NHS Pensions
Layla Moran Excerpts(1 day, 18 hours ago)
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Madam Deputy Speaker (Caroline Nokes)
I call the Chair of the Health and Social Care Committee.
Layla Moran (Oxford West and Abingdon) (LD)
I have to say that I am none the wiser about what exactly has happened. If we are to ensure that this will not happen again—that these deadlines will be met—we need to know how we got into this position. It may well be the fault of the previous Government. Will this Government commit to a full review of exactly how we got here, so that we can ensure that the published deadlines are met this time?
Karin Smyth
The Chair of the Health and Social Care Committee makes a good point, as she so often does, about what went on previously. This is an issue from the McCloud judgment that runs across many Departments. It was a problem under previous Governments, starting with the coalition Government. I know that the Public Accounts Committee, on which I served, and the Treasury Committee have looked at the matter over time. The Department will certainly co-operate with any inquiry and investigate what happened across Government. I am happy to get back to the hon. Lady on that point.
NHS England Update
Layla Moran Excerpts(2 weeks, 6 days ago)
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Madam Deputy Speaker
I call the Chair of the Health and Social Care Committee.
Layla Moran (Oxford West and Abingdon) (LD)
This is a bold change indeed. The job of my Committee is to help the Secretary of State to do it, so let me start by asking him to come in front of the Committee as quickly as possible—certainly before Easter—because there is a lot of detail that we need to drill down into.
On a more substantive point, the right hon. Member mentioned the financial reset that Sir Jim Mackey announced to integrated care boards just yesterday, which means that they need to cut their running costs by 50%. I am concerned that when my Buckinghamshire, Oxfordshire and Berkshire West ICB struggled with money, the first thing it cut were the place-based teams. If we are to deliver the neighbourhood NHS that the Secretary of State and I both want, those are not the teams to cut. Will he send a signal to ICBs that cost savings should not be at the expense of the broader shifts in the 10-year plan?
Wes Streeting
First, I give the Chair of the Select Committee my assurance that I would be delighted to appear in front of her Committee at the earliest opportunity —that means soon. I appreciate that it will want to scrutinise these changes in more detail, and I would welcome the constructive challenge that it offers. I also reassure her that the direction that we are giving to frontline leaders is to deliver the three big shifts in our 10-year plan, and to ensure that as we take immediate steps to bring the finances under control, we do so in a way that lays the firm foundations for the future of the NHS that we need to build.
My cautionary note to Members across the House is that when we ask frontline leaders to reform and to change ways of working, sometimes that requires not just changes to the bureaucracy as it were—the easier and lower hanging fruit—but service reconfiguration in the interests of patient outcomes and better use of taxpayers’ money. Sometimes, they get those changes wrong. I have successfully campaigned against closures of services such as the King George accident and emergency department, which should not have closed and where we won the case on clinical grounds.
Sometimes, let us be honest, the public can get anxious, and Members of Parliament feel duty bound to act as megaphones and amplifiers for public concerns. It is important that we support and engage with local NHS leaders. By all means, we should scrutinise, challenge and ask questions, but we must give local leaders the support to do the task that we are asking of them on behalf of patients and taxpayers. The powers that I have to intervene in those frontline service reconfigurations are ones that I will use only in the most exceptional and necessary cases, and that is why I have not used them once in the past eight months.
Department of Health and Social Care
Layla Moran Excerpts(4 weeks ago)
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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.
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.
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.
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—
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.
Oral Answers to Questions
Layla Moran Excerpts(1 month, 3 weeks ago)
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Layla Moran (Oxford West and Abingdon) (LD)
I welcome the Under-Secretary of State for Health and Social Care, the hon. Member for West Lancashire (Ashley Dalton), to her place. I look forward to working with her, as I do with other Ministers.
As the Minister for Care will know, 20% of the burden on the NHS is due to mental health, yet only 10% of the budget is allocated towards it. The mental health investment standard has been a welcome maintenance under this Government. However, the Select Committee heard from Amanda Pritchard the other day that the standard is guaranteed for only the next two years. Does the Minister agree that the standard has had a positive effect on mental health community services, and would he commit to protecting it?
Stephen Kinnock
The Chair of the Committee will have seen that we have made an explicit commitment to the mental health investment standard—we are absolutely committed to that. In addition, we have to drive reform in the system so that it is about not just the amount of investment going in, but how we ensure that it is working properly. I am absolutely confident that the commitment to 8,500 new specialists, the Young Futures hubs and having a mental health specialist in every school will facilitate the delivery of services in a far more effective way than is currently the case.
Health and Social Care: Winter Update
Layla Moran Excerpts(2 months, 2 weeks ago)
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Madam Deputy Speaker (Judith Cummins)
I call the Chair of the Health and Social Care Committee.
Layla Moran (Oxford West and Abingdon) (LD)
May I press the Secretary of State on that data point? It is not just the Liberal Democrats making these representations; the Royal College of Nursing, the Royal College of Physicians, the Royal College of Emergency Medicine, HealthWatch, the British Medical Association, Age UK and many others also want the data. This matters, because the situation causes moral injury to staff and compromises patient safety—and the problem is not just corridor care; it encroaches on to other wards. Will the Secretary of State commit to releasing that data before the NHS England board meeting on 4 February? In addition, what assessment has he made of the impact of this winter on less urgent care, and on elective waiting lists?
Wes Streeting
I am grateful to the Chair of the Select Committee for her questions. I cannot give her a commitment to publish those statistics ahead of the next NHS England board, but I can give her an undertaking to go away and look carefully at the rhythm and pace at which we publish performance data, to make sure that we are being as transparent as we can, as fast as we can. That, I think, should be the principle that underpins our approach to the publication of data. She is right to talk about wider system pressures as a result of what we see in emergency departments. We will wait to review the performance of the NHS overall until we exit winter. I think we have seen some effective protection of elective activity throughout this winter, but that will of course vary from provider to provider.
The hon. Member mentioned a whole number of organisations calling for more data transparency. I, too, welcome the very public representations that we have heard from the Royal College of Emergency Medicine and others about the need to tackle corridor care. Let me assure her and all those who have made representations that we are absolutely determined to turn this situation around, and not just improve the performance of urgent and emergency care, but get a better system working. Ultimately, it is through ensuring better patient flows, and ensuring that people get the right care in the right place at the right time, that we will finally get this country out of the cycle, created by our Conservative predecessors, of winter crises.
Oral Answers to Questions
Layla Moran Excerpts(2 months, 3 weeks ago)
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Layla Moran (Oxford West and Abingdon) (LD)
Following the theme raised by my hon. Friend and neighbour, the hon. Member for Bicester and Woodstock (Calum Miller), may I make a plea for Summertown health centre? They are my doctors, by the way, so I declare an interest. They operate in an old Victorian building and are desperate to move to new premises. That health centre was at the top of the priority list, but the ICB says that there is no money, and the doctors say that there is no pot that they can bid into in order to get this seen to. Will the Secretary of State meet me as well? Clearly, £102 million spread across 50 projects in the country is not going to be sufficient. Can we get creative about how we can get new premises built for Summertown health centre?
Wes Streeting
Of course I will meet the hon. Lady. It would be daft of me to say no to the Chair of the Select Committee; otherwise, she will see me in less pleasant circumstances. In all seriousness, we are looking creatively at this issue. There are enormous capital pressures right across the NHS estate. We are regularly lobbied on new hospitals, for example, but we are also lobbied on general practice, the mental health estate and the rest. We will do as much as we can as fast as we can, thinking creatively about how we can get more capital investment in, and I would be happy to discuss that further with the hon. Lady.
Health and Adult Social Care Reform
Layla Moran Excerpts(2 months, 3 weeks ago)
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Layla Moran (Oxford West and Abingdon) (LD)
Given that the Health and Social Care Committee’s first inquiry is “Adult social care reform: the cost of inaction”, we welcome any action. As the name of the inquiry suggests, we are concerned about the length of time taken, because every year without reform costs money, not only to the NHS, but to the wider economy and in people’s lives. We have Andrew Dilnot in front of us on Wednesday, and it is 14 years since his report, which has been put into legislation twice. I ask the Secretary of State to be specific: what will stop the next iteration of the Committee having Louise Casey in front of it in 15 years’ time? What will be different this time, so that we get that cross-party consensus and it sticks?
Wes Streeting
That is a great question. First, I will put on my shin pads and crash helmet if Andrew Dilnot is in front of the hon. Lady’s Select Committee this week. I can well understand his frustration. He is a decent man who did an excellent piece of work. It must be frustrating to see one Government after the next not implementing something that was welcomed. The issue for us as an incoming Government is that the money was not there, and even if it had been, the system had not been set up to deliver for the October 2025 deadline. We chose to act on other immediate pressures in other areas, because we saw those needs as more pressing. That does not mean for a moment that I think Andrew Dilnot’s work is no longer valuable—I think it might well be. However, we have to consider the issues in the round and come up with a clear and sustainable plan that we can stick to.
On why the Casey commission will be different and will work, it is important to have as much political consensus around the House as possible. The national consensus and getting the public on board will be important. Anyone who has ever met Louise Casey will know she is a difficult woman to say no to. I have no doubt that if Louise Casey says something needs to be done, this Government and future Governments—whoever is in government—will make sure that it happens.
Winter Preparedness
Layla Moran Excerpts(3 months, 2 weeks ago)
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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.
Tobacco and Vapes Bill
Layla Moran ExcerptsTuesday 26th November 2024
(4 months, 1 week ago)
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Wes Streeting
My hon. Friend is absolutely right. I am really proud of the impact that the last Labour Government made in reducing smoking harms and the prevalence of smoking in our country.
That brings me on to the next point that I wanted to make. President Truman famously said that it is amazing what you can accomplish
“if you do not care who gets the credit.”
When I first sat down with Rachel Sylvester of The Times in January 2023 and flew a kite to start a debate that a Labour Government might introduce a ban on children and young people today ever buying cigarettes, of the type introduced by our sister party in New Zealand, I was not necessarily convinced my own side would buy it, but I thought it was a debate worth having. I never imagined, in a million years, that I would tune into a Conservative party conference speech by a Conservative Prime Minister announcing his intention to legislate for such a ban. I will do something I do not often do with Conservative party conference speeches and quote extensively—and approvingly—what the then Prime Minister said.
“As Prime Minister I have an obligation to do what I think is the right thing for our country in the long term. And as Conservatives, we have never shirked that responsibility.”
I say that bit through gritted teeth.
“We have always been at the front of society, leading it—”
Who wrote this?
“And when we have the tools at our disposal…to do for our children what we all, in our heart of hearts, know is right, we must act, we must lead…we must put the next generation first.”
In that spirit, I pay tribute to the former Prime Minister, the right hon. Member for Richmond and Northallerton (Rishi Sunak), for picking up the proposal and running with it despite opposition from his own party. That took courage. While we have taken steps to improve this Bill compared with the one put forward by the previous Government, I hope that hon. and right hon. Members on the Conservative Benches will follow his lead, showing that the one nation tradition still has a constituency in the modern Conservative party, and vote for this Bill in the national interest.
The Darzi investigation into the NHS set out the twin challenges facing me, my Department and this Government. The national health service is broken; it is going through the worst crisis in its history. At the point we came into office, waiting lists stood at 7.6 million. We had worse cancer survival rates than most comparable countries, ambulances not arriving on time, the number of GPs falling and dentistry deserts across the country.
Some of the most shocking findings in Lord Darzi’s report, however, were about not the sickness in our NHS, but the sickness in our nation. Children are less healthy today than they were a decade ago. Life expectancy was extended by three and a half years over the course of the last Labour Government, but in the past 14 years, it has grown by just four months. Brits now live shorter lives than people in any other country in western Europe, and we spend fewer years living in good health, becoming sicker sooner. Those are huge costs, borne by all of us as individuals. It means less time in which we are able to live our lives to the full, to do all the things we love and to spend time with the people we love. Sickness is forcing many of us out of work long before retirement age, leaving us dependent on welfare, ridding us of the purpose and belonging that work provides, and for everyone else, it means higher costs to us as taxpayers. Our sick society is holding back our economy, and that is why we should act.
Wes Streeting
I give way to the Chair of the Health and Social Care Committee.
Layla Moran
In the spirit of cross-party working, I want to congratulate Members on the Conservative Benches for deciding, when the former Prime Minister put this policy forward, that it was a priority. It shows how important it is that No. 10 gets behind this kind of thing, and I hope we learn that lesson for the Government’s missions.
I gently say, however, that it is not just the evil tobacco lobby that has concerns about the age escalator. I completely agree with everything that the Secretary of State says, but if smoking is that much of an issue, why are we not just banning it for those under an age of, say, 25? That would have been another way to go. What is the thinking behind an age escalator, as opposed to a ban for those under a particular age so that people do not need new ID every time?
Wes Streeting
I recognise that there are people who have the freedom and the liberty to smoke today, the vast majority of whom, by the way, want to stop and struggle to do so. That is why we are announcing support to enable people to do that, with £70 million of investment in smoking cessation services. That is important, but for a future where people are no longer able to smoke, a phased approach is the right thing to do. It is also essential for the health of the individual, the nation and our economy.
Since 2018, our productivity has dropped by £25 billion due to worsening health alone. Some 900,000 more people are off work than would have been on pre-pandemic trends. That is more people than are employed by Tesco, Sainsbury’s and Asda put together. Smoking alone accounts for more than £18 billion in lost productivity. The rising tide of ill health, coupled with our ageing society, presents an existential challenge to our health service. If we do not act now, ever-increasing demands for healthcare threaten to overwhelm and bankrupt the NHS. That is the choice that we face.
Oral Answers to Questions
Layla Moran Excerpts(4 months, 2 weeks ago)
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Layla Moran (Oxford West and Abingdon) (LD)
Last week, I visited Summertown health centre. Staff there implored me to say to the Government that the issue is not just more money—we welcome the £100 million that has been allocated for capital investment in primary care—but the snarled-up process at integrated care board level and getting investment to the right places quickly. What will the Secretary of State’s Government do to ensure ICBs deliver that money to where it is needed, and fast?
Wes Streeting
The Chair of the Health and Social Care Committee is right that investment is vital, but so is reform. We tasked ICBs with leading the development of the new neighbourhood health service. We are removing their responsibility for performance management of trusts in order to free up their focus, so that primary and community services have the attention that is desperately needed. In the coming weeks, we will be talking to the British Medical Association and the Royal College of General Practitioners about how we ensure the investment announced by the Chancellor leads to improved patient care and a reformed neighbourhood health service.