Department of Health and Social Care

Nesil Caliskan Excerpts

Wednesday 5th March 2025 Commons Chamber

[Nesil Caliskan (Barking) (Lab)]

May I take this opportunity to thank the Chair of the Public Accounts Committee, the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown), for his work, as well as other Members who I sit on the Committee with?

The financial sustainability of our national health service will have an impact on patients now and in future. Given that such a huge amount of money is spent by the Government, it is imperative that they focus on value for money for the taxpayer so that, at a time when demand is going up but resources are limited, we can deliver the very best health service that the British people deserve and that my constituents in Barking can rely on.

For too long the Department and NHS England have taken a short-term approach to budgeting, relying on reallocating capital budgets to cover revenue shortfalls. Between 2014 and 2019, more than £4 billion was raided from the Department’s capital budgets to fund day-to-day spending. As a former council leader, that approach has always been curious to me, given that, as others have mentioned, local authorities are not permitted to have the same approach. Equally, councils are legally obliged to set annual balanced budgets, and even when they overspend because of demand-led statutory services, they cannot set deficit budgets.

[Josh Fenton-Glynn]

Another issue my hon. Friend may wish to reflect on is that the council tax base differs from place to place, so councils are even more disadvantaged than the NHS on funding.

[Nesil Caliskan]

My hon. Friend makes an important point, because health inequalities are determined by a multitude of factors and the work that local authorities do on public health is crucial too.

Compare the point I made about local authorities not being able to set deficit budgets with the situation in the NHS, where every year winter pressures mean that our NHS is at crumbling point and that despite the money poured in, the NHS overspends. Last year, that overspend was £1.4 billion, more than double the previous year. Those issues have not emerged in a silo; they are a result of years of mismanagement and failed leadership by former Ministers and by a Government who decided to allow the chaos of one year budget setting, hindering health leaders from being able to effectively plan for the future.

A lack of political commitment, coupled with a refusal to invest in the future, has led to awful consequences for patients. On the NHS estate, the National Audit Office report shows that since 2019, over 5,000 appointments, surgeries and other clinical incidences have had to be cancelled because of issues in buildings. That is absolutely shocking, so I take on board the points made by Members from across the House.

[Anna Dixon (Shipley) (Lab)]

On that point, will my hon. Friend give way?

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[Nesil Caliskan]

I will not take any interventions at this point—actually, I will.

[Anna Dixon]

I thank my hon. Friend for giving way. It is always a pleasure to serve with her on the Public Accounts Committee under the leadership of the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown). She makes an excellent point about the raising of capital budgets. In my constituency, we have the RAAC-infested Airedale hospital. Does she agree that it is only with the new Labour Government and a properly funded and deliverable plan for new hospitals that we will see that put right, following the decision made by the Chancellor to ringfence capital funding?

[Nesil Caliskan]

I am very pleased to have accepted my hon. Friend’s intervention and I entirely agree with her. If we want to see an improvement in the estate of the NHS, we need to have money allocated to it.

When the NHS was at breaking point, my constituents had to feel the pain of not being able to get appointments for their sicknesses. The population I represent already has some of the worst health inequalities in the country, exacerbated by the lack of primary healthcare provision. Some wards in my constituency have no GPs at all, so I welcome the remarks made by Members from all parties about the importance of primary healthcare provision.

Without reform, the NHS is simply not financially sustainable, but alongside reform there must be a culture of change in NHS England. The Public Accounts Committee report highlights that last year NHS England failed to approve ICB financial plans until months after the financial year had begun. Working with local NHS bodies, we have seen examples of ICBs, as other hon. Members have said, talking a good talk on prevention and public health, but we see a lack of action from many areas on commissioning in a way that has a positive impact on prevention.

[Gregory Stafford]

I entirely agree with the point the hon. Lady makes, but does the impetus not have to come from the top? Unless the Government are making strides to shift moneys from healthcare to social care, why on earth should any of the ICBs follow suit?

[Nesil Caliskan]

I do not disagree with that, which is why the Government commitment around reform will be so critical. I sit on the Public Accounts Committee that produced the report that highlighted some of those gaps. As a Committee, we will be looking closely at the reforms that have come forward from the Government, and I would welcome further reassurance from the Minister.

The Government are right to invest in the NHS to help to deal with the current critical waiting lists, but only alongside reform will the additional investment in the NHS be value for money. Only through reform can the NHS improve productivity to make it sustainable. I endorse comments made by Members from all parties about productivity because, without reform, the NHS cannot even meet its own productivity targets. That is why the estimates under discussion are so important. The 4.9% increase in investment is welcome because it will help to cover the pay review body’s recommended pay increase for NHS staff, stop the strikes, improve staff retention and keep more doctors and nurses at work. That is crucial if we want a properly functioning NHS.

The Secretary of State for Health and Ministers in his team have said time and again that the NHS is beaten but not broken. These estimates are important because they set the foundation and springboard for what is required to fix our NHS.

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[Helen Morgan]

There is clearly a point in the debate at which we need to urge the Government to go further and faster. As a constructive Opposition, that is exactly what we will do.

Primary care providers are on their knees, and I am afraid to say that that has been made worse by the national insurance hike announced in the Budget. They cannot meet demand for local appointments as things stand, and in many cases the constraining factor is the estate in which they operate. Prescott surgery in Baschurch in North Shropshire wants to provide additional services to the community and keep people away from hospital, but the surgery is physically not big enough. A local developer has provided land for a new surgery, and the local council has community infrastructure levy funding for that building, but it cannot be done because the ICB will not pay the notional rent, which everybody has agreed to forfeit. It is crazy. I hope that the Minister can commit to finding some kind of easy solution to that kind of nonsensical situation that we find ourselves in.

[Nesil Caliskan]

On the point about the inability of ICBs sometimes to get things going, in my constituency it has taken the ICB nine months to procure something very similar. Does the hon. Lady agree that it is about not just their ability to pay, but their procurement processes?

[Helen Morgan]

I fundamentally agree. There are many such instances, and I chose that one because I spoke to the providers there recently.

I will come on to community pharmacy, because I am particularly concerned about pharmacies, which are a key pillar of care in the community, dispensing prescriptions and providing over-the-counter medicines and advice. Critically, they also provide Pharmacy First, but they are closing at an alarming rate. Analysis by the National Pharmacy Association predicts that another 1,000 pharmacies will close—900 of them by the end of 2027—if the current rate of closures continues. That is because of a 40% real-terms cut in their funding since 2015.

In fact, community pharmacies are essentially subsidising the NHS by making a loss on many of the prescription drugs that they dispense. In a few weeks’ time, in April, they will be clobbered by not only the NICs hike, but the increase in business rates, which will affect high street retailers. Shamefully, they have not even had their funding rates for the current financial year confirmed—the one that ends in three weeks’ time.

Pharmacy First, the flagship plan to move care into the community, has not had its funding confirmed beyond the first week of April this year, which is in just a few weeks’ time, according to the National Pharmacy Association. In her remarks, will the Minister confirm the future of Pharmacy First? Is there a funded plan to deliver that service? What steps are being taken to keep our community pharmacies in business? If we want to see care in the community, it is essential that we support them.

I want to mention dentistry. In Shropshire, Telford and Wrekin, the number of NHS dentists fell by 12.3% from 2019-20 to 2023-24. Many of my constituents cannot access a dentist, and the Government have committed to improving the situation, so can the Minister confirm when the negotiations on the new dental contract will begin?

The crisis that the social care system faces is daunting, not least because of the additional national insurance hike that will take place in a couple of weeks’ time. Last week, caring organisations launched an unprecedented day of action, with thousands of people marching on Westminster to highlight the precarious state of the organisations that provide care. The Darzi review found that people waiting to access social care account for 13% of NHS hospital beds. We all understand the urgency of tackling social care, but the cross-party talks collapsed last week—they have not started. There is no date for a new meeting, and there are no published terms of reference. We think that 2028 is far too late to resolve this problem, so can the Government urgently reinstate those talks and act now to deal with the social care crisis?

Before I conclude, I will talk about mental health. As Lord Darzi has said,

“There is a fundamental problem in the distribution of resources between mental health and physical health. Mental health accounts for more than 20 per cent of the disease burden but less than 10 per cent of NHS expenditure. This is not new. But the combination of chronic underspending with low productivity results in a treatment gap that affects nearly every family and all communities across the country.”

He is dead right. By April 2024, about 1 million people were on a waiting list for NHS mental health services, of whom 340,000 were children. My casework is full of children who wait months and months for the diagnosis and treatment that they need. The Government have removed the targets for mental health waiting lists; I urge them to reinstate those targets, so that we have parity between mental and physical health in our health service.

I am very conscious of time, so in conclusion, I will just reiterate our asks. Those are to ensure that social care talks start immediately; to deal with the problems with pharmacies; and to make sure that mental health and social care receive parity.