Department of Health and Social Care

Layla Moran Excerpts

Wednesday 5th March 2025 Commons Chamber

[Sir Geoffrey Clifton-Brown (North Cotswolds) (Con)]

Thank you, Madam Deputy Speaker, for granting us the opportunity to debate this supplementary estimate, which provides an opportunity for all Members of this House to look at the Public Accounts Committee’s report on health and discuss how the money might be spent on different priorities.

As the Chair of the Public Accounts Committee, I am honoured to introduce the first estimates debate on the supplementary estimate of the Department of Health and Social Care. I made this application jointly with the hon. Member for Oxford West and Abingdon (Layla Moran), the Chair of the Health and Social Care Committee, and my right hon. Friend the Member for Salisbury (John Glen).

As Members of this House will know, the Public Accounts Committee is one of the oldest Committees of this House. It exists to protect taxpayers’ money and ensure that their pound is being used effectively. It goes back, I think, to about 1867. Unlike other Committees, we do not take evidence from Ministers; instead, we take evidence directly from permanent secretaries and the most senior civil servants and public sector officials. The National Audit Office provides us with audited accounts and value for money reports, and we produce reports of our own with recommendations to Government to which they must formally respond as part of the Treasury minute.

At this point, I pay tribute to Amanda Pritchard, who has recently announced that she will be stepping down as chief executive of NHS England this summer. She oversaw the NHS at a time when it was under so much pressure post pandemic, and I wish her well in her future endeavours. I also congratulate Chris Wormald on his promotion to Cabinet Secretary. These vacancies at the head of NHS England and the Cabinet Office provide an opportunity for completely fresh thinking within the NHS.

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

I echo the hon. Gentleman’s thanks to Amanda Pritchard for her time at the head of NHS England. While I also welcome the appointment of Dr Penny Dash as its new chair, the hon. Gentleman is right to say this is a really important moment in the future of the national health service.

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

We are proving that estimates are not dull, although they have a terrible reputation for being so. Everything comes from the money, and if we do not follow the money, we do our constituents a disservice. The Government have announced an incredibly welcome £22.6 billion increase in day-to-day spend on health and social care, in addition to the further £3 billion in capital expenditure. It sounds like, and is, a huge amount of money. The only thing bigger than the uplift will be the disappointment of our constituents if the money is not spent wisely and does not lead to the change that they desperately want and need.

I will start with an example. My constituent was referred to her GP for an NHS-funded assessment for autism spectrum disorder. She took tests, and exceeded the threshold in all of them, and was told that she would be put on a waiting list, with an expected wait of 16 years to 18 years—yes, years. She is 34 with young children, and will be waiting for an appointment until she is 51. That is clearly ridiculous.

We welcome the three shifts, the 10-year plan and the long-term thinking, which hopefully will end stories like the one that I just told; I know Members from across the House will have similar stories. I was interested to hear the Secretary of State choose technology as his top pick when I pressed him to pick a favourite priority at our Committee hearing on 18 December. In recent correspondence with the Committee, which is now online, the Department credited technology with a 0.7% productivity contribution this year alone. I am concerned, though, that we do not have much detail about how exactly technology will achieve that, and we will press the Department on that figure.

Prevention is also incredibly important, and it is always in danger of being overlooked. I assure the Minister—I know she is responsible for prevention—that if the Government do not pursue it, we will press them to, as will the electorate, I am sure, because is a no-brainer.

[Gregory Stafford]

If we want prevention, we have to invest in social care, but the Government are putting almost all the investment that the hon. Member talks about into the NHS, rather than social care. Surely there needs to be a rebalancing.

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[Layla Moran]

In our Committee hearing just this morning, we heard that all parts of the system want this. Acute care trusts recognise that they have the bulk of the investment, but they realise that unless they start pooling budgets and working in an integrated way, we will not achieve the productivity gains that we desperately need.

[Mike Martin (Tunbridge Wells) (LD)]

The Government’s policy is actually achieving the opposite for social care of what the hon. Member for Farnham and Bordon (Gregory Stafford) suggests. Peter runs a small domiciliary service in my constituency that is going bust. That means 35 people without a job, a loss of £100,000 in taxes every year, and all those patients now blocking beds in hospitals. Does my hon. Friend the Member for Oxford West and Abingdon (Layla Moran) agree that the Government’s policies are downgrading and trashing social care, rather than boosting it?

[Layla Moran]

I share my hon. Friend’s frustration that we are not doing more faster. Indeed, the first inquiry that our Committee has launched is on social care and the cost of inaction, because there is a cost to doing nothing, and we need to quantify that as best we can.

On the three shifts, the shift to the community is incredibly important, not least because successive Secretaries of State have said that they want that shift, yet the money has flowed in the opposite direction.

[Steff Aquarone (North Norfolk) (LD)]

In Cromer in my constituency, about 18 months ago, the Conservative-controlled county council closed down Benjamin Court reablement centre. That is exactly the sort of facility that we need to help bridge the gap between acute hospitals and community and primary care. Does my hon. Friend agree that we must work to reopen those facilities, which do not stand a chance until there is proper integration of NHS budgets and the budgets of adult social care providers?

[Layla Moran]

We should be celebrating examples of where this works well, not shutting them down.

In Oxford, the Hospital at Home programme, run by Oxford University hospital ambulatory team, does incredible work. I visited 91-years-young Mavis the other day, who was receiving top-notch ultrasounds in her home—ultrasounds of better quality than those that she would have got in the hospital. That saves hundreds of pounds for the NHS and means no long trip for her and her family. That is definitely something that we should do more of.

Let me turn to the estimates, because they are why we are here. The supplementary estimates have been published. I will not hit anyone over the head with them—they are incredibly heavy. They are worth a read. They talk about a £198.5 billion day-to-day spending budget. At face value, that is an increase of £10.9 billion on the estimate from July, but £9.2 billion is for staff pay increases. Let us be clear: staff deserve that pay rise. It is long overdue. Retention and mental health are important, and we must invest in our workforce, but that does leave just £1.7 billion.

[Jen Craft]

Will the hon. Member give way?

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[Layla Moran]

I will make progress, if I may, because the clock is ticking down. As for that £1.7 billion, once we add in national insurance contribution increases and inflationary costs, the NHS has had to ask for an additional £812 million on top, so it is already running a little behind. Next year, the increase is due to be £10.6 billion, but as the Committee heard in a hearing, the expected pressures are £11.7 billion. We can all do the maths. There is a problem. The way it will get solved, at least on paper, is through an enormous 4% productivity increase, combined with cost reduction. We need more detail about how exactly that will be done.

I echo the point made by my fellow Committee member, the hon. Member for Uxbridge and South Ruislip (Danny Beales), about capital expenditure. In these estimates, we see that there has already been a decrease in capital spend of £1 billion from the 2024-25 main estimate. It is explained away as a transfer to day-to-day spending, due to a reclassification of spending on technology and new hospitals as day-to-day spending. I do not know how others feel, but that does not sound quite right to me. I am concerned that the Government are falling into the same trap as previous Governments—perhaps understandably, because they have to pay for the day-to-day somehow. The Government gave an assurance to the Public Accounts Committee that they would stop making those sorts of changes. Is that still the case?

Finally, I want to do more of this; I want to undertake more scrutiny of the estimates, but it is quite hard to do, because there is a lack of detail. For example, in the document, £120 billion comes under the sub-heading, “NHS providers”, and there is absolutely no detail under that. Will the Minister commit to working with the Committee and the House of Commons scrutiny unit to provide Parliament with a meaningful breakdown, so we can have more wonderful debates just like these?

[Several hon. Members rose—]

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[Ben Coleman]

Will my hon. Friend give way?

[Layla Moran]

Will the Minister give way?

[Ashley Dalton]

I will give way very briefly.

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[Layla Moran]

The Minister will have noted, on page 53 of the estimates, a £1 billion decrease in capital spending in the departmental accounts. Will that be explained, and can the Minister explain now how new hospitals constitute day-to-day spending?

[Ashley Dalton]

I will be coming to that, but I thank the hon. Lady for raising it.

We have talked about productivity, an issue that has been raised by many Members including the Chair of the Public Accounts Committee. I am delighted that Members on both sides of the House, including Conservative Members, have now recognised and accepted the value of the Darzi report, which this Government commissioned.

We are committed to meeting a 2% productivity target by 2025-26. To help us to achieve that, there is a £2 billion investment in NHS technology, allocated to freeing up staff time, ensuring that trusts adopt electronic patient records—we have heard a great deal about old-fashioned paper today—and enhancing cyber-security measures, while also improving patient access to services via the NHS. The current measures of health productivity data do not capture all the outputs and outcomes adequately, and NHS England is working with the Office for National Statistics and the University of York to refine those metrics. Reform is at the heart of our 10-year plan.

We are rebuilding our capital-starved NHS through £1.6 billion of national capital funding in 2025-26, which will help us to achieve constitutional standards. The money will help to deliver more than 30,000 additional procedures and more than 1.25 million diagnostic tests as they come online through investment in new surgical hubs and diagnostic scanners, new beds across the estate, and a £70 million investment in new radiotherapy machines to improve cancer treatment. Questions have been asked about the shift from capital to revenue. Some of investment has met historic need, including capital funding for technology and new hospitals programmes, but because of the nature of the funding it needed to be defined as revenue. It is still being spent on those programmes. The autumn Budget included a commitment to ban shifting from capital to revenue, and I can confirm that no shifts of that nature have taken place since then. I will now give way.