Income Tax (Charge)

Paul Holmes Excerpts

Tuesday 5th November 2024 Commons Chamber

[Wes Streeting]

I will make some more progress.

Speaking of the Conservative party, I welcome the right hon. Member for Melton and Syston (Edward Argar) to his new position as the shadow Health and Social Care Secretary—the best job in the Opposition. In the two and a half years that I did his job, I faced five Health Secretaries. I am determined to make sure he faces only one. I had differing relationships with each of my predecessors. At best, we went hammer and tongs in this place, thrashing out our disagreements, but we would also get on the phone and work together in the national interest, particularly during covid when I had a particularly constructive working relationship with Sir Sajid Javid. I hope we can work together in that spirit. If he has any ideas to fix our broken NHS I am all ears—he just needs to go to change.nhs.uk, as hundreds of thousands of people across the country have already done. I must disappoint him, however: I will not be fired out of a cannon.

Choosing to serve is not always easy, especially in a job as thankless as being a member of His Majesty’s loyal Opposition. Let me applaud the right hon. Gentleman for stepping up to the plate. Having done his job until recently, I have some advice: first, it is easy to oppose for opposition’s sake, but the public will rightly expect him to have an alternative. The Leader of the Opposition refused to say at the weekend how Conservative Members will vote on the Budget. Apparently, whether they support or oppose £26 billion of investment in our NHS is, to quote her, “inside baseball”.

If the Conservatives finally decide to oppose the Chancellor’s measures, they will need to say what they would do instead. Would they keep our investment in the NHS? If so, how would they pay for it? Would they cancel our investment and the extra appointments, send doctors and nurses back out on strike or cause waiting lists to soar even higher? The Conservative party has to choose. At the moment, our only clue about the future of the party is the Leader of the Opposition’s comments about charging patients to use the NHS. She gave an interview to The Times just weeks ago in which, on the principle that the NHS should be free at the point of use, she said:

“we need to have a serious cross-party, national conversation.”

I am happy for the Conservative party to start that conversation any time. As far as I am concerned, it will be a short debate, and we will win: the answer is no. The Labour party will never surrender on the principle of the NHS being a public service, publicly funded and free at the point of use. It is time that the Leader of the Opposition made her position clear—although she has taken to opposition with such vigour, she tends to oppose things she said herself only days before.

I welcome the Leader of the Opposition’s call for honesty. The public have lost trust in politics, and we all have a responsibility to rebuild it. If we are not honest about the scale of the challenge and its causes, we have no hope of fixing them. Would it not be a welcome start to the role if the new shadow Secretary of State admitted what a mess his party made of our national health service and said sorry? It is not all the right hon. Gentleman’s fault; in fact, he and I have something in common. When he walked into the Department in 2019, he also inherited waiting lists already at record levels. It is true that waiting lists soared even further during the pandemic, but they were already at record levels before, and they continued to rise afterwards because of the damage that the Conservative party did to our NHS.

The Darzi investigation was clear about what is to blame: the top-down reorganisation, the chronic under-investment and the undoing of the last Labour Government’s reforms that saw NHS productivity fall off a cliff. Can the shadow Health and Social Care Secretary do what his predecessor could not, and accept the doctor’s diagnosis? Does this new Conservative leadership finally accept Lord Darzi’s findings? If the right hon. Gentleman cannot accept the work of an eminent cancer surgeon who has served both Labour and Conservative Governments, I wonder if he might agree with this damning assessment of his party’s record, made by one of his former colleagues:

“British citizens have the worst rate of life expectancy in western Europe. We have higher avoidable mortality rates than our neighbours. Survival rates for breast, cervical, rectal, lung, stomach and colon cancer are lower in the UK than in comparable jurisdictions. NHS patients who suffer heart attacks or strokes are more likely to die than in France, Spain, the Netherlands, Canada, Italy and New Zealand.

More than seven million people are on waiting lists...Every month, tens of thousands wait more than 12 hours for treatment after being admitted to accident and emergency wards. It is then no surprise that the number of (wealthier) patients opting to pay to be treated privately is at a record level...so we have a two-tier health system in this country in which the rich secure the best care, those in pain wait in agony and those with life-threatening conditions know their treatment would be better in Marseille or Madrid than in Manchester or Middlesbrough.”

The author of that quote was Michael Gove. If he can be honest about the mess the Conservatives made of the NHS, I hope the right hon. Gentleman can, too.

While the Conservatives work out what they stand for, we are getting on with cleaning up their mess, rebuilding our public services and reforming our NHS. As I said before the election, there is no point pouring more money into a broken system. Next week I will set out a package of reforms to make sure that every penny going into the NHS is well spent and benefits patients. Unless I am convinced that the money going in will deliver results, it will not get out the door.

Every bit of investment announced by the Chancellor last week will be linked to reform. The Budget will fund 40,000 extra appointments a week, and the appointments will be delivered through reformed ways of working. They are already being used in hospital across the river from here, where operating theatres are run like Formula 1 pit-stops. We will get hospitals motoring right across the country using that reformed way of working. We are investing not just in new scanners but AI-enabled scanners that diagnose faster and more accurately, increasing productivity and busting the backlog of 1.5 million patients waiting for tests and scans.

The investments in the Budget have fired the starting pistol on the three shifts that our 10-year plan will deliver. It increased the disabled facilities grant, to help people stay well, independent and out of hospital, funding an extra 8,000 adaptations to people’s homes. We are raising the carer’s allowance, worth an extra £2,300 to family carers so that they can stay in work while looking after their loved ones. That is the biggest expansion of carer’s allowance since the 1970s. We are expanding NHS talking therapies to treat an extra 380,000 mental health patients. We are investing in bricks and mortar outside of hospitals, opening new mental health crisis centres and upgrading 200 GP surgeries.

[Paul Holmes (Hamble Valley) (Con)]

I congratulate the Secretary of State on the extra investment that he has secured for the national health service, in spite of the Chancellor. Does he agree that primary care needs to be diversified? Could he outline whether that includes walk-in centres? If it does, could I have a meeting to discuss a new walk-in centre at Fareham community hospital in my constituency?

[Wes Streeting]

I am not sure whether this is within the rules of the House—you will tell me if not, Madam Deputy Speaker—but I will do the hon. Member a deal: if he votes for the investment, he can have the meeting.

Turning to the second of the big shifts that we need, from analogue to digital, the Darzi investigation found that the Conservatives left the NHS 15 years behind the private sector on technology. This Budget invests £2 billion to arm the NHS with modern technology so that staff spend less time pushing paper and more time on the frontline. In 2024, that the NHS is still using paper records to store patients’ medical history is absurd and jeopardises patient safety. The investment in this Budget will provide every trust with electronic patient records, and upgrade the NHS app so that patients can access care with a few taps on their phone. We are backing British scientists and researchers to develop the treatments of the future, with record investment in the National Institute for Health and Care Research, support for life sciences innovation and strengthening the UK clinical trial network.

We are also shifting from sickness to prevention. Today, we have announced the biggest public sector health reform in a generation. We are raising the legal age at which people can buy tobacco by one year, every year, protecting children and people from the harmful effects of second-hand smoke outdoors as well as indoors. We are cracking down on the marketing and targeting of vapes at children, so that we can create the first ever smokefree generation. Unless we act on public health reform and public service reform, the demands and costs on the NHS will spiral and the service will become unsustainable. If we want the health service to survive, and we do not want to pay ever higher taxes to fund it, we have to help people stay healthy. Prevention is better than cure—that is why we are introducing the Bill. I hope it will continue to command cross-party support.

It is not just smoking; obesity costs the NHS almost £12 billion a year. That is why we have already introduced the motion to ban the targeting of junk food ads at kids. We are strengthening councils’ powers to stop fast-food shops setting up outside schools. In the Budget the Chancellor increased the soft drinks industry levy so that manufacturers continue to reduce their sugar content while we review the exemption for milk-based drinks.

Madam Deputy Speaker, as you know, it was a Conservative Chancellor who introduced the sugar tax and a Conservative Prime Minister who introduced the first Tobacco and Vapes Bill. Because he is sensible, I know the shadow Health and Social Care Secretary will support those measures, but I cannot say the same for the Leader of the Opposition, so trapped in the prison of ideological dogma is she, so scared is she of the Reform dog that is barking over their shoulders. I hope the shadow Health Secretary will continue to hold the torch for one nation conservatism, even as its light dims in his party. If we want to know when the Conservative party has changed, maybe we will know when they have learned once again to love George Osborne.

Fixing the foundations of the NHS starts with fixing its little foundations. Lord Darzi pointed to how the Conservatives raided capital budgets time and again to plug the gaps in day-to-day spending. Indeed, that is the position we found ourselves walking into this year. Lord Darzi called it a

“combination of austerity and capital starvation”.

The Budget will begin to rebuild our NHS with the biggest capital investment since Labour was last in office, including £1 billion to tackle dangerous RAAC—reinforced autoclaved aerated concrete—and the backlog of critical maintenance and repairs across the NHS estate, keeping staff and patients safe and boosting productivity.

In conclusion, we cannot fix 14 years of mismanagement and neglect in one go, but the Budget marked an historic turning point for our country. For years the Conservatives pretended that the problems facing Britain did not exist, leaving them to grow. This week, the Chancellor ran head first into those challenges, taking the tough, difficult decisions on tax, spending and welfare because the choice was stark: we could stick to the status quo of 14 years of underinvestment that has knee-capped our economy and crippled our NHS, or we could begin to fix the foundations, kick-start the economy and rebuild our health service. The choices the Chancellor made will give the NHS the investment and reform it desperately needs to cut waiting times, rebuild crumbling buildings, arm NHS staff with modern technology, get more out of the NHS for what we put in, and fix the foundations and rebuild Britain. That is the change the country voted for; that is the change this Labour Budget delivers.

--- Later in debate ---

[Edward Argar]

I am grateful to the hon. Gentleman. If he pauses for just a moment, I will turn to capital investment and seek to address his point.

[Paul Holmes]

Will the shadow Secretary of State give way on that point?

[Edward Argar]

I will make a little progress, but then I will happily give way to my hon. Friend.

Apart from the press releases and the reviews, where is the action? We need to see where the £22 billion will be spent. What plans does the Secretary of State have for additional investment for the NHS this winter? He knows, as I knew when I was a Minister, that winter in the NHS is always challenging. I look forward to him setting out what additional investment he plans.

[Edward Argar]

I will give way to my hon. Friend the Member for Hamble Valley (Paul Holmes) in a second. Nice try, Secretary of State.

Is the right hon. Gentleman directing where that NHS funding goes himself, or will it be for his officials or NHS England to set the priorities for that, and who will be held accountable for ensuring that it is prioritised in the right places?

[Paul Holmes]

I thank my right hon. Friend for giving way and congratulate him on his appointment as shadow Secretary of State. Does he share my concern that, although the extra investment in the NHS is welcome, the lack of clarity from a Budget in which growth has actually been revised down means that in future years we could see additional investment in the NHS actually being cut back, because the Budget does not deliver the growth for public service investment?

[Edward Argar]

My hon. Friend is absolutely right. You cannot tax your way to growth and you cannot invest in public services without that growth. If the predictions we are seeing about growth are borne out, there is a real risk to our public services’ sustainability in future.

The Chancellor said that the funding would help to deliver 40,000 more NHS appointments a week, but again we see no reference to specific actions by which that will be achieved. The Government seem not to know the difference between a target and a plan, and simply restating their ambition while throwing money at the challenge will not be enough to deliver on that commitment.

As I have said, elements of the Budget relating to the Department of Health and Social Care were welcome, one of them being the Secretary of State’s one-nil win over the Chief Secretary in respect of funding. An additional £2 billion to drive productivity is important. I fear that it is a slimmed-down version of the £3.4 billion NHS productivity plans that we announced and funded, but I will study it closely, and, similarly, the Secretary of State’s plan for mental health is deserving of serious study. On both sides of this Chamber, we recognise the importance in mental health investment of not only parity of esteem but parity of services, and it is therefore right for us to scrutinise very carefully how the right hon. Gentleman intends to build further on the success that we had in driving that agenda forward.

Let me now turn to the subject of capital investment, which was touched on by the hon. Member for Kensington and Bayswater (Joe Powell). It concerns me that, as far as I am aware, the Secretary of State has still not told us exactly when his review of the new hospital programme will report and set out the future for each and every one of the hospitals that he committed himself to delivering during the election campaign—the programme to which the previous Chancellor had committed funding, building on the original £3.7 billion allocated in 2019. The question for the Government, and the question for the Chief Secretary to answer when he winds up the debate, is: “When will that review report, and when will each and every one of those colleagues and communities who are looking forward to a new hospital know whether it will be delivered in line with the Secretary of State’s pledge, or whether the programme will be cut?”

Nearly a week after the Budget, Members will be familiar with the verdict of the Office for Budget Responsibility: namely, that the £25 billion assault on businesses risks lower wages, lower living standards and lower growth. And let us not forget what this tax hike will mean for those providing essential services across primary, secondary and social care—the general practices, care homes, adult social care providers, community pharmacists on our high streets, hospices and charities such as Marie Curie and Macmillan which provide additional care for patients alongside the NHS.

I was deeply disappointed that the Secretary of State did not take the opportunity offered by my hon. Friend the Member for Hinckley and Bosworth (Dr Evans) to state clearly that all those groups would be exempt and would not be hit by this hike, and I hope that when the Chief Secretary winds up the debate he will be able to give that reassurance. The Royal College of General Practitioners has warned that the extra costs of the employer’s national insurance hike could force GP surgeries to make redundancies or close altogether, and the Independent Pharmacies Association has warned that community pharmacies will have to find an extra £12,000 a year, on average, to pay for the hike.