Building an NHS Fit for the Future

Liz Kendall Excerpts

Monday 13th November 2023 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

It is a real pleasure to close this important debate and to follow my hon. Friends the Members for North Tyneside (Mary Glindon) and for City of Durham (Mary Kelly Foy) who spoke powerfully about the need to take more action to help people quit smoking and not take up smoking in the first place. As a former smoker myself, I wish to goodness that I had never ever taken it up, and I can reassure Members that a Labour Government would do everything within our power to take further action in this area.

My right hon. Friends the Members for North Durham (Mr Jones) and for Walsall South (Valerie Vaz), and my hon. Friends the Members for Tooting (Dr Allin-Khan) and for Putney (Fleur Anderson) rightly held the Government to account for once again failing to bring forward legislation to reform the Mental Health Act 2007, despite all the serious problems that need addressing, all the promises that have already been made and the cross-party agreement that there is on the need to act.

My hon. Friends the Members for Blaydon (Liz Twist) and for Liverpool, Wavertree (Paula Barker) talked about the importance of reforming social care—another area where promises have repeatedly been made and repeatedly been broken—and the real importance of giving older and disabled people more support in the community, rather than their ending up in hospital, which is worse for them and worse for taxpayers.

My hon. Friends the Members for Ellesmere Port and Neston (Justin Madders) and for Ealing North (James Murray) rightly talked about the desperate need to build more affordable housing, including social housing, to tackle problems in the private rented sector, and to reform leasehold. Those are huge issues in my constituency. My hon. Friend the Member for Nottingham South (Lilian Greenwood) talked about the terrible problems of people waiting in huge pain and distress in ambulances or on trolleys in A&E, and many hon. Members talked about the need to improve GP access and dentistry care.

Last but by no means least was my hon. Friend the Member for Luton South (Rachel Hopkins), who talked about the fantastic work her council is doing to tackle health inequalities, and the need to understand that a good job is part of a healthy life, and good health is vital to getting a job.

The point that I wish to make today is that the health of our nation is critical to the health of our economy and that, after 13 years of the Conservatives, both are in a perilous state. There was nothing in the King’s Speech to address these problems or meet the scale of the challenge we face. But Labour has a plan: to improve the health of the nation; to get Britain working again; and to give our country its future back.

Ministers repeatedly attempt to claim that everything in the garden is rosy when it comes to the state of our economy and to employment, but the truth is that we are the only country in the G7 with an employment rate that still has not returned to pre-pandemic levels. The underlying reason for that is the increasing number of people out of work due to long-term sickness. Some 2.6 million people are now shut out of the labour market due to ill health, which is the highest number ever. Frankly, that is a scandal in what is still, despite all our problems, one of the richest countries in the world. Around half of this group are more than 50 years old—that is more than double that of any other age group—and musculoskeletal problems, such as bad hips, knees, backs and other joints, are the most common problem.

Many of the over-50s are also caring for elderly, sick or disabled loved ones, for which there is precious little help and support. Women are consistently more likely to be workless due to long-term sickness than men. Indeed, women account for more than two thirds of the increase that we have seen over the past decade. But the rise in worklessness due to long-term sickness is not just an issue for older people; there has been a sharp and hugely worrying increase in the number of young people not working due to ill health, predominantly driven by mental health problems—an issue that many of my colleagues have raised. The number of 18 to 24-year-olds who are workless due to ill health has doubled in the last decade, while the number of 24 to 35-year-olds has almost trebled. Those problems are even more likely for young people who lack basic qualifications and who live in parts of the country that are struggling economically, often outside our big cities in towns and rural and coastal areas.

The fact that such problems are more likely to affect certain parts of the country in the midlands and the north comes as no surprise to Opposition Members. In Conservative Britain, people are twice as likely to be out of work due to ill health if they live in one of the most deprived areas in England than if they live in the least deprived areas, with rates of economic inactivity due to long-term sickness in the north-east and midlands almost double that of London and the south-east.

That really matters to families, to our economy and to wider society. Being shut out of work because of poor health is terrible for individuals, especially during a cost of living crisis. It is bad for businesses, which need to draw on the skills and talents of all our population if they are to grow, expand and thrive. It is also bad for taxpayers, who are now paying an extra £15.7 billion a year in lost tax revenues and higher benefits bills, compared with before the pandemic. The Office for Budget Responsibility says that the rise in health-related economic inactivity poses a significant risk to our fiscal sustainability, because it reduces our prospects for growth, reduces tax receipts and puts ever-increasing pressure on health and welfare spending.

Yet despite all that, we have not seen a plan from Conservative Members that is anywhere near serious enough to get Britain working again. No doubt, when he rises to speak, the Secretary of State for Work and Pensions will tell us about work coaches and health MOTs for the over-50s. I am not against those measures—I support them; I have met work coaches in my own jobcentre, and I know how hard they are working to try to support people back into work—but they are nowhere near big or fundamental enough to get to grips with the root causes of worklessness, or to reform the way the system runs.

Britain deserves so much better, and that is what Labour will deliver. Our top priority will be to ensure that everyone who can work does work. We believe that the benefits of work go beyond a payslip to the dignity and self-respect that good work bring. We will tear down the barriers to success, tackle the root causes of worklessness and get Britain working again.

Our long-term plan for the NHS will invest an extra £1.1 billion a year, paid for by abolishing the non-dom tax status to provide 2 million more appointments a year and clear the NHS backlog—[Interruption.] The hon. Member for North West Norfolk (James Wild) laughs, but I say to him: if you were a woman stuck on a waiting list, waiting for help and treatment for your hips, for your knees, for your back, you would not be laughing. We will recruit 8,500 more mental health staff, with support in every school and every community to tackle mental health problems in young people early on.

But that is not all. We will transform jobcentres so that they provide personalised help and support, work in genuine partnership with local employers and services, and help people not just to get work, but to get on in their work, with all the benefits that progression from low pay brings. That is an issue that the Government’s own review said they needed to tackle, but they have completely failed to act on it.

[Richard Fuller]

For a shadow spokesperson, the hon. Lady is making some good points, but she has just raised the interaction of the non-dom status and the health service. As she will be aware, the General Medical Council said today how important it was that we continue to attract doctors from overseas, but many would be impacted by a change in the non-dom status. How will Labour’s policy affect our ability to recruit people from overseas for our health service?

[Liz Kendall]

I have spoken to many doctors who come to work in the hospitals in my constituency—

[Mohammad Yasin]

And Bedford.

[Liz Kendall]

—and in many other parts of the country, and they want to come, work and support the work that we do. We have looked at all those issues and taken them into account, and made a small-c conservative estimate of the impact that it would have. We are confident that that will provide the resources we need to get the backlog down and get Britain working again.

We will overhaul skills with new technical excellence colleges and by reforming apprenticeships, so that no one is ever written off again, whatever their age. We will devolve employment support to local areas to better meet local needs, because the man—or even woman—in Whitehall can never know what is really needed in Leicester, Liverpool or Leeds. We will grow our economy in every part of the country by getting Britain building, through our plans to make Britain a clean energy superpower, and by ensuring that we are the best place to start up and grow a business.

Those are the long-term changes that our country needs. In contrast, the King’s Speech just tinkered at the edges or ignored those problems all together. And what have we seen today? The latest round of chaos, confusion and division in the Conservative party—a party so concerned about its own future that it cannot focus on the future of the country, proving once more than it can never be the change from 13 years of its own failure—and a weak Prime Minister, finally forced to sack his Home Secretary, and to bring back a former Prime Minister he accused only weeks ago of being part of a failed status quo, in a desperate attempt to save his own neck. The people of this country deserve better. They want change. It is time for an election so Labour can give Britain its future back.

--- Later in debate ---

[Mel Stride]

I have just set out for the right hon. Gentleman two very significant actions that this Government have taken: £2 billion of additional funding compared with just four years ago, and a staff increase of some 20% since 2010.

I have to pick up on the non-doms point, because we hear it so often from the Opposition. Those poor old non-doms are going to be paying for the entire British economy over and over again. They pay UK taxes on their UK income, and it is just not realistic to expect to be gaining more tax in the longer term as a result of taxing them.

We have heard much about waits for NHS services. We have been working very hard on that issue, and it has to be recognised that we have had a pandemic, as well as a considerable amount of industrial action. Frankly, if the Opposition had done more with their trade union paymasters to encourage them to go back to work, we would have had smaller backlogs than we do at the moment. We have already largely eradicated the 18-month waits; the two-year waits have already been abolished; and we are rolling out all sorts of approaches to make sure we have more provision going forward, including 140 new surgical hubs. When Labour tells us about their plans, we need only to look at Wales, where we can see the results of Labour’s stewardship of the health service: on average, waiting times in Wales are five weeks longer than in England.

The hon. Member for Leicester West spent some time discussing employment, an area in which we have a first-class record. Economic inactivity, which she raised, is almost 300,000 lower than it was at its peak during the pandemic: it is below the average level of the OECD and the average level across the European Union. Unemployment is at a near-historic low, the number of those in payroll employment is at a near-historic high, and youth unemployment is down 44% on 2010. What happened under the Labour party? As Opposition Members know, it went up by almost exactly the same amount—another 44%. Labour is the party of unemployment; it has never left office with unemployment anything other than higher than when it came in. Under Labour’s stewardship, 1.4 million people were languishing on long-term benefits for over a decade, and that is a disgrace.

[Liz Kendall]

The Office for Budget Responsibility has said that

“A sustained rise in health-related inactivity poses a significant risk to fiscal sustainability by reducing the UK’s medium-term economic growth prospects and tax receipts”.

Does the Secretary of State disagree with the OBR?

[Mel Stride]

I do not, inasmuch as I recognise that long-term sick and disability has been on a rising trend for at least five years now. The hon. Lady knows that, but that is not the point that I was making; neither was it the point that she was making when she referred to the figures on economic inactivity.

That brings me to what this Government are doing. In the previous Budget, the Chancellor set forth plans for £2 billion to go towards resolving issues around long-term sickness and disability. We have consulted on occupational health across businesses to get upstream of this issue. The hon. Lady will know of our White Paper and the structural reforms that will make sure that, for the 2.5 million people on long-term sickness and disability benefits, we always focus on what those people can do, not on what they cannot do. The universal support we are rolling out is there to place people into work and give them a whole year’s worth of support, so we can make sure that those people stay in work. She will be aware of the pilots that we are now rolling out under the Work Well banner, which are there to bring people together with work. We believe that is one of the answers to mental health issues alongside medical support. Of course, we have just concluded our work capability assessment consultation, in which we are looking at how we can further help those people who can and want to work to go into employment, because we believe that that, ultimately, is in the best interests not just of the economy and of society, but very much of those people themselves.

This Government are not afraid to take long-term decisions in the national interest. The next generation of welfare reforms that I am bringing forward are part of this Government’s mission to deliver a better future for everyone across the country. It is a future that brings together employment support and healthcare to help disabled people and those with health conditions to realise their full potential. It is a future in which, thanks to the decisions we are now taking, the NHS can deliver better care in a changing world. It is a future that sees the first smoke-free generation become a reality, a future in which the most vulnerable in society continue to be the Government’s priority and are protected, and a future where work grows our economy, but perhaps more importantly still, changes lives, with thousands more people enjoying all the financial, social and health benefits that employment brings.

Ordered, That the debate be now adjourned.—(Mr Mohindra.)

Debate to be resumed tomorrow.

NHS Long-term Workforce Plan

Liz Kendall Excerpts

Monday 3rd July 2023 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I thank the Health Secretary for advance sight of his statement. I say “statement”, but what I really mean is “admission”—an admission that, after 13 long years, the Conservatives have run out of road, run out of ideas, and turned to Labour to clear up the mess that they have made. Make no mistake: at its heart, this is Labour’s workforce plan. It is a plan that we have called for since last September; a plan that we have begged the Government to adopt again and again. They say that imitation is sincerest form of flattery, and I, for one, am relieved that the Government have finally seen sense, but the question that the Health Secretary and Conservative Members need to answer today is: what on earth took them so long?

This week, the NHS celebrates its 75th anniversary as it faces the biggest crisis in its history—a crisis that has been building for years under this Government: a staff shortage of 154,000, 7.4 million patients stuck waiting for treatment, people across the country finding it virtually impossible to see a GP, and families desperately worried that if they need an emergency ambulance, it just will not arrive on time. Ministers constantly blame covid for those problems, but the truth is that waiting list numbers were rising and staff shortages increasing long before the pandemic struck.

Patients now want to know when they will finally see a difference. Can the Health Secretary confirm that, under his proposals, the NHS will not have the staff that it needs for at least eight years? Does he now regret the cut in medical school places that his Government brought in in 2013? Does he regret the decision taken last summer to cut the number of medical school places by 3,000 just when the NHS needed them most?

The Health Secretary claims that this is the first long-term NHS workforce plan, but let me set the record straight. In 2000, the last Labour Government produced a 10-year plan of investment and reform—a plan that delivered not only 44,000 more doctors and 75,000 more nurses, but the lowest-ever waiting times and the highest-ever patient satisfaction in the history of the NHS. That was a golden inheritance that Conservative Members can only dream of and that they have squandered through a decade of inaction and incompetence.

Let me turn briefly to what is missing from the proposals. Without a serious strategy to keep staff working in the NHS, Ministers will be forever running to catch up with themselves. Yet the Secretary of State has completely failed to put forward a proper plan to end the crippling strikes that are having such a huge impact on patient care. Six hundred and fifty thousand operations and appointments have been cancelled because of industrial action. Next week, junior doctors will walk out for five days, followed by two days of consultants’ strikes. After seven months of disruption, can the Health Secretary tell us when he and the Prime Minister will finally do their job, sit down and negotiate with staff, and bring an end to this Tory chaos?

The one part of Labour’s workforce plan that Ministers have not stolen is our plan to fund it by scrapping the non-dom tax status. In fact, when the Health Secretary was touring the media studios yesterday, he was asked nine times how he was going to pay for the plan and he completely failed to answer. He has had a little more time to prepare, so I am going to try again. Will he fund it through higher taxes, when we already have the highest tax burden for 70 years, or will he fund it through higher borrowing, when our nation’s debt is at record levels? Labour will introduce plans only when we can show how they will be paid for, because that is what taxpayers deserve. It is high time that Conservatives did the same.

From the windfall tax to help for mortgage holders to a proper plan for the NHS workforce, where Labour leads, the Conservatives only follow. This tired, discredited Government have had their day. The public know that it is time for change, and in their hearts Government Members too know that it is time for change. It is time for them to move aside and let Labour finally deliver.

[Steve Barclay]

Well, that really was a confused response. The hon. Lady began with reference to Labour’s proposals and the claim that our plan followed them. I took the precaution of bringing Labour’s announcement with me to the Chamber. Members can look at it in their own time, but it does not use the word “reform” once, despite the fact that “Train, retain, reform” is a key part of our proposals. Proposals for reform include moving from five-year to four-year medical undergraduate training; the expansion of roles such as physician associate; a significant expansion in the use of apprenticeships; and flexibility for retiring consultants, so that they can return to roles in, for example, out-patient services. A wide range of reforms came about as a result of the consultation with 60 different NHS organisations and are a key feature of the plan, but in Labour’s proposals reform is not mentioned once.

In addition, Labour’s proposals are for a 10-year period. Our plan covers 15 years. Its proposal covered 23,000 additional health roles; our proposal deals with 50,000. I could go on and talk about the fact that the Labour proposal does not even mention GP trainees. Labour Members keep coming to the House and saying that primary care is important, but their proposals did not even touch on the workforce with regard to GPs. They did not even mention pharmacists, even though, as part of a primary care recovery plan, a key chunk of our proposal is Pharmacy First. It is extremely important that we can deliver services to patients in innovative ways. The ultimate irony is that the shadow Health Secretary, in one of his many interviews, including interviews to promote his book, said that the NHS “must reform or die”. He said that it must reform, yet Labour’s proposals do not mention reform at all.

Labour welcomes the plan, but it goes on to say that it will take too long to implement, while claiming that it is its plan, which, again, points to the confusion among Labour Members. Let me remind the House of what has been done. We had a manifesto commitment for 50,000 additional nurses—we are on track to deliver that, with 44,000 in place. We had a manifesto commitment to have 26,000 additional roles in primary care, and we have met that, with 29,000 roles in place. In 2018, we made a commitment to five new medical schools in parts of the country where it is hard to recruit. We have delivered that—a 25% expansion in the number of medical students, who will come on stream in hospitals next summer. However, as we celebrate the 75th anniversary of the NHS, it is right that we also look beyond that to the longer-term needs of the NHS. That is exactly what the plan does with its doubling of medical places, but alongside that, it innovates by embracing things like a medical apprenticeship so that we can look at different ways of delivering training.

The hon. Lady talked about strikes, which is a further area of confusion on the Labour Benches. Labour Members say that they do not support a 35% pay rise for junior doctors, on the grounds that the shadow Chancellor, the right hon. Member for Leeds West (Rachel Reeves), says that they should not. Either Labour Members want to support the junior doctors, or they do not—once again, their position seems confused.

I will finish with one final area of confusion on the Labour Benches. The hon. Lady talked about the elastic non-dom revenue raiser, despite the fact that the former shadow Chancellor, Ed Balls, has said that it would not raise the funds that are claimed. He has said that it would do quite the opposite: it would deter investment in the UK. In addition, Labour has already spent those funds on a range of measures, such as the breakfast clubs that Labour Members come to the House and talk about. The reality is that it would not fund Labour’s proposals, whereas we have made a commitment to back our plan with £2.4 billion of funding from the Treasury.

This is a historic moment as we celebrate the 75th anniversary of the NHS. It is a long-term commitment from a Government who are backing the NHS through the biggest investment in the NHS estate—over £20 billion —and a series of recovery programmes, expanding our diagnostic capacity and our surgical hubs. That is why the workforce plan is truly innovative. It does not just train more staff or offer opportunities to retain more staff; it reforms as well—something that is sadly lacking in Labour’s proposals.

Hospice Services: Support

Liz Kendall Excerpts

Wednesday 14th June 2023 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Nokes. This has been a really important and good debate; we do not always say that about debates in this place. I thank the hon. Member for Eastleigh (Paul Holmes) for securing it. He spoke with great passion and personal insight, and I am sure Sue’s family and friends will thank him for what he said. I also thank all hon. Members who spoke about their personal experiences. It is not always easy to do that here, but they have shown great courage.

Many Members thanked the amazing hospices in their constituencies. I hope they will forgive me for also paying tribute to LOROS Hospice in Leicester West, which I have visited many times. I am blown away by the care and compassion there, and the complete humanity shown to others. I am very grateful for that.

The argument I want to make today is that we need a much bigger, more serious debate about what makes for a good death, in the words of the hon. Member for Strangford (Jim Shannon). Policy really needs to change across the board. When the welfare state and the NHS were created, average life expectancy was 63. Now it is over 80, and one in four babies born today is going to live to 100. Back then, most people died of infectious diseases or accidents. Now, it is long-term chronic conditions. That means we are now experiencing death in a very different way. Often, death is not sudden; it may be long and difficult, both physically and emotionally.

Hospices—including hospice at home, because that is where many people want to die—need to be seen as an essential part of our health and care system, not an optional extra, a luxury or an add-on, as part of that much bigger debate about what makes for a good death. “A good death” is not perhaps a great campaigning slogan for any political party to focus on, but it is the truth of what we face, and politics needs to keep up with the changes in society. We need to start looking at that. The vital role of hospices and the need to properly plan a funding system, our workforce, training and how we link services and support is the context within which I see today’s debate. Quite frankly, people do not want to die in hospital. They want to die in the community and at home, with integral support for family and friends. That is our vision; that is what we need to deliver.

[Abena Oppong-Asare (Erith and Thamesmead) (Lab)]

I thank the shadow Minister for giving way. I completely agree with the points she has raised. I thank the hon. Member for Eastleigh (Paul Holmes) for bringing the debate forward and for sharing his personal story, as have others in this room. It is not easy to share those stories, but it is important that we do.

I have seen first hand how hospices play a vital role in communities. They go over and beyond, and are truly heroic. I am patron of Greenwich and Bexley Community Hospice in my constituency; I have seen how they provide compassionate end of life care. Does my hon. Friend agree that it is vital that the Government recognise the issues hospices face, particularly during the pandemic and with the cost of living crisis?

[Caroline Nokes (in the Chair)]

Order. I remind the Member that interventions should be short.

[Liz Kendall]

I absolutely agree with my hon. Friend and will come on to many of the points she raises.

I want to touch on about five issues, as part of shifting us to a different position on how we ensure people have a good death in the 21st century. The first issue, which I hope the Minister will comment on, and which all right hon. and hon. Members have spoken about, is the real need to review how hospices in England are funded, so that this absolutely critical sector has certainty and security in the months and years ahead. That was a key recommendation of the all-party parliamentary group for hospice and end of life care.

Many Members have spoken about the huge financial pressures on hospices: food prices, energy costs, the costs of NHS pay settlements. As Sue Ryder says, most hospices have seen a 10% increase in their costs, but only a 1% increase and in some cases no increase at all in NHS funding from integrated care boards, creating a perfect storm. ICBs have a statutory requirement to meet palliative care and end of life needs of their populations, but where is the funding? I hope the Minister will say whether the Government will institute the review because, without that, we will not have security for the future.

My second point, which has not been discussed in this debate but which I care passionately about—I would like to hear the Minister say something about this—is inequalities in access to hospice, end of life and palliative care. We know from the Parliamentary Office of Science and Technology that the pandemic exacerbated inequalities in accessing good palliative and end of life care for minority ethnic groups, and there are also socio-economic inequalities in access to hospice care. We know from Sue Ryder that there are also inequalities in access to bereavement support. We want to see everybody have fair access. Will the Minister say something about that?

The third issue relates to help to die at home, something I have campaigned on for many years as a Member of Parliament. There are still at least 10,000 people a year dying in hospital when they want the choice of dying at home. They are not getting the fast track NHS continuing healthcare support that they are supposed to get within 48 hours so that they can die at home. Our brilliant hospices have all sorts of support that they want to give, so I ask the Minister: why is that still a problem and what are we doing about it?

My next issue, which has been raised by many Members, concerns children’s hospices. Rainbows, the sole children’s hospice in the east midlands, wrote to me to express its concern about the children’s hospice grant potentially being wound up. As recently as 22 May, the Government replied to a written question:

“Funding arrangements for children’s hospices beyond 2023/24 have not yet been agreed.”

We cannot have children’s hospices not knowing what is happening to their grants. We have to be able plan ahead better.

Fourthly is something that my hospice, LOROS, has raised with me, but also lots of care homes. Bear with me on this. Many care homes are now essentially providing a lot of end of life care because the level of need that people have when they go into a care home is so great that that is what they need. But the staff might not be properly trained, and LOROS has said that it could work with care homes to make sure the staff are trained. That is one specific ask, so perhaps the Minister could meet me and LOROS to look at what hospices could do to better support our care homes.

Last but by no means least is workforce shortages. Sue Ryder stated:

“The Government must plan for the workforce as a whole system across health and social care”

and charitable providers. That is really important. We have to stop seeing all those different bits of the system as separate. We Labour Members have set out our plans for the biggest expansion in the NHS workforce’s history and for fair pay agreements and for social care staff. We urgently need to see the Government’s workforce plan, and I would like to see that covering all the issues.

In conclusion, we have heard today about the manifold pressures on hospices. I do not think I have ever been in a debate where so many Members have spoken so powerfully and positively about a part of the health and care system and what it does. It shows the strength of feeling and support, but I ask everyone here to think about how we as a Parliament can put achieving a good death as a big thing that we can make progress on and continue this campaign in future. I look forward to hearing the Minister’s comments.

National Carers Week

Liz Kendall Excerpts

Thursday 8th June 2023 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I am very pleased to speak in the debate and congratulate the hon. Member for Gosport (Dame Caroline Dinenage) on securing it. I always feel privileged to speak on behalf of His Majesty’s Opposition, but this issue is close to my heart. Across the country, millions of us are doing what any daughter or son, husband, wife or partner, mum or dad would do when someone they love is sick, frail, elderly or disabled: look after them the very best we can.

It can be hugely rewarding to care for the person who means so much to you and who has helped you so many times. But it can also be a terrible struggle: trying to hold down your job, or travelling up and down the country, while battling to get your mum or dad out of hospital; spending hours arranging seemingly endless NHS and care appointments on the phone, wondering why on earth no one else seems to be talking to each other; searching for the right home care, or a care home that you can actually trust; and figuring out what help, if any, you or the person you are caring for are entitled to, financial or otherwise. The pressure, stress and, often, guilt, can wreak havoc with your own physical and mental health. The financial costs can be ruinous, too, especially if you just cannot make it all work and have to quit your job. Most of the time, you just feel ignored or invisible—not just to all the different services that you are battling with, but in your workplace and in wider society.

Hon. Members have spoken powerfully about their and their constituents’ experiences, about what needs to change to improve the lives and life chances of Britain’s amazing army of unpaid carers, and about the need to better recognise and improve support for the physical and mental health of family carers who are battling to see a GP, or anyone else. They are not even getting the statutory assessment to which they are entitled under the Care Act 2014, not least because of the cuts to local government services. There is a real need for breaks—not just physical breaks from caring, but something for carers to look forward to and to help them keep going. Many carers face poverty: a quarter have to cut back on the essentials of life and people sell everything they have just to try to keep the show on the road.

The real implications of providing care when young include the sacrifices you make of your hopes and dreams, and the shame that you feel, which often never leaves you. On finding out who is a carer in the first place, let us be honest: most people do not think that they are a carer—they are just trying to be a good son or daughter, husband or wife—but without that recognition, they will never get any help.

Those issues are not new, but they are growing. After 13 years of failure on social care reform, on top of covid and the cost of living crisis, the pressures on families are becoming unbearable. However, the argument that I will make is not the moral case for transforming support for unpaid family carers, although that is a case in which I firmly believe; it is the economic case, particularly the need for us to start to see a decent social care system as part of our country’s economic infrastructure, not just as a vital public service.

We live in the century of ageing and, as we all live for longer, more and more of us are going to have to work and care for longer. Almost 5 million people are already juggling work with caring for an older, sick or disabled relative. That is one in seven of all workers and it is only going to increase. The burden often falls on women, especially those in their 50s and 60s. The latest census shows that one in five of all women aged 55 to 60 are caring for an older or disabled loved one. That is a staggering figure that has received far too little attention to date.

The fact that our care system is stretched to the absolute limit means that 2.5 million unpaid carers have had to give up work or reduce their hours because they cannot get the help they need. Let us look at the increase in economic inactivity in over-50s since the covid pandemic, which there has been a lot of focus on. We know that the primary reason for this increase is poor physical and mental health and the increasing waiting lists in the NHS, which are now at a staggering 7 million. The second biggest reason, which no one has mentioned so far, is caring responsibilities.

Being forced out of the workplace is not good for families, especially in a cost of living crisis. It is not good for women and women’s equality, because women in their 50s and 60s are in the prime of their lives, with all the experience and knowledge they have. It is not good for businesses, which need to draw on the talents of everyone in our country in order to succeed, and it is not good for our economy, especially when the UK is stuck in a doom loop of low growth, poor productivity and ever higher taxes. If we want to help the over-50s to stay in work or get back into work, I suggest that the Chancellor spends a little more time focusing on the broken care system and a little less complaining about people spending too much time on golf courses.

We know that decent public services require a growing economy to put the money in, but the truth is that a growing economy depends on decent public services too. In modern Britain, social care and, I would also argue, childcare are as much a part of our economic infrastructure as the roads and the railways, and they should be at the heart of our economic policy and strategy for growth.

That is why Labour has made improving care one of the four missions of our industrial strategy—we understand that it is central to the workforce and economic growth. We are calling for a 10-year programme of investment and reform. That must include a new deal for the paid care workforce. We are never going to help family carers unless we have enough properly paid staff and tackle the record vacancies and high turnover rates. We need to have a much more joined-up system of health and care, so that families do not have to battle their way around the system, and a big shift in focus towards prevention and early intervention, to help people stay living fit, well and healthy at home for as long as possible.

We also need proper support for unpaid family carers, so that they can better balance work and family life, including improvements in flexible working and care leave. Opposition Members will remember that Labour women in the ’70s and ’80s argued that childcare was vital for children, the workforce, the economy and women’s equality, and that is the case we are making on social care too.

Madam Deputy Speaker, I am sure you will agree that sometimes politics seems very frantic, with things changing day by day, but sometimes I think it is all so unbelievably slow in understanding how the world has changed around us. My mum often says to me, “Why are you so surprised that there are so many of us olds? We’ve been born a long time.” That is true. We need to wake up to these changes and understand just how important a decent social care system is for families, the NHS, women’s equality and our wider economy too. The last Labour Government had a national carers strategy signed up to by senior Cabinet members at all levels, looking at all the things that impact on family life. I urge the Government to commit to that strategy today.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 6th June 2023 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Liz Kendall (Leicester West) (Lab)]

There is a particular group of women whose health needs should be highlighted during Carers Week: women who look after an older or disabled relative. The majority of unpaid carers in their 50s and 60s are women. Eight million unpaid carers have seen their own health suffer, with those providing high levels of care twice as likely to have poor health as people without caring responsibilities. So will the Minister finally commit to a cross-Government national carers strategy, including health issues in it, as the last Labour Government did? That is a key demand during this year’s Carers Week.

[Maria Caulfield]

I thank the shadow Minister for her question. My colleague the Minister for Social Care is hosting an event today for carers, and £300 million for carers in the better care fund has also been released. I am a carer for my dad, who thankfully is well and spritely, so I understand the pressures of this. Recently, I met carers from Kinship; often they are grandparents, and older aunts and uncles, who look after young children. Work is going on between us and the Department for Education on how we can better support kinship carers, who do fantastic work in looking after young children. We fully recognise the issue, and the Social Care Minister is not just providing funding, but meeting those carers to see how we can better support them.

Oral Answers

Liz Kendall Excerpts

Tuesday 25th April 2023 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Liz Kendall (Leicester West) (Lab)]

The Minister says this Government back social care—I would love to see what the reality would be if they were against it. We already know that the Conservatives have completely failed to deliver their flagship policy of a cap on care costs, and over Easter we learned that they have broken the rest of their promises on social care too. The £500 million promised for the care workforce has been cut in half; the £300 million promised for housing in care has been slashed by two thirds; and as for the £600 million of other promises, your guess is as good as mine, Mr Speaker. They have not had the courage to announce this to Parliament or the nous to grasp that if people are not kept in their own homes, they end up stuck in hospital, with all the knock-on consequences for NHS waiting times and emergency care. Will the Minister tell us where all that money has gone? Why on earth should older and disabled people and their families ever believe the Conservatives on social care again?

[Helen Whately]

Out of that, I can pick one thing we agree on: the importance of helping people to live independently at home for longer and social care as a part of that. I say to the hon. Lady, as I said a moment ago, that we have not cut a penny of funding from our commitments to adult social care, both on adult social reform and on the historic £7.5 billion of adult social care funding announced in the autumn statement. We are forging ahead with our reforms, with the workforce at their heart, because the workforce is crucial, hand in hand with the digitisation of social care, improving data, joining up health and social care, and supporting unpaid carers.

Brain Tumour Research Funding

Liz Kendall Excerpts

Thursday 9th March 2023 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I thank the Backbench Business Committee for granting this debate, the hon. Member for St Ives (Derek Thomas) for securing it, and all those charities and organisations that work so hard to push this issue up the agenda, including Brain Tumour Research and the Tessa Jowell Foundation. I also thank all hon. Members who have spoken on behalf of their constituents so very passionately and powerfully, particularly my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh), who I thought gave an incredibly brave speech, which moved us all to tears—she did not mean to move us to tears; she meant to move us to action, and that is what we must resolve to do as a result of today’s debate.

We have heard that 16,000 people a year are diagnosed with a brain tumour, 3,200 of whom are diagnosed with glioblastoma, the most common primary brain tumour in adults. Getting this diagnosis can be utterly devastating —life can change in the blink of an eye—because we know that more children and adults under the age of 40 lose their lives to brain tumours than to any other cancer. They take the lives of more women under 35 than breast cancer, and the lives of more men under 70 than prostate cancer. I think we owe it to all those who have been diagnosed with a brain tumour and their families to set out a proper plan to improve outcomes. In particular —and I think this is the most important point for all of us here today—what are we going to do differently in the next 10, 20 or 30 years, because nothing has changed in the past 30 years? If we keep repeating what we have done before, we will only get the same result.

But I do not believe that it has to be this way. We have seen huge improvements in survival rates for so many other cancers. We know that 54% of people diagnosed with leukaemia will now survive for more than five years, and 85% of those diagnosed with breast cancer will survive for five years or more. That is an incredible success story, and I think that we need to look long and hard at how that was achieved. What changes were made, yes, in research funding, but also in training, in clinical trials, and in other forms of treatment and support?

We know that when we put our minds to it—when we have leadership, focus and a plan for action—we can deliver results. We must do that here. Fewer than 12% of people diagnosed with a brain tumour will survive beyond five years and, as my hon. Friend the Member for Mitcham and Morden said, the average survival for patients with glioblastoma is only nine months. That has not changed for 30 years. We need a different approach.

Many hon. Members have rightly said that proper investment in research is vital. Since 2002, only 1% of the national spend on cancer research has been allocated to brain tumours. That is around £126 million. Over the same period, just over £550 million was spent on leukaemia research, and £775 million on breast cancer research.

I do not think that anyone doubts that has made a real difference to the outcomes we have seen, so I hope that, when the Minister stands up to reply, he will say how he will deal with this issue. We know how this works: more research goes into areas where more people are suffering from a condition, but that cannot be the answer. I hope that the Minister will say whether the Government intend to change those funding proportions, and if so, how.

However, alongside investment there must be reform, because the current system is not working. We have heard from many hon. Members that, in response to the campaigning of the late Dame Tessa Jowell, the Government committed £40 million in funding on brain tumours to be made available via the National Institute for Health and Care Research. However, as of January 2023, just £15 million of that had been awarded. I would like the Minister to spell out why that has happened and what he will do to change it.

We must be much less risk averse when allocating research funding, and we must ensure that the people who are making the decisions fully understand the issues around brain tumours and research. I think that the Minister needs to explain whether NIHR actually has that expertise on its board, and if not, what he will do to change it.

We also must look at the issue, which many hon. Members have spoken about, of research funding getting stuck in lots of different silos. The Department of Health and Social Care and the Department for Science, Innovation and Technology must work together much more closely to ensure that early-stage research quickly progresses to clinical trials, and then to the bedsides of patients via new treatments. Is there any sort of group or format to do that? If there is, it is obviously not working, so how does he intend to change that? That is one of the key asks of the APPG on brain tumours, so I think that we really need to get to the bottom of it.

I now want to focus on the issue of clinical trials—although, my hon. Friend the Member for Mitcham and Morden spoke so powerfully that I almost feel that I should just sit down and let that speak for itself. However, I spoke to Professor Paul Mulholland, who is a medical oncologist who exclusively treats brain cancer, at University College Hospital, the National Hospital for Neurology and Neurosurgery, and Mount Vernon Cancer Centre. He is, rightly, extremely concerned about how few, if any, patients with glioblastoma in this country are currently on clinical trials. Unless we significantly increase both the number and the size of those trials, we will never make progress and patients will be forced, if they have the means to do so, to go to other countries. That is not acceptable.

How are we going to do that? Professor Mulholland believes that the first change required is for all medical oncologists to receive mandatory training in primary brain cancer. We may be told that they receive training in brain cancer, but that usually relates to secondary brain cancer. He believes that there needs to be a minimum period of specific training, because it is not currently required. That will increase understanding of the issues and possibly the propensity to support and understand the risks and benefits of clinical trials.

The second change required is clear targets for increasing the number of brain tumour patients on drugs trials, starting with 200 a year and increasing to 1,000 a year in five years’ time. We must have a goal and must know how we are going to get there. The third change required is that the pharmaceutical sector must be involved— no ifs, no buts. Professor Mulholland believes that the Government need to have a very targeted working group, with Cancer Research UK, the pharma companies and Health Education England saying, “We’re going to make this happen,” and explaining how and when.

I know that the Minister has received many requests for meetings during this debate, but I urge him to meet Professor Mulholland to talk through those ideas. They are different and are not necessarily what others are calling for, but he has an idea about how things need to change. We need change, so I hope that that is what happens.

For all those who have died from brain tumours, for the families who have felt that devastating impact, for all those who are currently going through all the stress, strain and trauma of treatment, and for all the families who love them and want to make a difference, we need change and we need to get it right, and I really look forward to hearing the Minister’s response.

--- Later in debate ---

[Will Quince]

I thank the right hon. Gentleman for his question, and I shall try my best to answer it. It is a question that I listened to very carefully when he posed it in his contribution, and it is one that I have posed myself when looking at the NIHR and what it does. The committees for NIHR and the programmes that come forward receive a diverse range of applications, which is understandable. Their make-up, therefore, is that of a broad range of expertise. As I said a few moments ago, they may or may not contain experts in the field of brain tumour research. However, having said that, the NIHR committees then use peer review from appropriate experts, which would include brain tumour expertise as relevant to the brain tumour proposal that is under review in each individual case. That is there deliberately to inform their decision-making. They co-opt particular expertise on to the committee, which is an option always available to NIHR if the committee needs that particular input. If clinicians and scientists are telling the right hon. Gentleman that that is not happening, or is not happening to the degree that we would want and expect it to, I would want to take that away and look at that further.

I wish to come back to a comment that the right hon. Gentleman made about brain tumours and why they remain a challenging area for research. There is the complexity of the brain itself as an organ, and the way that perception, memory, and emotion— everything the brain does—can be affected differently by different types of tumour. Brain tumours are different diseases that can differ in terms of histology, molecular characteristics, and clinical behaviour, meaning that many different treatments must be developed. Brain tissue is precious and obtaining it for research purposes can be difficult. Obtaining biopsy samples is risky and invasive, and animal models are of limited applicability. Additionally, the community of active clinical researchers is relatively small—it is certainly small in relation to the scale of need. This all makes research on brain tumours challenging, as has been well articulated today, and progress, if we are to make it—and I am determined that we will—requires a collaborative effort between researchers, clinicians, and funding agencies.

How do we grow the field of brain tumour research? This was a challenge from the shadow Minister. We have been taking action to grow the field by supporting researchers to submit high-quality research bid proposals. That has been supported by working with the Tessa Jowell Brain Cancer Mission, which hosts workshops for researchers, and provides research training specifically for clinicians.

Since the initial Government announcement of £40 million over five years ago, we have spent £33.9 million on brain cancer research across Government. I am conscious that there is a difference in the two figures, but that is because we are combining spending from UK Research and Innovation with the spending of NIHR. However, as I have made clear already, we want to spend more and the NIHR welcomes funding applications for research into brain tumours, and the Department of Health and Social Care priority call on brain tumours remains open. Critically, all applications that have been assessed as “fundable” in open competition have been funded, and that will continue.

As I have said, brain tumour research is one of the most difficult scientific challenges of our age. We need to invest across the translational pipeline, from fundamental science through to effective treatments. These are long-term challenges and we are committed to them for the long term. To be clear, the £40 million announcement was a signal to the research community that we are serious about funding research in this space. It is not a ceiling. If we can spend more on the best quality science, let me assure the House that we will do so. I understand and share the frustrations that only a proportion of the £40 million on brain tumour research has been allocated so far, but this funding will remain available. I genuinely believe that the funding for brain tumour research is promising and we look forward to considering the all-party group recommendations with colleagues across Government. I am confident that the Government’s continued commitment to funding will help us make progress towards effective treatment.

[Liz Kendall]

As the Minister may be about to close, I would like to ask him whether he would respond to a request to meet Professor Mulholland about the other issues that he raised around training and clinical trials, because that would make a hugely useful contribution to the debate.

[Will Quince]

The hon. Lady pre-empts not only that I am coming to a close, but my final response. I have a little more time than I would ordinarily, but in closing such debates, one never quite gets the opportunity to answer every single question. I have never turned down a meeting with a colleague, and I do not intend to start doing so today—it is important that we consider some of the issues that have been raised this afternoon, including the report’s recommendations—and, of course, I would be very happy to meet senior clinicians and scientists in the field as well.

In closing, I want to say how much I appreciate the vital work of my hon. Friend the Member for St Ives as chair of the all-party parliamentary group on brain tumours, of all those who have spoken so powerfully today, and of the powerful advocacy for more research on brain tumours and better treatments and care for patients, not least in last week’s report and in this important debate. It has been my pleasure to respond to the powerful points that everyone has made.

Covid Pandemic: Testing of Care Home Residents

Liz Kendall Excerpts

Wednesday 1st March 2023 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the testing of care home residents during the covid pandemic.

[The Minister for Social Care (Helen Whately)]

The covid-19 pandemic was an unprecedented global health emergency involving a novel coronavirus that we were still learning about day by day, even hour by hour. Even in those early days, the UK Government and colleagues in my Department were clear that testing would be crucial. That is why the former Secretary of State, my right hon. Friend the Member for West Suffolk (Matt Hancock), set ambitious testing targets to drive a true step change in the quantity of tests, because he knew that testing would be a vital lifeline until vaccines could be developed and proven safe and effective.

The importance of testing was never in doubt, and there was full agreement on that in every part of Government, from the chief medical officer to the Health Secretary and the Prime Minister. But in a situation where we had the capacity to test, at most, a few thousand each day, tough decisions about prioritisation had to be made. Those decisions were taken on the best public health advice available. Thanks in no small part to the bold testing ambitions driven by the Government, we were able to build the largest testing network in Europe.

I put on record my thanks to all those who worked tirelessly on this mission day and night, from civil servants to the NHS and, of course, our incredible social care workforce, who did so much to look after their residents. They all deserve our lasting gratitude.

The situation in our care homes was extremely difficult during the pandemic, not just in England but across the UK and, indeed, across the world. Because of the vulnerability of residents and the large number of people who come in and out of care homes, it is vital that we learn lessons.

It is equally vital that we learn those lessons in the right context. Selective snippets of WhatsApp conversations give a limited and, at times, misleading insight into the machinery of government at the time. The covid inquiry is important so that we have the right preparations in place to meet future threats and challenges.

[Liz Kendall]

Throughout the covid pandemic, Ministers repeatedly claimed that they had thrown a protective ring around England’s care homes and that they had always followed the evidence and scientific advice, but WhatsApp messages from the former Health Secretary revealed in today’s Daily Telegraph suggest that nothing could be further from the truth.

Will the Minister confirm that the chief medical officer first advised the Government to test all residents going into care homes in early April 2020? Can she explain why the former Health Secretary rejected that advice and failed to introduce community testing until 14 August—a staggering four months later? Can she publish the evidence that following the advice would have muddied the waters, as the right hon. Member for West Suffolk (Matt Hancock) claimed? And can she confirm that 17,678 people died of covid in care homes between the CMO’s advice and the Government finally deciding to act? She should know, because she was responsible for care homes at the time.

Former Ministers are touring the studios this morning claiming that this delay was simply because there were not enough tests. Where is the evidence for that? Even if tests were in short supply, why were care homes residents not prioritised when the devastating impact of covid was there for all to see?

Nobody denies that dealing with covid was unbelievably difficult, especially in the early days, but care home residents and staff were simply not a priority. Yet the former Prime Minister and former Health Secretary were first warned about the emerging horror in care homes by my hon. Friend the Member for Hove (Peter Kyle) in March 2020. I myself raised the lack of testing in care homes with the Health Secretary on 8 April, 28 April, 19 May and 17 June 2020, long before the CMO’s advice was finally followed.

The Minister will no doubt say that all these issues will be looked at in the public inquiry, but its findings will not be available for years. The families of the 43,000 care home residents who lost their lives will be appalled at the former Health Secretary attempting to rewrite history—an attempt that will turn to ashes along with his TV career. We need more humility and less celebrity from the right hon. Member for West Suffolk, and above all we need answers.

[Helen Whately]

It is relatively easy for the hon. Member to come to the House today and make these highly political points. Knowing how she and I worked together in the pandemic, and that she and I talked about all that we were doing to look after people in care homes, I am shocked and disappointed by the tone she has taken today, when we are dealing with extremely serious questions.

I will turn first to some of the difficult prioritisation decisions that were made, given the limited quantity of testing we had at the beginning of the pandemic. The Government followed the expert public health advice available at the time. We had the capacity to test just 3,000 cases a day in mid-March, and I am sure colleagues will understand why the health advice at the time was to prioritise those working on our NHS frontline and, for instance, the testing of people in hospitals and care homes who had symptoms. In fact, the courts have already agreed that our prioritisation decisions on testing were completely rational.

As we dramatically ramped up testing capacity, we also adjusted that prioritisation in line with the public health advice and the capacity, so by mid-April—just a month later—with testing capacity exceeding 38,000, we were in a position to test more widely. In fact, that is reflected in our adult social care plan published on 15 April, which made it clear that everyone discharged from a hospital to a care home should be tested even if asymptomatic, and that all discharged patients, regardless of the result of their test, should be isolated for 14 days. It is worth reflecting just what a dramatic increase in testing the Government oversaw, from just 3,000 in March 2020 to over 38,000 in mid-April, to over 100,000 by mid-May, to the point where we could test many millions in a single week. We established the largest testing network in Europe from a standing start, and the science proves that it saved lives.

The hon. Lady asked about the content of the WhatsApp messages that have been published. I say to her that it is a selection from a larger quantity of messages. Clearly, while there were discussions and debates between Ministers and colleagues, partly on WhatsApp, there were also meetings and conversations and other forums in which advice was given and decisions made. A huge quantity of that is with the public inquiry, but I can say to her that, for instance, a meeting to discuss the implementation of the advice on testing was not referenced in the WhatsApp messages she is talking about. There is an email following the exchange to which she is referring that says, “We can press ahead straightaway with hospitals testing patients who are going into care homes. And we should aspire, as soon as capacity allows and when we have worked out an operational way of delivering this, that everyone going into a care home from the community could be tested.” As I say, she is basing her comments on very selective information.

As I said, the hon. Lady knows how the Government, and me personally, strained every sinew, worked day and night, and did everything in our power to help people, and specifically the most vulnerable, during the pandemic. She and I spoke about it regularly during our frequent calls. In fact, at the time I appreciated her perspective, questions and insights from her own area of Leicester. I say to her that we should go about this discussion in the right way for the country. This is not the time to play political games. We should look to save lives. That is the purpose of the public inquiry: to learn lessons in the right way in case this should ever happen again.

Future of the NHS

Liz Kendall Excerpts

Thursday 23rd February 2023 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I congratulate my hon. Friend the Member for Jarrow (Kate Osborne) on securing this important debate. It really is a privilege to speak after so many powerful and passionate contributions.

I want to start by telling the House about my constituent Mo Peberdy and her father, who is 83 years old. He has stage 5 kidney failure, diabetes—which has already led to a serious foot infection and the loss of one toe—and early-onset dementia. He is on a raft of medications and he has carers coming in four times a day.

On the weekend of 10 and 11 December, Mo’s father started to go downhill. By the 15th, he was in crisis. He had hugely swollen testicles and terrible sores all over his groin and backside. He could not eat or drink, let alone sit down, and he had severe diarrhoea, which was green and contained blood.

Mo immediately called the GP. She was told that no one was available and that she needed to ring out of hours. She did. When they called back several hours later, she was told to call 111. Mo called 111. Again, she waited several hours for them to ring back. When someone eventually did, at 6 pm, they said her call had been transferred to 999, so Mo and her father were told they had to wait for an ambulance—and wait, and wait, and wait. It was not until 8 am the next day—14 hours later—that a paramedic finally arrived.

All that evening, night and morning, Mo tells me,

“my dad was screaming in agony, wanting, begging to die… to listen to him in such pain, I will never forget it in all my life… My dad is one case amongst many… Our NHS is broken… We have to change from the top.”

She is right.

Time and again in this debate, we have heard about the crisis in our health and care system after 13 long years of this Conservative Government. More than 7 million people are now waiting for hospital treatment, after Labour ended waiting in the NHS. In the last month alone, 42,700 people waited more than 12 hours in A&E, and people who needed category 2 ambulance responses for suspected heart attacks and strokes waited one hour and 33 minutes on average. The target is 18 minutes.

The Royal College of Emergency Medicine estimates that up to 500 more people are dying every week due to delays in emergency care. I hope that the Minister will say what the Government are doing to investigate that and put it right, because it is a national scandal. The target that patients with suspected cancer should not have to wait longer than two months from GP referral to treatment has not been met since 2015.

As many colleagues have said, the situation in social care is even worse, with 1.5 million older people who need help with the very basics of daily living—getting up, washed, dressed and fed—not getting any help at all. Even among those who are in the system, half a million are waiting to have their care needs assessed or reviewed, or for treatment to start. Some 2.5 million unpaid family carers have been forced to give up work because they cannot get the help they need to look after their loved ones. With staff shortages in so many parts of the economy, where on earth is the sense in that? That basic issue—staff shortages—is at the heart of so many of these problems. There are 133,000 vacancies in the NHS and 165,000 in social care; the combined total is the same as the population of Newcastle. What a damning indictment of this Government.

Nobody denies that the covid pandemic and its aftermath have posed huge challenges to the NHS and social care, and I pay tribute to the frontline workers who gave us their all and got us through those dark days, but the reality is that NHS waiting times were at record levels, staff shortages were soaring and social care was stretched to breaking point long before the pandemic struck—something the Government refuse to acknowledge.

This dire situation makes the Government’s refusal to deal properly with the current industrial action in the NHS even more unforgivable.

I am pleased that Ministers are finally talking to the Royal College of Nursing about pay, but why did they not do that before Christmas, when the RCN first told the Government that it would call off the strikes if Ministers just got round the table for meaningful talks on pay? Why are they not also meeting the other unions and the junior doctors? Since the RCN first made its offer, 140,000 operations or hospital appointments have been cancelled as a result of the strikes. Those cancellations could have been prevented if Ministers had done their job and got round the table.

My constituents, and people throughout the country, deserve a Government who get on with the job, and they need a proper plan to get our NHS and care system back on track. That is why I am proud that my right hon. Friend the Leader of the Opposition has announced today that building an NHS fit for the future is one of Labour’s five key missions for government.

[Rob Roberts]

If Labour Members have this plan, have they communicated it to the Welsh Health Minister? Why is this not happening in Wales? With the greatest respect, and I really do not want to score these political points—

[Rob Roberts]

It is not a political matter! These issues affect the entire United Kingdom. Does the hon. Lady agree that that is the case? Does she agree that these matters are just the same in Wales as they are here, and that we need much wider reform?

[Liz Kendall]

May I gently say to the hon. Gentleman that I know what is best for his constituents and the people of Wales, which is a Labour Government in Westminster as well as a Labour Government in Wales delivering the changes that we are seeing? If he looks at Labour’s record when we were in government in Westminster, he will see the improvements that were made. May I also gently suggest that he focus on the lack of a workforce plan and the lack of a proper social care plan from his own Government, rather than trying to make these petty points?

Our plan will reform health and care services to speed up treatment by harnessing life sciences and technology to reduce preventable illness, and by cutting health inequalities. As a first step, we will carry out the biggest expansion of the workforce in the history of the NHS, doubling the number of medical school places, creating 10,000 more nursing and midwifery training places, recruiting 5,000 more health visitors, and doubling the number of district nurses. We will pay for this by scrapping the non-dom tax status, because we believe that people who come to live in the UK should pay their fair share of tax here. We read today in The Times that the NHS itself backs Labour’s plan, so why do the Government not back it?

[Sir Geoffrey Clifton-Brown]

I listened very carefully to what the leader of the hon. Lady’s party said on the “Today” programme this morning. He said that any proposals he would include in his manifesto for the next general election would be properly costed. Has the hon. Lady properly costed the proposals that she has just outlined, and if so, how much will they cost?

[Liz Kendall]

Yes, we have properly costed these proposals, because we—unlike the hon. Gentleman’s party, which announced huge amounts of borrowing without saying anything about where the money would come from under the former Prime Minister’s plans—will only set out our commitments when we can say where we will get the money from. We will get it by cancelling that non-dom tax status, and I urge the hon. Gentleman to encourage the Chancellor to follow that example in his Budget. I hope that when the Minister responds he will put the House and, more importantly, the public out of our misery. and just adopt Labour’s plan. If he does, he will surely have the backing of the Chancellor, who said only a few months ago that he very much hoped that the Government would adopt our proposals,

“on the basis that smart governments always nick the best ideas of their opponents.”

The truth is that Labour is proposing the solutions to the problems that the country faces because the Conservatives cannot be trusted to fix the mess that they have caused. Instead of introducing the long-term reforms that the country needs, they are constantly lurching from crisis to crisis—always reacting, always behind the curve. Every year there is a winter crisis, with more elderly people ending up stuck in hospital because they cannot get the social care and other local services that they need in the community or at home. Every year, people struggle to get the proper mental health support they need, so they end up reaching crisis point, which is worse for them and more expensive for the taxpayer. Every year, people are left hanging on the phone for hours and hours trying to get a GP appointment until there is no choice but for them to end up in A&E. Every year, there is a sticking plaster and never a cure. In contrast, Labour is calling for a 10-year plan of investment and reform to deal with the root causes of the challenges that we face and to build a care system fit for the future.

We will fix the front door to the NHS in primary care, recruiting more doctors to deliver better access to GPs, ensuring that patients can see the doctor they want in the manner they want—whether that is face to face, over the phone or online. We will fix the exit door out of the NHS and into social care, including by delivering a new deal for care workers so that they get the pay, the training and the terms and conditions that they deserve, which will mean that we can deal with the problem of delayed discharges.

We will recruit 8,500 mental health workers to provide faster treatment and also the support in schools that young people need, which will stop them from getting to crisis point, too. We will enshrine the principle of home first. Ultimately, what we need is a fundamental shift in the focus of care out of hospitals, into the community and more towards prevention. The big challenge that we face is an ageing population, with more people living with one, two, three, four or more long-term conditions. We must get that shift towards prevention. We must enable and support people to take more control over their health and care. We must have one team, with one point of contact, because people do not see their needs in the health or care silos. That is what Labour will deliver. When I first became an MP, I remember seeing in my own constituency people with the telemedicine that they needed to manage long-term conditions, such as chronic obstructive pulmonary disease. I remember visiting Totnes where there was a single, joined-up health and care team. I remember the sexual health and other support services from public health teams that Labour put in place, all of which, in my constituency, have disappeared.

I know from my time working for the last Labour Government that we cannot solve all the problems that the Tories have created overnight, but I also know—and Labour’s record in Government proves this—that with vision, determination and a clear plan, which is drawn up with the staff who provide the services and, crucially, with the users and their families, the NHS and our care system can be transformed. We have done it before. We stand ready to do it again, and Members on the Labour Benches will work day and night to deliver it.

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O’Brien)]

I am grateful to the hon. Member for Jarrow (Kate Osborne) for securing this very important debate. We have had a very large number of interesting and important speeches this afternoon—there are too many to list every single one of them. We had an important contribution from the former Health and Social Care Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock), about the importance of technology and building on the lessons of the vaccination campaign, which we are certainly doing. We had a very interesting intervention from the right hon. Member for Islington North (Jeremy Corbyn) who stressed the importance of housing for health. He is absolutely right about that, which is why we are taking forward the extension of the decent homes standard to the private sector and taking through the Social Housing (Regulation) Bill to fix some of those issues. My hon. Friend the Member for The Cotswolds (Sir Geoffrey Clifton-Brown) talked fascinatingly about the digital revolution in Denmark and the standardisation of new hospital builds there, which is something that we are in fact doing through Health 2.0. We are also looking at the discharge figures in his local area that he mentioned.

The hon. Member for Bolton South East (Yasmin Qureshi) talked about the dental reforms and said that they were only a starting point. I absolutely agree and will come on to that matter in a moment. My hon. Friend the Member for Delyn (Rob Roberts) talked about the challenges facing the NHS in Wales, reminding us that this is a common challenge across the UK. I can reassure my hon. Friend the Member for Christchurch (Sir Christopher Chope) that we are very interested in driving forward apprenticeship and non-degree routes into healthcare. We are extremely enthusiastic about that and I am happy to pursue that conversation with him after this debate.

Before I begin, I wish to pay tribute to our NHS and care workforce. Our staff work tirelessly to provide excellent care for patients, and our country is rightly very proud of them. The covid pandemic tested the NHS like never before, and all the NHS staff rose to meet those tests in extraordinary new ways. As we look to the future, we can take pride in the NHS’s response to covid-19, and take inspiration from the new and innovative ways of working that were born from the most difficult of times.

The NHS has certain foundation stones that we will never change, including being free at the point of use, regardless of income, and comprehensive services provided solely on the basis of need. It will never be for sale to the private sector. Of course we cannot just preserve the NHS; we need to make it fit for the future. The challenges we face are changing, including an ageing population and the backlog created by covid, and the NHS needs to change with them.

Today I will talk about: finance and the workforce; supporting urgent care; cutting backlogs; and improving social care and primary care. Those are some of the issues raised by hon. Members this afternoon.

The spending review provided a record settlement to the Department over this Parliament, increasing core resource spending by £46.9 billion to £180.4 billion in 2024-25, to ensure long-term sustainable funding is available to support the NHS of the future. In addition, the Chancellor’s autumn statement made up to £14 billion extra available for the NHS and adult social care.

According to the King’s Fund, real-terms spending will have increased by about 42% between 2010 and the end of this Parliament. That funding, a record both in real terms and as a share of the economy, will enable us to ensure that the NHS has the long-term resources and workforce it needs, because our NHS would be nothing without our fantastic health and social care workers. That is why we are on track to recruit an extra 50,000 nurses by March 2024, and it is why we have already expanded medical training places by 1,500 a year, or 25%. We now have 35,000 more doctors and 47,000 more nurses working in the NHS than in 2010.

Alongside recruitment, training our existing workforce is hugely important. Ensuring the NHS is a workplace that provides the environment and flexibility to support long-term careers is a key priority, which is why there are now 900 more medical specialty training posts in 2023, including 500 in mental health and cancer treatment, in addition to the 700 additional specialty training posts that we funded in 2022 and the increase in GP training posts from 2,400 a year to a record 4,000 a year.

We are committed to further supporting our NHS staff to develop their skills and to deliver excellence to patients, which is why the Government have committed to publishing a long-term NHS workforce plan this year.

[Liz Kendall]

Will that long-term workforce plan include social care staff?

[Neil O’Brien]

It will be right across the piece. We have already set out some of our plans for social care, and the full details will hopefully be with the hon. Lady in the not-too-distant future.

The NHS recently published a delivery plan for recovering urgent and emergency care services. It is backed by record investment, including a £1 billion dedicated fund for hospital capacity over 2023-24. We will achieve these improvements by delivering 800 new ambulances and 5,000 more sustainable, fully staffed hospital beds, as well as an ambition to scale up innovative virtual wards, which are already making huge improvements, to support 50,000 people a month in their own home.

The number of ambulance and ambulance support staff is up by 40% since 2010. As well as having those extra staff, we are putting in an extra £50 million in capital funding to upgrade and expand hospitals, including with ambulance hubs and facilities for patients who are about to be discharged. That will free up hospital beds and address handover delays, helping to get those extra ambulances swiftly back on the road.

As well as getting people to hospital, we must further prevent the need for urgent care. That is why we extended vaccinations and are rolling out fall services across the country. We also need to improve the flow through hospitals, as the hon. Member for Leicester West (Liz Kendall) said, by investing in social care. I will say more about that in a moment.

Members know only too well the pressure that the pandemic put on the NHS. The number of people waiting more than 52 weeks for elective care rose from 1,468 in August 2019 to 436,000 in March 2021. In February 2022, the NHS published a delivery plan for tackling the covid-19 backlog, which set out a series of public commitments and initiatives to reduce the backlog. We met our first target by virtually eliminating waits of two years or more by July 2022—that is from a peak of 23,800 at the start of January 2022. To support that elective recovery and to cut backlogs, one of our top five priorities is to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund made available last year. As well as having 4,800 more doctors and 10,900 more nurses than this time just last year, we have 89 new surgical hubs and 92 community diagnostic centres already up and running—the hon. Member for Stockton North (Alex Cunningham) talked about the one in his local area.

As part of this elective recovery, we continue to deliver the huge investment in mental health that was set out in the long-term plan for the NHS, with £2.3 billion extra by next year, supporting an extra 2 million people to get the treatment they need each year. Taken together, that elective funding could deliver the equivalent of about 9 million more checks and procedures, and means that the NHS in England is aiming to deliver about 30% more elective activity by 2024-25 than it was delivering before the pandemic—that is a huge increase. We are aiming to end 18-month waits by April and the NHS is making good progress towards that.

Turning to general practice and primary care, I know that GPs are under huge pressure, and I am incredibly grateful to them and their teams for their hard work. We are investing an extra £1.5 billion to create an additional 50 million general practice appointments a year by 2024. We are doing that by increasing and diversifying the workforce and we are well on our way to hitting that target. In December and indeed January, there were, on average, 1.34 million general practice appointments per working day, excluding the covid vaccinations that GPs are doing. That is about a 10% increase on pre-pandemic levels. GPs are doing more than ever before and a wider range of things than ever before, and they are really working hard.

Since 2019, we have recruited more than 2,000 more doctors into general practice and more than 25,000 additional clinical staff into general practice. So we are well on the way to hitting the 26,000 extra commitment that we made ahead of schedule. They are covering a wide range of extra roles, from pharmacists to physios, mental health specialists and more. So GPs are now effectively leading a diverse team with many different specialist skills. We also had a record-breaking number starting training as GPs last year—it is up from about 2,400 a year to 4,000 a year now. As we committed to do in our plan for patients, we have amended funding rules to bolster general practice teams with new roles. We have increased the clinical services available from community pharmacies already and we are looking at how we can go further. We have introduced new digital tools and improved IT systems, where, again, we are looking to go further.

Of course, we know we need to do more. In the autumn statement, we committed to creating a recovery plan for primary care that addresses the challenges facing general practice. That plan will aim to make it easier for the public to contact their practice and easier for practices to see their patients sooner. That is due to be published in the coming weeks.

--- Later in debate ---

[Neil O’Brien]

I want to make a bit of progress. I am sorry, but I will perhaps come back to the hon. Lady in a bit.

Let me complete the thought on primary care. We will also be saying more about dentistry, which was an issue raised by the hon. Member for Bolton South East. She mentioned some of the reforms that we made. We are trying to make dental practice more attractive. We started reforming the contract and creating more unit of dental activity bands to better reflect the fair cost of NHS work and so incentivise it. We have introduced the minimum UDA value to help where it is particularly low. We are letting dentists deliver 110% of their contracted UDAs to encourage more activity. We have changed the law to make it easier for overseas dentists to do NHS work here, which someone mentioned earlier. Plans are advancing for centres for dental development in Ipswich and places such as Cumbria. But there is much more to do, as the hon. Lady said, and we will be saying more about that soon.

On adult social care, we are taking decisive action, with record investment, making available up to £7.5 billion over the next two years to support adult social care and discharge. That historic funding boost—that record investment in adult social care—will put the system on a much stronger financial footing and help local authorities to address pressures in the sector.

[Liz Kendall]

The Minister has repeatedly used this £7.5 billion extra for social care figure, but will he confirm that £3.15 billion of that is from the Government’s failure to implement the cap on care costs and postponing the right of self-funders to have their care funded at local authority level, and that £1.75 billion of it is from the social care precept? In other words, this is a tax on ordinary people—it is not coming from the Government as new money.

[Neil O’Brien]

Is that not a revealing comment from the Opposition? The Government do not have any money. All this spending comes from hard-working taxpayers, and the Conservative party wants to keep the burden of tax down. On the hon. Lady’s point about the other pot of spending, we chose to prioritise funding through the frontline. That is our choice and it is one we will defend because we know we urgently need to improve social care—[Interruption.] It is tax, yes. All Government spending comes from tax, that is correct, and the idea that that is in some way a revelation speaks volumes about where the Opposition are.

In December 2021, “People at the Heart of Care: adult social care reform” was published, setting out a 10-year vision for reforming adult social care. We have made good progress over the last year on some of the commitments in that White Paper. We invested £100 million to begin implementing reforms on digitisation and technology, local authority oversight and new data collections and surveys, so that people working in the NHS and adult social care have improved access to the information they need to ensure personalised, high-quality care. The Carer’s Leave Bill, currently going through Parliament, will introduce a new leave entitlement as a day 1 right, available to all employees who are providing care for a dependant with a long-term care need. We will set out our next steps on social care soon.

We are committed to supporting our NHS by putting in place the investment and reform to secure its future and we will bring forward a workforce plan later in the year. We are building back better from the pandemic.

Oral Answers to Questions

Liz Kendall Excerpts

Tuesday 24th January 2023 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Liz Kendall (Leicester West) (Lab)]

Ministers will never deal with the record waits for NHS treatment until they stop older people being stuck in hospital because they cannot get decent social care in the community or at home. Does the Minister understand that this is not just about getting people out of hospital, but about preventing them from being there in the first place? Is he aware that more than half a million people now require social care but have not even had their needs assessed or reviewed? Where on earth is the Government’s plan to deal with this crisis, which is bad for older people, bad for the patients waiting for operations and bad for taxpayers?

[Will Quince]

As I said, we are creating 7,000 additional general and acute beds. We are investing £500 million in adult social care specifically for discharge, and that goes up to £600 million next year and £1 billion the year after. There is also an extra £250 million. The hon. Lady asks specifically about adult social care. That is exactly why the Chancellor announced £7.5 billion in the autumn statement—the largest investment in social care ever.