressure on the NHS and local authorities. The impact on disabled people and older adults who rely on regular, consistent, high-quality care will be profound.”

I do not believe that the Government intended to hammer the disabled or older people who need care, so will the Minister prove me right and look at the policy again?

[Karin Smyth]

The right hon. Gentleman was part of the last Government—I am pleased to note that he is talking to his new constituents. The £22 billion black hole and the report from Lord Darzi indicate the fragility of the system we have inherited. We are ensuring that vulnerable groups are supported through the allocations provided to both the Department for Health and Social Care and the Department for Work and Pensions.

[Andrew Lewin (Welwyn Hatfield) (Lab)]

When Labour came into government in July, every element of our health service was in crisis. Since, then, we have announced record investment in our national health service, but I am yet to hear whether the Conservative party supports that record investment. Does the Minister agree that the Government are listening to health professionals, taking tough decisions and not simply playing politics?

[Karin Smyth]

My hon. Friend makes an excellent point. We have still not heard from the Opposition whether they agree with the extra investment that has gone into the sector or with Lord Darzi’s report that diagnosed their legacy, including why they left that legacy and the serious issues we now have to address.

[Munira Wilson (Twickenham) (LD)]

Shooting Star children’s hospice in Hampton serves children with life-limiting conditions and supports their families not just in my constituency but across south-west London and Surrey. With the national insurance hike, it faces a bill of £200,000, on top of all the inflationary costs that it has had to absorb. It is also waiting for confirmation as to whether the children’s hospice grant, which this year provided it with £1.8 million, will continue beyond April 2025. Will the Minister commit to making hospices exempt from the NI rise, not just for nursing staff but for all staff, and when will she be able to give Shooting Star and other children’s hospices confirmation on whether the children’s hospice grant will continue? They need to plan now.

[Karin Smyth]

I commend the hon. Lady for raising the great work done by hospices. We understand the pressures and the precarious situation that many have been left in after 14 years of the last Government. We are willing and keen to talk to representatives from all types of hospice, and others. We are going through the process of the allocations and we will be able to get back to them as soon as possible.

[Mr Mark Sewards (Leeds South West and Morley) (Lab)]

Hundreds of my constituents in Leeds South West and Morley are stuck on record long waiting lists, thanks to the Conservative party. It is essential that we get those waiting lists down, because they have profound effects on our economy and on the health of those waiting. Will the Minister confirm that the measures that we set out in the Budget will provide the additional appointments needed to get those waiting lists down?

[Karin Smyth]

My hon. Friend makes an excellent point. As I said in my response to the hon. Member for Hinckley and Bosworth (Dr Evans), we faced a situation where we were told that we would have to reduce appointments by 20,000 a week. We have taken serious steps, and my right hon. Friend the Secretary of State fought hard for our Budget allocation so that we can have 40,000 extra appointments as promised in our manifesto, which was overwhelmingly endorsed by the British public. We are determined that we will bring change to the system and tackle the waiting lists.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

Increased taxes for hospices, care homes, GPs and pharmacies. Is that a deliberate decision by the Labour Government or just a cock-up?

[Karin Smyth]

We understand the precarious situation that hospices are in—the precarious situation that they found themselves in before we came to power— and we are committed to talking to them and other affected providers. We will be going through the normal process of allocations in the next few months.

[Alex Ballinger (Halesowen) (Lab)]

Many of my constituents continue to wait on record-long waiting lists. Does the Minister agree that, before the Opposition throw stones, we should remind the House that their spending plans would have cut £15 billion from the NHS, which would have completely shattered an already broken NHS?

[Karin Smyth]

Those Conservative Members who have held on to their seats—I have been in that situation as well—know that the public, staff and patients understand exactly what state they left the NHS in. That is why they had such a disastrous election result. We are determined to change the NHS and to make it fit for the 21st century. Part of what we have done in this Budget through that extra allocation, our conversations with those in the health and social care system and our 10-year plan will do just that.

[Seamus Logan (Aberdeenshire North and Moray East) (SNP)]

While Scotland’s public sector is facing a £500 million bill for the Chancellor’s reckless national insurance hike, Scotland’s charities, including hospices, face a £75 million price tag under these changes. The Budget simply cannot be balanced on the back of Scotland’s charities and hospices. This is a disgraceful decision for which the Labour Government are rightly being hounded. There is still time for them to do the right thing and cover these costs—I agree with what the Father of the House said. Will the Minister tell us whether they will do so?

[Karin Smyth]

The SNP has been in charge in Scotland for something like 20 years now—I forget exactly how long, but it seems like a very long time. Again, the Scottish people gave us an excellent result at the general election, and I am delighted to have so many Scottish colleagues here with me now. However, the SNP has the opportunity to make decisions in Scotland around health and social care as well, so I suggest that they do a better job.

[Karl Turner (Kingston upon Hull East) (Lab)]

It is disappointing to put it mildly that the Opposition spokesperson was unable to mention the record funding committed in the Budget.

--- Later in debate ---

[Mr Speaker]

The Government have no responsibility for that.

[Karin Smyth]

Well, I do agree with my hon. Friend. As I have said, when I became a Member of Parliament in 2015, I remember very clearly the absolute shock that I felt when the Conservatives immediately announced that they were not going to meet the commitment that they had made to implement the Care Act 2014 at that time, and we are still playing catch-up on that issue.

[John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)]

Doctors from Duns, Galashiels, Selkirk, Kelso and across the Scottish Borders have contacted me about the impact that this national insurance hike will have on their practices. They tell me that the decision will be a huge retrograde step for primary care, will have a huge financial impact on their practices, and will undermine access to primary and patient care. Why have the Labour Government made this choice to hammer local doctors?

[Karin Smyth]

As I have said, we have made a commitment to general practice and primary care by releasing extra GPs into the system. We recognise the situation in which GPs find themselves. I know this because I worked with GP practices in my previous career. We need those practices to be the foundation of our neighbourhood services, which is why we will talk in the normal process about the allocations over the next few months as part of the contract.

[Mr Clive Betts (Sheffield South East) (Lab)]

If we are to reform the NHS, we need to move resources over time into primary care. The reality is that GPs see at first instance 90% of patients, but receive only 8% of NHS funding. Will my hon. Friend ensure that, in the settlement that is agreed with NHS providers, particular attention is given to supporting GPs?

On the social care sector, when we help the hospices and social care providers, which are charities and small organisations in particular, can perhaps do so without subsidising some of the hedge funds that are now investing heavily in social care? We do not want to add to their profits while supporting the small charities involved.

[Karin Smyth]

My hon. Friend has led fantastic work in previous Parliaments on the health and social care system, which he understands very well. He makes an excellent point about ensuring that additional funding goes where we want it to, which is towards supporting our constituents, particularly with social care. We have all seen the situation over the last decade over so. Improving that is critical to the urgent and emergency care system, and to the dignity of those people who need the service. We will continue to talk to them, and to local systems, about the impact of any changes.

[Mr Alistair Carmichael (Orkney and Shetland) (LD)]

I hear what the Minister says about the Government wanting to stop the NHS going into reverse, but that is exactly what risks happening to GP practices in my constituency. I met with one on Friday that told me that, as a consequence of having to find extra funds for national insurance contributions, it will no longer be able to make permanent a temporary support post, or proceed with the recruitment of the extra GP that it wanted to take on. There is a contradiction at the heart of the rules: GPs are treated as private contractors, but if they were private contractors, they would be eligible for employment allowance. Because their work is entirely in the public sector, they cannot get it. Surely something has to give.

[Karin Smyth]

The right hon. Gentleman tempts me to go into my previous career working with GPs and their employment and contractual status, but I will not do that now, Mr Speaker, as you would rightly curtail me. GPs have a complicated contractual status that has been long in the process. We understand the precariousness of primary care. GPs are crucial to our plans for developing the health service, and we will discuss with them, in the normal process, the allocations for the following year.

[Jim Dickson (Dartford) (Lab)]

Last month’s Budget finally gave my constituents hope that there will be an NHS that works for them. Will my hon. Friend assure me that this Government will avoid the sticking-plaster, piecemeal approach of the last Government, and bring forward a long-term plan to fix the NHS for the future?

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[Karin Smyth]

My hon. Friend is right: getting away from short-term fixes and sticking plasters is exactly what we are attempting to do. That is why we put in the extra security of extra GPs over the summer, committed to extra funding in the Budget, and launched our 10-year plan. I encourage all hon. Members and their constituents to submit their views to that exercise at change.nhs.uk.

[Sir Roger Gale (Herne Bay and Sandwich) (Con)]

Dr Aleksandra Fox of the Ash surgery in my constituency is one of a number of GPs who have pointed out to me the deleterious effects of an ill-thought-through Budget. In addition, charities such as Shooting Star and Demelza children’s hospices are facing problems now. They cannot wait for discussions through the normal channels while this cock-up is put right. When will something be done about it, please?

[Karin Smyth]

The right hon. Gentleman says that it is an ill-thought-through Budget. I do not know whether he agrees or disagrees with the extra funding that the Government have committed to the NHS after the disaster of the last 14 years.

[Johanna Baxter (Paisley and Renfrewshire South) (Lab)]

This morning, we learned that the Scottish Government have wasted £28 million of taxpayers’ money on the flawed, ill-conceived National Care Service (Scotland) Bill, which did not command the support of almost any of the stakeholders needed to pass it. Does my hon. Friend agree that the additional funding for the NHS that has been committed to in our Labour Budget should be used to come up with a proper plan for social care across the UK that does not follow the flawed approach in Scotland?

[Karin Smyth]

I am so pleased to see my hon. Friend in her place. As I said to the hon. Member for Aberdeenshire North and Moray East (Seamus Logan), the SNP has been in charge of Scotland for a very long time. We have certainly missed having a Scottish Labour voice in this place. She makes an excellent point and shines some sunlight in this place on the actions that have been taken up in Holyrood.

[John Glen (Salisbury) (Con)]

Julia’s House hospice does amazing work across Wiltshire and Dorset, but its chief executive Martin Edwards came to Parliament on Tuesday to tell me that the additional national insurance contributions will cost the hospice £250,000 a year. For that hospice, and Naomi House, which does similar good work, the changes are a significant concern. I know that the people of Wiltshire and Dorset will do as much as they can to raise additional funds, but will the Minister reflect on that unexpected gap and offer some reassurance?

[Karin Smyth]

I agree with the right hon. Gentleman that his hospice, and the hospices in many of our constituencies, do great work. We are aware of the precarious situation that they have been in for a number of years, and we want to ensure that they are fully part of end of life care. He will know from his time in the Treasury that there are complicated processes, both in the Treasury and in the Department of Health and Social Care. When I talk about the normal processes for allocating money, I think he understands that well. We are mindful of hospices’ concerns, and we will continue to talk with them.

[Anna Dixon (Shipley) (Lab)]

Between 2013 and 2023, during the Conservatives’ time in government, the number of general practices fell from 8,044 to 6,419. Does my hon. Friend agree that it is a bit rich for the Conservatives to pretend now that they care so much about general practice, given that 1,600 practices closed on their watch?

[Karin Smyth]

My hon. Friend brings a great deal of expertise to the House from her work in social care, so she knows and understands the precarious nature of the sector, which we cannot stress enough. I do not know whether the Conservatives have actually read the report by Lord Darzi, but that report and its appendices give a really clear idea and diagnosis of the state in which the NHS and social care system was left. It will take a long time to rebuild it, and the sustainability of general practice and primary care is particularly problematic. That is why we took those actions in the summer, and why we will continue to support them and build up a neighbourhood health service.

[Bob Blackman (Harrow East) (Con)]

The Minister will understand that GPs are private contractors to the health service, as are pharmacists, hospices and many wonderful charities. The Government have decided to ensure that the public sector is protected from the national insurance increase. All that the Minister—or her Secretary of State—needs to do is agree that all the suppliers to the national health service are also protected, which would safeguard their position. Otherwise, care homes will close down, pharmacies will close down, and hospices will not be able to provide their services. My constituency has the wonderful St Luke’s hospice, which does brilliant work—I helped to found it back in the 1980s—and which has told me that it will have to reduce services drastically as a result of the changes. Whenever nurses and other medical practitioners get a pay rise, those suppliers have had to cope without being given the money to fund that pay rise. They need to be protected from that as well.

[Karin Smyth]

I thank the hon. Gentleman for his comments and for supporting his local hospice. He is an experienced parliamentarian; he knows that this is not simple and that the provider landscape is complicated. As we heard from my hon. Friend the Member for Sheffield South East (Mr Betts), large private equity companies own many social care providers. We want to ensure that any additional funding from the Budget goes exactly where it needs to be: supporting patients—our constituents—where they live and need care. That is why, over the next few months, we will continue to talk to providers in the usual way about the allocation of those funds.

[Ellie Chowns (North Herefordshire) (Green)]

Since the Budget, I have been contacted by GPs, care providers and charities in my constituency, all expressing concern about the impact of the rise in employer NICs on their ability to serve the most vulnerable in our community. Will the Minister reconsider the change by finding a way to exempt the charitable sector in the same way as the public sector? I have written to Ministers and tabled early-day motions on this issue. Will she take this opportunity to assure the charitable sector that it will not be impacted by the measure?

[Karin Smyth]

The hon. Lady tempts me to make specific commitments, which I am not prepared to do, as I am sure she understands. She is right that people are expressing concerns about some of these decisions. That is because they are in such a precarious situation as a result of what we have inherited from the past 14 years. As the Prime Minister and the rest of the Government have been clear throughout the election and afterwards, we have a 10-year plan because it will take a long time to fix the foundations and build up the sector to make it more resilient and sustain it for the future. We want to fix those foundations, and we will talk closely with everyone affected over the coming months, but this will take a long time. Those providers are precarious because of the mess that we inherited.

[Martin Vickers (Brigg and Immingham) (Con)]

Earlier this week, I received a letter from the Lincolnshire and Nottinghamshire air ambulance, a charitable healthcare provider. The national insurance changes will add £70,000 a year to its costs, and if it is forced to close, lives will be lost. May I urge the Minister—I know she will want to protect this service—to do all she can to ensure that that air ambulance and others across the country are not hit by this tax?

[Karin Smyth]

I assure the hon. Gentleman that since we were elected, the Government have already taken action to secure extra investment in the health and social care system, and we are committed to building a thriving health and social care system for the rest of the 21st century.

[Mr Lee Dillon (Newbury) (LD)]

A rural pharmacy—one of the few remaining in my constituency—derives 90% of its turnover from providing NHS services. Will the Minister consider giving pharmacists for whom NHS services account for such a large proportion of their work an exemption from the NICs rises? What assessment have the Government made of the impact on the continuing delivery of programmes such as Pharmacy First if pharmacists have to shut their doors?

[Karin Smyth]

The hon. Gentleman makes an excellent point about pharmacies. We absolutely understand their importance, both in urban constituencies such as mine and in rural areas. I remember from when I became an MP in 2015 the changes that the previous Government made to the pharmacy contract, and I am aware of the precarious situation that pharmacists have been in. We will continue to talk to them as part of the normal process, but we understand how important they are to building a neighbourhood service and to the future of the NHS.

[Dame Harriett Baldwin (West Worcestershire) (Con)]

Acorns children’s hospice, St Richard’s hospice and GPs, care homes and pharmacies across West Worcestershire have all been in touch with concerns about the extra cost burden that the Government have imposed on them. Can the Minister explain how it fits in with her strategic plans to slap extra cost on the community sector while rebating the NHS trust sector?

--- Later in debate ---

[Karin Smyth]

I am sure that all those hospices, which do great work, were also in touch with the hon. Lady when she was part of the previous Government. She will know from her time on the Treasury Committee that following the Budget, we go through the planning guidance and have conversations with all core contracted sectors. That is part of the normal process. We are absolutely committed to building back the foundations of the NHS and social care system, making it fit for the 21st century and creating a 10-year plan to which we want everyone to contribute. Community and neighbourhood systems are a fundamental part of that.

[Ben Lake (Ceredigion Preseli) (PC)]

GPs, pharmacies and social care homes from across Ceredigion Preseli have contacted me to express their concerns about the impact of the policy changes surrounding employer national insurance contributions. It is essential that they are supported with the cost that comes from this policy. The Minister has suggested that there might be additional support for some of them through the usual systems. Will she clarify whether that will mean funding being found from the Department’s budget, or whether there will be additional new money from the Treasury? That would have certain ramifications for the Welsh Government and whether they get additional Barnett formula funding.

[Karin Smyth]

I understand the concerns of the providers that have come to the hon. Gentleman, and he is right to raise them in this place. As he knows, health and social care is devolved to the Welsh Government, and there has been much benefit already from the Barnett consequentials of the Budget. We will continue to talk to the devolved regions—in, may I say, a much more co-operative way than the previous Government did—to ensure that we have a good system across the entire United Kingdom.

[Robbie Moore (Keighley and Ilkley) (Con)]

In a tweet to the Health Secretary, Caroline Rayment, who is the clinical lead for the Wharfedale and Silsden community partnership, said,

“you came to our practice in June and told us you wanted to support the family Dr. Costs for the NMW and NI will come to approx £50k—we are a small practice of 7000 patients—how is this helping us?”

Can the Minister answer Caroline’s question?

[Karin Smyth]

I am not abreast of all the Health Secretary’s tweets and the responses to them, but Caroline makes a point that has been made by many people in the Chamber today, as well as a number of providers. As I said in my opening statement, we understand the precarious situation that those providers have been put in because of the failures of the past 14 years and the £22 billion black hole that the Government have inherited. As my hon. Friend the Member for Shipley (Anna Dixon) said, general practice has been put in a precarious situation over the past 14 years, with thousands of practices going bust and giving back their contracts. That is a situation that we promised the British public we would change, and we will do so.

[Nick Timothy (West Suffolk) (Con)]

In Suffolk, the national insurance increase creates £11 million of additional pressures on adult social care alone. I do not think the Minister understands that she is not just engaged in some party political knockabout with Conservative Members; GPs, hospices, care homes and pharmacies are watching this debate and are looking to the Minister for answers. They know that this problem was caused by the Government’s tax rise, which is being implemented without a plan for them, so can she tell them when a solution is going to be brought forward by the Government? When are they going to get reassurance about their future?

[Karin Smyth]

The hon. Gentleman may or may not think that this is political knockabout, but I was very clear in my opening statement that we understand the pressures that the sector is under. We understand the mess that we inherited, and we are fixing it. We are working with social care, GPs, providers and hospices that are affected by any changes in the Budget, and we will continue to talk to them in the usual way. We are committed to doing this faster than the last Government did it. Under the last Government, planning guidance and commitments to the NHS were always running late—they were always playing catch-up. We are committed to making sure that the sector is much more sustainable, so that it can do the important job we are asking it to do.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Jim Shannon.

[Jim Shannon (Strangford) (DUP)]

Thank you, Madam Deputy Speaker. As Members know, I am the last person —when I am called, the debate is almost over.

Will the Minister confirm whether consideration has been given to the fact that the rise in national insurance contributions will not affect the NHS as a whole, as the block grant for us in Northern Ireland will cover it? However, GP practices in my constituency of Strangford will suffer, and unlike high street businesses or manufacturing, they cannot increase prices to cover that impending rise, leaving practices with no option other than to reduce hours in order to stay solvent. Does the Minister agree that this is the last thing already overstretched GP practices need, and will she commit to take this issue back to the Treasury for reconsideration as it relates to healthcare businesses such as GPs, dentists and pharmacies?

[Karin Smyth]

As the hon. Gentleman knows, health and social care is a devolved issue. We will continue to work closely with all the devolved areas, because we think that that is important, unlike the last Labour Government—the last Conservative Government. [Laughter.] I slipped there—I almost got through.

We absolutely understand the precarious nature of general practice and, in particular, I understand the really serious issues around health and social care in Northern Ireland. The hon. Gentleman knows that, and he makes a good case for the sector. We want to ensure that it supports people in Northern Ireland with the good primary and community care they deserve.