NHS: Independent Investigation

Wes Streeting Excerpts

Thursday 12th September 2024 Commons Chamber

[The Secretary of State for Health and Social Care (Wes Streeting)]

With permission, I would like to make a statement on Lord Darzi’s investigation into the NHS.

Unlike the last holders of this office, this Government will be honest about the problems the NHS faces and serious about fixing them. That is why I asked Lord Darzi, an eminent cancer surgeon who served both Labour and Conservative-led Governments with distinction, to conduct an independent investigation into the state of our national health service. I am sure the whole House will want to join me in thanking him for producing this expert, comprehensive report, a copy of which I have placed in the Libraries of both Houses.

I told Lord Darzi that we wanted hard truths, warts and all. His findings are raw, honest and breathtaking. He says:

“Although I have worked in the NHS for more than 30 years, I have been shocked by what I have found”.

He has uncovered an enormous charge sheet, too long to list in this statement, so these are just a few: the NHS has not been able to meet its promises to treat patients on time for almost a decade; patients have never been more dissatisfied with the service they receive; waiting lists for mental health and community services have surged; 50 years of progress on cardiovascular disease is going into reverse; and cancer is more likely to be a death sentence for NHS patients than for patients in other countries. It is not just the sickness in the NHS that concerns Lord Darzi, but sickness in society. Children are sicker today than a decade ago and adults are falling into ill health earlier in life. That is piling pressure on to the NHS and holding back our economy.

Those are some of the symptoms; the report is equally damning on the causes. First, a decade of under-investment left the NHS 15 years behind the private sector on technology, with fewer diagnostic scanners per patient than almost every comparable country, including Belgium, Italy and Greece, and in 2024 mental health patients are treated in Victorian buildings with cockroach and mouse infestations, where 17 men are forced to share two showers.

Secondly, there was the disastrous 2012 top-down reorganisation overseen by Lord Lansley. Lord Darzi’s assessment is damning:

“A calamity without international precedent…it took a ‘scorched earth’ approach to health reform”.

“By 2015…ministers were…putting in place ‘workarounds and sticking plasters’ to bypass the legislation”.

“Rather than liberating the NHS, as promised, the Health and Social Care Act 2012 imprisoned more than a million NHS staff in a broken system for the best part of a decade”.

“the effects…are still felt to this day.”

Just imagine if all the time, effort and billions of pounds wasted on dissolving and reconstituting management structures had instead been invested in services for patients—clearly, the NHS would not be in the mess it finds itself in today.

Thirdly, there was coronavirus. Everyone can see the lasting damage caused by the pandemic, but until now we did not know that the pandemic hit the NHS harder than any other comparable healthcare system in the world.

The NHS cancelled far more operations and routine care than anywhere else. As Lord Darzi writes:

“The pandemic’s impact was magnified because the NHS had been seriously weakened in the decade preceding its onset.”

In other words, it is not just that the Conservatives did not fix the roof while the sun was shining; they doused the house in petrol and left the gas on, and covid just lit the match. That is why waiting lists have ballooned to 7.6 million today. [Interruption.] If I were an Opposition Member, I would not complain about the diagnosis. I would take responsibility.

Fourthly—this sits firmly at Opposition Members’ door, so they should sit and listen—there was the failure to reform. From 2019 onwards, the previous Government oversaw a 17% increase in the number of staff working in hospitals. Did it lead to better outcomes for patients? No. At great expense to the taxpayer, the NHS has instead seen a huge fall in productivity. We paid more, but got less—a deplorable waste of resources when so many parts of our health and care services were crying out for investment. As Lord Darzi has put it:

“British Airways wouldn’t train more pilots without buying more planes.”

Doctors and nurses are wasting their time trying to find beds for their patients and dealing with outdated IT when they ought to be treating patients.

Too many people end up in hospital because they cannot get the help that they need from a pharmacy, a GP or social care. The effective reforms of the last Labour Government, which drove better performance and better care for patients, have mostly been undone, and that is why patients cannot get a GP appointment, an operation or even an ambulance when they need one today. That is what the Conservatives did to take the NHS from the shortest waiting times and highest patient satisfaction in history to the broken NHS that we see today.

Lord Darzi has given his diagnosis. Now it is over to us to write the prescription, and we have three choices. The first is to continue the Conservatives’ neglect, and allow the NHS to collapse. That is the path on which they set the NHS, and the path that it is on today. Or we could—as some of my critics on the left demand—pour ever-increasing amounts of money in without reform, wasting money that is not there and that working people cannot afford to pay. That would be wasteful and irresponsible, so we will not take that path. This Government are making a different choice: we choose recovery and reform. We are taking action today to deal with the immediate crisis by hiring 1,000 GPs whom the Conservatives had left without a job while patients were going without an appointment, and agreeing an offer to end the strikes that they allowed to cripple our health service.

At the same time, we will introduce the fundamental reforms needed to secure the future of our NHS. Earlier today, my right hon. Friend the Prime Minister confirmed that the Government would publish a 10-year plan for change and modernisation, on the foundation of Lord Darzi’s report. Our plan will deliver the three big shifts needed to make our NHS fit for the future. The first is from analogue to digital, giving patients proper choice and control over their own healthcare, and finally realising the untapped potential of the NHS app. There will be fully digital patient records so that your surgeon can see the notes that your GP writes. By marrying our country’s leading scientific minds with the care of more than 1.5 million NHS staff, we will put NHS patients at the front of the queue for cutting-edge medicines and treatments that we can only imagine today.

Secondly, there is the shift from hospital to community, turning our NHS into a neighbourhood as much as a national health service so that patients can get their tests and scans on their high streets and be cared for from the comfort of their own homes. That means bringing back the family doctor and building a national care service that can be there for us when we need it, able to meet the challenges of this century.

Thirdly, there is the shift from sickness to prevention, which means taking the decisions that the Conservatives ducked to give our children a healthy, happy start in life. It means stopping the targeting of junk food ads at children, banning energy drinks for under-16s, reforming the NHS to catch illness earlier—starting by offering health checks in workplaces and on smartphones—and delivering the Tobacco and Vapes Bill that the Conservatives failed to pass, to tackle one of society’s biggest killers.

Lord Darzi’s diagnosis is that the NHS is in a “critical condition”—unless we perform major surgery, the patient will die—but he also finds that

“its vital signs are strong”:

an extraordinary depth of clinical talent, and a shared determination to improve care for patients. This is a public service, free at the point of use, so that whenever we fall ill we never have to worry about the bill. The NHS is broken, but it is not beaten. Every person I have met in the NHS during my first two months as Health and Social Care Secretary is up for the challenge. It will take time, but this party—the party that created the NHS—has turned the NHS around before, and we will do it again. I commend this statement to the House.

[Mims Davies (East Grinstead and Uckfield) (Con)]

On a point of order, Mr Speaker.

[Victoria Atkins (Louth and Horncastle) (Con)]

Thank you, Mr Speaker. I thank the Secretary of State for advance notice of his statement.

The NHS belongs to us all, and we all care about it, so let us stop the political posturing and talk constructively about its future. We all know that our healthcare system faces significant pressures, as do all health systems around the world. We are living longer, and with multiple and complex conditions. We have wider societal pressures, such as the impact of social media on the development of some young minds, as well as the cost pressures of miracle drugs developed by our world-class life sciences sector for their treatment benefits, and the shock of the pandemic has had catastrophic impacts on the NHS and its productivity.

I believe there is much to be proud of in the NHS. Its dedicated staff look after 1.6 million people a day— 25% more people than in 2010. It has more doctors, more nurses and more investment that at any point in its history. It is delivering tens of millions more out-patient appointments, diagnostic tests and procedures for patients than in 2010, and we delivered the fastest roll-out of vaccinations for covid in the world, freeing our society more quickly than other countries. We have more healthcare in the community, with the opening of 160 community diagnostic centres—the largest central cash investment in MRI and CT scanning capacity in the history of the NHS—and 15 new surgical hubs; and the launch of Pharmacy First, helping to free up 10 million GP appointments for those living with more complex conditions. [Interruption.] I say to the Secretary of State that I paid him the courtesy of listening to him in silence, so I hope he will do the same for me.

[Wes Streeting]

I didn’t say anything!

[Victoria Atkins]

The right hon. Gentleman was chuntering from a sedentary position. We on the—[Interruption.]

--- Later in debate ---

[Mr Speaker]

Order. I am sorry; I meant that you were to conclude now, not to continue with the rest of the speech. I call the Secretary of State.

[Wes Streeting]

The first word that the shadow Secretary of State for Health and Social Care should have said was “sorry”. She says that she never pretended everything was fixed, and that is true, but it is about time that she admitted that it was her party that broke the NHS in the first place.

In fact, it has been a feature of debate in the House since the general election that the Opposition have taken absolutely no responsibility for the mess they left our country in, including a £22 billion black hole and the new hospitals programme that the right hon. Lady referred to, in which the timetables were a work of fiction and the money ran out in March. She knew that when she went to the country to claim that the programme was fully funded. She talks about the decisions made by NICE; that was a new Labour reform and modernisation—one that thankfully survived the last 14 years.

The right hon. Lady has endorsed the right hon. Member for Newark (Robert Jenrick) in the Conservative party leadership election. I wonder what she makes of his admission that the Conservatives failed to make the tough reforms that the NHS needed because they were afraid of what Labour might say. Is that not the most derisory excuse for 14 years of neglect?

My predecessor does not bear responsibility for everything in the Darzi report—this crisis was more than a decade in the making—but I wonder when the right hon. Lady will show some humility on behalf of her party and apologise for the mess that her Government made of our national health service. Otherwise, why should anyone trust what the Conservatives have to say ever again?

This Government were given a mandate for change, and nowhere is that more needed than in our NHS. The report must mark the beginning of the long, hard work of change. It is the platform from which we will launch a decade of reform that will make sure that the NHS can be there for us when we need it—for us, our children and our grandchildren. It must draw a line in the sand, so that we never go back to the pain, fear and misery that the Conservative party inflicted on millions of patients.

[Several hon. Members rose—]

[Clive Efford (Eltham and Chislehurst) (Lab)]

Thank you, Mr Speaker. I will rise to the challenge.

I welcome the Secretary of State’s statement. In 2008, the previous Labour Government commissioned a report from Sir Michael Marmot on the state of society and health, and he found that there was health inequality, particularly in deprived areas. Ten years on, his second report found that health inequality had become even worse against the backdrop of an underfunded NHS. Does that not demonstrate the urgency of the need to invest in those communities under this Government? What can my right hon. Friend do to direct resources into the most deprived communities in order to turn around those health inequalities?

[Wes Streeting]

My hon. Friend is absolutely right that our country has stark health inequalities. It is not right that people who live in different parts of the country have such different chances of living well. A girl born in Blackpool can expect to live healthily until she is 54, whereas a girl born in Winchester can expect to live healthily until she is 66. That is why, with the Prime Minister’s mission-driven approach, we will not just get our NHS back on its feet and make sure it is fit for the future; we will also reduce the cost and burden of demand on our national health service by attacking the social determinants of ill health.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Daisy Cooper (St Albans) (LD)]

Much of the content of Lord Darzi’s report has been known for some years. None the less, today’s report is a scathing summary of the complete devastation that the Conservatives have wrought on our health services and on the health of our communities. We Liberal Democrats have long argued that we need to shift healthcare from hospitals to high streets, and from treatment to prevention, because doing so improves health outcomes and saves taxpayers’ money. It is a win-win.

But the report is long on diagnosis and short on prescription, so may I invite Ministers to read our fully costed manifesto to fix public health and primary care by recruiting 8,000 GPs, ending dental deserts, boosting public health grants by £1 million, implementing our five-year plan to boost cancer survival rates, and putting a mental health expert in every school?

Does the Secretary of State accept that there is an elephant in the room: social care? Will he meet me to discuss the Liberal Democrat plans for social care, starting with free personal care? This bold idea would prevent many people from going into hospital in the first place, as well as enabling them to be discharged from hospital faster. Does he accept that it is a truth universally acknowledged that we cannot fix the NHS if we do not fix social care too?

As for the dire state of our hospitals and primary care estate, well, the Conservatives have left it to fester like a wound. Will the Secretary of State give the green light to hospitals that are ready to rebuild, such as mine in west Hertfordshire? Will Ministers look to reform outdated Treasury rules that are preventing our integrated care boards and hospital trusts from spending and investing their funds in the GP practices and hospitals that we need? This Government say that they want growth. Well, health and wealth are two sides of the same coin, which is something the Conservatives do not understand. If Labour wants economic growth, fixing our health and social care must be its top priority. And it must be a priority without delay.

[Wes Streeting]

How refreshing to have constructive opposition in the Chamber. It was clear throughout the election campaign that my party and the Liberal Democrats have much in common, both in the commitments we made, which in some cases were identical, and in our shared areas of emphasis: the link between health and wealth, the importance of prevention and the importance of social care.

As the Prime Minister reiterated again this morning, we are absolutely determined to address both the short-term crisis and the long-term needs of the century in our social care system. We want to work on a cross-party basis wherever possible, so I would be delighted to meet the Liberal Democrat spokesperson.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

Hundreds of thousands of operations, including dozens of my own lists, were cancelled because of the strikes in the NHS over the past two years. Does the Secretary of State agree that the Conservatives’ refusal to negotiate with the doctors contributed to the terrible state of the health service, and that ending the strikes is the first step towards fixing the NHS?

[Wes Streeting]

It sticks in the craw to hear the carping and criticism from the Conservatives, and their obvious bitter resentment that we were able to do in three weeks what they failed to do in over a year. All the while they complain about the costs of solving the strikes, they say nothing about the costs they racked up—the direct financial costs of covering the strikes, as well as the untold costs of misery to patients whose operations, procedures and appointments were cancelled, even as the shadow Secretary of State for Health and Social Care and her Ministers had not even bothered to meet the junior doctors since March this year. The Conservatives have no grounds to complain.

[Mims Davies (East Grinstead and Uckfield) (Con)]

I thank those who daily work in NHS services across our country. If the Secretary of State is truly serious about assisting and supporting the whole of our NHS in England, across all our constituencies, “warts and all”, as he says, will he explain thoroughly why the health outcomes and experiences of families across Wales, over the last 25 years, do not merit this attention equally? Is it perhaps because Wales is Labour-run?

[Wes Streeting]

I have never denied, nor have the Welsh Government, that our health and social care systems are in crisis across the United Kingdom, and that waiting times and patient outcomes are not where they should be. [Interruption.] The Conservatives do not wish to acknowledge the truth, and even now, without a shred of humility or acceptance of the responsibility of their record in government, they carp from the sidelines. They will not admit or accept that different parts of the United Kingdom have different strengths and weaknesses.

Regardless of the fact that there is a Scottish National party Government in Scotland or a unique arrangement in Northern Ireland, as well my friends in the Welsh Government, I am proud that in my first weekend as Secretary of State for Health and Social Care, I made it my business to phone my counterparts in Scotland, Wales and Northern Ireland. I made it clear that we will always work constructively, whatever our parties and however hard we will fight each other at the ballot box. Rather than pointing fingers at other parts of the United Kingdom, as the Conservatives did when they were in government, this Government are determined, just as the last Labour Government were, to create a rising tide that lifts all ships. I look forward to working with every devolved Administration to improve health and care outcomes across the whole of our United Kingdom.

[Ms Stella Creasy (Walthamstow) (Lab/Co-op)]

The Secretary of State is right that the future of our NHS lies in reform, and not waiting until people get sick before we intervene to keep them well, but we cannot do that without money. He says we cannot waste money that is not there, but we are wasting money that is there on the contracts we have with the private sector. He knows I feel strongly about this issue. Millions of pounds are being paid to private equity-backed funds to run sexual health centres in the NHS—the iCare clinics. Billions of pounds are being lost to the legal loan sharks of our NHS—the private finance initiative companies—and some trusts are spending more on PFI payments than on drugs. As part of the process, will he commit to an urgent review of the way in which the NHS has worked with the private sector, because reform must also include restructuring our debt?

[Wes Streeting]

My hon. Friend has done a lot of work in this area and I would be delighted to meet her. Let me give the Conservative party a lesson in humility. However proud I am of the last Labour Government—and I am incredibly proud of what they did to our health estate, the investment they brought in, through a range of different types of private financing, and the impact that had; I can see the benefits in my own constituency— I have never shied away from what we did not get right. At the same time as celebrating what we got right in government, we must reflect on what we did not get right and genuinely learn those lessons, which is what we did in opposition. It took us too long to get back into government—we will learn from that for the future—but it has been really interesting to listen to Conservative Members over the past nine weeks. They have not learned anything, they have not got the message and they are not going to change.

[Dr Kieran Mullan (Bexhill and Battle) (Con)]

As Labour embarks on a reform programme, may I ask whether the Secretary of State has read the report of the Mid Staffordshire public inquiry, which looked at the shocking patient neglect last time Labour was in charge? Reading it might temper the hubris that he is showing in the Chamber today, in the face of the challenges that his colleagues in Wales have certainly not managed to overcome.

[Wes Streeting]

I gently point the hon. Gentleman to the bold claims made by the now shadow Chancellor, the right hon. Member for Godalming and Ash (Jeremy Hunt), about patient safety. He might like to reflect on every subsequent patient safety scandal. In fact, he might want to walk into maternity services across the country and ask himself whether the Conservatives bothered to learn lessons on patient safety.

[Nick Smith (Blaenau Gwent and Rhymney) (Lab)]

Pharmaceutical producers Auden Mckenzie and Actavis UK charged excessive and unfair prices for hydrocortisone tablets. NHS spending on those products rocketed because producers gamed the system. How will my right hon. Friend ensure that future procurement processes deter the rigging of drug prices?

[Wes Streeting]

My hon. Friend makes a great point, and he has given great service to the Public Accounts Committee of this House by drilling into waste, inefficiency and exploitation of the public purse. I want to work with the great life sciences sector and pharmaceutical industry in this country and globally, but in a spirit of genuine partnership. A really good working relationship requires social responsibility; it certainly involves not ripping off the taxpayer.

[Andrew George (St Ives) (LD)]

I welcome the report. The previous Government left this Government with NHS and care services in the worst crisis in their history. The Secretary of State led by emphasising the decade of underinvestment; that needs to be coupled with pointing out the very weak workforce planning. When he meets the Liberal Democrats, will he review our costed plan to raise the investment necessary to address the issues highlighted in the report and to strengthen workforce planning in order to deliver services?

[Wes Streeting]

Fiscal policy is a matter for the Chancellor. I know on which side my bread is buttered, so I will not write her Budget or spending review now, but let me reassure the hon. Gentleman that, notwithstanding the £22 billion black hole that the Conservatives left in the public finances this year and the weak foundations of our economy that we have inherited, the Chancellor knows as well as I do that it is investment and reform that will deliver results. It will take time—we cannot reverse more than a decade of underinvestment in a single Budget or even a single spending review—but at least we have a Government able to face up to the hard choices and capable of making them.

[Jo White (Bassetlaw) (Lab)]

I very much welcome Lord Darzi’s report, which exposes how our country was let down by the previous Government. In my Bassetlaw constituency, I will be asked when people who need a GP appointment will get one, and when the 2,000-person dental waiting list will come to an end. I am listening to my GPs and my dentists so that I can work with them to tackle this crisis. I will be meeting them shortly. What is the Secretary of State’s message to them all?

[Wes Streeting]

My hon. Friend, who I am delighted to see representing Bassetlaw, is already showing herself to be an outstanding champion for her community. She raises a really good challenge that we all face as constituency MPs: the public recognise that change takes time and that we cannot fix more than a decade of problems in the immediate future, but they want to know that at least we are hitting the ground running and getting the job done.

I can reassure my hon. Friend’s constituents in Bassetlaw that within our first couple of months, this Government employed 1,000 more GPs on the frontline who had been left unemployed by the previous Conservative Government. We did that pretty much immediately. We have settled—I hope; we await the outcome of the ballot—the junior doctors’ dispute, so we can remove the cost of disruption and industrial action and start work on getting the waiting lists down. We will be working at pace to deliver 40,000 more appointments every week so that we can cut waiting lists, and 700,000 urgent emergency dentistry appointments so that we can ensure that people get the care they need. Every single promise in our manifesto, notwithstanding the challenges in the public finances, was a fully costed, fully funded promise that we will keep and that the country can afford.

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

May I urge the Secretary of State to learn from what is working well in the NHS, as well as from what has gone wrong? In reference to the Health and Care Act 2022, paragraph 14 on page 121 of the report states:

“The result is that the basic structure of a headquarters, regions, and integrated care boards (ICBs) is fit for purpose.”

I draw the Secretary of State’s attention to the Suffolk and North East Essex ICB, which is one of the most successful in the country. Can we learn from that success, and build it into other areas?

[Wes Streeting]

I thank the hon. Gentleman for his constructive approach. The tragedy of the Health and Care Act 2022 was that a large part of its focus was on trying to correct the enormous damage done by Lord Lansley through a top-down reorganisation that nobody wanted and that the country could not afford. That is why I have said very clearly that we will not repeat the mistakes of top-down reorganisation. With the architecture of the system, we will take an approach of evolution rather than counter-revolution.

On the hon. Gentleman’s point about learning from what is working well in the NHS, what gives me great hope for the future of our national health service is that every day there are amazing people providing great-quality care, reforming, innovating and showing us what the future looks like. It is the responsibility of this Government to take the best of the NHS to the rest of the NHS. That is exactly what we will do.

[Olivia Blake (Sheffield Hallam) (Lab)]

Lord Darzi’s report makes grim reading and lays bare the failure of the last Government. NHS staff up and down the country will recognise everything in it. Does the Secretary of State agree that much more needs to be done on retaining, recruiting and compensating the NHS workforce and making sure that we have a workforce fit for the future?

[Wes Streeting]

For all the innovations that modern technology will bring—the revolution in big data AI, machine learning and medical advances that we will see very soon but can scarcely imagine today—health and social care will always be fundamentally a people-based service. If you do not value your people, you lose them and end up in the appalling situation that we are in today. We have invested so much money and time in training people who imagined a long future for themselves in the NHS but who, because of the reality to which they were subjected by the previous Government, are now packing up and moving into different careers—or to other continents. We are determined not just to recruit the great staff we need, but to value and retain the brilliant staff we already have.

[Dame Caroline Dinenage (Gosport) (Con)]

The Secretary of State will know that cancer is the biggest cause of death by illness for children under 14 in the UK, and that this is Childhood Cancer Awareness Month. He will not know that it is also the third anniversary of the death of my constituent Sophie Fairall, who was 10 years old. With Sophie’s mum Charlotte, I have been campaigning for the past three years for the children and young people cancer taskforce to be set up. The taskforce was set up at the beginning of this year with the stated aim of meaningfully changing detection, treatment and care for children with cancer. I have listened carefully to the Secretary of State and have heard him passionately set out that he wants to focus on prevention and early intervention, yet this month we learned that he is pausing the taskforce. Parents of children with cancer are deeply disturbed by that announcement, as am I. Can the Secretary of State set out why it was made?

[Wes Streeting]

Absolutely. I thank the hon. Member for the way she put her question. I send my deepest condolences to Sophie’s family on what will inevitably be a difficult day—I suspect just the latest of many difficult days—on the imaginable pain, grief and loss that they have suffered. I thank the hon. Member for her work over many years campaigning on children’s cancer in this House on behalf of her constituents and so many other families affected by young cancer.

The pause is because we are looking at the breadth of the work of the Department to make sure that we have the right vehicles to deliver the outcomes that we want. That is why we have paused rather than cancelled, slammed or criticised the work that she was doing. I would be delighted to meet her to talk about the genesis of the taskforce and how we can take forward the outcomes that she wants to see. What we are trying to avoid is a plethora of taskforces, and the risk that there has sometimes been—this is not a party political point, because this spans successive Governments—of taskforces being an alternative for action. I know that she wants action, so let us meet and see what we can do together.

[Jacob Collier (Burton and Uttoxeter) (Lab)]

When I grew up in Stretton under the last Labour Government, I could get an appointment with my family doctor the next day. After 14 years of the Conservatives, Stretton residents now often have to travel more than six miles to a GP surgery in another village just to get an appointment for which they have already waited weeks. Does the Secretary of State share my view that this is unacceptable, and that it falls to this Government to fix the Conservatives’ mess?

[Wes Streeting]

My hon. Friend is absolutely right. We need to make sure that we have the right staff in the right place and an equitable distribution of access to NHS services right across the country. We also want to shift from the hospital-centred NHS that we see today to a neighbourhood-centred service. That is why we have acted immediately to put 1,000 more GPs on the frontline before the end of this year. I am looking forward to working with GPs to expand access to primary care right across the country, especially in communities that are particularly under-served.

[James Wild (North West Norfolk) (Con)]

This review highlights the need for capital investment in the NHS. The question that NHS staff and patients in North West Norfolk have is urgent: are the Government committed to replacing their hospital, which is affected by reinforced autoclaved aerated concrete, with a new Queen Elizabeth hospital in King’s Lynn by 2030—yes or no?

[Wes Streeting]

I can absolutely reassure the hon. Member that RAAC-impacted hospitals are a priority. We are putting safety first, and it is just a shame that when his residents had a Prime Minister in their backyard, the Conservative Government did not fix the problem.

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

For the sake of openness and transparency, I will just mention that I am a former chair of an NHS trust and a public health academic. I recognise the real issues that are raised in the findings of the Darzi rapid review. I am grateful to Lord Darzi for referring in particular to the inequalities that we have experienced, and how those inequalities were laid bare during covid. Will the Health and Social Care Secretary expand on the cross-departmental work that he is doing? I agree with my hon. Friends the Members for Walthamstow (Ms Creasy) and for Eltham and Chislehurst (Clive Efford) that people’s socioeconomic circumstances drive their health status. We do not want a situation where, for every 1% increase in child poverty, six additional babies per 100,000 live births do not reach their first birthday.

[Wes Streeting]

I thank my hon. Friend for her question and congratulate her warmly on her election to the Chair of the Work and Pensions Committee. I am looking forward to sharing, through the Secretary of State for Work and Pensions, the work that our Departments are doing together, particularly on the link between mental health and unemployment and on integrating pathways. She is right about the social determinants of ill health. That is why I am genuinely excited that, through the mission-driven approach that the Prime Minister has set out, we are already bringing together Whitehall Departments, traditionally siloed, to work together on attacking those social determinants. The real game changer is genuine cross-departmental working, alongside business, civil society and all of us as active citizens, to mobilise the whole country in pursuit of that national mission, in which we will be tough on ill health, and tough on the causes of ill health, as someone might have said.

[Madam Deputy Speaker (Judith Cummins)]

I call the Father of the House.

[Sir Edward Leigh (Gainsborough) (Con)]

I greatly respect the Secretary of State, and, as an older person who relies on the NHS, I support his radical zeal. I repeat what he said in his statement: cancer is more likely to be a death sentence for NHS patients than for patients in other countries. We have had this conversation previously, but can he at least look at the health systems in other countries, particularly those in the Netherlands, Australia, France and Germany? Those countries, which have wonderful health systems protecting the vulnerable, use a mixture of social insurance and public and private funds to maximise inputs into their health services.

[Wes Streeting]

Every time the right hon. Gentleman praises my zeal for NHS reform, Labour Members get very nervous. Let me reassure him that I have looked at other countries, and I will definitely continue to do that. I genuinely do not think that it is the model of funding that is the issue—the publicly funded, public service element. I hope that he knows me well enough to understand that if I did think so, I would be more than happy making, and would quite enjoy taking on, the argument, but I think that the equitable principle that underpins our NHS is one that we should cherish and protect. The single-payer model has enormous potential for the century of big data, AI, and machine learning. There is huge potential there that we must unlock, but that does not mean that we cannot learn from the way that other countries organise care, particularly in the community and particularly social care. This week, I met virtually with my friend the Health Minister in Singapore. I will continue to work with my international counterparts to learn from other countries whose health outcomes are far better than ours.

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

In my constituency of North Warwickshire and Bedworth, patients wait far too long for GP appointments. The Conservative party has presided over sticking-plaster solutions, papering over the cracks in our health service rather than making it fit for the future. Does the Secretary of State agree that today’s report is a chance to get the right diagnosis of the problems, so that this new Labour Government can come up with the right prescription, and my constituents can once again get the treatment that they so desperately need?

[Wes Streeting]

I am delighted to see my hon. Friend in her place. She is absolutely right. We will take Lord Darzi’s diagnosis to write the prescription and ensure that our reform agenda benefits every part of the country—not just big cities and the wealthiest communities—so that every person, wherever they are from, grow up and live, has access to the very best health and care services.

[Ayoub Khan (Birmingham Perry Barr) (Ind)]

A key finding in the Darzi report is that NHS staff morale is low. The Medical Defence Union of medical practitioners stated recently that more than 44% of NHS staff will reduce the number of hours that they work, because of low morale. Will the Secretary of State meet representatives of the union to explore those issues and work out ways of improving staff morale?

[Wes Streeting]

Of course we seek to work constructively with all trade unions representing staff across our health and care services, and also with the royal colleges. We want to work in a spirit of partnership, and we are only able to do so because people sent Labour MPs to Parliament to replace the Conservatives.

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

I agree with my right hon. Friend: this is the most devastating analysis that I have read of the NHS in over 30 years. It just shows the challenges that lie before him. Talking of challenges, will he challenge the integrated care boards to focus on moving resources into primary care? In particular, will he look at what is happening in York, where Nimbuscare has been able to pull out services from the acute sector and deliver work in the community?

[Wes Streeting]

I am really grateful to my hon. Friend for her question. She has a huge amount of expertise in health and care, and she is absolutely right about the need for that shift. I have made it very clear to ICB leaders and to trusts across the country that I want more focus on secondary prevention, which means much more activity in the neighbourhood. I know that she will keep on championing these causes. She is a good critical friend, and I know that she will hold my feet to the fire to ensure that I deliver.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

I declare my interest as the husband of an NHS doctor; I also served as a non-executive director of my local NHS trust. The last time that Lord Darzi was brought into service was by a Labour Government, shortly before they appointed him to the House of Lords. Will the Secretary of State take steps to ensure the widest possible input from senior clinicians? It is clear that some, including Professor Sir John Bell, do not share Lord Darzi’s prescription for the improvement of the NHS. Will he also apologise to my constituents for the doubt that he has cast over the future of the new Hillingdon hospital, on which work had already started under the previous Government?

--- Later in debate ---

[Wes Streeting]

I am not sure that is a fair characterisation of Sir John Bell’s position. I have a huge amount of respect for him. I am grateful to Lord Darzi for writing the diagnosis. Given that the Conservative party was in government for 14 years, repeatedly promised to rebuild Hillingdon hospital and left my Department in a position where the money for the new hospitals programme ran out in March, the hon. Member has some brass neck to point the finger at us while he is in opposition.

[Sean Woodcock (Banbury) (Lab)]

In 2016, the Horton hospital in my constituency lost its consultant-led maternity unit—a temporary downgrade that ended up being made permanent three years later. Is it not about time that someone from the Conservative party apologised for the damage done to Banbury’s hospital, as well as to the NHS as a whole?

[Wes Streeting]

I am delighted to see my hon. Friend here. His constituents can already see that he is not backwards in coming forwards. He will stand up and champion their interests in this House as a great constituency MP. When it comes to the Conservative party, sorry seems to be the hardest word.

[Alison Bennett (Mid Sussex) (LD)]

I welcome the announcement of the Secretary of State about the shift from hospital to community care. My fellow Liberal Democrats and I fully believe that fixing social care is part of the solution in getting the NHS back on its feet, so I also welcome the announcement of a national care service. Part of care in the community is of course the hospice sector. I recently met the chief executive of St Catherine’s hospice, which is in the constituency of the hon. Member for East Grinstead and Uckfield (Mims Davies). He highlighted to me that, although the hospice has 24 beds, it is currently using only 12 of them. What assurance can the Secretary of State give me, and people right across the country, that fixing the hospice sector will be part of the solution as we take the NHS forward?

[Wes Streeting]

I am so grateful for that question, not least because it gives me the chance as a constituency MP to say a huge thank you to St Francis hospice and Haven House children’s hospice for the care they provide to constituents, like so many other hospices around the country. I know that the sector is under real pressure. We look forward to working with the sector throughout the period of the spending review and the 10-year plan, not only to support our hospices but to improve end-of-life care, which is pertinent to debates that I know this House and the other place will have about how we ensure a good death for everyone, in every part of the country.

[Tahir Ali (Birmingham Hall Green and Moseley) (Lab)]

On Tuesday, I was at the Birmingham children’s hospital. Will the Secretary of State join me in congratulating the excellent staff on their work and their commitment to each individual patient who goes through the door? That evening, I was also with a local GP at Sparkbrook health centre whose frustration was with the outdated computer system. If he could get one message across to the Secretary of State, it would be that he has to reboot his computer numerous times a day. Will the Secretary of State put resources in to ensure that the IT is up to date?

--- Later in debate ---

[Wes Streeting]

First, my hon. Friend is right that we should celebrate and thank staff who are doing an outstanding job against a very difficult set of circumstances. On his second point, we have to ensure that, on the tech side, we unlock productivity in the system. Having literally sat looking over the shoulder of GPs at their IT systems, I well understand those frustrations. For the benefit of all observers, there is sometimes a perception that I am up against NHS staff when it comes to reform. Actually, it is staff who are crying out for change.

[Bob Blackman (Harrow East) (Con)]

One aim of the Lansley reforms was to transfer from Ministers to clinicians decisions on the day-to-day running of the health service. It is not clear from his statement whether the Secretary of State intends to change that process, but let me give him a constructive proposal that he might take on board, which is to streamline the business planning side of the NHS. Staff have to go through multiple bids and preparations of business plans before decisions are made. That means that more money is spent on employing business consultants than consultants in hospitals. I have campaigned for this change for many years. Will he take that on board? [Interruption.]

[Wes Streeting]

The Minister for Secondary Care was whispering in my ear that it was her frustration with exactly the bureaucratic processes that the hon. Gentleman describes that led to her seeking election as a Member of Parliament to sort them out, so I defer to her on this one.

On a serious note, he is right that wherever we find waste and inefficiency designed in, we must deal with it. I want to see an NHS that is more clinically led, free from political interference. We must also be honest: as it is such an enormous part of the public sector, which the public pay an enormous price for and value so much, there will always need to be an accountability relationship. What I have tried to build with NHS England in the last couple of months, with real joy in the process, is a real team between the Department of Health and Social Care and NHS England, as well as the team across the country. I look forward to continuing to galvanise that team as we embark on the 10-year plan process.

[Dr Marie Tidball (Penistone and Stocksbridge) (Lab)]

In my constituency, a staggering 28% of patients said that it was “not easy at all” to get through to someone at their GP practice. Worse, the figure for patients who said that doing this was “generally easy” was far below the national average. Does the Secretary of State agree that the Conservatives have pushed the NHS to breaking point, and only this Government can get the NHS fit for the future?

[Wes Streeting]

I am delighted to see my hon. Friend in her place, standing up for her communities in Penistone and Stocksbridge. In opposition, it was very frustrating watching successive Ministers promise better hold music for people trying to get through to their GP, rather than solving the problems of access. Fixing general practice, and building general practice so that it can meet the needs of this century, will be a vital part of our 10-year plan process.

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

May I make the Secretary of State a little more nervous? The Darzi report makes seven high-level recommendations, the fourth of which is to drive productivity in hospitals. From 2017, in south Essex we saw a merger of Basildon, Chelmsford and Southend hospitals to create the Mid and South Essex NHS Hospital Trust. It has not been an unmitigated success. As local MPs, we were promised significant back office savings that could be channelled into patient care. In fact, the reverse has been true, and there has been such a turnover of senior managers in that trust in recent years it has been like a game of musical chairs. The trust is now trying to appoint three permanent managers and directors for each hospital to provide stability, which makes sense, but is offering a salary of £200,000 for each post, which is more than the Prime Minister earns to run the country. Now that this is on his watch, will the Secretary of State take a personal interest? We should pay a good rate for that job, but £200,000 sends the wrong signals to all the other very hard-working people in the trust.

[Wes Streeting]

I thank the right hon. Gentleman for that question. He is not too far away from me geographically, but he is miles away from me politically, and I always get nervous when he stands up to praise me. We have to keep a sharp eye on value for money. The Darzi report presents some politically challenging messages about NHS management. I could be wildly popular with the country if I stood up and said, “I’m going to take the axe to management across the country and sack loads of managers.” What we need is better management and a sharp eye on value for money. The NHS would not work without good leadership. We have to ensure that we have the right people in the right place, delivering against the public’s expectations, so it is a more nuanced position, but I am sure that what he says will have been heard by his local trust. I will certainly keep an eye on value for money across the country.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

The Darzi report rightly says that prevention is better than cure, and that public health interventions that protect health are far less costly than tackling the consequences of illness and ill health. Does my right hon. Friend agree that the recklessness and incompetence of the 14 years of Conservative government, stripping millions of pounds from local authorities, which deliver the public health work, has contributed to children being sicker than they were 10 years ago, and adults getting iller sooner?

[Wes Streeting]

My hon. Friend is right, and at some point the Conservatives will have to take responsibility for it. We learned through bitter experience that if we did not change as a party, the country would not choose to change the Government. Long may the Conservatives continue, therefore, with their head in the sand, and long may we continue to get on with the job of clearing up their mess and building an NHS that is fit for the future.

The relationship between the NHS and local government, and between my Department and local government, is of particular importance in relation to social care, which is why I was especially delighted that the Prime Minister chose this week to appoint Tom Riordan, the chief executive of Leeds city council, as second permanent secretary. He is an outstanding public servant with a demonstrable record on health and care integration, public health and prevention. I look forward to having that local government perspective, and local community delivery perspective, at the heart of our Department.

[Richard Tice (Boston and Skegness) (Reform)]

I think the whole House agrees with what the Secretary of State said in his statement: the NHS needs reform. In reality, when I speak to people in the NHS, almost all of them say that this is not about a shortage of money, but about the legendary levels of waste, bureaucracy and mismanagement. Indeed, the report refers specifically to the huge number of regulators, accountants and bureaucrats from the top down. Is there recognition among the NHS senior leadership that management reform is a critical part of improving healthcare in the United Kingdom?

[Wes Streeting]

I welcome the hon. Member to his place and thank him for that question. I am always cynical about huge volumes of regulation. We reassure ourselves as legislators and regulators that putting regulations in place means that we have dealt with the issue. But the problem is that if we fail to deliver, we put another regulation in place, then another, and then more, and before we know it, we have drowned the people responsible for delivery in so much regulation that they cannot sort the wheat from the chaff or see the wood for the trees, compromising standards and patient safety. That is why I welcome the work that Penny Dash has done in relation to the Care Quality Commission, and we will continue to work with her to reduce the burden of regulation, focus on the things that really matter and free NHS staff from red tape. I hope that he finds that reassuring. I plead with him not to send his party leader to agree with me as well, or I really will be in trouble.

[Ms Julie Minns (Carlisle) (Lab)]

I declare an interest as the mother of an NHS nurse. It is important that we remember what is at the centre of this issue: people. Three individuals came to my Carlisle surgery last week because they were at the end of their tether about the care that their loved ones had received, or not received, at our local hospital. One is the husband of a woman who has profound physical disabilities and cannot leave the House unaccompanied. She now has no trust in her local hospital because, among other things, her recent care involved her being fed food that she was known to be allergic to.

I also saw the parents of a young woman who has epilepsy, a physical disability and profound anxiety. The failure to put in place a care plan to account for all that means that she is now self-harming. The other case was that of an elderly woman whose husband was discharged from the hospital without her consent. He is now in a care home 20 miles away, and she cannot visit him. Will the Secretary of State assure those people that this Government will not only fix our NHS, but restore their broken trust in it?

[Wes Streeting]

I am so grateful to my hon. Friend. I enjoyed visiting her Carlisle constituency ahead of the general election campaign, and I look forward to working with her to improve health services there and across the north-west, especially in the rural and coastal communities that rely on the hospital in Carlisle, as well as on more local neighbourhood services. I must warn new Members that one of the most depressing things about the last nine years has been constituency advice surgeries, where people would come to see us about the consequences of the failure of Government and the failure of this place. We owe it to them to do better—better integration of health and care services, better access and outcomes, and better joined-up care. As she has painfully described, if we do not tackle the problems early, they become multiple, higher-cost and personal tragedies. We have seen enough of that.

[Dame Harriett Baldwin (West Worcestershire) (Con)]

Famously, the House has not seen an impact assessment of the withdrawal of the winter fuel allowance from frail 85 and 90-year-olds on low incomes. Has Lord Darzi or the Secretary of State seen an assessment of the impact of that decision on NHS bed capacity over the coming winter?

[Wes Streeting]

The hon. Member is an experienced Member of this House, as both a former Chair of the Treasury Committee and a former Treasury Minister, so she knows how impact assessments are done at the Treasury. She knows that impact assessments of all the Chancellor’s fiscal decisions at the Budget and the spending review will be published at that time. She also knows, I suspect, that despite the withdrawal of the winter fuel allowance from some pensioners—it will be targeted at those most in need—they will still be better off because the Government have committed to maintaining the triple lock and to extending the warm home discount scheme and the available hardship support, so that pensioners are not left behind as we clean up the £22 billion mess that the Conservatives left behind.

[Uma Kumaran (Stratford and Bow) (Lab)]

Lord Darzi’s report lays bare the scale of the challenges that our NHS faces. Does the Secretary of State share my deep concern that because of the Conservative party’s dismal record, the progress made by the previous Labour Government on heart disease and stroke—of which I have had recent personal experience—is now in reverse? The number of people in England dying from cardiovascular disease before the age of 75 has risen to its highest level in 14 years.

[Wes Streeting]

I am delighted to see my hon. Friend in the House representing my old east end stomping ground. I wish her and her husband well in his recovery, and for their recovery, as a family, from his experience. Let me reassure her that, when it comes to the future of health and social care, we will clean up the mess that the Conservatives made. That will take time. The reverse in the progress made on cardiovascular disease, and the early warning signs of an uptick in smoking, are why we must put public health and prevention at the forefront. That is not just about what is good for the individual, their health and their chances; look at what the Office for Budget Responsibility says today about the long-term cost to the Exchequer. We have no choice but to act.

[Nigel Huddleston (Droitwich and Evesham) (Con)]

A key conclusion of the report is the absolute necessity of focusing on productivity and not just throwing money at the NHS; I think we all agree on that. Ministers are constantly telling us that government is about making difficult decisions—something that that we already knew. Why, then, on one of his first opportunities, did the Secretary of State do the absolute opposite of that? In solving the doctors dispute, he took the easy option of throwing money at it, and did not require productivity enhancements and changes. Will he reassure me that in future he will practise what he preaches?

[Wes Streeting]

I like the hon. Gentleman very much, but what audacity to criticise this Government for cleaning up the Conservatives’ mess. He fails to acknowledge the cost to the Exchequer and to patients in delayed and cancelled operations, appointments and procedures. More than £1 billion has been lost and more than 1 million appointments cancelled because of the Conservatives’ gross incompetence and failure to understand the difference—they are penny-wise and pound-foolish. That is why they have been sent into opposition and Labour has been trusted to clean up their mess.

[Natasha Irons (Croydon East) (Lab)]

There can be no greater example of the previous Government’s failure than the shocking outcomes for our children and young people, as Lord Darzi’s report highlights. Our children now have some of the worst health outcomes in Europe, with higher rates of obesity, diabetes and asthma, and poor oral and mental health. From head to toe, they have been failed. Will the Secretary of State ensure that the Government’s long-term plan for our NHS will give young people’s health the priority that it deserves?

[Wes Streeting]

I am delighted to see my hon. Friend in her place. She might be from the wrong side of the river, but she is absolutely right about the importance of prioritising children’s health. As the Prime Minister said this morning, it is shocking that the No. 1 cause of hospital admission among children aged between six and 10 is tooth decay. I was criticised by the shadow Secretary of State, who said that I called our children “short and fat”; she is more outraged by my calling out the scourge of childhood obesity that her Government fuelled than she is by the scourge of child obesity itself. That is why we will act and why the Conservatives failed.

[Richard Foord (Honiton and Sidmouth) (LD)]

I welcome the fact that the Health Secretary talks about a shift from hospital to community care; that builds on Lord Darzi’s finding that 13% of beds are occupied by people who are waiting for care in more appropriate settings. Caring for patients in community hospitals is much more cost-effective than caring for patients in big acute hospitals like the Royal Devon and Exeter hospital where I live. What thought has the Secretary of State given to the use of community hospitals that have lost beds in the last decade, such as Seaton, Axminster, Honiton and Ottery St Mary?

[Wes Streeting]

The hon. Gentleman is absolutely right about the value of community hospitals, step-down accommodation and care close to people’s homes—or, better still, wherever possible, in their homes, so long as it is clinically safe and the right support and care is available. The shift from hospital to community will be at the heart of our 10-year plan for reform and modernisation. Like lots of his colleagues on the Liberal Democrat Benches and lots of those on the Government Benches behind me, the hon. Gentleman has already done a good job of putting his local lobbying of Ministers on the record in the House.

[Several hon. Members rose—]

[Ms Polly Billington (East Thanet) (Lab)]

A recent survey of staff at East Kent Hospitals University NHS foundation trust showed that less than half of employees would be happy for their loved ones to be treated at an east Kent hospital. That is a devastating verdict from staff, showing the impact on their morale and on confidence in the community for the care that people need. Does the Secretary of State agree, however, that a broken NHS is not the fault of staff like them, but down to the previous Government’s decade of austerity and top-down reorganisation of the NHS?

[Wes Streeting]

I am delighted to see my hon. Friend in her place. She is absolutely right. I feel really sorry for NHS staff for what they have been put through over more than a decade of mismanagement and political incompetence, and we will work with them to clean up the mess. She establishes exactly the right test, which is whether we would want our loved ones to be treated in our local health and care services, and whether we would have confidence that, in every case, on every occasion and in every interaction, they would have access to the best-quality care. The truth is that we do not have that certainty, and too often it feels like chance. That is why we will always put the patient voice, the patient interest and the patient experience at the heart of our reform and modernisation programme.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for the honesty in his statement, and for his contact with the regional Minister responsible at the Northern Ireland Assembly. Those are the first actions of a Secretary of State who, I suggest, does not run away from issues but takes them head on. I congratulate him on that.

I appreciate the terminology used in the report, which outlines the seriousness of conditions in the NHS but also highlights the fact that the vital signs are still strong. Will the Secretary of State outline how he intends to address the fact that the NHS in devolved regions is in an arguably worse condition? Will he confirm that the review will incorporate Northern Ireland and will he ensure that the findings, new practices and standards will be in place for Northern Ireland, along with increased funding in a new funding formula?

[Wes Streeting]

I thank the hon. Gentleman for what he said; coming from him, that means a great deal to me. I reassure him that I am committed to working with Ministers in all devolved Administrations to improve health outcomes for everyone in every part of our United Kingdom. I know that the system is particularly pressed in Northern Ireland and I will do whatever I can, working with Ministers in Northern Ireland, to help that situation and create the rising tide that lifts all ships right across the UK.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

I truly learned to appreciate the NHS when I became a parent and saw the care given to my family and children. It therefore horrified me, having sat in A&E with an ill child, to see in Lord Darzi’s report that 100,000 infants waited for over six hours in A&E last year. Does the Secretary of State agree that that is a shocking state in which to leave the NHS? Will he commit to bringing the numbers down and making sure that parents do not have to endure that terrible wait?

[Wes Streeting]

I am delighted to see my hon. Friend representing Calder Valley. He has captured the fear and anxiety about the length of the wait experienced by far too many parents when they access A&E departments. It is a terrifying experience, particularly for parents with small children, to be in that situation. Frankly, the lack of focus on paediatric waiting lists and waiting times, whether in A&E or for electives, really is shameful. We have got to put children first and that is exactly what this Government will do.

[Jessica Toale (Bournemouth West) (Lab)]

My constituents in Bournemouth West have faced rising NHS waiting times; we have GP surgeries closing despite rising populations and health burdens; there are no dentists accepting any NHS adult patients and residents are being told to go to Southampton; and the junior doctors and nurses I meet are devastated that they cannot deliver the quality of service that they want to. Does the Secretary of State agree that although the road ahead is long, Lord Darzi’s frank and raw assessment is the first step to recovery under a Labour Government?

[Wes Streeting]

I am delighted to see my hon. Friend in her place representing the people of Bournemouth. The great thing about where we are at this moment is that, for the first time in a long time, there is a feeling of hope and optimism about what the future could be. We are determined to build on that and give staff and patients the confidence of knowing that the best days for the NHS lie ahead.

[Mr Calvin Bailey (Leyton and Wanstead) (Lab)]

Lord Darzi’s report highlights the use of capital expenditure to cover in-year spending by successive Tory Governments. Money intended for long-term investment has been redirected over and over, and that has exacerbated the extremely serious and urgent problems that the Secretary of State so rightly raises today. Does he agree that that has stopped us making progress on capital projects that would enable big productivity improvements and improve access to care for all, particularly those in my constituency of Leyton and Wanstead?

[Wes Streeting]

I am delighted to see my parliamentary neighbour in his place; he has big shoes to fill and he will certainly do that. The Chancellor and I are determined to break the vicious cycle in which ballooning costs and overspends in day-to-day spending see raids on capital and tech budgets to fund the shortfall. The £22 billion black hole that we have inherited is a direct example of exactly where Conservative short-termism leads. That is why, in respect of the spending review, I assure my hon. Friend that productivity, tech and capital will be my focus in my representations to the Chancellor and in the work we will do together to fix the mess that the Conservatives left behind.

--- Later in debate ---

[Emily Darlington (Milton Keynes Central) (Lab)]

To return to a subject close to the Secretary of State’s heart, does he agree that people’s actual experience is how we will measure whether the NHS has been improved? One of my children’s grandparents, who was diagnosed under a Labour Government, had 12 great years of cutting-edge treatments and 12 years with their grandchildren. Their grandfather, who was diagnosed under a Conservative Government, had 12 weeks.

[Wes Streeting]

I am grateful to my hon. Friend for the work she does championing Milton Keynes. Therein lies the challenge: it cannot be right that delays in diagnosis lead to the difference between life and death. I am very lucky that my cancer was caught early. It was diagnosed quickly and treated quickly. Not everyone is fortunate, and I am so sorry that my hon. Friend’s family is bearing the consequences of what happens when things go wrong.

[Sonia Kumar (Dudley) (Lab)]

Despite the damning analysis of the state in which the Conservatives left the NHS, Lord Darzi says that its vital signs remain strong. Does the Secretary of State agree with the case for the health service being taxpayer funded, free at the point of use, and based on need and not the ability to pay?

[Wes Streeting]

I am delighted to see my hon. Friend from Dudley. I agree wholeheartedly, 100%, unequivocally.

[Emma Foody (Cramlington and Killingworth) (Lab/Co-op)]

In a recent conversation, a nurse in Brunswick Village in my constituency shared her damning experience of the increasing number of black alerts in her hospital. Does the Secretary of State agree that, although her experience is no surprise to many who have used the NHS recently, the Tories have pushed our NHS to the brink and it is up to Labour to fix it and make it fit for the future?

[Wes Streeting]

Absolutely.

[Darren Paffey (Southampton Itchen) (Lab)]

The amazing NHS staff in my constituency work tirelessly, day in and day out, in our local hospitals and surgeries. Will my right hon. Friend join me in thanking them, and will he be clear that Lord Darzi’s shocking findings are not on them, but on the appalling legacy of the Conservatives, who still have not apologised?

[Wes Streeting]

NHS staff did not break the NHS—the Conservatives did—and this Labour Government will mobilise them to help fix it.

[Anna Dixon (Shipley) (Lab)]

It was great to see the Prime Minister speaking this morning at the King’s Fund, where I worked as director of policy for a number of years. In my constituency, I met a man who had been told he needed urgent surgery on his leg, but was still waiting 18 months later and had had to give up work. It is clear from today’s report that too many people have been stuck on NHS waiting lists and locked out of work. Does the Secretary of State share my view that a healthy nation is critical to a healthy economy, and will he work with his colleagues in the Department for Work and Pensions to deliver that?

[Wes Streeting]

My hon. Friend is absolutely right: the health of the nation and the health of the economy are inextricably linked. Under this Government, the Department of Health and Social Care is a Department for growth as well as a Department for health and care, and the Chancellor understands those linkages too. I can say to my hon. Friend and all of her friends at the King’s Fund—we were delighted to see them host the Prime Minister this morning—that unlike our predecessors, this Government cannot get enough of experts.

[Madam Deputy Speaker (Judith Cummins)]

That concludes the statement. We have had more than 45 contributions from Back Benchers, so I thank you for your patience.