Patient Choice

Steve Barclay Excerpts

Thursday 25th May 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

May I begin by joining colleagues from across the House in paying tribute to the former hon. Member for Redditch? I entered the House at the same time as her. She was a much-loved and popular colleague. I send, as I know so many do, condolences to her family and her many friends.

With permission, Madam Deputy Speaker, I shall make a statement about the action the Government are taking to improve patient choice as a way to help reduce NHS waiting times, one of the Government’s five key priorities.

There are currently significant variations in waiting times across the country, and sometimes even within the same integrated care system. Analysis from the Patients Association suggests that improved patient choice can reduce waiting times by up to three months. When he took office last year, the Prime Minister promised to make it easier for patients to make a meaningful choice and to raise public awareness of the patient’s right to choose.

Because of the pandemic, we have an NHS waiting list of over 7.3 million. Of that number, around 80% are waiting for outpatient appointments and around 20% are waiting for operations. Greater patient choice will help us address this built up demand including, where appropriate, opening more routes for NHS patients to get treatment free at the point of access in the independent sector, provided it meets NHS costs and standards, because we should use all available capacity in tackling the pandemic backlogs. For example, for patients currently waiting for ear, nose and throat treatment in London, the wait could be up to four months shorter with another provider, or with trauma and orthopaedics in the north-west, choosing another provider in the same region could cut someone’s wait by three months.

Empowering patients to exercise their right to choose was one of the recommendations of the elective recovery taskforce, which identified it as a vital way of delivering the post-pandemic recovery. While we were addressing the 78-week backlog, analysis showed that 50% of those who were waiting more than 78 weeks for elective care were in just 11 trusts, which reinforced the opportunity offered by raising awareness of patient choice and making it easier for patients to exercise that choice in a meaningful way.

As well as cutting waiting lists, choice empowers patients to decide which aspects of the hospital service matter most to them. Patients themselves can prioritise the speed of care, alongside other factors such as distance travelled and the Care Quality Commission rating of the provider, or they may have had previous care from a consultant-led team and want to return to that team. We believe that empowering the patient is an intrinsically good thing, and we also believe that it cannot be the preserve of the groups with the sharpest elbows; it must be open to all. Research from the King’s Fund has found that

“older respondents, those with no qualifications, and those from a mixed and non-white background were more likely to value choice.”

When we combine improved patient choice with better real-time data and greater transparency, we can drive up standards. When patients know much more about how their local hospital is performing, the pressure is on poor performers to close the gap with their near neighbours, where patients are often being treated more quickly.

The case for patient choice is clear, so with the aim of improving it, we are announcing significant changes in a number of areas. The first is technology. More than 30 million people have now signed up for the NHS App, and our target is for three quarters of all adults in England to be registered by next March. The app is already giving patients an improved “front door” for NHS services, and we are continuing to build on that. When GPs make a referral, they will make a shortlist of the five most suitable providers, and patients will be able to choose from the shortlist on the app. In March we completed the work of supplying a single list of providers for these shortlists, irrespective of whether the services are commissioned locally or nationally. While the Opposition’s plan to organise waiting lists on a regional basis might look like a good idea on paper, in reality it would add an extra layer of bureaucracy, whereas national lists under this Conservative Government will empower patients to choose treatment wherever they like. For example, a patient registered in Sheffield might happily choose to receive treatment in Manchester, particularly if family members there could help with the patient’s care and recovery.

The second area of work is improving the experience of those who are already on waiting lists, so that they can obtain treatment more quickly. From October this year, patients who have waited more than 40 weeks for an appointment, or who have a decision to treat but do not have a treatment date, will be able to request a transfer to another provider with a shorter waiting list. It is our ambition to expand that offer to other groups of long waiters, progressively lowering the waiting time towards 18 weeks as fast as is clinically possible.

Our third focus is on communications. We want to increase public awareness of today’s announcement through a national campaign, with the particular aim of reaching the groups who are most likely to benefit from greater choice as well as those least likely to exercise it. We will also ensure that general practitioners, and others who refer patients for consultant-led care, are offering more patient choice and are supported with the right training and technology.

Fourthly, we will focus on transparency. Real-time information on performance will be made more transparent to patients so that they can gain a clearer understanding of the variations from place to place, which will help them to exercise informed choice. We have worked to make ratings by the Care Quality Commission available and accessible to all, and we are merging the “My Planned Care” platform with the NHS website.

The Labour party has been busy announcing initiatives that we already have under way, such as expanding the NHS App, embracing virtual wards and stopping kids from vaping, but while its members have been busy talking in England and failing to act on behalf of patients in Wales, we have been busy acting to empower patients, and today’s announcement is another example of that. We are committed to cutting NHS waiting lists, and the measures that we have announced will help us to do that—by empowering patients to gain access to faster treatment in hospitals with available capacity; by giving patients technology enabling them to exercise their right to choose, and giving them the information that will help them to make that choice; by increasing communication to raise public awareness of the right to choose; and by fostering much greater transparency and, through funding, following the patient, to encourage trusts to improve their offer to patients to better match the service offered in hospitals elsewhere.

Taken together, those measures will enable patients to access treatment more quickly and meet the Government’s priority of reducing NHS waiting lists. I commend this statement to the House.

[Wes Streeting (Ilford North) (Lab)]

I thank the Secretary of State for advance sight of his statement. I also join him in paying tribute to the late Karen Lumley and, even more important, extending condolences to her family and her many friends on both sides of the House —but particularly on the Conservative Benches—for their loss. I know that the sadness is felt very deeply throughout the Chamber.

Let me now turn to the first of today’s two statements from the Health Secretary. It seems that quantity is not matched by quality. In a week in which the Leader of the Opposition announced Labour’s plans to give patients more choice, with regional waiting lists for care and more power through the NHS App, the Conservatives’ big idea to cut waiting times is to give patients a choice that they already have. It is thanks to the last Labour Government that patients waiting for planned treatment already have a right to choose an alternative provider if they have been waiting too long.

Beneath the spin, the Health Secretary’s announcement is actually a watering down of the measures that are already in place. He says that patients will have the right to choose an alternative provider if they have been waiting longer than 40 weeks, but in 2019 the Conservatives said that they should have that right after 26 weeks—which, even then, was worse than the 18-week standard to which patients were already entitled thanks to the last Labour Government. Is it not the case that he is once again shifting the goalposts because he cannot even meet his own standards, let alone those that patients expect?

The Health Secretary concluded his statement by talking about his Government’s record. That was a bold move, because 7.3 million people— the highest number on record—are currently waiting for planned treatment in England. As usual, the Health Secretary said that that was because of the pandemic, but the figure was already at a record high before the pandemic. Behind this shocking statistic are real people, waiting, waiting, waiting in agony. It does not matter how often the Health Secretary says that the Government are committed to reducing the waiting lists; people can see with their own eyes the numbers that do not lie, which show that waiting lists are getting higher and things are getting worse, not better.

The Health Secretary’s total incompetence when it comes to preventing strike action in the NHS has inflicted untold misery on patients. So far the total number of appointments affected by NHS strikes in recent months is more than half a million, a figure that the Health Secretary called “deeply disappointing”. Well, that is something on which he and I can agree, for once, but with another round of strike action planned by junior doctors, he must surely see the risk to patient choice and waiting lists. What is his plan? Ministers blame strikes as if they were mere bystanders, but it was their refusal to speak to nurses, paramedics and junior doctors that forced them out on strike in the first place. I am afraid the Health Secretary’s warm words today are not going to cut it, when all he is doing is giving more patients more choice over where their next appointment or operation is to be cancelled because of the strikes that he and the Prime Minister have failed to prevent.

Finally, let me turn to the supermassive black hole that is at the heart of today’s announcement. I will keep on reminding the Health Secretary of this until the penny drops. It does not matter which hospital patients choose; they can only receive care on time if there are enough staff to treat them—so why are we still waiting for the NHS workforce plan that the system is crying out for? Why do we have net migration at the highest level ever, with the Government over-reliant on recruiting staff from overseas because they cannot be bothered to train home-grown talent? Where is the plan to train the doctors and nurses whom the NHS is so desperately short of? Labour has set out our plan to double medical school places and train 7,500 more doctors and 10,000 more nurses a year, which we would pay for by abolishing non-dom tax status. [Interruption.] I am afraid that Conservative Members like non-doms more than they like nurses, but the public are not with them on that. Let me once again, in the spirit of generosity, before we break for the recess, offer the Secretary of State our fully costed, fully funded plan. It is available to him—[Interruption.] Conservative Members should not laugh too much now. I wager that, before we break for the summer, the Government will finally swallow their pride and announce the doubling of medical school places. We will wait and see.

After 13 years of Conservative Government, people can see for themselves where it has landed this country and compare it with 13 years of Labour Government, which delivered the shortest waiting times and the highest patient satisfaction in history. We will offer real choice and cut waiting times, so that the NHS is there when people need it. We did it before; we will do it again. We have the ideas and we have the plan. That is why only Labour can build an NHS that is fit for the future.

[Steve Barclay]

Not since the famous 1p on income tax from the Lib Dems, which was to be spent on every issue going past like a passing bus, have we heard of money being spent in as many different ways as the non-dom money. No wonder the hon. Member for Ilford North (Wes Streeting) said it with a smile; the whole House could see how credible that proposal is.

The theme of the hon. Gentleman’s response was comparison, so I think we should compare the substance of the announcement on patient choice with the situation where Labour is in office. In Wales, patients do not have the ability to choose where they receive treatment; that right is not offered to patients. In NHS Wales, patients registered with a GP in Wales do not have a statutory right to choose at which hospital they receive treatment. We can compare what a Government in England are doing—empowering patients, giving them that choice as well as the information and technology they need to make it—with NHS Wales, run by the Labour party, which deprives patients of their choice.

I hesitate to draw the comparison with Wales, however, because another Labour Front Bencher, the hon. Member for Denton and Reddish (Andrew Gwynne), says that he does not want Labour to be judged on its record in Wales. That is slightly confusing because the leader of the Labour party, no less, says that he wants Labour in Wales to be

“a blueprint for what Labour can do across the UK”.

So they cannot even compare among themselves, never mind compare between England and Wales.

The hon. Member for Ilford North talked about strike action but seemed to skirt around the fact that the Government have reached a deal with the NHS Staff Council in relation to Agenda for Change staff—a deal that his own union, Unison, voted 74% in favour of. His own union—the union that gives him money—supported the deal. He chides us about junior doctors, but those of us who were present in the Chamber the last time heard him say that he did not support the junior doctors’ demand for 35%. When we did negotiate with them, they even increased their demand to 49%, when next year is added in, further confusing the position.

It will come as no surprise to the House to discover that people in Wales are almost twice as likely to be waiting for treatment as people in England. That is the true comparison that we are addressing. We can see that situation play through to people waiting more than 18 months. In England, we have virtually eliminated 78-week waits—at the end of March, it was under 11,000—but in Wales, it will come as no surprise to Members, the number was closer to 75,000, and of course Wales has a smaller population. So we can compare waiting times, which we in England are bringing down. We have an electives plan, we cleared virtually all the two-year waits in the summer and over 90% of the 18-month waits at the end of March, which contrasts with the situation in Wales. We are giving patients choice, enabling them to move if they want to in order to get quicker treatment elsewhere. We are on the side of patients. We can see what the Labour party is doing by its disastrous performance in Wales.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

This form of patient choice has of course been available for at least 15 years; it just has not been made available to patients. Can the Secretary of State confirm that the referral management centres sitting at integrated care board level will be compelled, not asked, either to change that or to get out of the way altogether? Given that the vast majority of people on the waiting lists are already there with a specific trust, how exactly will they be given the option either to stick where they are, or to twist and exercise that choice to receive treatment sooner?

[Steve Barclay]

My hon. Friend, as ever, makes a shrewd point. Yes, the referral centres are part of this system. The key focus is on the initial GP referral and how we facilitate that with better data, transparency and tech, but the referral centres are a part of this. We want to roll it out to the 40-week waits from October, and to bring waits down to 18 weeks. There is a clear plan to achieve that wider scope, and that is what I have set out to the House today.

[Valerie Vaz (Walsall South) (Lab)]

Karen Lumley was indeed a wonderful woman. Our thoughts and prayers are with her family at this difficult time.

The statement is admirable, but how will patients have a choice if the Secretary of State does not address the workforce issue? When will he do that? When will he speak to the junior doctors?

[Steve Barclay]

As I touched on in my statement, the choice is there now; it is available right now, but only about 10% of patients exercise it. There is massive variation in the system now, with the existing workforce. We are increasing the workforce. We have made a commitment to produce a workforce plan, but the point is that there is variation within the system now. What patient choice is about is empowering patients to take advantage of it and to access treatment sooner, for example, by being willing to travel often short distances to access it.

[Greg Smith (Buckingham) (Con)]

I really do welcome the revolution in patient choice that my right hon. Friend has outlined, but as chair of the all-party parliamentary group on minimally invasive cancer therapies, it is clear to me that some cutting-edge technologies and treatments are available only in certain trusts under certain consultants. Can he confirm that, within the choice available to them, patients will be able to choose centres that provide unique treatments, rather than the universal treatments that are available everywhere?

[Steve Barclay]

Yes, I can. Part of this is allowing patients to choose according to a number of factors. Some may have had treatment previously and want to go back to a particular consultant-led team. Some may want to look at CQC ratings and other performance metrics. Some may want the convenience of not travelling—relatively small numbers say they are not willing to travel; far more are willing to do so. Patients will look at a range of factors when shaping their decision. The key is to have transparency and the technology that enables patients to take control.

[Daisy Cooper (St Albans) (LD)]

Of course we all want to see real patient choice, but for millions of people who are waiting in pain, a choice between travelling miles away or paying to go private is no choice at all. We all know that the key to unlocking millions of people from the NHS backlog is tackling the crisis in the workforce. Why on earth are we spending precious parliamentary time talking about the NHS app instead of the NHS workforce?

[Steve Barclay]

We are talking about the wider workforce. The hon. Lady mentions private capacity. This patient choice will enable people to make much better use of the independent sector and to do so free at the point of access. Given the size of the challenge of pandemic backlogs, the question is: how can we make full use of capacity across the NHS and in the independent sector?

[Dr Kieran Mullan (Crewe and Nantwich) (Con)]

The problem of variation in waiting times is symbolic of all sorts of variations across the NHS. My previous employer, the national clinic audit programme commissioner, focused on identifying and spreading good practice. Will the Minister join me to meet the programme’s CEO, Jane Ingham, to hear her insights on how to tackle this challenge, and also join me in paying tribute to her as she retires after 10 years of dedicated public service in this role?

[Steve Barclay]

I am very happy to join my hon. Friend in paying tribute to Jane Ingham, who, as he says, is retiring after 10 years in that post. She has a long history of working to improve the quality of healthcare in the NHS and it is right that we pay tribute to her. I am sure the ministerial team are keen to engage with her on lessons to be learnt from her career.

[Marsha De Cordova (Battersea) (Lab)]

The Secretary of State’s words on patient choice will ring hollow until he addresses the NHS workforce crisis. In ophthalmology, 80% of eye units do not have enough consultants to meet current demand, and 65% of eye units had to rely on locums last year. Labour has a fully funded plan for the biggest workforce expansion in NHS history. Where is his plan? He has not answered previous questions. Can he say whether this workforce plan will actually address the deficit in eye health and ophthalmology?

[Steve Barclay]

As the record shows, numbers have been increasing. There are 37,000 more doctors and 52,000 more nurses within primary care than in 2010. We have already reached our manifesto commitment on additional roles in primary care to deliver more appointments. We have repeatedly said that we will bring forward a workforce plan and we are committed to doing so shortly.

[Sir Edward Leigh (Gainsborough) (Con)]

I congratulate my right hon. Friend on promoting more choice than in the socialist republic of Wales, which is a pretty low bar, but can we go further and promote real choice by adopting two previous Conservative policies? Both would be wildly popular. The first is a patient passport, by which a patient could get a free operation on the NHS, or take the same cost to a private or charitable hospital, which would promote choice and accountability. The second is tax relief for private health insurance, which is a matter for the Chancellor, but the Secretary of State could have a quiet word with him.

[Steve Barclay]

My right hon. Friend has lobbied me on this issue a number of times, including outside the Chamber. As such a senior parliamentarian, he well knows that tax is a matter for the Chancellor, who I am sure will have noted his wider point.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his very positive statement. He referred to long waiters, the second area of work. One oft-neglected area is access to specialist in-patient services for eating disorders. My constituents in Northern Ireland do not have access to a clinic to allow them a choice between a weekly weigh-in with their GP and specialised treatment. What discussions, and practical and physical assistance, can he offer the Department of Health at the Northern Ireland Assembly to help people with eating disorders?

[Steve Barclay]

As so often, the hon. Gentleman raises an extremely important point about how we tackle the serious issue of eating disorders. As he knows, we are increasing our funding for mental health. It is a key priority in the long-term plan, which is providing an extra £2.3 billion a year. On different approaches, we are looking much more actively at our use of digital apps and platforms, which is an area that the Chancellor specifically funded in the last Budget. We are also looking at how we address mental health issues earlier, particularly for children. We are rolling out mental health support teams in schools because, obviously, early intervention has significant benefits and targeting schools is a great way to do that.

[Kit Malthouse (North West Hampshire) (Con)]

I, too, congratulate the Secretary of State on a profoundly Conservative step forward in dealing with the waiting list issue. Does he agree that the provision of greater patient choice holds out the possibility of stimulating more investment in private sector capacity, particularly for volume procedures such as hips and knees? However, the private sector, to make such heavy investments in facilities, requires long-range certainty. As waiting lists fall, will he review the threshold—the time limit—at which patients can seek private sector assistance in getting their operation done more swiftly, so that the efficiencies of the private sector can be realised for the system as a whole in the longer term?

[Steve Barclay]

My right hon. Friend raises a very good point. As he knows, there is interaction between what is and is not on the balance sheet. His point particularly relates to the roll-out of diagnostic centres. I have looked at the facility in Blackpool that is using artificial intelligence in endoscopy and picking up 20% more cases than would be seen with the human eye. We are thinking about how we use the private sector to add more capacity at scale and pace, and how it can use the latest technology. Obviously, we need to do that in a way that is compliant with Treasury rules. Ensuring there is greater capacity in the system—but doing so where it is free at the point of access to NHS patients—is an area where we have already done quite a lot. However, there is always scope to look at it afresh.

[Robbie Moore (Keighley) (Con)]

I commend my right hon. Friend for the statement, which will undoubtedly help waiting lists in my Keighley and Ilkley constituency. Can he confirm that this expansion will be available first to those who have been waiting longest?

[Steve Barclay]

I can confirm that, from October, we will roll this out to those who have been waiting more than 40 weeks, and we will look to bring down that threshold over time. We will focus first on the longest waits.

[Mr Louie French (Old Bexley and Sidcup) (Con)]

I share my right hon. Friend’s desire to increase patient choice and reduce waiting times. One way to do that in south-east London is to expand further the number of services at Queen Mary’s Hospital, Sidcup, which is an excellent modern hospital with the capacity to expand services. However, there needs to be a will within NHS leadership, especially within the new integrated care boards, to get on with doing so, particularly for community diagnostics. Will my right hon. Friend please agree to meet me to discuss further how we can improve patient choice and patient outcomes in Bexley?

[Steve Barclay]

I share my hon. Friend’s desire. As part of this announcement, payment will follow patients to incentivise trusts to take on more, which further underpins patient choice. We are actively engaged on accelerating the diagnostic centres and, as a result of ministerial intervention, we have speeded up the diagnostic centre programme. I look forward to updating the House on how many additional scans and tests will now be done this year, as opposed to the original plan for those tests to be done in 2024. I am very happy to have further discussion with him.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I normally allow a bit of movement between statements, but it seems that a change of scene and personnel is not necessary as everyone is already in place.

Recovering Access to Primary Care

Steve Barclay Excerpts

Tuesday 9th May 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

With permission, I would like to make a statement on the primary care recovery plan. For most of us, general practice is our front door to the NHS. In the last six months, over half the UK population has used GP services, and GPs in England carry out around 1 million appointments every single day. They are doing more than ever. General practice is delivering 10% more appointments a month than before the pandemic—the equivalent of the average GP surgery seeing about 20 additional patients every working day. There are more staff than ever, with numbers up by a quarter since 2019, and we are on track to deliver our manifesto target, with an additional 25,000 staff already recruited into primary care. We are investing more than ever, too, with the most recent figures showing that funding was around a fifth higher than five years before, even once inflation is taken into account.

But we know that there is a great deal still to do. Covid-19 presented many challenges across the health service, leaving us with large numbers of people on NHS waiting lists, which need to be tackled. In general practice, patient contacts with GPs have increased between 20% and 40% since before the pandemic. As well as recovering from the pandemic, we face longer-term challenges, too. Since 2010, the number of people in England aged 70 and above has increased by a third, and this group attends five times more GP appointments than young people. Not only that, but advances in technology and treatments mean that people understandably expect more from primary care systems.

Today I can announce our primary care recovery plan, and I pay tribute to the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), for his work on this plan. I have deposited copies of the plan in the Libraries of both Houses. Our plan will enable us to better recover from the pandemic, to cut NHS waiting lists and to make the most of the opportunities ahead by focusing on three key areas: first, tackling the 8 am rush by giving GPs new digital tools; secondly, freeing up GP appointments by funding pharmacists to do more, with a “pharmacy first” approach; and thirdly, providing more GPs’ staff and more appointments. NHS England and my Department have committed to make over £1.2 billion of funding available to support the plan, in addition to the significant real-terms increases in spending on general practice in recent years. Taken together, our plan will make it easier for people to get the help they need.

The plan builds on lots of other important work. Last year, we launched the elective recovery plan, which is making big strides to reduce the backlog brought by covid-19. We eliminated nearly all waits over two years by last July, and 18-month waits have now decreased by over 90% since their peak in September 2021. By contrast, in the NHS in Labour-run Wales, people are twice as likely to be waiting for treatment than in England. They still have over 41,000 people waiting over two years and nearly 80,000 waiting over 18 months. In addition, this January, I came before the House to launch our urgent and emergency care plan, which is focused on how to better manage pressures in emergency departments, with funding to support discharge to improve patient flow in hospitals. Today’s plan is the next important piece of work.

Turning to the detail of the plan, our first aim is to tackle the 8 am rush. We will do that by providing GPs with new and better technology, moving us from an analogue approach to ways of working in the digital age. An average-sized GP practice will get around 100 calls in the first hour of a Monday morning. No team of receptionists, no matter how hard-working, can handle such demand. About half of GPs are still on old analogue phones, meaning that when things get busy, people get engaged tones. We are changing that by investing in modern phone systems for all GPs, including features such as call-back options, and by improving the digital front door for even more patients. In the GP practices that have already adopted those systems, there has been a 30% improvement in patient feedback on their ability to access the appointments they need. That also reflects the fact that online requests can help find the right person within the practice, such as being directed to a pharmacist for a medicine prescription review or to a physio for back pain.

In doing that, we will make the most of the 25,000 more staff we now have in primary care. Today’s plans fund practices without this technology to adopt it, while also providing them with staff cover to help them manage a smooth transition to the technology. Indeed, many small GP practices in particular find it hardest to fund new technology, or to manage the disruption that comes with transitioning to new ways of working, so we are funding locum cover alongside the tech itself. Notwithstanding that, people will always be able to walk in or ring if they prefer; if someone wants to ring up and see someone face to face, these investments will make that easier, too.

We also want to make sure that patients know on the same day that they make contact how their request is going to be handled. Clinically urgent issues will be assessed on the same day, or the next day if raised in the afternoon. If the issue is not urgent, an appointment will be scheduled within two weeks, but crucially, people will not be asked to call back the following day. Instead, they will get their appointment booked on the same day or be signposted to other services.

The second area of the plan is Pharmacy First. As well as giving GPs new technology, I know that we need to take pressure off GPs where possible by making better use of the skills of all clinicians working in primary care. We saw the incredible role that pharmacists played during the pandemic—their capacity to innovate and deliver for the communities that they served, freeing up GP appointments in doing so—so the second part of our plan is to introduce a new NHS service, Pharmacy First, on which we are already consulting with the Pharmaceutical Services Negotiating Committee.

Some 80% of people live within a 20-minute walk of a pharmacy, so making it easier for pharmacists to take referrals can have a huge impact. Referrals might be from GPs, NHS 111 or, from next week, urgent and emergency care settings. Community pharmacies already take referrals for a range of minor conditions, such as diarrhoea, vomiting and conjunctivitis, but with our Pharmacy First approach we can go further still. We will invest up to £645 million over the next two years so that pharmacists can supply prescription-only medicines for common conditions, such as ear pain, urinary tract infections and sore throats, without requiring a prescription from a GP.

One of the most significant shifts we are making is on oral contraception. Pharmacists can already manage the supply of contraception prescribed elsewhere; from later this year, they will also be able to start women on courses of oral contraception. This is another way in which, in light of our women’s health strategy, we aim to reduce the barriers to women accessing contraception. Pharmacists will also be able to do more blood pressure checks, which is one of the most important risk factors for cardiovascular disease. Not only will those kinds of steps make it easier for people to get the care they need, we expect them to release up to 10 million appointments a year by 2024-25.

The third part of our plan is about providing more staff and more appointments. We are making huge investments in our primary care workforce, and are on track to meet the manifesto commitment of 26,000 more primary care staff by next March, meaning that we have more pharmacists, physios and paramedics delivering appointments in primary care than ever before. In 2021, we hit our target of 4,000 people accepting GP training places, and our upcoming NHS workforce plan will set out how we will further expand GP training. We are also helping to retain senior GPs by reforming pension rules, lifting 9,000 GPs out of annual tax changes. These are the pension reforms that the British Medical Association welcomed, describing them as “significant” and “decisive” changes and citing them as “transformative for the NHS”.

As well as freeing up more staff time, our plan cuts bureaucracy, too, so that GPs spend less time on paperwork and more time caring for patients. We will remove unnecessary targets, improve communication between GPs and hospitals, and reduce the amount of non-GP work that GPs are being asked to do. For example, patients are often discharged from hospital without fit notes, meaning that they then have to go to their GP to get one. By the end of this year, NHS secondary care services, which understand those patient conditions better, will be able to issue fit notes, and we have streamlined the number of targets on primary care networks from 36 down to just five. Taken together, this work will free up around £37,000 a practice.

Today’s primary care recovery plan funds and empowers our GPs and pharmacists to do more, so that we can prevent ill health, keep cutting NHS waiting lists and improve that vital front door to the NHS for many millions of people. I commend this statement to the House.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the shadow Secretary of State for Health and Social Care.

[Wes Streeting (Ilford North) (Lab)]

I thank the Secretary of State for advance sight of his statement. This announcement was meant to be the Prime Minister’s relaunch after he received a drubbing in the local elections. Unfortunately for Conservative Members, it seems that the Prime Minister is bouncing back in true Alan Partridge-style.

Having read that Downing Street had drawn up plans for a health-focused mini relaunch, I eagerly tuned into the radio this morning to hear the Health Minister, the hon. Member for Harborough (Neil O’Brien). What was the Conservatives’ message to the public this morning, following their worst defeat since 1997? They are breaking their manifesto commitment to recruit 6,000 new GPs. Once again, the Conservatives have over-promised and under-delivered.

I think the Secretary of State just admitted to missing his target to eliminate 18-month waits by April. Is that the second broken promise of the day? It is hard to keep up. Millions of patients are waiting a month to see a GP, if they can get an appointment at all, in pain and discomfort, unable to go about their normal lives. That is the price patients are paying every day for 13 years of Conservative failure. The Prime Minister has no idea what it is like to be most people in this country. He is completely out of touch with what NHS patients are going through, and that is why he cannot offer the change the country is desperately crying out for.

The Health Secretary has called this announcement the GP access recovery plan. What is this a plan to recover from, if not his party’s appalling record of under-investment and failure to reform? Does he now regret the 2,000 GPs cut since 2015, the 350 GP practices that have closed in the same time, and the 670 community pharmacies that have shut up shop on their watch? Is expecting the Conservatives to fix the NHS after they broke it not just like expecting an arsonist to put out the fire that they started? It is just not going to happen.

It is not just the voters who are turning to the Labour party for answers; the Government are, too. In January, we set out our plans for the future of primary care, including allowing pharmacies to prescribe for common conditions, opening up self-referral routes into things such as physiotherapy, and ending the 8 am scramble. Sound familiar? The problem is, that is where the similarities end, because what the Conservatives offer today is a pale imitation of Labour’s reform agenda. Where is the plan to give patients real choice? There is nothing on enabling patients to see the same doctor at each appointment, when doctors themselves tell us that continuity of care is important. There is nothing on allowing patients to choose whether they are seen face-to-face or over the phone, merely the promise of better hold music and the “invention” of things such as call-back, which has existed for many years. In fact, where is the plan for better mental health support, more care in the community and in people’s homes and more health visitors to give children a healthy start in life, or have all those issues been dumped into a box marked “Too difficult”?

The Secretary of State says that patients will get an appointment within two weeks as if it is some kind of triumph. When we were in government, we delivered GP appointments within two days. When will this pitiful promise be delivered? There is no date or deadline. By when can patients expect the 8 am scramble to end? There is no date or deadline. When will patients with urgent needs be seen on the same day? There is no date or deadline. In fact, I wrote to the Minister and asked him how many patients are currently not seen on the same day. He said he did not know and that the Department does not hold that information. What is the point of these pledges if Ministers do not know whether they are being met? The document says that the NHS and the Department have “retargeted over £1 billion” to pay for the announcements, but not where that money has come from. Where has the Secretary of State cut NHS services to pay for these announcements?

The Secretary of State’s plans for patients to refer themselves to physios for back pain, bypassing GPs, could lead to 5,000 cancer patients missing their diagnosis. That, as perhaps he remembers, was according to—that is right—the Conservative party back in February. Three months later it is the Government’s policy, so perhaps the Secretary of State can clarify: was the Conservative party telling porkies back in February, or does he simply not know what on earth he is doing? Given that this is meant to be a primary care recovery plan, where is dentistry? NHS dentists are in even shorter supply than Conservative council leaders.

Finally, let me turn to the super-massive black hole at the heart of today’s announcement: where is the plan to train the doctors and nurses the NHS is so desperately short of? Labour has set out our plan to train 7,500 more doctors and 10,000 more nurses each year, paid for by abolishing the non-dom tax status. When will the Secretary of State finally admit he does not have any ideas of his own, and adopt Labour’s plan? After 13 years, the Conservatives have no plan to give the NHS the staff it needs, they have broken their promise to recruit 6,000 new GPs and they have missed a golden opportunity to give patients real choice. Only Labour has a plan to rebuild and renew the NHS, and that is why people across the country are coming home to Labour.

[Steve Barclay]

The hon. Member started with the message to the public, and the message to the public can be seen by what key figures in the sector say about this recovery plan. Let me just share that with the House. The Pharmaceutical Services Negotiating Committee says that the plan is

“the most significant investment in community pharmacy in well over a decade”.

The Boots chief executive says that this is

“great news that they’ll be able use their clinical expertise more widely”.

The Company Chemists Association says that it is a

“real vote of confidence for the future profession”.

The message to the public from the industries in this sector is clear that this is a well thought through plan which will have a beneficial impact for patients. I will give one final quote: the chair of the Royal Pharmaceutical Society says that this plan will be

“a real game-changer for patients”,

and that is what our focus has been.

The hon. Member raised the issue of our delivery against the 18 months target. It is very generous of him to give me the opportunity to share once again with the House the contrast with Wales, but perhaps he missed it first time around. We have reduced the wait for 18 months by over 90%, yet Wales still has vastly more—over 80,000 waiting there—and that is from a much smaller population. Wales still has over 40,000 waiting more than two years, a target that we virtually eliminated as long ago as last summer. Those who want to see what a Labour Government would mean for the NHS can see it with the performance against the two-year waiting list and the 18-month waiting list in Wales, so it is very generous of him to give me the opportunity to share that once again with the House.

The hon. Member talks about what the recovery plan is for. Clearly, the pandemic has placed huge pressure on primary care, and we can see that just from the increased volumes of appointments that primary care faces. Again, I touched in my opening remarks on the fact that GPs and primary care are seeing more than 10% more appointments than before the pandemic—1 million appointments a day. It is clear why we need to invest in new forms of working, online booking technology and cutting bureaucracy: it is so that GPs can focus on the aspects of their role that apply purely to GPs and we can better use the 25,000 additional roles that are being recruited into primary care.

The hon. Gentleman talked about his direct referral policy. We actually announced our policy guidance in December, a month before his announcement, so it is something of a stretch to say that we are following his approach. He again kindly raised the issue of mental health, which gives me the opportunity to remind the House of the increased funding that this Government are making in mental health. That was a key priority when my right hon. Friend the Member for Maidenhead (Mrs May) was Prime Minister and a cornerstone of the long-term plan, with an extra £2.3 billion going into mental health. But we did not stop there. At the Budget, the Chancellor further prioritised mental health—for example, mental health digital apps were a cornerstone of the measures for economically inactive people. We are recruiting an additional 25,000 roles into primary care in recognition that specialists are needed, whether physios, pharmacists, paramedics or specialists in mental health support.

The hon. Gentleman spoke about other aspects of primary care such as dentistry. We have said frequently that we have a recovery plan for dentistry that we will announce shortly, so that should not be news. On funding, it is slightly bizarre that, although this plan announces more than £1 billion of new funding for primary care, investment in tech, new ways of working, additional staff and empowering our pharmacists, who bring great clinical expertise that we can better harness, the hon. Gentleman, rather than welcoming that, went back to the hackneyed non-dom funding. We have heard that so much before and it has been spent so many times. We have set out ways of best using the skills of our GPs and of the additional roles, where we are delivering on our manifesto with an extra 25,000 already recruited. Above all, we have set out ways of best using our pharmacists, who are a huge resource that we can better use. That is why we are targeting more than £600 million additional funding into pharmacists, which will allow people to better access the care they need in a timely fashion.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I call the Chair of the Health and Social Care Committee.

[Steve Brine (Winchester) (Con)]

I welcome the plan, which I note the Government have released at the first possible moment after the local election purdah period. Members of the Health and Social Care Committee and I will study it carefully, and I know the primary care Minister has already agreed to come before us so that we can give it a good going over. My question is about timing. How quickly can investment in the 8 am scramble part of the policy make a difference to those practices that do not have it? The Secretary of State said that they were already negotiating with the Pharmaceutical Services Negotiating Committee, so how quickly can that very welcome new investment get to the frontline of community pharmacy?

[Steve Barclay]

The short answer is this year, but the Chair of the Health and Social Care Committee is right to focus, as with all recovery plans, on deliverability. I hope he will take comfort from the fact that around half of GP practices already have cloud telephony, which is why we are so confident that it is the right approach. It is one that is already working. We are seeing from patients’ positive feedback that they hugely value online booking and call-back systems, but they also allow primary care to better triage calls to specialists and therefore to use the additional roles we have recruited in an optimum way. That will be rolled out this year, but it is already up and running and we can see that it is working.

[Dame Margaret Hodge (Barking) (Lab)]

I would like to take the Secretary of State out of the bubble of Westminster and the green Benches and into the reality of what is happening on the ground in my constituency. We have the second highest number of A&E attendances for minor injuries—people who should be going to their GP. We are the most under-doctored and second most under-nursed area in north-east London and, last year, just under 9% of patients could see their GP within 14 days of requesting an appointment. So for me, the recovery plan announced today is deeply underwhelming. I hope that the Secretary of State can answer these three questions. When will he, not plan, but deliver the 6,000 extra GPs promised? What work is he doing to move GPs from working part time to putting in more hours at the frontline with their patients? Where is the commitment to deliver face-to-face appointments for those who want them in my constituency? Only when I have answers to those questions will I feel confident that there really is a plan for GP services in Barking and Dagenham.

[Steve Barclay]

I know the right hon. Lady well, having served with her for four years on the Public Accounts Committee, so I hope that she will not mind me being slightly surprised about being told, as someone who lives in the Fens and not in London, that I am in the bubble. On her points, obviously, we have 37,000 more doctors than when the Government came to power. Directly, the changes to pensions lift about 9,000 GPs out of the tax changes. It is also about training more—4,000, compared with 2,600 in 2014—so being on track in terms of the number we are training. It is also about the additional roles that we are funding, the 25,000 and the manifesto commitment of 26,000. Also, the pharmacy announcement is all about freeing up GP capacity for face-to-face appointments for those who want come in. By enabling pharmacy capability for those who want to get oral contraception, have a blood pressure test or access services for the seven common conditions—including urinary tract infections and ear infections, for which prescriptions can then be given—we will free up GP time for face-to-face appointments. If we look at last year’s patients survey, we see that about two fifths of patients hugely valued continuity of care and face-to-face, which means about three fifths preferred to prioritise speed of access, rather than seeing the same GP or seeing someone face to face. So it is about tailoring the offer to what the patient wants, and patients do not always want the same thing. Some want speed and pharmacies can deliver that.

[Jackie Doyle-Price (Thurrock) (Con)]

I congratulate my right hon. Friend on his announcement on pharmacy, for which I have been calling for a number of years. We ought to be making more use of this massively skilled body of medical professionals, particularly to free up GPs. For many people, they are the front door to the NHS more than the GP surgery is. Could he confirm that, for the additional work that they will be doing to support our NHS, they will get some reward?

[Steve Barclay]

First, I commend my hon. Friend because this is an issue that she has championed and she has been right to do so. These are degree-qualified clinical roles, so it is sensible that we make far better use of the skills that they offer. We saw during covid just how much value they offer to their communities. I confirm that they will be paid for these roles; that is what the additional funding is all about. She has been right over the years to highlight the importance of pharmacies and what they can offer, and that is what this announcement is all about.

[Mr Clive Betts (Sheffield South East) (Lab)]

First, I thank the GPs in my constituency and their staff for the job that they are doing for my constituents under the most enormous pressure. I want to include in particular GPs’ receptionists in that for the up-front service they give; there is particular pressure on them. GPs—often in their 50s—are saying to me that they want to leave and give up not because of pensions but because of the overbearing workload they have, and the incredible centralisation and red tape coming from NHS England at national level. They look for new GPs coming through and see so many trainees and qualified doctors now going off to Canada, New Zealand and Australia because the terms and conditions of work are better there. When will we see from the Secretary of State the workforce plan that has been promised over and over again—it was supported by the Chancellor when he was Chair of the Health and Social Care Committee—to deliver the amount of training we need and the efforts to retain the GPs we already have?

[Steve Barclay]

I agree and thank the hon. Member, who is absolutely right to recognise the huge amount of work done by GPs and their staff, including receptionists. That is why the recovery plan is very much targeted at recognising the workload. I flagged in my statement the additional volume of patients that a typical GP surgery is seeing and that reflects the huge amount of work that is done. I think pensions were a factor, certainly in the feedback from the profession. The issue was raised. The changes the Chancellor announced take 9,000 GPs out of the tax changes, but the hon. Gentleman is right—that was not the only factor; the workload was another. The recovery plan looks to cut bureaucracy and, as I say, reduces the targets to five. It also looks at areas where there are appointments that we do not feel are necessary—so it looks at how secondary care can do fit notes, for example, rather than someone needing to go to the GP to get one. There are areas where we can streamline GPs’ workload and that is what the recovery plan does. On the workforce plan, we have said on a number of occasions that, post purdah, we would set that out very shortly. We will have more to say on that in due course.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

I join the hon. Member for Sheffield South East (Mr Betts) in inviting the Secretary of State to thank all our GPs for their incredible work. I very much welcome his statement. Will the Pharmacy First plan enable places such as Harwich and Dovercourt in my constituency to increase the out-of-hours cover that pharmacies provide? Otherwise people will have to travel miles just to get a prescription. Also, where are all these new GP staff going to be put? Most GPs have very cramped premises. West Mersea surgery in my constituency has been trying to develop new premises for a long time, unsuccessfully because the GPs’ partners will not take the risk. At the Mayflower surgery in Harwich, there is empty space in the building rented by the NHS from a failed Labour private finance initiative project, but the GPs cannot afford to pay the rent, so the space sits empty, although it is still paid for by the taxpayer. What are we going to do about that?

[Steve Barclay]

First, I join my hon. Friend in paying tribute to the work that GPs do in his constituency, as they do elsewhere. On pharmacies, part of the reason for the investment is to support pharmacy, including in rural settings. The more funding going in, the more they can prescribe. The more things they are able to do, the better the business model. There are more pharmacists and more pharmacy shops than there were in 2010, but it is important we make the business model more viable and that is what the announcement does. On estates planning, that is an issue for each integrated care board to consider. He mentions a specific issue locally with a former PFI and how it is being used. That is not a new issue. I sat on the Public Accounts Committee when it was chaired by the right hon. Member for Barking (Dame Margaret Hodge) and I remember looking at many a Labour PFI. The regional fire control centres were a case in point; the estate could no longer be afforded and the space was empty. If there is an issue like that, I will be happy to look at it in due course.

[Taiwo Owatemi (Coventry North West) (Lab)]

As chair of the all-party parliamentary pharmacy group and as a pharmacist myself, this is a step in the right direction. However, I have spoken to many pharmacists and many in the sector, and we believe that, for the policy to unleash the full potential of pharmacy, there needs to be proper investment in the workforce plan. What we are seeing is pharmacists who can prescribe leaving community pharmacies and going into other sectors. It is great that they have the ability to prescribe, but if the pharmacies are not there the full potential cannot be unleashed. Secondly, we have a funding crisis, with many pharmacies closing, so the plan needs to be accompanied by further funding and steps to address the medicines supply chain.

Will the Minister clarify a few points? Will pharmacists be paid competitively for their prescribing skills? In previous Government announcements, that has not been the case. Pharmacists would like to feel valued from this announcement. Will the announcement be followed by actual support for premises as well? I am sure the Minister is aware of pharmacists who have challenges, for example, in accessing a patient’s record, and who do not have the workforce needed to take time out to go out to speak to patients. Will he meet me and the APPG to discuss those issues further?

[Steve Barclay]

First, I thank the hon. Member for recognising, constructively, that this is a step in the right direction. As the quotes from the sector show, many working within pharmacy welcome it. As I said a moment ago, there are 20,000 more pharmacists than in 2010. The additional funding, including—directly to her question—for prescribing, will make the business model more viable and therefore support the workforce within the pharmacy sector.

We are working on IT as part of the recovery plan. There is a big read-across into the NHS app and how we better empower patients both to access their own medical records and to find the right services, including by being directed from the NHS app to pharmacies.

[Maggie Throup (Erewash) (Con)]

I welcome today’s announcement, which will undoubtedly widen access to primary care services. However, will my right hon. Friend consider investing in point-of-care diagnostic testing in pharmacies and GP surgeries, to speed up the diagnostic pathway and help to reduce NHS waiting times?

[Steve Barclay]

My hon. Friend raises a great point. I am extremely keen on how we can improve diagnostic testing and make it more accessible. As she knows from her time in the Department, early treatment is more effective and more cost-effective. Looking at more home testing, more testing at pharmacies and more work with employers to accelerate early detection is a win for patient outcomes and for delivering care in a more affordable way.

[Daisy Cooper (St Albans) (LD)]

Liberal Democrats and many others in this House have called for a pharmacy first approach for a long time, but there appear to be two major problems with today’s announcement. The first is that the Government’s own plan says that the money will be re-targeted; I would be grateful to know from the Secretary of State which other service will miss out.

In my constituency two pharmacies have already closed, and across England 16% of pharmacies have said that they do not think they will survive another year. How does the Secretary of State expect people to access a pharmacy first if their pharmacies continue to close?

[Steve Barclay]

As I said, there are more pharmacists than in 2010 and more people working in the pharmacy sector—the numbers have gone up by 24,000 since 2010—so to address the hon. Lady’s second question, there are more. On funding, as I said in my statement, this is new funding for primary care. That is the commitment that we made, and it should be welcomed in the primary care sector.

[Bob Seely (Isle of Wight) (Con)]

I welcome the statement. I notice the difference in opinion on the Opposition Benches between the people who know what they are talking about and the people who do not.

Pharmacy First is a brilliant idea, and I thank the Secretary of State. I very much hope it will be welcomed by pharmacies in my patch. I want to reiterate some of the points that have been made. First, some of my pharmacies have been under a lot of financial pressure recently. Will the financial package be able to support them and make them feel valued, considering what extraordinarily good value for money they are? Related to that, will any financial support or grants be made available to pharmacies—especially the smaller ones in some of my rural areas and small towns—so that they can have a room to see patients and take advantage of this great Pharmacy First scheme?

[Steve Barclay]

I welcome my hon. Friend’s comments. There is £645 million of funding over the next two years to support the expansion of this work through Pharmacy First. As I said a moment ago, the estates programme is more an issue for the integrated care boards. We should not try to determine all the decisions on estates from Westminster; it is right that we let the 42 ICBs have more discretion over what is the right estate strategy in their area. I am sure that his local ICB will hear his representations.

[Sir Chris Bryant (Rhondda) (Lab)]

I completely support the idea of pharmacists being able to do more. For instance, it makes more sense that someone with shingles can go to a pharmacist today to get antivirals prescribed. My fear is that what has been announced today does not fully understand the crisis in primary healthcare. According to the numbers given by the Government’s own Ministers, in September 2015 we had 29,364 fully qualified GPs in England, but last September we had 27,556. By the Government’s own numbers, that is 2,000 fewer. Community pharmacies have gone from 11,949 in 2015 to 11,026—a nearly 10% fall. Do we need to do more to enthuse people to work in our NHS across the whole of primary healthcare? Would it be a good idea to change the model for GPs, so that we have more salaried GPs?

[Steve Barclay]

I have touched on the numbers a few times, but let me give the hon. Gentleman the precise figures. There are 335 more pharmacists than there were in 2010, so it is simply not the case that there are fewer. There are 2,000 more doctors in general practice, and there are also the extra 25,000 in additional roles. As I have said, someone who wants a prescription review should see a pharmacist, and someone with back pain should see a physiotherapist; not everything has to go through a GP, and it is better for GPs’ time to be used more effectively. There are also more doctors in training: 4,000 are receiving training in primary care, as opposed to 2,600 in 2014. So we are seeing more staff, more effort on recruitment, more effort on retention through the pension changes, and better use of the additional roles.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I am pleased that the Government are looking at how they can best support GPs and improve access to primary care, but how will these plans protect and enhance the role of GPs who dispense in their own practices? How will my right hon. Friend deal with concerns about antibiotic resistance, and how will he solve the root cause of the problem, which is the fact that there are not enough GPs?

[Steve Barclay]

In respect of my hon. Friend’s first point, these plans will not make any changes. As for the second, about prescribing, that will be part of the consultation, and we will be learning lessons from what is being done elsewhere: for instance, Pharmacy First is already up and running in Scotland. We are looking into what tests can be performed alongside those prescribing rights so that antimicrobial resistance is targeted effectively.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

The steps proposed in the statement reflect what Labour has been calling for, and are well overdue. I am glad that at least some steps are being taken, but they fall well short of the scale of the challenge that we face. Pharmacists need to work in a strong primary care environment. We need to see more GPs, an increase in primary care services, and more tests, diagnoses and minor procedures carried out in the community, speeding up primary care and taking the pressure off secondary care.

Three years ago, I met Ministers and officials in the Department to seek advice on and support for the rebuilding of the rundown Heston health centre in my constituency. What is the Government’s strategy on the rebuilding of rundown primary care facilities, not only to assist the recruitment and retention of GPs but to better facilitate the work taking place between GPs, pharmacies and other community healthcare services?

[Steve Barclay]

There seems to be a slightly confused response from the Opposition. They challenge this announcement on the grounds that they are not happy with it, and in the same breath claim that it is part of Labour’s plan or a step in the right direction. They need to make up their mind.

As I said in response to two earlier questions, it is for the integrated care boards to adopt estate strategies in their areas. Not all decisions about estates should be made centrally. However, one of the changes that we are setting centrally involves embracing more modern methods of construction and a more modular approach. The unit cost of that approach is much lower, and when the level of confidence is higher, the contingency cost is much lower as well. So we are changing the way in which we build our estate, but the estate strategy is an issue for the ICBs.

[Michael Fabricant (Lichfield) (Con)]

As the hon. Member for Coventry North West (Taiwo Owatemi) will know, it takes five years to obtain a master of pharmacy degree and to become fully qualified. Training continues as pharmacists continue in their work, so they are a valuable resource, and I welcome the statement. As my right hon. Friend the Secretary of State will know, in France, for instance, where it costs €26.50 to see a GP, most people would choose to see a pharmacist first, but is he sure that by taking pressure off general practices, he will not overwhelm pharmacists such as mine in Lichfield and Burntwood?

[Steve Barclay]

My hon. Friend is right to draw attention to the practice in other countries, and the fact that patients are very happy to visit pharmacists when that is more appropriate for the treatment that they are using. That is what the Pharmacy First strategy and the learning of lessons are all about, although we must also think about how to mitigate some of the risks connected with antimicrobial resistance. In the context of the impact on pharmacy, I refer my hon. Friend to what has been said by those in the sector. This is a move that they have called for and have now welcomed, and it responds very much to our discussions with pharmacists who have said that they can do more and are keen to do more, but need the funding to enable them to do so—which is what Pharmacy First delivers.

[Rachael Maskell (York Central) (Lab/Co-op)]

The impact of today’s announcement will be miniscule compared with the scale of the challenge facing primary care right now. In York, our GPs are innovative and ambitious—far more ambitious than the Secretary of State—and want to bring real change to the way pathways operate. In light of that, will additional money be available for innovation in primary care, so that GPs can meet the challenge and lead the change that is needed?

[Steve Barclay]

There is funding in other parts of the Department’s budget, not least for tech innovation and the work we are doing on artificial intelligence. There is further scope to use AI in demand management, for example to relieve pressure on GPs by looking at changes in the behaviour of frail or elderly patients and picking up changes early. The use of AI presents a significant opportunity. There are questions about how we can use data better; indeed, there are challenges for those across the House in how we can use data better to manage pressure within primary care. So there is funding elsewhere in the Department’s budget, in addition to what I have announced here.

[Paul Bristow (Peterborough) (Con)]

I am pleased to inform the House that my mother has moved in with my wife and me, from the Secretary of State’s constituency. One of the joys of living with my mother is helping her with Tesco orders and Amazon deliveries and with surfing what she calls the interweb, and I am looking forward to helping her with the new NHS app. Does my right hon. Friend agree with me that enabling many more people to use the NHS app, including Mrs Bristow, and having many more services available on the NHS app is more convenient for patients and will free up GP time, so that GPs can do what they should be doing?

[Steve Barclay]

I am happy to recognise the scope for Mrs Bristow and many others to make more use of the NHS app. That app is all about empowering the patient and enabling them to get the right care, in the right place, at the right time, whether from a pharmacist, one of the additional primary care roles we are creating or a GP where applicable. The NHS app can free primary care practices from many of the tasks that are currently placed on them, such as people phoning for their records or repeat prescriptions. It is a key part of streamlining such tasks.

[John Cryer (Leyton and Wanstead) (Lab)]

In my constituency, we have lost GPs and surgeries. There are increasing numbers of people on fewer and fewer lists. Community pharmacies are under pressure and some have closed, so people then go to the local hospital, Whipps Cross University Hospital, which is struggling, with 100% bed occupancy rates. The Secretary of State has been ducking making an announcement about funding for the new Whipps since he took on the job, but that hospital is struggling every day. My question is twofold: when will the Secretary of State announce the workforce plan for primary care, and when will he finally get around to making an announcement for Whipps Cross University Hospital?

[Steve Barclay]

Far from ducking Whipps Cross, I have actually been and visited in person, so I am very familiar with the issue and I recognise the importance of the new hospital programme. I hope to make an announcement about that programme and about the workforce plan shortly, just as I am doing today about the primary care recovery plan.

In today’s plan, the hon. Gentleman may want see at the proposals to look at the contribution to pressures on primary care from new housing developments, and at what changes might be made to ensure that where such developments take place, funding from them goes not only to new schools, as it frequently does, but into primary care, and particularly GPs.

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly praise all those who work in primary care in my constituency, including Dr John Henderson and Dr Stephen Price, who are the leaders of my two primary care networks.

It is great to see another 25,000 staff in primary care. They now need somewhere to work, including somewhere in the middle of Leighton Buzzard before we get the extra health facilities next year. When we build tens of thousands of extra houses, my experience, over decades, is that no Government, comprised of any party, have made sure that extra primary care facilities come on stream with as much certainty as a new primary school. If we could crack that, we would do a huge service to the whole nation. Please could the Secretary of State make it his personal mission to do that?

[Steve Barclay]

We plan to change planning guidance this year to address that specific issue. I have visited my hon. Friend’s constituency, and we resolved one of the issues in relation to the estate, which was extremely constructive. I know he has been discussing a further issue with the Department, but I hope he can take some comfort that his representations have been heard. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is planning to make changes to the guidance to better ensure that, where there is new housing, a contribution is made to primary care.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

The problem in primary care is that we do not have enough GPs to meet the demand for appointments. The problem is not with the telephone system. The area I represent has one of the lowest ratios of GPs to population in the whole country. Will the Secretary of State support our campaign to train more doctors at Hull York Medical School, and for Hull York Medical School to set up a training facility for pharmacists and dentists?

[Steve Barclay]

As I said in my statement, we have 4,000 doctors training in primary care, compared with 2,600 in 2014. We are also looking at how we can better retain the GPs we have. That is why we made the pension changes, which will affect around 9,000 GPs. It is also why we are looking at additional roles to take pressure off GPs, and at how we can reduce some of the burden of bureaucracy, too. We are training more doctors, and we are looking at retention and bureaucracy. No one is suggesting that this is solely an issue of telephony or online booking, as the hon. Lady suggests, but all of this will help to relieve pressure on extremely busy primary care.

[Dr Luke Evans (Bosworth) (Con)]

I am pleased to be talking about primary care, for obvious reasons. It is important that the Government made the pension changes, which will make a difference to retention, but I am also pleased with the next part of the plan. When I was a clinician, 15% of my workload was chasing letters and administration, which is borne out by the evidence we have heard on the Health and Social Care Committee. Will the Secretary of State comment further on the bureaucracy he is cutting? Will he ensure that this is the first step in pushing down on that bureaucracy, as that will improve the welfare of both our workforce and our patients?

[Steve Barclay]

My hon. Friend has a great deal of experience, and he is right to focus on the amount of clinical time often spent on non-clinical issues. Sending reminders through the NHS app will reduce non-attendance. We are also looking at the key interface between secondary care and primary care, as well as considering which appointments can be done elsewhere, such as through pharmacies and the additional roles. The online booking system can better triage people to the right place, and there will be some self-referral in order to take pressure off GPs—not for things that carry a clinical risk, such as internal bleeding, as the Opposition suggest; but for things like hearing aids. If a person has taken a hearing test, they will not need to clear an appointment for a hearing aid through their GP.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I reinforce what colleagues have said. This is a step in the right direction, but it fails to grapple with the grave situation in which there has been a threefold increase in waiting lists since 2010, including a twofold increase since 2019, before the pandemic. In Oldham we have fewer GPs and more patients with increased acuity, so when will we get our fair share of the promised 6,000 GPs?

[Steve Barclay]

I have recognised throughout that demand has increased. Primary care is treating 10% more patients than before the pandemic, with around 1 million appointments a day. There is more demand, not just because of the pandemic but, as I said in my opening remarks, because we have a third more people over the age of 70, and they are five times more likely than younger people to go to their GP. That demographic change, the impact of the pandemic and a change in public expectations of advances in medicine are all creating additional pressure, which is why it is right that we use the full range of additional roles and that we invest in technology, in addition to the 2,000 more doctors in general practice.

[Siobhan Baillie (Stroud) (Con)]

GPs, pharmacists and primary care teams do an incredible job for local people in the Stroud district, and I look forward to the funding flowing to our pharmacists, as many of them have made a constructive case for it. A local GP told me that he believes a national education campaign is needed to advise patients of when to access general practice and when to access other services, such as pharmacies. I think this is a good idea, given today’s announcement. Will the Government take it up?

[Steve Barclay]

My hon. Friend is absolutely right on this and we plan to have a communications campaign. The front door to the NHS can often be confusing for people—whether they should go to primary care, a pharmacy, accident and emergency or elsewhere. We will have a campaign, not just linked to the opportunity to access care through Pharmacy First, but looking at the technology innovations we are bringing on stream, particularly on the NHS app. We are also making changes to 111. So there will be a communications campaign, on exactly the lines she references.

[Kim Johnson (Liverpool, Riverside) (Lab)]

I wish to thank all the primary care workers in my constituency. Despite the Minister’s assurances, 600 pharmacies have closed since 2015, which is having a significant impact on our most disadvantaged communities. Does he agree that more funding is needed to prevent more pharmacies from closing and to fix the broken NHS? Will he join me in condemning the Rowlands Pharmacy on Lodge Lane, which is pulling out of the community and preventing another pharmacy from taking its place?

[Steve Barclay]

I join the hon. Lady—as I did the other colleagues from across the House who have done this—in paying tribute to the primary care staff in her constituency for the work they do. We have touched a number of times on the fact that there are both more pharmacies and more pharmacists than there were in 2010, so there is more capacity. However, we also recognise the scope to better use the expertise within pharmacy, which is why an additional £645 million of investment—new funding—is going into pharmacies over the next two years.

[Matt Warman (Boston and Skegness) (Con)]

I am married to a trainee GP, so I have read all 46 pages of this excellent plan—reading it makes me different from those on the Opposition Front Bench. Importantly, the plan is littered with examples of brilliant practice up and down the country, with case studies that should be adopted more widely. Almost all of them come back to the use of technology. Will the Secretary of State say that he will target the help needed to adopt that technology at the practices that need it most, which are so often those in coastal constituencies such as mine?

[Steve Barclay]

My hon. Friend is right about the opportunity that tech offers to deliver changes at scale and the fact that this is proven technology that is working and already up and running in many primary care settings. So often within the NHS the challenge is not the initial innovation—we get pockets of wonderful innovation—but how we industrialise it across the wider NHS. This recovery plan focuses on that, looking at how we scale the case studies to which he refers. About half of primary care does have digital telephony. The opportunity here is to target that funding at the other half; that is often the smaller GP practices, as well as those in coastal communities, because they find the transition to tech more difficult. That is why a key part of this recovery plan is about the investment in not just the tech, but in locums, to provide cover so that staff can make the transition to that new way of working.

[Dame Diana Johnson (Kingston upon Hull North) (Lab)]

The NHS workforce plan has been promised for years. Meanwhile, as my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) says, we are short of GPs, pharmacists and dentists in Hull. Will the Secretary of State answer the question she put to him: can we please build on the excellent work of the Hull York Medical School to set up a dental training school there, and a school of pharmacy and one for ophthalmologists? That would help in the longer term, but we need a proper workforce plan and the Government need to get on with it.

[Steve Barclay]

As I have said several times, we will publish a workforce plan shortly. We are committed to that and the Chancellor set that out in the autumn statement. Of course, when he was doing this job and when I was previously in the Department, we expanded medical undergraduate places by a fifth, so there was an increase then. I have said that we will also set out a dental recovery plan in due course.

[Jack Brereton (Stoke-on-Trent South) (Con)]

I very much welcome these plans to improve access to primary care, particularly around the 8 am scrum, which is beneficial neither for patients nor for NHS staff. In North Staffordshire we have some very good GP practices, but also some very poor ones, which we need to see improve. Will my right hon. Friend confirm that, with these new measures, the archaic practices that we see in some of those GP surgeries will be outlawed, and that we will put in place the new services as soon as possible?

[Steve Barclay]

My hon. Friend touches on an extremely important point. The measures will provide, for all Members of the House, much greater transparency on the variation between primary care settings. I am keen that we should publish much more information showing, within constituencies, the differences in the services offered by different primary care settings. We already see that between those that have digital telephony and online booking and those that do not, but we also see that in other indicators, and I am keen that he and other Members of the House get visibility of that.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement. The primary care recovery plan is very welcome, and it will be wonderful for NHS England when the goals are achieved. However, I have a very specific question about Northern Ireland. My constituents are struggling to get hold of their medical records over the phone for personal independence payment assessments and appeals. He referred in his statement to improvements in the app system. What discussions will he have with the Department of Health in Northern Ireland about introducing a similar system to enable patients in Northern Ireland to access their medical records via an NHS app?

[Steve Barclay]

The hon. Member is right to recognise the importance of access to medical records. It is a key part of the functionality that we are delivering through the NHS app. He is correct that that is focused on England and not on Northern Ireland, but I am very happy for us to have discussions with him and his colleagues in Northern Ireland on any shared practice.

[Simon Jupp (East Devon) (Con)]

Today’s welcome announcement will help patients get prescriptions directly from hard-working, resilient but sometimes overstretched pharmacies, freeing up GP appointments. Will my right hon. Friend outline how pharmacies in my constituency of East Devon will be able to access funding and support to deliver this?

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[Steve Barclay]

The funding will include for prescriptions for the seven common conditions, which form part of Pharmacy First. That will be part of a new NHS service that will be offered, as set out in this plan. That is what the £645 million over the two years is targeted at, and obviously we will have further discussions with the sector on the roll-out.

[Greg Smith (Buckingham) (Con)]

I very much welcome this recovery plan. It is the right thing to do and will make a big difference. Does my right hon. Friend agree that it is also critical for rural communities to have local and convenient access to GPs? With that in mind, will he redouble his Department’s efforts, alongside the Buckinghamshire, Oxfordshire and Berkshire West ICB, to find a way to fund the construction of Long Crendon’s innovative model to replace the old village surgery, which sadly had to close under covid. This will not only deliver first-rate primary care to the village of Long Crendon and surrounding villages, but relieve the pressure on Brill surgery, where patients find themselves displaced to.

[Steve Barclay]

My hon. Friend has raised this issue previously, and he is quite right to champion it—I know that it is hugely important to his constituents. I hope the ICB will take heed of the issue he raises, particularly in relation to the level of visibility on the estate plan. Based on our conversations, I think that more can be done to share that with him. I urge the ICB to engage closely with him to make sure that the estate plan addresses the very real needs that his constituents have identified.

Agenda for Change: Pay Deal

Steve Barclay Excerpts

Wednesday 3rd May 2023 Written Statements

[The Secretary of State for Health and Social Care (Steve Barclay)]

I am pleased to be able to inform the House that today I am formally confirming that the Government will move to implement the offer made to “Agenda for Change” staff, following the request from the Staff Council on 2 May.

Following consultations with their members, the majority of the AfC unions voted to both accept and implement the offer, which was supported by employers.

As a result, over 1 million eligible NHS staff on the “Agenda for Change” contract will receive two non-consolidated payments for 2022-23. This is on top of an at least £1,400 consolidated pay award that they have already received, which was in line with the recommendations of the independent pay review body.

Eligible AfC staff will receive an award worth 2% of an individual’s salary for 2022-23. In addition, these staff will receive a one-off bonus that recognises the sustained pressure facing the NHS following the covid-19 pandemic and the extraordinary effort these members of staff have been making to hit backlog recovery targets. This NHS backlog bonus is an investment worth an additional 4% of the “Agenda for Change” pay bill, and will mean staff will receive an additional payment of between £1,250 and £1,600. With both of these payments, a nurse at the top of band 5, for example, will receive over £2,000 in total.

For 2023-24, the Government will implement a 5% consolidated increase in pay, backdated to April 2023. In addition, the lowest paid staff will see their pay matched to the top of band 2, which is over £1 more per hour than the national living wage.

As a result, a newly qualified nurse will see their salary go up by more than £2,750 over two years from 2021-22 to 2023-24. On top of this, they will also receive over £1,890 in one-off payments for the 2022-23 financial year.

An experienced paramedic at the entry point of band 6 will see their salary go up by more than £3,000 over two years, from 2021-22 to 2023-24. On top of this, they will also receive over £2,000 in one-off payments for the 2022-23 financial year.

The Government will therefore no longer be seeking recommendations on the 2023-24 pay award from the NHS Pay Review Body (NHSPRB). However, the Government continue to value the work of the NHSPRB and would welcome its observations on the pay deal in England. The Government have written to the NHSPRB to confirm this.

On top of the pay package, the Government have also committed to important measures, including but not limited to:

a review into the timing and appointment process of the NHSPRB to ensure that the pay-setting process and the NHSPRB operates effectively;

identifying ways to tackle and reduce violence against staff;

amendments to terms and conditions to support existing NHS staff develop their careers through apprenticeships;

improving support for newly qualified healthcare registrants; and

Staff Council consideration of the application of a cap to redundancy payments of £100,000 and over.

This package, alongside the comprehensive NHS long-term workforce plan, which NHS England will publish shortly, will help ensure that the NHS can recruit and retain the staff it needs to meet the growing and changing health and wellbeing needs of patients.

[HCWS760]

Oral Answers

Steve Barclay Excerpts

Tuesday 25th April 2023 Commons Chamber

[Gavin Newlands (Paisley and Renfrewshire North) (SNP)]

23. Whether he has made a recent assessment of the potential relationship between poverty and life expectancy.

[The Secretary of State for Health and Social Care (Steve Barclay)]

The Government are committed to our levelling-up mission to narrow the gap in healthy life expectancy by 2030. That is why, in October, we committed an additional £50 million to 13 local authorities to tackle inequalities and why we are also setting out our plans through the major conditions strategy.

[Rob Butler]

Even in areas that people consider to be affluent, such as Buckinghamshire, health inequalities can be a serious concern. Figures from Opportunity Bucks show there is an eight-year difference in life expectancy between residents of the Aylesbury North West ward and the Ridgeway East ward, both of which are in my constituency, yet the funding for those areas is essentially the same. Will my right hon. Friend explain the steps he is taking to ensure that deprived communities, wherever they are in the country, get the additional help and support—not necessarily purely financial—that they need to address their needs?

[Steve Barclay]

My hon. Friend is absolutely right to highlight the importance of targeting health inequalities. Let me give the House a practical example. For lung cancer, patients are 20 times more likely to survive five years if we catch it early rather than late. Before the pandemic, those in the most deprived communities had the worst diagnosis. However, as a result of the targeted action we took with lung cancer check vans, they now have the best early diagnosis, which obviously has a big read-across for the five-year survival rate.

[Gavin Newlands]

The UK ranks 29th in global life expectancy. Professor Martin McKee from the London School of Hygiene and Tropical Medicine notes that one reason why the overall increase in life expectancy has been so sluggish in the UK is that it has fallen for poorer groups. The Scottish Government are doing everything they can within devolved competencies to fight poverty—the Scottish child payment and so on—but Westminster controls 85% of social security. What representations has the Secretary of State made to Cabinet colleagues and the Department for Work and Pensions about the damaging effects of their policies on life expectancy?

[Steve Barclay]

The hon. Gentleman raises a very important point. He can see the success of the representations I made to Cabinet colleagues from the Chancellor’s Budget statement, when he announced additional funding to tackle, in particular, health impediments to access to the labour market. He will also have seen the recent announcement of targeted action on, for example, smoking cessation, which is a particular driver of health inequalities. That includes our financial incentive scheme to pregnant mums, which obviously has a big impact on both their health and the health of their baby.

[Derek Thomas (St Ives) (Con)]

It is becoming clear that in Cornwall the only way to get dental care is to go to a private dentist. In a deprived area, of which there are many across Cornwall, that is just not an option for people on low incomes. What can the Secretary of State do to increase the accessibility of NHS dentistry?

[Steve Barclay]

This issue concerns Members across the House. We have already started to reform the dental contract. We have introduced the £23 minimum value for units of dental activity and created more UDA bands, reflecting the fair cost. We are seeing more patients nationally—to March, up nearly a fifth on the year. But I recognise that there is more to do, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), is undertaking that work as we speak.

[Jon Trickett (Hemsworth) (Lab)]

Women in my constituency have a healthy life expectancy of only 56 years. Could the Minister explain why the difference between West Yorkshire and North Yorkshire—where the Prime Minister has his constituency—is 10 years? Why should women have to put up with that kind of experience? What is his explanation of how that has happened?

[Steve Barclay]

The hon. Gentleman is right that we should narrow the health inequalities gap, and we are committed to doing that. That is why in the women’s health strategy, which I set out in the summer, we committed to having women’s health hubs as one-stop shops to tackle some of the gender inequality. It is also why, whether on obesity, smoking or lung cancer, we are targeting our screening and public health interventions to close the gap, which he is quite right to highlight.

[Mr Speaker]

I call the shadow Minister.

[Steve Barclay]

There is consensus in the House on our desire to close the health inequality gap—everyone agrees that is a key aim. The hon. Gentleman seems to have written the question before hearing my answer. I just gave a practical example of how we have transformed the early detection of lung cancer. He raised the public health grant, and I am happy to update the House that we are delivering 2.8% funding growth in the public health grant to help local authorities.

It is also about areas such as obesity and access to employment, which can have a big impact on mental health. The Chancellor announced specific funding—[Interruption.] The shadow Minister chunters away about children; I am conscious that one does not want too long an answer, but let me give the example of mental health. In the Budget we announced extra funding for a whole load of digital apps—[Interruption.] The shadow Minister keeps chuntering about children. Let me talk about the roll-out of our mental health support in schools, which is targeted at getting that early mental health intervention to school children.

[Bob Blackman (Harrow East) (Con)]

3. What steps he is taking to tackle vaping by young people.

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[James Sunderland (Bracknell) (Con)]

9. What progress his Department has made on the delivery plan for recovering urgent and emergency care services.

[The Secretary of State for Health and Social Care (Steve Barclay)]

The urgent and emergency care recovery plan sets out how we will invest more than £1 billion in increasing capacity, including 800 new ambulances, an additional 5,000 core beds and a further 3,000 virtual wards, to provide more than 10,000 out-of-hospital care settings.

[Andrew Lewer]

A key component of delivering better urgent care services will be expanding the network of urgent treatment centres across the country. Can my right hon. Friend assure me that a UTC in the major population centre of Northampton will be a high priority for the Department?

[Steve Barclay]

My hon. Friend is right to highlight the importance of UTCs. Nationally, they are above the national standard: 95.5% of patients are seen within four hours. He is a highly effective campaigner on health issues—he helped to secure the £2.8 million of investment for a new paediatric emergency department in his local area—and I know that he will be making a similar case to his local commissioners.

[James Sunderland]

Ultimately, the best way to improve urgent and emergency care services is through new build, purpose-built hospitals. Can the Secretary of State confirm where we are with the Royal Berkshire Hospital and Frimley Park?

[Steve Barclay]

As the House knows, I am extremely committed to modern methods of construction and modular building capacity. We are using that as a central component of our new 40 hospitals programme. My hon. Friend will know that the RAAC—reinforced autoclaved aerated concrete—hospitals are very much part of that discussion, not just at Frimley but at King’s Lynn, at Hinchingbrooke and in a whole range of other settings. He will also know that we are in a purdah period, so we are constrained in what we can say, but we will have more to say on this very shortly.

[Clive Efford (Eltham) (Lab)]

We have had 13 years of Conservative government. There are record numbers of patients on waiting lists, record numbers of vacancies in the NHS, and a crisis of vacancies in social care. As for emergency care, the Government cannot meet their 18-minute target for category 2 ambulance responses. If the Conservatives were really concerned about the NHS, would we not be in a better position than this after 13 years?

[Steve Barclay]

The hon. Gentleman talks of 13 years. People are nearly twice as likely to be waiting for treatment in the Labour-run Welsh NHS as people seeking treatment in England, and, indeed, waits are longer in Wales: we have virtually eliminated two-year waits in England, whereas more than 41,000 people in Labour-run Wales are waiting more than two years.

[Sarah Champion (Rotherham) (Lab)]

I recently conducted a major surgery—[Laughter]—I mean a major survey of Rotherham residents to learn about their experiences of the NHS. A staggering 73% of respondents who had called ambulances needing a category 1 response had waited longer than the seven-minute target time. Given that minutes can mean the difference between life and death, what are the Government doing to ensure that my constituents receive the life-saving support that they need, when they need it?

[Steve Barclay]

I know we have clinicians in the House who do second jobs, but I did not know that the hon. Lady had expanded that definition to such an extent! She is right to highlight, through her survey, the importance of timely care. There is currently a range of initiatives, such as the development of the NHS app, the review of the 111 service, and the examination of innovations such as artificial intelligence. We are looking into how we can manage demand in the case of, in particular, frail elderly people by noting changes in behaviour patterns, which will allow us to ensure that, for example, someone who has a fall at home receives care much earlier before arriving in the accident and emergency department, because we know that once frail elderly people have been admitted they will often be in hospital for about 14 days. The hon. Lady has raised an extremely important issue through her survey, and one on which we are focusing in our urgent and emergency recovery plan.

[Mr Speaker]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

That urgent and emergency care plan, which was announced in January, was received with acclaim by me and, indeed, with wide acclaim. It was described as a two-year plan to stabilise services by, for instance, returning to the A&E target that the Secretary of State has mentioned. What assessment has he made of the impact of the ongoing industrial dispute among the Agenda for Change cohort, and, of course, the junior doctors, on the delivery of the plan?

[Steve Barclay]

As a result of the fantastic work of Sir Jim Mackey and Professor Tim Briggs through the Getting It Right First Time programme, we have been making significant progress in respect of elective procedures. When it comes to urgent and emergency care, there are lessons coming out of the various strikes which we are keen to adopt, but this situation is also clearly having an impact on patients and the number of cancellations. As my hon. Friend well knows, we publish the figures.

We have been working constructively with the NHS Staff Council. Unison voted by a majority of 74% to support the deal, there will be further votes this week from other key trade unions, and there will be a decision from the staff council on 2 May. Obviously, that will be extremely important when it comes to addressing the concern highlighted by my hon. Friend.

[Derek Twigg (Halton) (Lab)]

According to figures that I obtained recently from the House of Commons Library, in January 2023 54.4% of patients who were treated after an urgent referral received their first treatment within 62 days of that referral. The target is 85%. The figure for performance in January 2020, before covid, was 73.6%. Why has there been such a deterioration?

[Steve Barclay]

To be honest, I think the position is mixed. In certain areas we have seen significant improvements in performance: the faster diagnosis standard, for example, was hit for the first time this month. Purdah prevents me from going into the details of the 78-week wait, but I expect to be able to update the House very soon on the progress that has been made. As the hon. Gentleman says, there are still challenges as a consequence of the pandemic, but we are seeing much more progress than the NHS in Wales, and it is also worth reminding the House that, through Barnett consequentials, the Welsh NHS receives more funding that the NHS in England.

[Mr Speaker]

I call the shadow Minister.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

This may surprise you, Mr Speaker, but I have found evidence that the Health Secretary has got something right. He recently hailed the power of local news outlets, and he was spot on. I have here a story from his local paper, exposing the shocking length of waits in A&E for those in a mental health crisis: 5.4 million hours across England in just one year. He is very welcome to have a look if he would like to. Given his admiration for local journalism, does he feel embarrassed for his Government’s failings and will he apologise to all the people across the country who are stuck waiting in A&E?

[Steve Barclay]

There are two separate issues there: what we are doing for mental health in-patients and the point we just touched on about A&E. On mental health, it is good of the hon. Lady to give me the opportunity to remind the House of the significant increase in funding we are making to mental health. In the long-term plan, the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), made a major strategic choice to invest more in mental health—an extra £2.3 billion per year. The hon. Lady is right to highlight the need for more capacity for mental health in-patients—[Interruption.] She asked a question on what we are doing on mental health. I am able to tell her that we are spending far more and investing far more in it, but it seems that she does not want to hear that answer.

[Dame Caroline Dinenage (Gosport) (Con)]

8. What steps his Department is taking to tackle health inequalities experienced by people with learning disabilities and autistic people.

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[Greg Smith (Buckingham) (Con)]

12. What steps he is taking to reduce the waiting time from receiving a cancer diagnosis to first treatment.

[The Secretary of State for Health and Social Care (Steve Barclay)]

In February, the faster diagnosis standard was met for the first time. In addition, we are investing in additional screening, testing and tech in order to detect cancer much earlier.

[Greg Smith]

Recent data for the Buckinghamshire, Oxfordshire and Berkshire West ICB shows that 42.6% of cancer patients are waiting more than 62 days for treatment. That will only get worse without a significant programme of upgrading radiotherapy equipment and ensuring that there is a skilled workforce of radiographers. So what steps is my right hon. Friend taking to ensure that new, cutting-edge radiotherapy equipment is making it to the frontline, coupled with a fully staffed workforce to operate it and save those lives?

[Steve Barclay]

My hon. Friend is right to highlight the interaction of workforce and capacity in equipment. That is why we have 810 more consultant training places over three years, and we have grants to enable more than 1,000 nurses to train, for example, in chemotherapy and 1,400 new recruits to the cancer diagnostic workforce. Obviously, that sits alongside the expansion in capacity, including both in our surgical hubs and our expanded diagnostic centres.

[Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

My constituent had emergency surgery for a brain tumour, but this was after six months of going to the doctor repeatedly with problem headaches. Brain cancer causes 9% of cancer deaths but accounts for only 1% of cases. Sadly, my constituent is terminally ill, but he is in a position to explain his experiences. He has asked me to raise with the Secretary of State the issue of what work is being undertaken on genome sequencing, which could have a major impact on better treatment for brain cancers. It would be helpful if the Secretary of State not only answered this today but wrote to me in more detail on it.

[Steve Barclay]

The whole House will send their best wishes to the hon. Lady’s constituent. She raises an important point about genomics, which is why we have invested in Genomics England and 100,000 babies are being screened—that is a key programme of work. The Minister for Health and Secondary Care, my hon. Friend the Member for Colchester (Will Quince) recently hosted a roundtable with key stakeholders on that, but I am happy to write to her with more detail, because the prevention and capability that is offered through screening is a great way of getting early treatment to people.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

13. What progress his Department has made on increasing the number of GP appointments.

[The Secretary of State for Health and Social Care (Steve Barclay)]

I think the question is about GPs and workforce capability, and that is why we are investing in more doctors. We have recruited over 5,000 more doctors, including an additional 2,000 doctors in primary care.

[Sir David Evennett]

An increasing number of my constituents are having difficulties obtaining appointments in GP surgeries. However, I was pleased to learn that the GP workforce in my constituency of Bexleyheath and Crayford has increased by an estimated 75% since September 2019. Will my right hon. Friend confirm what further steps he is taking to continue growing the workforce in general practice, which is so crucial to increasing the number of appointments available?

[Steve Barclay]

Now that I have found the right page in my notes I can be precise in telling my right hon. Friend that it is a 75.7% increase in his constituency, so he is absolutely right about that. Nationally, we have recruited an additional 25,262 full-time equivalent primary care professionals, so that is expanding the workforce capability in primary care. As my hon. Friend the Minister for Health and Secondary Care said a moment ago, it is part of our £1.5 billion investment in the workforce in primary care.

[Charlotte Nichols (Warrington North) (Lab)]

As the House will know, this week is MS Awareness Week. Early diagnosis and treatment of MS are vital to delay disability progression and help those with the condition to manage it, yet, currently, 13,000 people have been waiting more than a year for a neurology appointment after GP referral. A recent study suggested that the UK comes a shameful 44th out of 45 European countries for neurologists per head of population. When will the Government bring forward a strategy to attract, recruit and retain the neurology workforce?

[Steve Barclay]

The hon. Lady raises an important issue related to MS. I am happy to write to her with a more detailed answer about the capability and the plan. There is always a tendency within government to lurch to a strategy rather than to look at what is needed for immediate delivery. I will happily set out what steps we are taking now as part of our pandemic recovery in order to target the workforce within the constraints that she raises.

[Mike Amesbury (Weaver Vale) (Lab)]

14. What steps he is taking to improve access to in-home health and social care services.

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[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Steve Barclay)]

The Government support the right to take industrial action within the law, but equally the law is there to protect patients and NHS staff alike. Following legal advice, NHS Employers and my Department are confident that the proposed strike action by the Royal College of Nursing goes beyond the mandate it secured from its members, which expires on 1 May at midnight. While NHS Employers has sought to resolve the issue through dialogue, the RCN’s failure to amend its planned action has led NHS Employers to request my intervention. Even as we work to resolve those issues through dialogue, I can tell the House that I have regretfully provided notice of my intent to pursue legal action. None the less, I am hopeful that discussions can still be productive, especially those between the RCN and NHS England on patient safety, and that they will continue to be guided by the imperative to keep people who use the NHS safe.

[Dr Huq]

The right to choose sounds attractive, but when diabetic eye disease and glaucoma seriously threaten the sight of millions, the fact that any qualified provider can and does cherry-pick reversible cataract work leaves the NHS with astronomical bills and all the complex cases. Will the Secretary of State praise award-winning clinicians Christiana and Evie at Central Middlesex Hospital and visit to see for himself how effectively writing a blank cheque for private treatment is destabilising NHS budgets and jeopardising the NHS’s ability to do award-winning research and to train junior doctors, who need routine work?

[Steve Barclay]

I am always happy to praise the brilliant work of clinicians up and down the NHS, who do a formidable job. Given the huge scale of the backlogs we face as a consequence of the pandemic, it is important that we not only use the full capacity available within the NHS, empowering patients through patient choice and technologies such as the NHS app to better enable that, but maximise the capacity in the independent sector.

[Michael Fabricant (Lichfield) (Con)]

T7. Following the excellent television campaign on bowel cancer, which by the way got me to take a test, can I now ask that we have a similar campaign to talk about the importance of pharmacists? If people consult pharmacists rather than their GPs on occasion, it will take the pressure off general practices.

[Steve Barclay]

My hon. Friend makes a brilliant point, and that is something that we are committed to doing. There is a huge amount of expertise within the pharmacy network, which is why we are looking, through technology such as the NHS app, at how we can better enable people to get the right care from the right place at the right time. Quite often, that is not by seeing the GP, but it might be by seeing those in additional roles in primary care or going to a pharmacist who can offer the right services.

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

A 13-year-old girl who has already waited more than a year for spinal surgery has seen her operation cancelled twice because of the Government’s failure to negotiate an end to the junior doctors’ strike. Why on earth is the Secretary of State still refusing to sit down and negotiate with junior doctors?

[Steve Barclay]

Like others in the House, my heart goes out to any 13- year-old girl in that situation. As the parent of a 12-year-old girl, I can only imagine how distressing it is to the family concerned to see that operation cancelled. That is why it is important that we have dialogue. The hon. Gentleman has said that the demands of the British Medical Association are unaffordable and unrealistic at 35%, as has the Leader of the Opposition. We have been clear on that, but the House saw that in our negotiation with the Agenda for Change staff unions we had meaningful, constructive engagement; that was how we reached an agreement with the NHS Staff Council, and we stand ready to have similar discussions with the junior doctors.

[Wes Streeting]

So why is the Secretary of State not sat down with them today? He says that he cannot negotiate because the BMA will not budge on 35%, but that is not true, is it? He says that the junior doctors have to drop their preconditions; they do not have any, do they? And he says that strike action will have to be called off before he can sit down; there are no strike days planned, are there? So is it not the case that he is quite happy to see hundreds of thousands of operations cancelled so that he can blame the junior doctors for the NHS waiting lists rather than 13 years of staggering Conservative incompetence?

[Steve Barclay]

It is slightly odd that the hon. Gentleman talks about 13 years when we are actually talking about a current industrial dispute. We have shown, through our negotiation with the NHS Staff Council, our willingness to engage and to reach a settlement. Indeed, the general secretary of the RCN recommended the deal from the AfC unions to her members. Unison—the union of which the hon. Gentleman is a member—voted for the deal by a margin of 74%. We stand ready to have engagement with the junior doctors, but 35% is not reasonable. He himself has said—[Interruption.]

[Mr Speaker]

Order. I do not need the Minister for Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), shouting from the end of the Treasury Bench. Okay? I call Henry Smith.

--- Later in debate ---

[Jeff Smith (Manchester, Withington) (Lab)]

T3. I was very grateful to get fantastic treatment for a detached retina at the brilliant Manchester Royal Eye Hospital, but 551 patients have lost their sight as a result of delayed eye doctor appointments since 2019, and the backlog for ophthalmology appointments is, at 630,000, the second largest in the country. The treatments are there, but what will the Government do to sort that problem out?

[Steve Barclay]

First, I very much welcome the good care that the hon. Gentleman received, and it is great to see him back in the Chamber. On the wider issue, that is why we have an elective recovery plan, in which we have applied a boost in capacity, particularly through the surgical hubs. We are looking at how we build greater resilience, especially in winter, when elective beds are often under pressure. We are also investing in areas such as eye treatment, and we are rolling out through Getting It Right First Time a programme of improvement in a range of areas, including that one.

[Dr Luke Evans (Bosworth) (Con)]

Provision for special educational needs and child and adolescent mental health services is one of the biggest issues in my inbox in Leicestershire, particularly in respect of delays in assessment and diagnosis. One of the Government’s plans was to introduce school mental health support teams. The Health and Social Care Committee heard that the aim was that 35% of pupils should be covered by 2023. May we have an update on progress and on when we are likely to reach 100%?

[Steve Barclay]

My hon. Friend makes an important point, and I am happy to update the House, as we have already achieved 35% coverage. By the end of the month, we expect to have 399 operational mental health support teams, covering 3 million children and young people. We plan to go further, with over 500 such teams by spring 2024.

--- Later in debate ---

[Mr David Davis (Haltemprice and Howden) (Con)]

Yesterday, when the Prime Minister met business, the huge value of the NHS database was highlighted. Unfortunately, the previous occasions on which the NHS has tried to open its database have been unmitigated disasters. Will the Secretary of State give an undertaking to stick closely to the recommendations of the Goldacre report so that we can deliver the database while protecting the privacy of patients?

[Steve Barclay]

It is a huge opportunity. My right hon. Friend and I have discussed this matter outside the Chamber, and I met Ben Goldacre in the summer to discuss his fantastic work in the context of covid. It is absolutely right that, given the potential of artificial intelligence, there are huge opportunities in relation to health inequalities and allowing us to better target provision. I think my right hon. Friend would agree that we should do that through the prism of patient consent. One thing that we are trying to build into the NHS app is the ability to better empower the patient to decide what they wish to sign up to and what they would like their data shared with.

[Dan Jarvis (Barnsley Central) (Lab)]

T6.   By 2040, cancer rates in the UK are expected to rise by a third. That is half a million new cases each year, so hundreds of thousands of lives literally depend on the Government implementing a long-term, fully funded, comprehensive plan for cancer. Will the Secretary of State recommit to a 10-year cancer plan?

[Steve Barclay]

We are committed to a major conditions paper, not least because many people with cancer have multiple conditions; that is why it is important that we look at these issues in the round. With the Minister for Social Care, I had a very useful roundtable with key stakeholders, including the cancer charities. The key issue is that as part of our work on cancer checks, over 320,000 more people are receiving treatment for cancer compared with last year—that is around fifth higher—and we are expanding our capacity through the diagnostic centres, the surgical hubs and the expansion of the workforce. All of that fits within the strategy we have through the major conditions paper.

[Andy Carter (Warrington South) (Con)]

St Rocco’s Hospice in Warrington provides invaluable palliative and end-of-life care for families. However, the charities that run hospices around the UK are finding it incredibly difficult to raise funds. Will the Minister give us an assurance that she is working very closely with the sector to ensure that those services continue to be provided?

NHS Industrial Action

Steve Barclay Excerpts

Tuesday 18th April 2023 Written Statements

[The Secretary of State for Health and Social Care (Steve Barclay)]

Yesterday evening NHS England published data about the impact of a 96-hour strike by junior doctors from 07:00 on Tuesday 11 April to 06:59 on Saturday 15 April.

It is regrettable that the BMA’s Junior Doctors Committee, HCSA, and BDA hospital trainees chose to cause maximum disruption to NHS services by staging such a long walk out with no national derogations immediately after the Easter bank holiday.

I would like to thank all those NHS staff, including nurses and consultants, who went above and beyond to provide cover last week and ensure patient safety.

Our priority is always to keep patients safe during any industrial action. The NHS makes every effort through rigorous contingency planning to minimise disruption and its impact on patients and the public during industrial action. The NHS rightly prioritised resources to protect emergency and critical care, maternity care and, where possible, continued to prioritise patients who have waited the longest for elective care and cancer surgery. Where necessary, Trusts cancelled non-urgent appointments to prioritise urgent and emergency care.

The data published last night shows that around 196,000 appointments were rescheduled due to strike action, with around 5,000 in mental health and community appointments. On average, around 26,000 junior doctors were absent each day. The data can be found at: https://www.england.nhs.uk/publication/preparedness-for-potential-industrial-action-in-the-nhs/#headinq-3. These figures are subject to change as not all Trusts have submitted data yet and hence, data is incomplete.

Through the Strikes (Minimum Service Levels) Bill we intend to legislate across different sectors, that will enable people to continue to attend their place of work, access education and healthcare, and go about their daily lives during strikes, while balancing this against the ability to strike. We are already consulting on whether minimum service levels should be in place for ambulance services. Given that increasingly strike action is being taken without voluntary derogations being agreed, we will now consider whether we need to consult on additional minimum service levels covering a wider range of health services to protect the lives and health of the public.

[HCWS725]

NHS Strikes

Steve Barclay Excerpts

Monday 17th April 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the impact of the junior doctors’ strikes and what steps he is taking to prevent further strike action in the NHS.

[The Secretary of State for Health and Social Care (Steve Barclay)]

I am grateful to the hon. Gentleman for his question. On its first part, we will not have firm figures on the number of patient appointments postponed until later today, because the NHS guidance has been to allow trusts a full working day to collate the data on those impacts. We do know from the previous three-day strike that 175,000 hospital appointments were disrupted and 28,000 staff were off. There is an initial estimate that 285,000 appointments and procedures would be rescheduled, but it is premature to set out the full impact of the junior doctors’ strike before we have that data. I am happy to commit to providing an update for the House in a written statement tomorrow. In the coming days, I will also update the House on the very significant progress that has been made on the successful action taken over recent months to clear significant numbers of 78-week waits, which resulted from the covid pandemic.

It is regrettable that the British Medical Association junior doctors committee chose the period immediately after Easter in order to cause maximum disruption, extending its strike to 96 hours and asking its members not to inform hospitals as to whether they intended to strike, thus making contingency planning much more difficult. Let me put on record my huge thanks to all those NHS staff, including nurses and consultants, who stepped up to provide cover for patients last week.

I recognise that there are significant pressures on junior doctors, both from the period of the pandemic and from dealing with the backlogs that that has caused. I do want to see a deal that increases junior doctors’ pay and fixes many of the non-pay frustrations that they articulate. But the junior doctors committee co-chairs have still not indicated that they will move substantially from their 35% pay demand, which is not affordable and indeed is not supported by those on the Opposition Front Bench.

Let me turn to the second part of the hon. Gentleman’s question and the steps we are taking to prevent further strike action in the NHS. We have negotiated a deal with the NHS Staff Council; it is an offer we arrived at together, through constructive and meaningful negotiations. It is one on which people are still voting, with a decision of the NHS Staff Council due on 2 May. The largest union, Unison, has voted in favour of it, by a margin of 74% in favour. So we have agreed a process with the trade unions, which I am keen to respect, and we should now allow the other trade unions to complete their ballot, ahead of that NHS Staff Council meeting on 2 May.

[Wes Streeting]

Thank you, Mr Speaker, for granting this urgent question.

Finally, the invisible man appears; the Secretary of State was largely absent last week during the most disruptive strikes in NHS history. He was almost as invisible as the Prime Minister, who previously said he does not want to “get in the middle” of these disputes—what an abdication of leadership during a national crisis. An estimated 350,000 patients had appointments and operations cancelled last week—that is in addition to the hundreds of thousands already affected by previous rounds of action. Having failed to prevent nurses and ambulance workers from striking, the Government are repeating the same mistakes all over again by refusing talks with junior doctors. Patients cannot afford to lose more days to strikes. The NHS cannot afford more days lost to strike. Staff cannot afford more days lost to strikes. Is it not time for the Secretary of State to swallow his pride, admit that he has failed and bring in ACAS to mediate an end to the junior doctors’ strike?

Last week also saw the Royal College of Nursing announce new strike dates with no derogations and a new ballot. What does the Secretary of State plan to do to avert the evident risks to patient safety? Government sources briefed yesterday that they are prepared to “tough it out”. That is easy for them to say. Will the Secretary of State look cancer patients in the eye, while they wait for life-saving treatment, and tell them to tough it out, as they are the ones who will pay the price for his failed approach?

Finally, writing in The Sun on Sunday, the Secretary of State said that he is worried about patient safety, but he offered no plan to get this matter resolved. He is not a commentator; he is nominally the Secretary of State for Health and Social Care with the power and responsibility to put an end to these strikes. When will he put his toys back in the pram, stop blaming NHS staff, sit down with junior doctors and negotiate a fair resolution to this terrible, damaging and unprecedented dispute?

[Steve Barclay]

The shadow Secretary of State seems to ignore the fact that we have negotiated a deal with the NHS Staff Council, and it is a deal that it has recommended to its members. Indeed, the largest health union has voted in favour of the deal—indeed it is his own health union that has voted in favour of it—and yet he seems to suggest that we should tear it up even though other trade unions are voting on the offer, and their leadership had recommended it.

Secondly, the shadow Secretary of State says that we should sit down and negotiate. We have made an offer of 10.75% for last year, compared with the Labour Government in Wales, who have offered just 7.75%, which means that, in cash terms, the offer in England is higher than that put on the table by the Welsh Government, whom, I presume, he supports. He says that he does not support the junior doctors in their ask of 35%, and neither does the leadership there. We need to see meaningful movement from the junior doctors, but I recognise that they have been under significant pay and workforce pressures, which is why we want to sit down with them.

The bottom line is that the deal on the table is reasonable and fair. It means that just over £5,000 across last year and this year will be paid for a nurse at the top of band 5. The RCN recommended the deal to its members, but the deal was rejected by just under a third of its overall membership. It is hugely disappointing that the RCN has chosen not to wait for the other trade unions to complete their ballot and not to wait for the NHS Staff Council, of which it is a member, to meet to give its view on the deal. It has chosen to pre-empt all that not only with the strikes that come before that decision of the NHS Staff Council, but by removing the derogations—the exemptions—that apply to key care, including emergency care, which is a risk to patient safety.

Trade unions are continuing to vote on the deal. The deal on the table is both fair and reasonable, including just over £5,000 across last year and this year for nurses at the top of band 5. The deal has been accepted by the largest union in the NHS, including, as I have said, the shadow Health Secretary’s own trade union. It pays more in cash to Agenda for Change members than the deal on the table from the Labour Government in Wales. It is a deal that the majority of the NHS Staff Council, including the RCN’s own leadership, recommended to its members. We have always worked in good faith to end the disruption that these strikes have caused and we will continue to do so. None the less, it is right to respect the agreement that we have reached with the NHS Staff Council and to await its decision, which is due in the coming weeks.

[Mr Speaker]

I call the Chair of the Select Committee.

[Steve Brine (Winchester) (Con)]

Reports over the weekend suggest that the British Medical Association has asked its members not to engage with trusts if they intend to strike, as the Secretary of State has confirmed today. That is putting trust chief executives—and this is not their fault—in an impossible position. They are being asked to meet very challenging targets that we are rightly setting them, not least with respect to the covid backlog. What more can he do by his good offices to break that impasse? It is patients who are losing out.

[Steve Barclay]

I agree; it is extremely surprising that the BMA has asked its members not to liaise with NHS managers as they put in place those contingency plans. I urge the BMA junior doctors committee to think of those colleagues who have to provide the cover for those strikes. I reaffirm my thanks to all those staff in the NHS who provided cover following the Easter period, but it puts more pressure on other NHS staff if the BMA junior doctors committee is not willing for its members to liaise with management on sensible contingency measures, as I urge them to do.

[Rachael Maskell (York Central) (Lab/Co-op)]

The bigger dereliction of duty by the Secretary of State is not addressing the retention crisis among junior doctors, who have the choice of going to New Zealand or Australia, to be paid more than double what they receive now, or to move over to work as locums, where they will not carry the stress levels they currently do. What is he doing to address the retention crisis of junior doctors in the NHS?

[Steve Barclay]

In part, that is why my door is open and I am keen to discuss with junior doctors the pressure they face not just on pay, but on non-pay issues. There is the issue of support for the number of doctors and the workforce plan we have committed to bring forward to boost recruitment, but other non-pay issues are also frequently raised by junior doctors, such as booking annual leave and rostering. I am keen to work constructively with junior doctors to address those, but for us to do so they need to move from an unrealistic and unaffordable 35%, which the Leader of the Opposition himself has recognised is an unreasonable position.

[David Morris (Morecambe and Lunesdale) (Con)]

The Secretary of State is right to say that the pay offer that has been put on the table, notwithstanding the junior doctors, is fair and reasonable. What should drive all parties in this situation is putting patients first, moving forward to address the serious challenges of recovering from covid and seeking to address the issues within the NHS. Everyone should be focused on patients first as this situation moves to a resolution.

[Steve Barclay]

I very much agree with my hon. Friend that this is a fair and reasonable settlement. As I say, it is more than £5,000 at band 5, and the NHS Staff Council has recommended it. The majority of trade unions, including the RCN, recommended this deal to their membership. That is why we should respect the NHS Staff Council process, respect the ballot that is still live and allow those votes to continue.

[Jon Trickett (Hemsworth) (Lab)]

Has the Secretary of State seen the recent report on the BBC that billions of pounds—my words, not the BBC’s—are being squandered on agency labour from private providers, with huge profits being generated? Is it right that one doctor alone received £5,200 for a single shift, as was reported by the BBC? What does the Secretary of State think the impact of that would be on his own staff? How can it be right for him to use bellicose language about the staff associations and unions while larding money into the pockets of the private agency providers?

[Steve Barclay]

One of the concerns at the moment is the BMA rate card, which is significantly increasing the cost of providing the required cover for the strikes, and in turn taking money away from things NHS staff have raised with me, such as improving our tech offer, improving the NHS estate and the many other priorities on which money could be spent. I am keen, as I am sure the hon. Gentleman is, to bring down the cost of agency workers. That is why we have the commitment to the NHS workforce plan and why I am keen to sit down constructively with the junior doctors committee, in the same way that I did with the NHS Staff Council. After we reached our deal, the leader of those negotiations for the trade unions commented on the meaningful and constructive approach that we took with the Agenda for Change negotiations. We are keen to do the same with the junior doctors, but that has to be based on a reasonable opening position from them.

[Paul Bristow (Peterborough) (Con)]

When union bosses open their pay demands at 19% for nurses and 35% for junior doctors, is it any wonder that some ordinary members feel let down when they have been asked to settle for a generous and fair 5%? Would it not be far better if the BMA junior doctors committee revised its ludicrous demand for 35%, got around the table and did its members some service by negotiating for a fair and reasonable pay offer?

[Steve Barclay]

I agree with my hon. Friend. The fact that even the Labour party does not support 35%—the Leader of the Opposition himself says that is not affordable —indicates how out of step the junior doctors committee co-chairs are on what is realistic to get the balance right in bringing down inflation and on the wider economic pressures we face. We stand ready to engage constructively with the junior doctors committee but, as my hon. Friend says, that has to be on the basis of a meaningful opening position.

[Daisy Cooper (St Albans) (LD)]

On 5 July, the British public will want to celebrate 75 years of our amazing NHS, but if they are still feeling the brunt of NHS strikes at that time, does the Secretary of State think it would still be right for him to be at the Dispatch Box?

[Steve Barclay]

We have agreed an offer with the Agenda for Change staff council. That is something that the staff council and the majority of trade unions have recommended to their own members, and that the largest health union has voted in favour of. I think we should allow that ballot to take place; it reflects meaningful and constructive engagement. That was reflected in the fact that trade union leaders themselves recommended the deal to their members. I hope that, when we come to the 75th anniversary, we can celebrate that.

[John Redwood (Wokingham) (Con)]

What actions are senior NHS managers taking to resolve non-pay issues for which they could offer better work experiences to doctors? What use can they make of flexibilities over pay increments, promotions and gradings so that good staff can be better rewarded?

[Steve Barclay]

As ever, my right hon. Friend raises an extremely important point. As part of the negotiation with the AfC staff council, a number of non-pay issues were discussed. Job evaluation is one such issue. Likewise, for junior doctors, areas such as e-rostering are extremely important. I share his desire for investment in technology, and to look at the time spent by clinicians that could be spent by others in the skills mix or through better use of artificial intelligence technology and a better estates programme. That is why it is important that we continue to have that funding, as well as reaching the offer that we have with the AfC staff council.

[Zarah Sultana (Coventry South) (Lab)]

Nurses, junior doctors and paramedics do not take strike action lightly; it is a last resort after more than a decade of working harder and longer for less and less. The Secretary of State will say that there is no money for a fair pay deal, but that is not true: it can be paid for by taxing the richest and redistributing the wealth. Ending non-dom status would raise £3 billion; introducing a 1% tax on assets worth over £10 million would raise £10 billion; and equalising the capital gains and income tax rates would raise £14 billion. What do the Secretary of State and Conservative Members prefer: nurses having to use food banks, or taxing the richest and making them pay their fair share?

[Steve Barclay]

The odd thing is that the hon. Lady seems to be disagreeing with the trade union leadership, which is not her usual position. Unison described it as a “decisive outcome” when 74% of its members voted in favour of the deal. It is odd that she wants to deny the GMB and other trade unions the space to vote on what their leaders have recommended—the GMB leadership has also recommended the deal to its members. Even the RCN leadership recommended the deal to its members. As Pat Cullen herself said:

“Negotiations work by compromise and agreement. We did not get everything and nor did the government. Ministers made improvements every day of those three weeks because we were able to say that returning to striking was the clear alternative. No union could enter negotiations and flatly say ‘no’ until you get everything you want. These talks will not be reopened if members reject this pay offer.”

The leadership of the RCN recommended the deal, as did the leaderships of the GMB and Unison. It is odd that the hon. Lady does not want to recognise that.

[Chris Grayling (Epsom and Ewell) (Con)]

It is ironic to hear the British Medical Association complain about staff shortages when it has in the past resisted the expansion of training places for doctors. When there have been disputes in the health service, those involved have always taken steps to ensure that lives were not endangered by the dispute. That appears to be no longer the case. That is, to my mind, a dereliction of professional duty. Will my right hon. Friend send the strong message to those involved that preserving life is a professional duty that must be maintained?

[Steve Barclay]

My right hon. Friend is absolutely right to focus on patient safety and the duty that all involved have to safeguard it. Indeed, I have previously given the Royal College of Nursing’s leadership credit and praise for granting strike exemptions, known as derogations—notwithstanding our disputes, I was happy to recognise that on the record. Given that less than a third of the RCN’s total membership has voted against the deal, and that the RCN’s leadership recommended it, it is very odd that it has now hardened its position and removed those exemptions. I very much hope that it will reflect further on the matter in the coming days, because I think its previous stance of granting exemptions was right.

[Richard Burgon (Leeds East) (Lab)]

We need to be clear: junior doctors have had a 26% real-terms pay cut. Restoring their pay would cost around £1 billion a year. That is less than half the giveaway handed to the super-rich through the non-dom tax avoidance scheme. Is it not the case that a proper pay rise for junior doctors is affordable—it is just that the Government have the wrong priorities?

[Steve Barclay]

It perhaps will not surprise the House to hear that the hon. Gentleman disagrees with his party’s leader on that, because the Leader of the Opposition says:

“I don’t think 35% is affordable”.

The hon. Member for Leeds East (Richard Burgon) is also wrong on the quantum, because the cost would be £2 billion, not £1 billion as he says. [Interruption.] Well, that has never been how departmental budgets operate—not when his party was in power, and certainly not now. He is wrong on the amount and wrong on the policy.

[Sir Julian Lewis (New Forest East) (Con)]

Given that the terms “emergency care” and “intensive care” imply that the life of those who need them is at risk, does my right hon. Friend share my dismay that people in that predicament are now clearly being targeted by strikers? Will he—and hopefully his Opposition counterpart—represent to the medical unions that whatever other strike action they take, they should not endanger the life of people in emergency or intensive care?

[Steve Barclay]

My right hon. Friend makes an extremely important point. Patient safety should come first for all parties in this dispute. That is why I urge the Royal College of Nursing to wait for the NHS Staff Council decision on the offer. Voting is still ongoing, and it would be premature to announce strike action ahead of that decision.

[Margaret Greenwood (Wirral West) (Lab)]

Nurses and junior doctors are being pushed to breaking point, because there simply are not enough of them, and the Government have failed to plan the workforce properly. A nurse I spoke to at the weekend told of the terrible queues in corridors, and said that patients were waiting in pain, and not in the dignified environment that they should be in. She also spoke of the lack of care packages to enable the safe discharge of many patients. Why are we still waiting for the NHS workforce plan, which the Government promised? Can the Secretary of State tell us on what date we can expect to hear a statement on it? Also, what urgent action will he take to address the social care crisis?

[Steve Barclay]

On social care, which relates to the hon. Lady’s point about discharge, she will recall that in the autumn statement the Chancellor put additional funding into adult social care—funding of up to £7.5 billion over two years, which is the largest ever increase in funding for social care. Also, I announced at the Dispatch Box in early January a reprioritisation of funding in the Department—it was a £250-million package—in the light of urgent and emergency care pressure. That included funding to support greater discharge, to get more flow. I touched on the workforce plan earlier. We will publish it shortly; in the autumn statement, the Chancellor committed to doing so.

[Anna Firth (Southend West) (Con)]

Does my right hon. Friend agree that the BMA pay demands are over four times the average private sector pay increase and that, were the Government to agree to them, they would place a huge additional tax burden on hard-working taxpayers across the country—including in Southend West—at just the time when they are battling with an unprecedented cost of living crisis?

[Steve Barclay]

I do agree with my hon. Friend. If that demand were agreed to, it would mean some junior doctors receiving a pay rise of over £20,000. We need to find a balance, with a fair and reasonable settlement for NHS staff, recognising the huge pressure from the pandemic and the backlogs it has caused, while at the same time bringing inflation down, because that matters not just to NHS staff, but to all working people who are impacted by inflation.

[Mary Kelly Foy (City of Durham) (Lab)]

The BMA has made it crystal clear that it is willing to enter into negotiations, so will the Secretary of State commit right now to asking ACAS to negotiate and mediate? If not, why not?

--- Later in debate ---

[Steve Barclay]

As I have said, we need to see meaningful movement from the BMA. The 35% demand that it has set out is not affordable, which is a point that is recognised by most colleagues across the House—certainly, Opposition Front Benchers recognise it. We need to see significant movement from the BMA to be able to have constructive and meaningful engagement.

[Matt Warman (Boston and Skegness) (Con)]

I welcome the Secretary of State’s acknowledgement that junior doctors deserve a pay rise, and not just because my wife is a junior doctor, and his focus on non-pay issues. For all the talk about ACAS from Opposition Members, is it not the case that so long as the BMA leadership maintain that their starting point is 35%, there is no point in going to ACAS, because the BMA is not prepared to negotiate? It is setting its face against the interests of doctors and patients. The only way to get through this is to get around the table with a meaningful starting point, and that cannot be 35%, as the Leader of the Opposition has said.

[Steve Barclay]

I very much agree with my hon. Friend, and he is right to highlight the wider issues that we want to discuss. The previous negotiation with the junior doctors included, for example, setting up a higher pay band, which has meant that there has been a cumulative increase of over 24% over four years. It included targeted action such as a £1,000 a year allowance for junior doctors who work less than full time, and targeted action around unsocial hours and weekend work. Those are the meaningful discussions that we want to enter into with junior doctors, but that has to be on the basis of a realistic and deliverable discussion, and 35% is not that.

[Dame Diana Johnson (Kingston upon Hull North) (Lab)]

I am not sure the Secretary of State understands just how angry people are. My constituents are absolutely furious with the Government’s stewardship of the NHS. Hull is the most under-doctored area in the country; we have the longest waits in A&E in the country; and we have had a very poor Care Quality Commission report on our local hospitals. On the junior doctor strikes, when will the Secretary of State start to put patients first? I want to make sure that he goes away from this Chamber and gets ACAS involved, so that we can get the junior doctors back at work, with no further delays and cancellations for my constituents and patients in Hull.

[Steve Barclay]

The rather odd thing is that we have a larger cash offer on the table for 2022-23 than the Labour Government in Wales, and we have reduced our longest waits far more than they have in Wales. We have a deal that the trade union leaders themselves have recommended, that the majority of staff councils have recommended and that the largest health union has voted emphatically in support of. It is right that we allow time for that deal to go through, and we stand ready to have similar meaningful and constructive engagement with the junior doctors once they move from what is an unrealistic position.

[Sir Desmond Swayne (New Forest West) (Con)]

Regulars in this Chamber will know that Opposition Members have habitually taken to urging Ministers to adopt their own policies. Does the Secretary of State share my difficulty that, in respect of this urgent question, none of us has any idea what their policy is?

[Steve Barclay]

In short, the position of the shadow Health Secretary seems to be to deny the vote of his own union, Unison, which voted 74% in favour; to not wait for the NHS staff council to reach its decision; and to unravel to some extent what has been meaningful and constructive engagement with the “Agenda for Change” staff council. My right hon. Friend is right to be confused about the Opposition’s actual position.

[Sir Chris Bryant (Rhondda) (Lab)]

I can see at least two other Members in the Chamber who know from personal experience that early diagnosis and treatment of cancer can save lives. I very much hope that any action taken over the next few weeks will not affect that, because that could mean people losing their lives before their time.

I have two significant worries about the long-term future of the NHS. One is seeing so many people, including those from poor constituencies and poor families, using all their life savings to buy an operation, because they know that that is their only means of getting back to work as there is such a long backlog. That feels like a form of privatising the NHS.

Secondly, there are terrible problems with recruitment and retention, with more than 110,000 vacancies in the NHS. I really hope we will see the workforce paper soon. It has been promised for a very long time, and I suspect “summer” may go on until autumn—it tends to every year, I suppose. It would be good to see that paper soon, because there are so many different parts of the NHS where we need to recruit more people. Everybody in this round is worrying, “Will the NHS be worth working for in 10, 15 or 20 years’ time?”. We can only do this if there is real confidence in the future.

[Steve Barclay]

The hon. Gentleman makes two important points. The workforce plan is critical, and I have referred to that already. He also raises the importance of early diagnosis of cancer, and he is absolutely right on that. He will have seen that the faster diagnosis standard was met in the latest operational performance data for February, which was extremely welcome news. There is obviously more still to do. That is why we are rolling out the programme of diagnostic centres and surgical hubs. We are redesigning patient pathways to streamline those journeys, and we are looking at variation in performance on such things as faecal immunochemical tests. There is a huge amount of work, but I hope he can see some progress in the latest figures.

More widely in terms of elective recovery, we made progress in the summer on the two-year waits, in stark contrast to Wales, which was significantly above 50,000. We got it under 2,000 in the summer. I will update the House shortly on the 78-week waits. We are working through the key actions in our elective recovery plan as we deal with the consequences of the build-up from the pandemic.

[Aaron Bell (Newcastle-under-Lyme) (Con)]

We all recognise how hard junior doctors work, but if we are to have successful negotiations, we need honesty and integrity in them. Does the Secretary of State share my concern that the BMA’s figure—its central campaign claim—of £14-an-hour pay for junior doctors has been shown to be misleading?

[Steve Barclay]

I do share my hon. Friend’s concern. Full Fact has shown that the figure is inaccurate. It disregards higher pay later in the evenings and at weekends. It ignores the 20% that goes into pensions and that junior doctors, probably more than any other profession, have very quick pay and career progression. That is why, as part of our listening exercise, we made changes to pensions in the Budget. That was a reflection of the fact that senior doctors have often accumulated those pension pots, which is one of the other challenges we are dealing with. It is an indication of the career and pay progression that many junior doctors will see later in their careers.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State very much for his endeavours to find a pay settlement, ever mindful that it is more than pay that some NHS staff wish to see. To give an example of that, I recently sat listening to one of my constituents who is in foundation year 1. She was brought to tears by the stress and pressure on her young shoulders. When she finally finishes shifts, she lies awake going over the decisions made. In her view, she would keep her pay the same to have more qualified staff available. How will the Secretary of State’s proposals make adequate support on the wards possible?

[Steve Barclay]

The hon. Gentleman raises an important issue, and there is a lot more we can do around the skills mix in the NHS and ensuring that people operate at what is referred to as the top of their licence and make the maximum of the training they have. Often there are restrictions in place. We are looking at physician associates and medical examiners and at the role of pharmacists within primary care, as well as at how we get the right continuing professional development to train people, so that we get more of the career ladder from different roles.

There is a lot that we are looking at, in the context of the workforce plan, around the right skills mix, the right training and job evaluation. That was one of the issues in my discussions with the staff council—for example, there was a particular focus on apprenticeships. Sometimes people take a pay hit when they go into an apprenticeship if they were at the top of their previous band. That is one of the things we agreed to work on with the staff council. Again, I am sure that an area of consensus in the House will be that apprenticeships offer great opportunities for people to progress, and we should not have a financial penalty when people pursue them.

[James Daly (Bury North) (Con)]

Many hon. Members have raised extremely important points, but the central issue is that the reckless and irresponsible actions of two trade unions are putting the lives of my constituents and people throughout the country at risk. The right to strike can never trump people’s right to receive healthcare and not have their life threatened by the actions of left-wing trade unions. Can I ask what my right hon. Friend is going to do to address this issue and to hold trade unions to account if they continue with this appalling behaviour?

--- Later in debate ---

[Steve Barclay]

I share my hon. Friend’s concern. We have worked constructively with the Royal College of Nursing and, as I say, I was happy to put on the record my acknowledgment of the exemptions it had previously granted. I hope that between now and the end of the month, it will further reflect on the fact that the 48 hours of continuous strike action will happen without consultation with other staff council members and without waiting for the decision of other trade unions that are currently balloting. He will know that “Agenda for Change” is a deal that covers all the trade unions, not just the RCN in isolation, and I think it is right to wait for all the trade unions to vote and for the staff council to meet.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I draw the attention of Members of the House to my entry in the Register of Members’ Financial Interests.

On Friday, I was working at the hospital and my usual clinic had cancelled all but one patient. I spoke to the secretaries about the various cancellations they had had to make as result of the strikes, and I was really sad to hear not only that they had often been verbally abused by people who were upset, but that they have had to cancel some patients on two occasions because of the earlier strikes and the more recent ones. I was also sad to hear that we are looking at further strikes in the next few weeks.

Will the Secretary of State join me in thanking the members of staff who came into work, who did not strike and who continue to deliver a very important and valuable service? What is he doing to expedite the legislation on minimum service guarantees, so that we do not have any implications from strikes on emergency and intensive care in particular?

[Steve Barclay]

First, I thank my hon. Friend for her service and for the work she was doing on Friday. I join her in putting on the record my thanks to all those staff who did provide cover, as I said in my opening remarks. She is right to highlight the minimum service legislation, and we will obviously need to reflect on recent events in that context. She also points to the fact that the decision by the BMA junior doctors committee to advise members not to notify hospital management about whether they were striking obviously made it more likely that clinics would be cancelled, even when it then transpired that doctors could have provided cover. That is clearly regrettable and indicates the need for resolution, and we want to work constructively with the junior doctors on this.

Junior Doctors’ Strikes

Steve Barclay Excerpts

Thursday 30th March 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the impact of the junior doctors’ strikes and what steps he is taking to prevent further strike action.

[The Secretary of State for Health and Social Care (Steve Barclay)]

I am grateful to the hon. Member for Ilford North (Wes Streeting) for his question. I know that colleagues and constituents will be concerned about the planned 96-hour walkout organised by unions representing junior doctors.

The hon. Gentleman asks about the impact, and we know that during the previous walkout by junior doctors earlier this month, 181,000 appointments had to be rescheduled. The disruption and risk will be far greater with this four-day walkout, not only because it lasts longer but because it coincides with extended public holidays and Ramadan, with knock-on effects on services before and after the strike action itself, and because a significant proportion of junior doctors will already be on planned absence due to the holiday period.

NHS England has stated that it will prioritise a number of areas, including emergency treatment, critical care, maternity care, neonatal care and trauma, but—[Interruption.] The hon. Gentleman asked the urgent question, so he might want to hear the answer. NHS England has been clear that it cannot fully mitigate the risk of patient harm at this time, which is concerning and disappointing. Patients should not have to face such disruption again, and I have invited the British Medical Association and the Hospital Consultants and Specialists Association to enter formal talks on pay, with the condition that they cancel strike action.

The BMA’s junior doctors committee’s refusal to engage in conversations unless we commit to delivering a 35% pay increase is unacceptable at a time of considerable economic pressure and suggests a leadership that is adopting a militant position, rather than working constructively with the Government in the interests of patients. None the less, we remain determined to find a settlement that not only prevents further strike action but, equally, recognises the important work of junior doctors within the NHS, just as we have done with the “Agenda for Change” trade unions in their dispute. We will continue to work in good faith, in the interest of everyone who uses the NHS.

[Wes Streeting]

More than 300,000 operations and appointments have been cancelled due to industrial action in the NHS since December. The strikes planned for next month will be longer than any previous ones, with no derogations planned and they will be coming off the back of the bank holiday weekend. Patients are worried sick and consultants have written to me to say they are terrified for patients’ safety—they fear that patients will die as a result. So when is the Health Secretary going to get junior doctors back in for talks, take them seriously and stop these catastrophic strikes from wreaking havoc on patient care?

First, the Government failed to learn the lessons of the nurses’ strikes and refused to speak to junior doctors until the last minute. Then, instead of treating junior doctors with respect and sitting down for proper negotiations, Ministers took to Twitter for a mud-slinging match. The British Medical Association accused the Secretary of State of misrepresenting the truth when he tweeted that its pay demand was a “pre-condition”. The BMA has since said that it is a “starting point” for negotiations. Will he today clarify which side is correct and who was spreading fake news?

Since the beginning of these disputes, the Government have acted like a bystander when patients needed action. Never was that clearer than when the Prime Minister said that he did not want to “get in the middle” of them. We have a Prime Minister whose idea of leadership looks more like cowardice. He talks about delivery, but the NHS is still waiting. These strikes come at a time when the Government are failing to cut the NHS backlog. But it is not only the backlog that they have built up—a plethora of plans were trailed in the press in recent weeks but on the final sitting day before recess none has emerged. There is no sign of the NHS workforce plan, when the NHS is short of more than 150,000 staff. There is no sign of the general practice plan, when patients are finding it impossible to see their GP. There is no sign either of the review of integrated care services or the social care update, which reports suggest contains a stealth cut of £250 million to the social care workforce. So can the Secretary of State say whether the Government are planning to get the bad news out over recess and avoid scrutiny in this House, or is it less sinister and they just do not know what they are doing?

[Steve Barclay]

The urgent question was on the junior doctors—[Interruption.] I am sure I will quote—[Interruption.] There is a rare point of agreement between us. The hon. Gentleman is chuntering, but let me go through the list of things that he did raise pertaining to the junior doctors’ dispute. He said that the Government should get the junior doctors committee in for talks; we have done so—his third question made reference to the fact that we have. We have had the junior doctors in for discussions—[Interruptions.] I will run through the questions.

The hon. Gentleman questions whether there are preconditions attached to those discussions. I have checked the minutes of the meeting and there was a list of conditions —a pay restoration of 35%, and a range of other factors that were put on the table— that were preconditions that the Government had to commit to. The point is that he has said in the media that he does not support those preconditions. He says that 35% is unaffordable, so what is his position? One minute he says that he supports the junior doctors and that they should not go on strike, yet the next minute he says that he does not actually support the precondition that the junior doctors have said is the requirement for them to enter into discussion.

The reality is that the Government have taken a constructive and meaningful approach to trade union negotiations. That is why we have reached agreement with the “Agenda for Change” trade unions. It is why the Royal College of Nursing, Unison, the GMB and the Royal College of Midwives are all recommending the agreement that has been reached, covering more than 1 million staff across the NHS, to their members. The junior doctors have set a precondition on those talks which the hon. Gentleman does not agree—[Interruption.] That is a precondition. He does not seem to understand the terms the junior doctors—[Interruption.] He asked the question, he is getting the answer and the fact that it points to the contradiction in his own position is one that he seems to be having trouble with. Conservative Members are used to contradictions from those on the Opposition Front Bench. He supports the use of the independent sector, whereas his deputy does not. He wants to nationalise the GP estate, but his shadow Chancellor does not. The Opposition are full of contradictions. The reality is that there is a position in terms of the—[Interruption.] The right hon. Member for Islington South and Finsbury (Emily Thornberry) chunters again. There is a position in terms of precondition. The shadow Secretary of State asked me to confirm at the Dispatch Box whether it was a precondition of the junior doctors. Ahead of the urgent question, I checked the minutes—[Interruption.]

[Madam Deputy Speaker (Dame Rosie Winterton)]

Order. We cannot have this constant chuntering.

[Steve Barclay]

The Opposition do not seem to like their question being answered. The shadow Secretary of State asked me to confirm the position, for the avoidance of doubt, at the Dispatch Box. That is exactly what I am doing. I have checked the minutes. I have spoken this morning with officials to confirm, before I made the statement to the House, that it was a precondition of the talks. We were told, in terms of the pay erosion of 26.1%, that that needed to be restored at 35%, alongside other things. The reality is that he does not support that. He is facing both ways, wanting to support the junior doctors, but not actually willing to support the pay that they are demanding.

[Sir Desmond Swayne (New Forest West) (Con)]

What does it do for a respected profession that, when one visits a hospital, one is confronted by a rabble chanting like a schump of rudies, particularly when they have not co-operated with hospital authorities to minimise the impact of their absence?

[Steve Barclay]

I would draw an important distinction between a militant group that appears to have taken over the junior doctors committee and the vast majority of junior doctors who do a hugely important job within the NHS. We recognise in Government that they have faced considerable pressures from the pandemic, and we stand ready to work constructively with them. There are, on the other hand, some within the BMA junior doctors committee who appear to have a more political agenda. Indeed, I refer hon. Members to the statements of members of that committee, who have said that they want to move the BMA to more traditional trade union activity and to pursue a more overt political agenda.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

This is an urgent question, but I do not get a sense of urgency from the Secretary of State that he wants to resolve the dispute. I am afraid that standing at the Dispatch Box and traducing the junior doctors for their approach will not help to resolve this matter. I urge him to drop any preconditions on any future meetings, because the only way that this can be resolved is through negotiation. Will he do that now?

[Steve Barclay]

First, there is absolutely no traducing going on. In my last answer, I praised the junior doctors and recognised the fact that they have faced huge pressure from the pandemic, which is why we stand ready to work with them. Some on the BMA junior doctors committee have a different agenda, but we stand ready to work very constructively with that committee. The hon. Gentleman suggested that I drop the precondition. It is not I who set the precondition; it is the junior doctors committee that did so. I remind the House that it includes restoration to 2008 levels of all elements of pay, not just basic pay; parking fees and exam fees; and “radical” reform of the Review Body on Doctors’ and Dentists’ Remuneration. It is the junior doctors committee that set those preconditions, not the Government.

[Andy Carter (Warrington South) (Con)]

I commend my right hon. Friend for the way in which he and his team have worked to find solutions with other trade unions, particularly the nurses. None the less, the 96-hour walkout is a significant period of disruption. Can he confirm that he is doing everything he can to ensure that those needing urgent healthcare in Warrington will be able to access it despite the industrial action by the BMA?

[Steve Barclay]

I thank my hon. Friend for his question. Yes, the Department is working very closely with colleagues in NHS England and across the NHS to mitigate as best we can the impact of the junior doctors’ strike. He is right that we had meaningful and constructive talks with the staff council representing “Agenda for Change” staff. I am very pleased that, as a result of the constructive engagement we had, the NHS staff council was able to recommend that pay award to its members. He is right that that points to the constructive approach that we have taken. We stand ready to have that constructive engagement with junior doctors, recognising the real pressures that the profession has been under. We will mitigate as best we can, but, given the timing over the Easter period, obviously, there is a risk in terms of patient harm. We will do all we can to mitigate that.

[Sarah Olney (Richmond Park) (LD)]

The latest figures from January 2023 showed 7.21 million people waiting for NHS treatment. What impact does the Secretary of State think this strike will have on the extremely hard work that has been done across the NHS to reduce those waiting lists, and what plans does he have to address the impact that the strike will have on waiting lists, if he does not plan to take any action to avoid it?

[Steve Barclay]

I think we can see what sort of impact it will have from the previous strike, which was over three days and impacted 181,049 appointments. We can see there will be a significant impact. On mitigations, as part of our electives recovery plan, we are doing a range of things, including expanding community diagnostic hubs and the fast-tracking of surgical hubs. The NHS is responding brilliantly with things such as super Saturdays, where teams process higher volumes of treatments, particularly in certain areas. We have the Getting It Right First Time programme, led by Sir Jim Mackey and Professor Tim Briggs, which is looking at how we embed best practice. Having hit the first interim milestone of our recovery plan in the summer, the two-year wait, we are now focused on the 78-week wait target and working our way through that.

[Selaine Saxby (North Devon) (Con)]

The British Medical Association’s pay demands are more than four times the size of the private sector average pay increase. Does my right hon. Friend agree that inflation is the enemy, making everyone poorer, and that public sector pay rises of over 25% will only drive inflation even higher?

[Steve Barclay]

I agree with my hon. Friend that we need to do both: we need to get inflation down, recognising that has an impact across the whole workforce, including for those working within the NHS itself, and we need to recognise the real pressure that junior doctors and others within the NHS have faced. That is why we stand ready to have meaningful and constructive talks with junior doctors, in exactly the same way as we have had with midwives, nurses and others within “Agenda for Change”. We must balance the wider issue of inflation and what is affordable to the economy against recognising the real pressures the NHS has faced and responding to that, including for junior doctors.

[Alex Cunningham (Stockton North) (Lab)]

The Secretary of State cannot blame the Opposition for his mess. Nearly every day I retweet ads from the local NHS trust, which is trying desperately to recruit doctors and other staff. Does he accept that pay is a key factor in the large number of vacancies within the NHS, and will he do something to sort that out?

[Steve Barclay]

I accept that pay is an important factor. It is not the only factor—the estate and technology are also important. There is a range of issues. That is exactly the conversation I had with the trade unions representing “Agenda for Change”. We discussed with them both changes to pay and the non-pay measures. There are a range of factors, and we stand ready to have those discussions with junior doctors. However, they have chosen to take a more political, militant stance, in contrast with the approach that other trade unions have pursued.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

I also feel that the Secretary of State’s attitude and language from the Dispatch Box this morning are not very helpful in negotiating with such a key group of people. The BMA accused the Secretary of State of misrepresenting the truth when he tweeted that its pay demand was a precondition. Does he now accept that the BMA has said its 35% demand is a starting point? Will he therefore sit down and negotiate an affordable settlement, without delay, and can he clarify which side is correct?

[Steve Barclay]

I have already answered that question twice, but I am very happy to repeat at the Dispatch Box the fact that I checked with my officials in the Department this morning—with people who were in the room—and have also checked the minutes. That was the position that the junior doctors set out in terms of a precondition. Indeed, they have repeatedly stated in the media that they expect a 35% pay restoration—and not simply that, but additional things such as exam fees, parking fees, reform of the DDRB and so forth. That is the position the junior doctors have set out. I repeat that we want to work constructively with junior doctors. We recognise that the profession has faced huge pressure through the pandemic and we stand ready to work constructively with them in the same way that we have with the GMB, the RCN, Unison and many other trade unions.

[Matt Western (Warwick and Leamington) (Lab)]

Junior doctors are the backbone of the NHS. I would never describe those whom I have met as “militant”; they are hard-working and of all ages. Somehow, this is the second strike that junior doctors have staged in the last 13 years—there was none in the previous 13 years, under a Labour Government. Will the Secretary of State confirm: has he not set out his own precondition, and that is that he will not meet them until they call off the strikes?

[Steve Barclay]

There are two different things there—one on which the hon. Gentleman is correct and one on which he is not. He is correct that we have said that a precondition for meaningful and constructive talks is that the trade union suspends strikes. That is a precondition that the other trade unions were more than willing to accept, and it is applied in other sectors such as education. We have been clear on that.

The hon. Gentleman is not correct on my point about militancy, which referred to the junior doctors committee specifically. We stand ready and recognise the real pressure that many within the junior doctors community have faced. The NHS has been under significant pressure coming out of the pandemic. We recognise that there are issues on which we want to work and have constructive engagement with them. It is just regrettable that some in the junior doctors committee of the BMA want, as they have said in media interviews, to take a more overt political agenda, rather than work with us to focus on the real issues that many junior doctors are concerned about.

[Jim Shannon (Strangford) (DUP)]

I note that the Secretary of State is trying extremely hard to try to find settlements. The settlement with the Royal College of Nursing and the nurses is an example of just that, although it took a bit of time—I would have liked to see it happen sooner. Will the Secretary of State outline what support is available for junior doctors who need greater support from registrars and consultants to restore confidence—that is the whole point of the F1 and F2 process—so that they are not left to drown under the pressure of handling entire wards on the worst shift patterns possible, wondering, when they go home, whether the decisions that they have made are the wrong ones? Will the Secretary of State ensure that financial and wage negotiations will be constructive, as he did when it came to the RCN and the nurses?

[Steve Barclay]

I am very happy to give the hon. Gentleman reassurance about our desire to have that constructive engagement, exactly as we had with colleagues on the NHS staff council. There are a number of issues on which we are keen to work with junior doctors: rostering; which he mentioned; holidays, which are sometimes cancelled at short notice—a range of issues have been raised with me. When I go on visits to hospitals, as I do frequently, staff raise a range of issues, and I am very keen to work through them with junior doctors. I think that people can see from the approach that we took not just with “Agenda for Change”, but with the pension changes that were announced in the Budget, that the Government are working constructively with the NHS to address those issues. We stand ready to have exactly that meaningful and constructive engagement with junior doctors.

NHS Staff: Pay Offer

Steve Barclay Excerpts

Thursday 16th March 2023 Written Statements

[The Secretary of State for Health and Social Care (Steve Barclay)]

I am pleased to be able to inform the House that today 16 March 2023, I have made a formal offer on pay for 2022-23 and 2023-24 to the unions representing staff on the agenda for change contract. The NHS Staff Council has discussed this offer and the Royal College of Nursing, UNISON, GMB, the chartered society of physiotherapy and the British Dietetic Association will recommend the offer to their members in consultations that will be held over the coming weeks. Strike action will continue to be paused while they are consulted.

Under the offer, over 1 million NHS staff on the agenda for change contract would receive two non-consolidated payments for 2022-23. This is on top of an at least £1,400 consolidated pay award that they have already received, which was in line with the recommendations of the independent pay review body.

Under the terms of the offer, all staff would receive an award worth 2% of an individuals’ salary for 2022-23. In addition, staff would receive a one-off bonus which recognises the sustained pressure facing the NHS following the covid-19 pandemic and the extraordinary effort these members of staff have been making to hit backlog recovery targets and meet the Prime Minister’s promise to cut waiting lists. This NHS backlog bonus is an investment worth an additional 4% of the agenda for change pay bill, and would mean staff would receive an additional payment of between £1,250 and £1,600. With both of these payments, a nurse at the top of band 5, for example, would receive over £2,000 in total.

For 2023-24, the Government have offered a 5% consolidated increase in pay. In addition, the lowest paid staff, such as porters and cleaners will see their pay matched to the top of band 2, resulting in a pay increase of 10.4%.

For example, this would mean a newly qualified nurse would get over £1,300, increasing their base salary to £28,407. A nurse at the top of band 6 would receive a pay rise of over £2,000, increasing their base salary to £42,618.

The Government firmly believe that this is a fair offer which rewards all agenda for change staff and commits to a substantial pay rise in 2023-24 at a time when people across the country are facing cost of living pressures and there are multiple demands on the public finances.

Setting pay is an annual process and, as is always the case, decisions are considered in light of the fiscal and economic context and ensuring awards recognise the value of NHS staff whilst delivering value for the taxpayer. While it is right that we reward our hard-working NHS staff with a pay rise, this needs to be proportionate and balanced with the need to deliver NHS services and manage the country’s long term economic health and public sector finances, along with inflationary pressures.

The Government asked the NHS Pay Review Body (NHSPRB) to report by the end of April 2023. We anticipate the progress made and the outcome of the union ballot to be taken into account. If the offer is accepted by unions, it will be implemented, but the Government would welcome observations from the NHSPRB on the pay deal in England.

On top of the pay package, the Government are also committing to important measures including the development of a national, evidence-based policy frame- work which will build on existing safe staffing arrangements and amendments to terms and conditions to support existing NHS staff develop their careers through apprenticeships.

In addition, having heard the concerns of nursing staff and their representatives about the specific challenges they face in terms of recruitment, retention and professional development, the Government have committed to address these issues and will therefore work with NHS employers and unions to improve opportunities for nursing career progression.

The Government are also committed to improving support for newly qualified healthcare registrants. It will commission a review into the support received by those transitioning from training into practice. And the Government will consult on the permanent easement of pension abatement rules.

This package, alongside the comprehensive NHS Long Term Workforce Plan that NHS England will publish later this year, will help to ensure that the NHS can recruit and retain the staff it needs to meet the growing and changing health and wellbeing needs of patients.

Alongside making this formal offer, I have today also written to the Royal College of Nursing to outline that, in undertaking work to address the specific challenges faced by nursing staff—in terms of recruitment, retention and professional development—this work will involve: how to take account of the changing responsibilities of nursing staff; and the design and implementation issues, including scope and legal aspects, of a separate pay spine for nursing staff exclusively.

The Government intend to complete this work such that resulting changes can be delivered within the 2024-25 pay year. In conducting this work, the Government will also consider whether any separate measures may apply to other occupational groups, taking into account the views of NHS Employers and unions.

[HCWS642]

Ambulance Services: Consultation on Minimum Service Levels

Steve Barclay Excerpts

Thursday 9th February 2023 Written Statements

[The Secretary of State for Health and Social Care (Steve Barclay)]

The Strikes (Minimum Service Levels) Bill requires the Secretary of State to consult with such persons as they consider appropriate prior to making regulations to establish minimum service levels for relevant health services in the event of strike action. The regulations must be approved by both Houses of Parliament before they are made. The consultation requirements may be fulfilled before and after the Bill receives Royal Assent. Minimum service levels will enable employers to issue work notices, ensuring adequate staffing for a minimum level of safety to be achieved in the event of strike action.

Minimum service levels aim to limit the impacts of strike action on the lives and livelihoods of the public and to strike a balance between the right of unions and their members to strike with the need for the wider public to be able to access key services during strikes.

This consultation focuses on minimum service levels for ambulance services, which the Prime Minister has identified as a priority, alongside fire and rescue services and rail services. Our proposal is that ambulance services should be covered in regulations as a priority recognising that disruption to blue light services puts lives at immediate risk. This consultation will help to inform a decision as to whether ambulance services should be covered by the regulations and if so the detail regarding the minimum service levels required in the ambulance service.

The consultation will open today, Thursday 9 February 2023, and will be open for a period of 12 weeks, closing on Thursday 4 May 2023.

Copies of the consultation will be deposited in the Libraries of both Houses.

[HCWS563]

Urgent and Emergency Care Recovery Plan

Steve Barclay Excerpts

Monday 30th January 2023 Commons Chamber

[The Secretary of State for Health and Social Care (Steve Barclay)]

Today we have published our new delivery plan for recovering urgent and emergency care services, which has been deposited in the Libraries of both Houses. Given the scale of the pandemic pressures that healthcare systems around the world and across the UK are collectively facing, we are building the NHS back to where we want it to be. That requires the widespread adoption of innovation, building on best practice already applied in specific trusts, together with significant investment in new ways of working, including a £14.1 billion funding boost for health and social care, as set out in the autumn statement.

Today’s announcement is the second of three plans to cut waiting times in the NHS. Our elective recovery plan is already in action, virtually eliminating the backlog of two-year waits in England. Our primary care recovery plan will be published in the next few weeks, to support the vital front door to the NHS through primary care. Today, together with NHS England, we are setting out our plans to reduce waiting times in urgent and emergency care through an increased focus on demand management before patients get to hospital, and greater support to enable patients to leave hospital more quickly through care at home or in the community, supported by a clinical safety net. In addition, the plan sets out how we will adopt best practice in hospitals by learning from the trusts that have displayed the greatest resilience in meeting the heightened pressures this winter.

Today’s announcement on urgent and emergency care does not sit in isolation, but is part of a longer-term improvements plan that builds on the legislative change enacted last year to better integrate health and social care through the 42 integrated care boards, which became operational in July. That was prioritised for additional funding through the £14.1 billion announced for health and social care in the autumn statement. Following the quick spike in flu cases over Christmas, with in-patient flu admissions 100 times that of the previous year and a sevenfold increase in December, we announced £250 million of immediate funding on 9 January for the pressures this winter, giving extra capacity to emergency departments to tackle the issue of patients who are fit to leave hospital but are delayed in doing so.

Today’s plan, developed in partnership with NHS England and social care partners, builds on the actions and investment that I set out to the House earlier this month as we put in place the more substantive changes required to enable the NHS to have greater resilience this time next year. To do that, this plan involves embracing technology and new ways of working to transform how patients access care before and after being in hospital. That in turn will help to break the cycle of emergency departments in particular coming under significant strain in winter.

Our plan has a number of commitments that are both ambitious and credible. First, we are committing to year-on-year improvement in A&E waiting times. By next March, we want 76% of patients to be seen within four hours. In the year after that, we will bring waiting times towards pre-pandemic levels. Our second ambition is to improve ambulance response times, with a specific commitment to bring category 2 response times—those emergency calls for heart attacks and strokes—to an average of 30 minutes by next March. Again, in the following year we will work to bring ambulance response times towards pre-pandemic levels. I am pleased that the College of Paramedics has welcomed the plan, saying that it is

“pleased to see a strong focus in the recovery of those people in the Category 2 cohort”.

Of course, this will not be the limit of our ambition, but it is vital that we get these first steps right and that we are credible as well as ambitious. To put these targets in context, achieving both would represent one of the fastest and largest sustained improvements in the history of the NHS.

Underpinning these promises is one more essential commitment: a commitment to better data and greater transparency. On data, the best-performing hospitals have benefited from the introduction of patient flow control centres to quickly identify blockages in a patient’s journey, and e-bed management systems to speed up the availability of beds when they become free. Through this plan, we will prioritise investment in improving system-wide data, both within the integrated care boards and on an individual trust and hospital site basis. This will allow quicker escalation when issues arise and a better system-wide response when individual sites face specific challenges.

On greater transparency, for some time voices across the NHS have called for the number of 12-hour waits from the time of arrival in A&E to be published. This is something I know the Royal College of Emergency Medicine has long campaigned for—I can see the hon. Member for St Albans (Daisy Cooper) nodding her head—and there has been criticism of the Government, including from Opposition Members, for refusing to provide this transparency. Instead, the data published to date has been a measure of 12 hours from the point of admission rather than from arrival in A&E. For the commitment to transparency to be meaningful, we must be prepared to publish data, even when that transparency will bring challenges, so today I can inform the House that from April we will publish the number of 12-hour waits from the time of arrival. Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, has previously said:

“The full publication of this data will be an immensely positive step that could be the catalyst for transformation of the urgent and emergency care pathway that should help to improve the quality of care for patients.”

I hope this transparency will be welcomed across the House.

Our plan focuses on five areas, setting out steps to increase capacity in urgent and emergency care; grow the workforce; speed up discharge; expand and better join up new services in the community; and make it easier for people to access the right care. Action in each area is based on evidence and experience, learning lessons from the pandemic and building on what we know can work. More than that, we are backing our plan with the funds we need, and the Government are committing to additional targeted funding to boost capacity in acute services and the wider system. That is why this package includes £1 billion of dedicated funding to support hospital capacity, building on the £500 million we have provided over this winter to support local areas to increase their overall health and social care capacity.

Taken together, this plan will cut urgent and emergency care waiting times by, first, increasing capacity with 800 new ambulances on the road, of which 100 are new specialised mental health ambulances. This comes together with funding to support 5,000 new hospital beds, as part of the permanent bed base for next winter.

Secondly, we are growing and supporting the workforce. We are on track to deliver on our manifesto commitment to recruit more than 50,000 nurses, with more than 30,000 recruited since 2019. The NHS will publish its long-term workforce plan this year. We are also boosting capacity and staff in social care, supported by investment of up to £2.8 billion next year and £4.7 billion in the year after.

Thirdly, we are speeding up the discharge of patients who are ready to leave hospital, including by freeing up more beds with the full roll-out of integrated care transfer hubs, such as the successful approach I saw this morning at the University Hospital of North Tees.

Fourthly, we are expanding and better connecting new services in the community, such as joined-up care for the frail elderly. This includes a new falls service, so that more elderly people can be treated without needing admission to hospital.

Virtual wards are also showing the way forward for hospital care at home, with a growing evidence base showing that virtual wards are a safe and efficient alternative to being in hospital. We aim to have up to 50,000 people a month being supported away from hospital, in high-tech virtual wards of the sort that Watford General Hospital has been pioneering, as I saw last month.

Finally, we are improving patient experience by making it easier to access the right care, including a better experience with NHS 111 and better advice at the front door of A&E, so that patients are triaged to the right point in the hospital without always needing to go through the emergency department—this new approach can currently be seen at Maidstone Hospital, as I saw earlier this month.

These are just some of the practical improvements already being delivered in a small number of trusts that, through this plan, we will adopt more widely across the NHS and, in doing so, deliver greater resilience ahead of next winter.

I am pleased that NHS Providers has welcomed today’s plan, and that the Royal College of Emergency Medicine has called it

“a welcome and significant step on the road to recovery”.

Taken together with all the other vital work happening across health and care, including our plan to cut elective and primary care waiting times, today’s plan will enable better care in the community and at home, for that care to be more integrated with hospital services and for existing practice to be more widely adopted. I commend this statement to the House.

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

I thank the Secretary of State for advance sight of his statement.

After 13 years of Conservative mismanagement, patients are waiting longer than ever before. Heart attack and stroke victims are waiting more than an hour and a half for an ambulance. Mr Speaker, “24 Hours in A&E” is not just a TV programme; it is the grim reality for far too many patients. Some 7.2 million people are waiting for NHS treatment. Why? The front door is broken—people are finding it impossible to get a GP appointment—so they end up in A&E. At the same time, the exit door is broken because care in the community is not available. Patients are trapped in hospitals, sometimes for months. Between the two is a workforce who are overstretched, burnt out, ignored by Government Ministers and forced out on strike.

Does this plan even attempt to get patients a GP appointment sooner? No. Does this plan restore district nursing so that patients can be cared for in the comfort of their own home? No. Does this plan see Ministers swallowing their pride and entering negotiations with nurses and paramedics? No. And does this plan expand the number of doctors and nurses needed to treat patients on time again? No.

The Health Secretary said a lot of things, but he did not say when patients can expect to see a return to safe waiting times. His colleague the Minister for Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), rather let the cat out of the bag this morning. She was asked, “Is there any plan at all for when we will get back to 95% of patients in A&E being seen within four hours?” Her answer—and I am not joking—was, “I can’t tell you that.” How can the Secretary of State claim that his plan is ambitious and credible? What kind of emergency care plan does not even attempt to return waiting times to safe levels? It is a plan that is setting the NHS up to fail right from the start—a plan for managed decline.

These targets are not plucked out of thin air; patients waiting more than five hours in A&E are more likely to lose their lives, and so are heart attack and stroke victims waiting more than 18 minutes for an ambulance. Sadly, that is exactly what has happened this winter, it is what happened this summer and it has been going on since before the pandemic began. The four-hour A&E waiting time target has not been met since 2015. The only time the Conservatives have met the 18-minute target for ambulance response times was during lockdown. What is the Secretary of State’s ambition now? It is 30 minutes —30 minutes waiting for a heart attack or stroke victim to receive an ambulance, when every second counts. Is not the truth that the Government missed the targets, so they are moving the goalposts? They are fiddling the figures, rather than fixing the crisis.

The Secretary of State boasts that he is pouring more money in—£14 billion, which is almost as much as his Department has wasted on dodgy, unusable personal protective equipment—yet standards are being watered down. So can he explain why patients are paying more in tax but waiting longer for care? Why is it that under the Conservatives we are always paying more but getting less? So what is their answer? It is:

“There are so many people in hospital who wouldn’t need to be there if we could provide quality care at home… medical science and technology…offers a world of possibility for the NHS to transform patient care… Virtual wards allow people to receive hospital care at home.”

Those are not his words—that is my party conference speech! He did not have a plan for the NHS so he is nicking Labour’s.

I am happy for the Secretary of State to adopt Labour’s plans, but here is what he missed: you cannot provide good care in the community, in people’s homes or in hospital without the staff to care for people. That is the supermassive blackhole in his plan published today: people. Virtual wards without any staff is not hospital at home; it is home alone. So where is his plan to restore care in the community? Labour will double the number of district nurses qualifying every year, so can he hurry up and nick that plan too?

Of course, good care in the community is not a substitute for good care in hospital—we need both, now. So why, in the middle of the biggest crisis in the history of the NHS, with hospitals so obviously short of staff, is the universities Minister writing to medical schools to tell them not to train any more doctors? This is ludicrous. Labour will double the number of medical school places and create 10,000 new nursing and midwifery clinical placements, all paid for by abolishing the non-dom tax status. I know that the Prime Minister might not like that last bit—[Interruption.] Government Members are all complaining, but they did not complain when they put up income tax. The Prime Minister does not like it, but perhaps this would be a good time for the Conservatives to act tough on tax dodgers. So when is the Secretary of State going to nick that plan?

And when is the Secretary of State finally going to get his act together and end the strikes in the NHS? Perhaps I am speaking to the monkey when the Chancellor is the organ grinder. If that is the case, when will we get a chance to question the real Health Secretary on the strikes that this one is causing in the NHS? Labour will create more front doors to the NHS and we will tackle the crisis in social care. The Secretary of State offers sticking plasters and by now it is very clear: only Labour can offer patients the fresh start the NHS needs.

[Steve Barclay]

The hon. Gentleman started by thanking me for advance sight of the statement, and then he made a series of remarks that simply ignored what was in it. Even his last point shows how riddled with contradictions the Opposition’s approach is. He says in interviews that he supports the pay review body process—that is the official position, or at least it was—but then he says, “No, we should be negotiating individually with the trade unions and disregarding the pay review process.” There is no consistency on that at all.

The shadow Secretary of State talks about operational performance—[Interruption.] He has just had his go; he should listen to the answers. He says that it is about operational performance, but in my remarks I tried to be fair and said that these are challenges that are shared across the United Kingdom and globally. He seems to think that they are unique to England alone. We need only look at Wales to see that more than 50,000 people—notwithstanding the fact that Wales has a smaller population—are waiting more than two years for their operations, when we cleared that figure in the summer in England, leaving fewer than 2,000 in that cohort.

The shadow Secretary of State talks about the workforce. Obviously, he did not bother to read or listen to what was said in the statement. We are on track to deliver our manifesto commitment of more than 50,000 nurses. We have more than 30,000 so far. We have 10,500 more nurses in the NHS this year compared with last year. The grown-up position is to recognise—[Interruption.] Well, in the first five years we were dealing with what that letter said, which was that there was no money left. [Interruption.] Labour Members just do not like the response, but the facts speak for themselves. We have 10,500 more nurses this year than last year. The grown-up position, as I was saying, is to recognise that we have an older population with more complex needs, and that the consequences of the pandemic are severe—they are severe not only in England, but across the United Kingdom, in Wales and Scotland, and indeed in countries around the globe.

The shadow Secretary of State says that the statement did not cover the plan for GPs. Well, again, I was clear that this was one of three plans. We had the elective plan in the summer, which hit its first milestone. We have the second component today on urgent and emergency care, and we will set out in the coming weeks our approach to primary care. That is the approach that we are taking. [Interruption.] The shadow Secretary of State keeps chuntering. We did not have the pandemic 13 years ago. [Interruption.] I can only surmise that he did not get his remarks quite right the first time, which is why he feels the need to keep chuntering now and having a second, third and fourth go—perhaps next time.

On ambition, the shadow Secretary of State ignores the fact that we need to balance being ambitious with being realistic. These metrics, in the view of NHS England, show the fastest sustained improvement in NHS history. Clearly, his remarks are at odds with NHS England.

On funding, we are putting an extra £14.1 billion of funding into health and social care over the next two years, which reflects the fact that the Chancellor, notwithstanding the many competing pressures he faced at the autumn statement, put health and social care, alongside education, as the key areas to be prioritised.

On virtual wards, I had not quite realised that the shadow Secretary of State was the clinician who had invented virtual wards. I think that the credit for virtual wards actually goes to the staff, such as those I met at Watford, who are driving forward that innovation. It is slightly strange that he sometimes wants to claim ownership of something that has been clinically led by those working on the frontline. We have recognised the value of virtual wards, which is why, at North Tees this morning, at Watford last month, or on various other visits, I have been discussing how to scale up those plans.

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

--- Later in debate ---

[Steve Barclay]

The funding to put that in place has been earmarked from the £2.8 billion next year. The key thing is less to do with the funding than the accuracy of the data, which will help us to see where there are gaps in coverage and how we get the right levels of community response. The integrated care boards have been set up to take an integrated approach on that. One of the best enablers will be the control centres that the ICBs will set up, which will allow us to get much greater visibility on where that has been delivered and how we escalate it when it has not.

[Rachael Maskell (York Central) (Lab/Co-op)]

The 300,000 vacancies in health and social care mean that, whatever the Secretary of State puts on the table, his plans will never be delivered. What is he doing to retain the burned-out, traumatised staff who currently work in the NHS, to resolve their pay dispute and to put enough money on the table to pay social care staff enough to come and work in the service?

[Steve Barclay]

We recognise the huge pressure on social care; that is why, at the autumn statement, the Chancellor set out the biggest-ever increase in funding into social care of any Government, £7.5 billion over two years. We are putting more funding in. On the workforce more generally, the Prime Minister and Chancellor have committed themselves to bringing forward the workforce plan, which will set out the longer-term ambition on workforce and will be independently verified. In addition, we are recruiting more staff, as I updated the House, whether that is the 3% more doctors this year than last year, the 3% increase in nurses, or the 40% more paramedics and 50% more consultants compared with 2010. We are recruiting more staff, but the grown-up position is to recognise that there is also more demand.

[Sajid Javid (Bromsgrove) (Con)]

I warmly welcome the plans set out by my right hon. Friend today, but he will know that one reason emergency care faces so much pressure is that successive Governments have not focused enough on the prevention agenda. Indeed, last week’s news that the Government will not go ahead with individual focused plans on cancer, dementia and mental health has concerned many. Can he assure this House that the Government’s new major conditions strategy will be published promptly and will be comprehensive and significant?

[Steve Barclay]

I am happy to give my right hon. Friend that assurance. I assure the House that our commitment to the cancer mission and the dementia mission through the Office for Life Sciences is absolutely there. He is right that we are bringing that together in one paper—I think we should take a holistic approach—but I share his ambition on prevention. In early January, I set out a three-phased approach: first, the £250 million immediate response to the pressures we saw from the flu spike over Christmas; secondly, as I announced today, building greater resilience into the system looking ahead to next winter; and thirdly, the major conditions paper on prevention, which is about bringing forward the innovative work that colleagues are doing through the Office for Life Sciences to impact the NHS frontline much sooner than might otherwise have been the case.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I want to raise the case of a constituent who described to me the state of Salford Royal’s A&E earlier in January, saying:

“My partner was taken by ambulance yesterday at about 11am. He has a severe chest infection and breathing problems. He was left sitting in a chair on oxygen until 10pm when a trolley was found for him to sleep on. There are no beds available.”

My constituent said that patients and staff

“feel that no one cares”.

After such a long wait, my constituent’s partner was found to have pneumonia and he has been very poorly. Now the Secretary of State is talking about a target of 76% of A&E patients being seen within four hours by next March. Will he tell me and my constituent why he thinks it is acceptable for patients to wait longer than is safe?

[Steve Barclay]

We are bringing times down; I think the current mean response for C2s is much more in the region of 25 or 26 minutes than it was in late December-early January, because across the UK there was a massive spike in flu. The hon. Lady will have seen exactly the same in the Labour-run NHS in Wales. Over December there was a 20% increase in 999 calls, for example. That is why we need to put in place greater resilience, as the plan I have set out to the House does.

[John Redwood (Wokingham) (Con)]

I strongly support the £1 billion for 5,000 additional beds and 800 more ambulances. I have long argued that, with a growing population and a growing elderly population, we need more capacity. Is it also possible to take some of the £14 billion of additional money to provide even more capacity? I think we are going to need it.

[Steve Barclay]

Within my right hon. Friend’s question is, I think, how we get more flow into hospital: once bed occupancy goes above a certain threshold, lack of flow is the key interaction that drives inefficiency within hospitals. That is why we are putting in the extra capacity. It is also a question of reducing the numbers going to hospital in the first place and speeding up the discharge of those who are fit to leave. Whereas at the moment someone might sit on a ward for three days because they have to have antibiotics every day, if one continuous dose of antibiotics can be administered through new kit at home, not only is that a much better patient experience but it relieves pressure on the wards.

[Daisy Cooper (St Albans) (LD)]

I welcome the additional transparency on data for 12-hour wait times, because it is only by shining a light on the problem that we can see just how bad it is, but the targets set out in the plan today are utterly woeful. The Royal College of Emergency Medicine says that we need 13,000 beds; the Government are offering 5,000. The percentage of patients who are seen within four hours should be 95%; the Government are aiming for 76%. Heart-attack and stroke victims should be seen within 18 minutes; the Government are aiming for only 30 minutes. Surely the truth is that this woeful lack of ambition means that our emergency care services are themselves on life support and that patients will continue to die needlessly for a very long time to come.

[Steve Barclay]

First, I thank the hon. Lady for recognising the steps that we have taken on transparency. That has been an area of challenge and it is part of my wider commitment to transparency.

The ambition of the targets has to be realistic, and targets are not a ceiling but a floor. It is about saying, “How do we set a target that is realistic?” Of course, we will aim to do better than that, but it is about setting something that the system feels is achievable, because that in turn gets much more buy-in.

On beds, we are increasing capacity, as my right hon. Friend the Member for Wokingham (John Redwood) alluded to. What it is really about is freeing up patients who are fit for discharge from hospital, who should not be there and would actually prefer to be getting care at home. It is about looking at the end-to-end bed capacity, not simply at beds within the acute sites.

[Dame Maria Miller (Basingstoke) (Con)]

I welcome my right hon. Friend’s statement. In the pandemic, the use of local private hospitals by the NHS, particularly in places such as Basingstoke, kept services such as cancer care going uninterrupted. Could the NHS be using more private facilities more widely to relieve some of the pressures that he so eloquently outlined in his statement?

[Steve Barclay]

My right hon. Friend makes an important point. Again, within that is patient choice and how we empower more patient choice—providing services that are free at the point of use—to use what capacity there is within the system, including in the independent sector. I absolutely agree that we should be maximising capacity. At Downing Street with the Prime Minister, we had a very useful roundtable with the independent sector about how we can make more use of its capacity. That is certainly an area that we are exploring.

[Derek Twigg (Halton) (Lab)]

I saw for myself only a few weeks ago the real crisis in our hospitals when I accompanied a close relative to Whiston Hospital, where I saw every single space in the corridors taken up by a bed, a trolley or a chair. Quite frankly, what the staff—doctors, nurses and support staff—were doing was amazing, and they deserve all our praise for the hard work that they are putting in. The Secretary of State’s lauding of the fact that two-year waits have virtually been eliminated is bizarre: when Labour left office, waits were somewhat less, with an 18-week target and many people being seen within weeks, not months. The Secretary of State said that the Government are on track to recruit 15,000 new nurses, but how many have left the NHS in the last two years?

[Steve Barclay]

First, the hon. Gentleman is right to recognise the work that the staff have been doing. He mentioned a family member; when I made a statement earlier in January, I recognised that there has been huge pressure on the system. We saw the flu numbers and the spike in cases. On the two-year waits, the point is simply that there has been pressure on services—the pandemic impacts—across the United Kingdom, but the two-year wait is far worse in Wales, whereas we have cleared it in England. On recruitment and retention, we are bringing forward the workforce plan. The fact is that we are recruiting more nurses, but it is about meeting demand pressure as well.

[Simon Jupp (East Devon) (Con)]

There is no doubt that the 5,000 extra beds will help the NHS to provide the best possible patient care. Community hospitals across East Devon and NHS Nightingale Hospital Exeter can play their part, too. Does my right hon. Friend agree that community hospitals can play a key role in helping to cut waiting lists?

[Steve Barclay]

Community hospitals are key to tackling the issue of delayed discharge. Community settings have been a bit of a Cinderella in the past. The data on community settings tends to be weaker than it is in other parts of the NHS. Alongside domiciliary care and making better use of residential care capacity, the third element for discharge is to look at how we use community step-down in a much more constructive way. One key issue there is to have wraparound services so that people do not simply get transferred to a community setting, but that it is a staging post before getting to the home, which is where most patients want to be.

[Jeremy Corbyn (Islington North) (Ind)]

The social care sector is dominated by dedicated staff who are paid low wages. High profits are made from it and there is an insufficiency of spaces. Will the money that the Secretary of State has announced go to local authorities? Can it be spent on public provision? Does he not think it is time to recognise that the internal market and privatisation have sucked money out of health and social care—money that could have been spent on patient care and caring for people in the community and in special facilities?

[Steve Barclay]

One area of the right hon. Gentleman’s question where I do agree with him is the importance of local authorities. One reason I am keen to see more clarity on data and transparency is that there can sometimes be a tendency for the local authorities to be blamed for discharge, when often it is factors within the NHS that contribute to some of those who are fit to leave hospital not doing so. On the money allocation, the £2.8 billion is targeted to local authorities—funding set out by the Chancellor—with £4.7 billion the following year. We are increasing the money for local authorities, but alongside that we are working with them to improve the data so that we can see where there are blockages due to local authorities. For example—Mr Speaker will be familiar with this—Blackpool often has visitors from out of the area, so the NHS there deals with a number of local authorities, not simply the nearest one. We are working intently on how we support local authorities as part of the wider discharge package.

[Sir David Evennett (Bexleyheath and Crayford) (Con)]

I welcome my right hon. Friend’s statement and commend his approach to this difficult problem that he faces and we as a nation face. Does he agree that while speeding up discharge from hospital and freeing up beds for patients needing urgent and emergency care is absolutely necessary, there is a real need for the expansion of new services in the community, which must be a top priority? In my area, one of the biggest reasons for bed blocking in hospitals is that there is no community service to pick up when people go home.

[Steve Barclay]

My right hon. Friend hits the nail on the head. He is right: it is about how we better manage demand in the community before people get to the emergency department. That is where, for example, action targeted at the frail elderly is so important. It is also about how we enable people to discharge sooner, where they are fit to do so, so that they can recover, whether in a community setting or, ideally, at home, with the right wraparound support.

[Karin Smyth (Bristol South) (Lab)]

The people of Bristol South will be ever so grateful to have data that they are waiting 12 hours, rather than perhaps ringing me up to tell me they have been waiting 12 hours. The Secretary of State is a Treasury man, so he must know we are now paying more for less. In the interest of transparency, can he be assured that in his own ICB, demand and capacity are matched, and will he know that? How will I know that demand and capacity are matched in my own ICB?

[Steve Barclay]

I think the hon. Lady was welcoming the transparency on 12 hours—I certainly hope so. The ICBs became operational in July, and we are working with them as to how, by taking a system-wide view, they can baseline the gaps in data, and one key area of that is on the community side. When she talks about matching capacity, part of that is about understanding virtual ward capacity, what conditions that applies to, what the physio wraparound services are, what is available within residential care versus community care and other domiciliary care packages, as the right hon. Member for Islington North (Jeremy Corbyn) touched on in terms of local authorities. We need to look at the data package across the piece on a system-wide basis. That is why we are setting up control centres. I am keen to make that much more transparent, because to be blunt, as a Secretary of State, I get the transparency anyway when things go wrong. Like the hon. Lady, I would rather have much more transparent data so that ICBs themselves can be better held to account, and indeed that is what the Hewitt review is looking at in terms of that wider transparency piece.

[Theresa Villiers (Chipping Barnet) (Con)]

I welcome the fact that Barnet Hospital’s emergency department will be expanding and improving its facilities and taking on new staff, and of course I welcome today’s announcement, but I urge the Secretary of State to ensure that it is effective on the ground soon, because there is a real crisis out there. This is a good announcement, but it must be delivered so that patients and staff feel it on the frontline as soon as possible.

[Steve Barclay]

I could not agree more, which is why this morning the Prime Minister and I were at University Hospital of North Tees, where it is effective on the ground. It is about looking at hospitals where such measures have been effective and are having an effect on the ground, such as in North Tees and at Maidstone Hospital, and how we take best practice from them. We then have to do what has sometimes been more difficult in the NHS, which is to scale those innovations and get them adopted across the piece.

[Valerie Vaz (Walsall South) (Lab)]

There are 165,000 vacancies in social care and there was nothing in the statement about how the Secretary of State will address them. Will he do that through better terms and conditions?

[Steve Barclay]

We are dealing with that through additional funding—the £500 million for this winter. That relates to the point made by my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) about the impact on the ground, which will be to give ICBs and local authorities discretion. Some of that £500 million is being spent on the workforce, including in social care, so there is discretion as to how they spend that. There is also the £2.8 billion of local authority and ICB funding that will be in place next year, and £4.7 billion the following year.

[Kevin Foster (Torbay) (Con)]

The Secretary of State will be aware of Torbay’s demographics, particularly the growth in the number of people aged over 85. They are living a good long time but, at that age, they need some level of support from the NHS, which obviously creates demand and puts pressure on our systems. On the resources announced today, what engagement is he planning to have with local ICBs, particularly those that cover areas where the demographics mean that they are at the leading edge and driving innovation, but need support to do so?

[Steve Barclay]

My hon. Friend makes an important and nuanced point about demographic pressure, which is not evenly spread and is more concentrated in certain parts of the country than others, so the pressure on ICBs is greater in those areas. That is why the ministerial team met almost all the ICBs in a series of meetings with chairs and chief execs in the run-up to Christmas, and it is why we want to bring greater transparency, so that we can right-size solutions for emergency departments and ensure that those facilities keep pace with the increased demand.

[Janet Daby (Lewisham East) (Lab)]

Last night, my constituent’s 11-month-old son had to wait in A&E for eight hours, which my constituent found extremely unacceptable. The waiting experience in our hospital is like being in a “disaster zone”, in the words of my constituent, who went on to explain about parents having to sit on floors and wait for hours for their children to be seen by a doctor. I press the Secretary of State on whether there is a plan to return to the standard of 95% of patients who come to A&E being seen within four hours.

[Steve Barclay]

As I said, we are not setting out that ambition in this statement, because the impact of the pandemic has been so severe. We need to set a target that is ambitious but achievable, which is what we have done. The president of the Royal College of Emergency Medicine said:

“This plan is a welcome and significant step on the road to recovery and we are pleased to see it released.”

It is about taking best practice from the areas that are working and ensuring that they are socialised across the piece. It is obviously concerning to hear about individual cases, such as the specific one that the hon. Lady mentioned, which are very traumatic for the families. That is why we have set out this plan and why we are putting in the extra funding.

[Sir Julian Lewis (New Forest East) (Con)]

From 2005 to 2006, there was a campaign within the NHS to close many in-patient beds in community hospitals. I was pleased by what the Secretary of State said earlier about beds in community hospitals having a role to play. In that connection, will he reconsider the future of the site of Fenwick Hospital in Lyndhurst in my constituency, where the in-patient beds were closed? The NHS is now proposing to sell it off, but I would have thought that, with a bit of imagination, such a site could increase capacity.

[Steve Barclay]

We are encouraging integrated care boards to take ownership of individual decisions, rather than trying to make all the decisions centrally from Westminster, so that those closer to the ground and to the issues are in power to make the trade-offs. I am sure my right hon. Friend will want to have those discussions with the chair and chief executive of his ICB. There is a wider issue of how we make greater use of community sites, not least given the workforce pressures and different staffing ratios that they have, and that is absolutely the way we help to get more people out of hospital who are fit to leave.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Ten days ago, I shadowed one of the brilliant emergency department consultants at Derriford Hospital. They are working their socks off under some very difficult conditions. The additional capacity for beds is welcome, especially because of the structural under-funding and lack of beds in the south-west, but doctors and nurses were saying that they want to slow the flow of people getting to the emergency department in the first place.

Can the Minister look again at the mothballed Cavell Centre programme—the super health hub programme—which would have done so much to slow the flow and deal with collapsing primary care services? In particular, can he look again at the Government’s decision to withdraw £41 million from the super health hub in Plymouth, which would have been the national pioneer, would have shown that this project works and could help our hospitals to deal with the crisis they are facing?

[Steve Barclay]

The hon. Gentleman asks how we slow the flow of people going to emergency departments and how we accelerate their discharge once they are fit. The substance of the point he raises is valid and absolutely right. It is why there are schemes such as the community response service and the falls service. We are looking at the likes of the North Tees model and getting more staff into community support, thereby integrating the health and social care side. As I said to my right hon. Friend the Member for New Forest East (Sir Julian Lewis) a moment ago, the trade-offs for individual sites are best determined by ICBs. I am very happy to look with ministerial colleagues at any specific proposals, but it is really for the ICBs to be looking at how to best use their estate.

[Greg Smith (Buckingham) (Con)]

I warmly welcome my right hon. Friend’s clear and credible plan, but on the uplift of 800 ambulances, which is good news, I urge him when it comes to their deployment to look at rural areas first. In these areas, ambulances by definition spend much longer per patient on the road going in between much more diversely spread out hospitals.

[Steve Barclay]

I recognise my hon. Friend’s point, not least as a rural constituency MP myself. I have talked to paramedics, as I am sure he has, and the principal cause of frustration of late has not been the issue of pay—important though that is. It has been frustration over long handover times, which has had a particularly damaging impact. I am happy to look at any specific issues in his area but he is right on the wider point about the pressures in rural areas.

[Mike Amesbury (Weaver Vale) (Lab)]

When can the people of Warrington, and indeed Halton, expect to hear about the new hospital campuses, which are much needed by both communities—with sufficient staff to resource them?

--- Later in debate ---

[Steve Barclay]

This statement is focused on urgent and emergency care. At Health oral questions and on other occasions, we often discuss the wider capital programme and the increased funding we are putting into that programme. Part of that is about outcomes and how we get more from that investment in capital. That is why through the NHS estate we are starting to standardise our builds, starting with the Hospital 2.0 programme. We will be rolling that out more widely through the estate. I am not familiar with the specific issues at the hon. Member’s local site, but I am happy to look at them after the statement.

[Maggie Throup (Erewash) (Con)]

I welcome this recovery plan and my right hon. Friend’s comments on the role community hospitals have to play in future. The 16-bed Hopewell ward at Ilkeston Community Hospital was re-opened ahead of this season to ease pressures, but it is due to be decommissioned in the spring. To aid with more efficient planning, will he work with my local community health trust and ICB to ensure that these beds form part of the extra beds for next winter and, more importantly, become permanent—rather than this ad hoc approach we have had until now?

[Steve Barclay]

Again, decisions on the estate are principally for the ICBs, but I am happy to look at any individual proposals my hon. Friend has on how we get more flow into the system, and that is about putting more capacity into the community.

[Kerry McCarthy (Bristol East) (Lab)]

I think I welcome what has been said about mental health ambulances and trying to divert people in mental health crisis from A&E, but I am a little concerned about whether those attending the scene in those ambulances will have access to the past records of people in that situation or be able to carry out a proper risk assessment for them. Will the Secretary of State reassure me on that, and also on whether there will be places other than A&E to take them to? It is one thing to say that we want to divert them, but we need to have other resources in place.

[Steve Barclay]

The hon. Lady raises a fair and important point about what is in the wider package, alongside the mental health ambulances, which I think are a positive step. Last week, I met Baroness Buscombe as part of the pre-legislative scrutiny of the proposed mental health legislation, which will pick up some of the points that the hon. Lady raises. Examples of innovation include empowering people before they have a mental health crisis to use one of the apps that have been developed to set out their statement of wishes and other information, which is very helpful for paramedic crews when they have a mental health crisis. We are looking at how we use innovation to better give voice to the patient, and often to do that before they have the mental health incident, rather than when the ambulance arrives.

[Tom Hunt (Ipswich) (Con)]

I welcome the announcement today; I think the key thing is that it makes a difference in the short term. The Secretary of State will be aware of plans to build a new A&E department at Ipswich Hospital. The plan is for it to open in January 2024. What assessment has been made of the difference that that could make in the medium to long term by increasing capacity and improving waiting times? Will he also be prepared to work with me and the hospital’s trust to potentially expedite the plan, so that it might even happen slightly before January 2024?

[Steve Barclay]

In a former role, when I was Chief Secretary to the Treasury, I signed off a significant expansion of A&E facilities. I hope that reassures my hon. Friend of my commitment to putting more capacity into emergency departments, not least because they need a certain level of capacity to be able to ensure same-day access, triage and ways of getting flow into the system. As for the wider site proposal, clearly the ICB for his area will want to prioritise that.

[Helen Morgan (North Shropshire) (LD)]

The urgent care and ambulance crisis has been brewing since autumn 2021 in Shropshire, and it has worsened since. Last week, a doctor went on the record to say that the emergency department was “like a war zone” and expressed her fear that, in a fire, not everyone would get out alive. In a six-week period to 12 January, the category 2 response time in the Oswestry area was two hours and 10 minutes. Will the Secretary of State acknowledge that in some areas the crisis is worse than in others? Will he agree to meet me and the other MPs representing Shropshire to discuss how we progress Shropshire further along this track to solve the urgent care crisis that is so serious there?

[Steve Barclay]

I am very happy to meet with the hon. Lady and colleagues to discuss this further. I think most people recognise that, since the huge pressures from flu over the Christmas period, the flu numbers have come down, but of course there is continued pressure in the system.

[Sir Robert Buckland (South Swindon) (Con)]

I welcome my right hon. Friend’s statement. In particular, I welcome the announcement today of over £26 million of funding to expand the emergency department at Great Western Hospital in Swindon. He knows from his previous incarnation that we have worked together on this issue. It is particularly important, not just for the integration of emergency services, but for the freeing up of other space in the hospital to allow for further beds or other clinical interventions. Does he agree that it is this sort of long-term measure that will guarantee progress in our much pressed national health service?

[Steve Barclay]

My right hon. and learned Friend has been key to securing the funding. He has assiduously lobbied me and ministerial colleagues to make a powerful case on behalf of his constituents, and I think he should be proud of the outcome, which reflects his and his parliamentary colleagues’ work on this issue. He is right; indeed, the case he made was around how this frees up capacity in the system, which will result in much better care for patients in Swindon.

[Tim Farron (Westmorland and Lonsdale) (LD)]

There is nothing in this plan to address the fact that thousands of people are now turning up at A&E as a direct result of being unable to get regular access to an NHS dentist. Last week, another Cumbrian dental practice, in Grange-over-Sands, wrote to all of its 5,800 patients, as it had been forced to quit the NHS too. There is now not a single NHS dental place available anywhere in Cumbria. What will the Secretary of State do to fix an NHS dentistry crisis that leaves a family of four having to cough up an extra £1,000 a year during a cost of living crisis to get access to dental care that they have already paid for through their taxes?

[Steve Barclay]

I have addressed that point, in that we are bringing forward the third component of our three plans. I spoke earlier about the elective recovery plan; today’s announcement is on the urgent and emergency care recovery plan; and the third element will be the primary care recovery plan. Of course, alongside the work we are doing on dentistry it is also about access to services, both dentistry and A&E. That comes together in things such as the 111 service and how we review that, as well as the NHS app. It is about looking at how we better manage demand at the front door, and the demand for dentistry is not only through NHS dentistry but often manifests itself through a lot of patients coming forward for dentistry at A&E.

[Anna Firth (Southend West) (Con)]

I warmly welcome my right hon. Friend’s plan, particularly his focus on increasing capacity in urgent and emergency departments. I welcome the Government’s recent investment of £8 million to reconfigure the A&E at my local hospital in Southend. Does my right hon. Friend agree that this will increase not just the capacity but the quality of the urgent and emergency care on offer in Southend?

[Steve Barclay]

I commend my hon. Friend for her assiduous campaigning on behalf of her constituents in Southend, through which she played a key role in securing the extra £8 million of funding. She is right that that will make a material difference not only to flow and capacity within the hospital but through that to the overall standard of patient care.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his clear commitment to extra funding for the urgent and emergency care recovery plan. Will he outline whether he is prepared to make additional funding available to meet the needs on maternity wards, which midwives feel are teetering on the brink? In reality, that means it is an issue of life and death, due to staffing levels. Will the Secretary of State ensure that additional funding makes its way to each devolved nation under the Barnett consequentials, to be used before the scheduled new financial year ends?

[Steve Barclay]

As the hon. Gentleman will know, the additional funding that the Chancellor announced in the autumn statement will lead to an uplift in health funding for Northern Ireland through the Barnett consequentials. On the flexibility within that, the hon. Gentleman will know that I agreed flexibility when I was Chief Secretary; it will of course be for Treasury colleagues to look at the requirements for ongoing flexibility within Barnett consequentials.

[Stephen Hammond (Wimbledon) (Con)]

I warmly welcome what my right hon. Friend has said. He is right to recognise that one of the long-term impediments to discharge is the disconnect between the NHS and social care and local authorities. Will he confirm that, to ensure that the additional money is well spent, the integrated care boards will be not only responsible for the establishment of the hubs and extra care packages but properly monitored and held responsible for their performance and for generating value for the extra money that is being put in?

[Steve Barclay]

As a former Minister in the Department, my hon. Friend speaks with great experience on these matters. He is right that the crux of the plan is now in its delivery. As I alluded to in my statement, a key component of that is more transparency in the data so that he and colleagues throughout the House can hold to account not only the ICBs but the local authorities. We need to bring those two datasets more closely into alignment.

[Selaine Saxby (North Devon) (Con)]

I warmly welcome today’s announcement, but will my right hon. Friend explain how for remote rural hospitals, such as the fantastic North Devon District Hospital, the workforce challenges that were present pre-pandemic might be addressed post pandemic, when we are now also dealing with a housing crisis? Might there be an opportunity to expedite the next phase of the redevelopment programme, which includes key worker housing?

[Steve Barclay]

I am keen to explore with colleagues how we can put more key worker accommodation on to the NHS estate, particularly by making use of modern methods of construction to expedite that. On the workforce plan, Devon is an area that has seen particular growth, given its older population, and greater pressure as a consequence. Those pressures will be worked through in the workforce plan that we will bring forward shortly.

[Several hon. Members rose—]

[Mr Tobias Ellwood (Bournemouth East) (Con)]

I welcome the statement and the extra investment in the NHS. It was a privilege to visit Bournemouth Hospital recently and meet the dedicated staff, and as the Secretary of State will know, it is expanding with a new A&E facility. Will he visit Bournemouth, meet the staff, and see the progress taking place?

[Steve Barclay]

I would be very keen to visit, subject to my diary. If it is not me, I am sure a ministerial colleague will do so.

[Ruth Edwards (Rushcliffe) (Con)]

I welcome the £1 billion funding announced today, and it is good that hospitals have benefited from innovations such as patient flow control centres, care transfer hubs, and virtual wards. When will hospitals and ICBs such as Nottingham and Nottinghamshire ICB, which has not been part of the pilot, be able to access those innovations, so that my constituents can start to access the benefits?

[Steve Barclay]

They can start to access them now. We announced £250 million at the start of the month, as part of the £500 million that was announced in the autumn statement, and hospitals know that funding of up to £8 billion is coming in the new fiscal year, so this is an opportunity for them to move at pace.

[Andrew Bridgen (North West Leicestershire) (Ind)]

The Secretary of State told the House that the NHS was put under pressure with a spike in influenza cases in December. Will he say where he thinks that influenza virus has been hiding for two and a half years?

[Steve Barclay]

I do not think it has been hiding. Flu seasons are not uncommon in the NHS and come round on a periodic basis, and that is why we anticipated it through the flu vaccine. On the hon. Gentleman’s wider point, it is also recognised that as a consequence of covid some resistance to flu may have been lowered, but we have had flu pressures on the NHS in past years.

[Mark Pawsey (Rugby) (Con)]

Would the Secretary of State consider more use of existing urgent care centres, such as that at St Cross in Rugby? Our nearest full A&E is 12 miles away at University Hospitals Coventry and Warwickshire NHS Trust, in Coventry, which means that 83% of my constituents are more than 15 minutes’ drive from an A&E. The hospital at Coventry serves a population of 600,000, which is twice the national average. Does he agree that extending provision at St Cross would go a long way towards reducing pressure at the hospital in Coventry?

[Steve Barclay]

My hon. Friend is right that not every patient accessing an emergency department needs a tier 1 A&E facility. This is about right place, right treatment for the patient, and making better use of urgent care centres. How those centres can better triage patients who can be treated there is a key part of the plan we have set out.

[Matt Vickers (Stockton South) (Con)]

In Stockton South we are incredibly grateful for the Government’s commitment to build a new diagnostic hospital so that local people can get access to lifesaving scans, tests and checks. We are also grateful for the £3 million announced to establish a new mental health crisis hub, so that people can get support in their hour of need. What is my right hon. Friend doing to ensure that we have the right people with the right skills in the right place to deliver great service at those facilities?

[Steve Barclay]

I am delighted that, thanks to my hon. Friend’s assiduous campaigning, he has secured his diagnostic centre, and that he assures me he will get it operational in one of the fastest times seen by any area. We are bringing forward our workforce plan, and as I set out, we have 2,500 more nurses this year compared with last year. We are on track for our manifesto commitment of an extra 50,000 nurses, with more than 30,000 recruited already.

[Andy Carter (Warrington South) (Con)]

May I take my right hon. Friend back to the response he gave to the hon. Member for Weaver Vale (Mike Amesbury) about Warrington Hospital? That A&E unit is incredibly under pressure. Over the weekend nurses talked to me about the 120 patients currently waiting to be discharged, which is putting intolerable pressure on that unit. My right hon. Friend said that he was not particularly familiar with those issues, but perhaps I can invite him to Warrington to see the pressure. While he is there, perhaps he will also look at the Health and Social Care Academy, which was set up by the local college to try to address the shortage in social care. A great level of innovation seems to be happening there, and I am sure he would like to see Warrington for himself.

[Steve Barclay]

That last question gives me a beautiful opportunity to correct an earlier answer regarding the constituency of my hon. Friend. He knows I am familiar with this issue, because I remember calling him at about half past 10 one evening to discuss his A&E when some particular issues had come to the attention of the media. I am familiar with the pressures on his hospital—[Interruption.] I was just placing the constituency of the hon. Member for Weaver Vale (Mike Amesbury) vis-à-vis that of my hon. Friend. Now clarified on place, I am familiar with the fact that that hospital is under pressure. I know the Minister of State is due to visit, and I am sure she will look forward to meeting both the hon. Gentleman and my hon. Friend.

[Mr Deputy Speaker (Mr Nigel Evans)]

I thank the Secretary of State for his statement and responding to questions for over an hour.