First 1,000 Days of Life

Debate between Paulette Hamilton and Danny Beales

Thursday 29th January 2026 Commons Chamber

[Paulette Hamilton]

My hon. Friend raises a crucial point. These services are just not joined up. We have got young children who, from birth to two and a half years old, are not getting the health services they need. They then go into the education system and are falling behind. The strategy is just not appropriate, as has been highlighted. As the Committee highlighted, we need a new strategy, and it must be joined up. We need a strategy that takes into account not just health issues, but education and care issues. Through that, we will incorporate all the professionals who are needed for that wraparound service to be delivered.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend for today’s statement and for her excellent work in chairing the Committee’s important inquiry. It is much appreciated. There is much to welcome in this report. Colleagues have already touched on a number of the measures, so I will focus in particular on vaccination.

The state of vaccination rates in this country shocked me during the inquiry. I think we all came to accept the success, the prevalence and the uptake of vaccinations, but now, for a number of reasons—including disinformation, some of which comes from elements in this Chamber—vaccination rates have been declining across the board for many years. This week, the UK lost its measles elimination status, which is shameful and an indictment of the situation in which we have got ourselves.

In the light of that, does my hon. Friend agree that we need to accelerate things such as the health visitor pilot for delivering vaccinations? We heard positive things about that in the Committee, but progress has been slow. Does she agree that we need to accelerate those actions already in train? Does she agree that we should restore the World Health Organisation target of 95% vaccination uptake nationally? Finally, does she accept that the last Government’s vaccination strategy, developed in 2023, has clearly failed, considering where we are today? Does she think that the Government need to look again at a new national vaccination strategy so that we can get back to where we once were and then make more progress, ensuring that every child has the vaccination they need to protect them and to live a healthy and fulfilling life?

[Paulette Hamilton]

My hon. Friend is passionate about the administration of vaccinations, and he has asked quite a lot of questions. I absolutely agree with them all, but I will focus on his questions relating to health visitors and to having more of a strategy on vaccinations. I hope that everybody present has read the report, which states very clearly that health visitors have massive caseloads of over 750. That means they are not able to give children the time that they need. We have recommended that we employ 1,000 extra health visitors, but we have also noted in the report that health visitors have a statutory right to visit children five times until they get to the age of two and a half. We have said that we should increase that to a minimum of six visits, which is what already happens in Wales. The minimum number of visits in Scotland is 11, and I think it is nine in Northern Ireland—I apologise if I have got that figure wrong. England has the lowest number of visits in the United Kingdom, and it needs to be increased.

I absolutely agree with my hon. Friend that we need to have more of a focus on vaccine levels, and to get the new strategy in place. Without a strategy, we are not going to get what we need in this area as quickly as we need it to happen.

Department of Health and Social Care

Debate between Paulette Hamilton and Danny Beales

Tuesday 24th June 2025 Commons Chamber

[Paulette Hamilton (Birmingham Erdington) (Lab)]

I am delighted to open this debate on the Department of Health and Social Care’s main estimate. My remarks will focus on the recent spending review, which includes some welcome funding increases and sets out some ambitious reform objectives. However, it also raises questions about deliverability, particularly of objectives to do with capital investment, efficiency savings and the role of social care.

Let me begin with capital investment. The Government have rightly emphasised the need to shift from analogue to digital systems across the NHS. The increase of nearly 50% in technology and transformation funding will mean that it reaches up to £10 billion by 2028-29, which is a welcome and substantial commitment. However, the NHS has a poor track record on digital transformation. The National Audit Office has highlighted the risks around fragmented delivery, unclear governance and unrealistic timelines, and those lessons remain highly relevant. Its 2020 report on digital transformation in the NHS found that despite £4.7 billion in national funding, many trusts were still reliant on systems that were outdated and not integrated.

The capital budget is being asked to do a great deal more than achieve digital transformation. The Government have committed to the new hospital programme, and to addressing critical infrastructure risks, such as those posed by reinforced autoclaved aerated concrete. Over five years, £30 billion is allocated for maintenance and repair, and £5 billion is allocated for critical risk. However, by the end of the decade, there will be no real-terms uplift in the capital allocations, compared with this year. In fact, in 2027-28, the funding settlement actually falls to £13.5 billion from £14 billion the previous year, meaning that inflation in construction costs and materials will significantly erode its purchasing power. The British Medical Association has warned that current funding cannot cover both the new hospital programme and essential maintenance, and now that programme must also compete for funding with the vital digital transformation. Can the Minister explain how the Department will choose its priorities from those competing essential demands on the capital budget?

Turning to resource spending, the Department’s day-to-day budget will grow by an average of 2.7% per year in real terms. That funding will be used to deliver several welcome commitments, including investment in elective recovery and urgent and emergency care; a £4 billion increase in adult social care funding; 700,000 additional urgent dental appointments annually; 8,500 more mental health staff; and £80 million a year for tobacco cessation programmes. Those are all positive steps.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend for giving way, as well as for her excellent chairing of the Health Select Committee at the moment and for opening today’s debate. Does she agree that this Government’s record investment in our health service will be vital to turning around the health service after 14 years of under-investment and a lack of reform? As my hon. Friend has touched on, that investment also needs to be targeted to enable the three shifts that the 10-year plan talks about. In particular, we need to reverse the trend of more spending going towards secondary care while less goes to primary care. We need a big uplift in dentistry, which my hon. Friend has mentioned, but also in primary care—in GPs—and in pharmacy.

[Paulette Hamilton]

Hear, hear. My hon. Friend makes some valuable points, and I agree with every one of them.

Underpinning the settlement I have described, however, is the Government’s pledge to generate £17 billion in efficiency savings over three years, with a staggering £9.1 billion expected in the final year of this Parliament. Critically, those savings have already been factored into the settlement—in effect, they have been spent before they have been delivered. In the light of that, we need absolute confidence that there is a clear and robust plan to generate those savings. The Government are assuming an annual productivity improvement in the NHS of 2%, more than triple the long-term average of 0.6%. They appear to be relying on digital transformation to unlock the bulk of those savings, which is risky, given the history of digital change programmes in the NHS.

Another source of savings is the plan to cut reliance on temporary staff by reducing sickness absence and overhauling staff policies, including limits on agency spending and eliminating the use of agencies for entry-level roles. Again, this is a welcome ambition, but delivering it will be a significant challenge, one that will require meaningful, sustained improvements to staff wellbeing and working conditions. We cannot build a sustainable workforce on good will alone. Therefore, will the Minister say when we can expect an updated and fully costed workforce plan to deliver on these ambitions?

Delivering the reforming elective care for patients plan is also central to achieving those efficiencies. It proposes reforms such as optimising surgical pathways through hubs, streamlining referrals, expanding remote monitoring and reducing unnecessary procedures. The plan assumes a rapid transformation of services, with significant improvements in productivity and patient flow expected within just a few years. That is ambitious, especially given the context of ongoing workforce shortages, ageing infrastructure and rising demand. Reform is essential, but it must be realistic, properly resourced and paced to succeed. We cannot afford to set targets that look good on paper but falter in practice, damaging morale and patient care. What steps is the Minister taking to ensure that the projected £17 billion in savings will materialise and be delivered on time? What happens to those additional resources for frontline delivery if those savings are delayed or fall short?

I will also touch on adult social care, which is in desperate need of reform. The Casey commission has an important job to do, but the terms of reference for the first phase of Casey’s work state clearly:

“The commission’s recommendations must remain affordable, operating within the fiscal constraints of Spending Review settlements for the remainder of this Parliament.”

Now that those settlements have been reached, can the Minister provide clarity to the House about precisely what fiscal constraints Baroness Casey’s recommendations will have to conform to? The £4 billion for adult social care announced in the spending review includes an increase to the NHS minimum contributions to the better care fund.