National Insurance Contributions: Healthcare
Debate between Karin Smyth and Luke Evans(1 week ago)
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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.
Access to Primary Healthcare
Debate between Karin Smyth and Luke Evans(1 month ago)
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Karin Smyth
I am tempted, but I know that many of the hon. Lady’s colleagues want to speak, and I am sure she is on the list.
Fixing the NHS will take years of discipline and hard work, and we are in this for the long haul. However, we must first clean up the mess we inherited, and that work has begun in earnest. We have found the funding to recruit an extra 1,000 GPs this year as our first step towards fixing the NHS’s front door and making the system more flexible.
Dr Evans
One of the keys to delivery is the GP partnership model, which is the mechanism by which they are set up. The Secretary of State, who is now in his place, said in 2023 that he wanted to phase out the GP partnership model, although he later reneged on that position. It would be interesting to hear what the Government now perceive to be the best model for delivering primary care, as that is really important for GP partners.
Karin Smyth
I wish the hon. Gentleman well with his own access to a GP at the moment. We are committed to working with the profession on the best way to organise primary care. The critical point is that primary care, however it is organised in neighbourhoods, is there for our constituents when they need it. It is not there now. The model is not working and has not worked over a period of time. It has merits, as we have said, and we are continuing to talk to people. I have worked in the sector for a number of years, so I understand the point the hon. Gentleman makes.
Assisted Dying Law
Debate between Karin Smyth and Luke Evans(4 years, 10 months ago)
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Karin Smyth (Bristol South) (Lab)
I am grateful for the chance to speak in this debate. I do so not only as the Member for Bristol South, but as chair of the all-party parliamentary group for choice at the end of life.
I want to pick up the discussion where we left it at the end of the last Parliament. We were hoping for a call for evidence and to have some discussion with the Government on that. The Government said that they would continue the debate but were not currently persuaded. We can indeed debate, but ultimately only the Government can make a call for evidence; only the Government have the power to gather evidence. Only this Government can show their own compassion and demonstrate to the people of this country that compassion is not a crime.
I was privileged last year to welcome Geoffrey and Ann Whaley to the House to talk about their experiences. I do not have time today to repeat their stories, but people like Ann Whaley and Adam and Kate Wellesley are still being investigated by the police. They dreaded that knock on the door, which did come. Police officers are required to intrude on a family in the last days and weeks before the loss of their loved ones. I therefore welcome the debate that is now happening within policing. It was surfaced by Ron Hogg, a police and crime commissioner, and many police and crime commissioners are now also asking for a review of the evidence. Ron sadly died in December, but that was a powerful call about how the law is currently impacting on policing.
The current law does not offer protection. Assisted deaths are very rarely investigated. Illegal and unregulated voluntary euthanasia happens now. Current end-of-life practice is, if anything, less safeguarded than assisted dying and it is just as ethically challenging. Who decides whether someone should be sedated until death? How do doctors check that someone is not being coerced into refusing treatment? Is it right to support someone to starve and dehydrate themselves to death? I do not think so. If assisted dying laws are not proven to work, why are more and more being introduced rather than the existing ones being overturned?
My own interest in this area came from my time working in the NHS with clinicians talking to people about how to live and die. I found that it is often no one’s job to talk to people about dying, and it is very lonely for those people. Despite the care from the NHS and our brilliant hospices, 17 people a day—
Dr Luke Evans (Bosworth) (Con)
I thank the hon. Lady for giving way; I appreciate that time is short. It is interesting that we are in a place that deals with finalities—death and taxes—yet we never have a wider debate about what death is. As a GP, I speak to people all the time, and it is very difficult to raise the subject of death. Fundamentally, as a society, we need to be talking about what death actually is, because it is inevitable. That inevitability means that we have to answer some of these questions. Does the hon. Lady agree with me that that may well be the best place to start to move the discussion on?
Karin Smyth
I wholeheartedly agree and am grateful for that intervention from a clinical perspective, because what the hon. Gentleman describes is also my experience. Around the world, the current law does not protect the doctor-patient relationship and people are not having those honest conversations. The law does not allow the doctor to really talk to people about end-of-life choices, because people are frightened that their intention to perhaps go to Switzerland will result in someone being fearful of breaking the law.
I am not sure what the Government’s response will be today. I hope that the Minister can respond with compassion for people who are desperate for some recognition of the way the current law is not working. We cannot keep ignoring that. Asking families to retell their stories only perpetuates the trauma that they are going through. Families will keep coming forward, and their experiences are shocking—heartbreaking. For me, representing the constituency of Bristol South, the fact that only people who have between £10,000 and £15,000 spare can access safe care—in Switzerland—is equally shocking.
Is the law working now? No, it is not. Are people safer now? No, they are not. I am disappointed not to have more time to go into why that is the case. That is why, beyond the debate today, we need a review of the current law and how it is working. People need to have time to review the law. It is not working for families at the moment, and I hope that the Government will meet me and others who would like to discuss how a review might work in practice.