Income Tax (Charge)

Wes Streeting Excerpts

Tuesday 5th November 2024 Commons Chamber

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

This Budget is the moment we turn the page on 14 years of Tory neglect of our NHS, when we begin to fix the foundations of our public finances and public services, when we wipe the slate clean after 14 years of stagnant growth and under-investment, and when we start to rebuild Britain. This Government were elected to deliver change: from economic chaos to stability, from crumbling schools and hospitals to first-class public services, and from short-term sticking plasters to a decade of national renewal.

On Wednesday, the Chancellor took the tough decisions to set our country on a better path to a brighter future. Labour’s manifesto promised to protect the payslips of working people while asking the wealthy to pay more, and the Chancellor delivered. We promised economic stability through new fiscal rules, and the Chancellor delivered. We promised more teachers in our state schools paid for by ending tax breaks on private schools, and the Chancellor delivered. We promised to end the non-dom tax status to fund 40,000 extra NHS appointments a week, and the Chancellor delivered.

Our country, our economy and our NHS were crying out for change, and the Chancellor delivered. She did so against the backdrop of the most appalling inheritance faced by any Government since the second world war—and not just the £22 billion black hole in the public finances. Let me set out for the House exactly what I was greeted with in my Department alone when I walked through the door on 5 July.

The Conservatives had told the country that they were on track to build 40 new hospitals by 2030. The former Health Secretary told the House that the funding had been provided. Putting aside the fact that there were never actually 40 new hospitals planned, I was informed in July not only that the programme was years behind schedule but that the funding was to run out in March. The only place those hospitals existed was in Boris Johnson’s imagination.

The Conservatives promised to cap social care costs by October 2025, just 15 months after the general election, but there was not a single penny set aside to pay for it; the cupboard was completely bare. Within weeks of the general election, councils were warning that it would be impossible to implement the cap by next October because the preparations had not been made. Those were fantasy pledges that the Conservatives never intended on keeping.

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

rose—

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[Wes Streeting]

I am happy to give way to the hon. Gentleman to tell us why.

[James Wild]

On the new hospital programme, the Government committed in the Budget to move swiftly to rebuild reinforced autoclaved aerated concrete hospitals. The Queen Elizabeth hospital in King’s Lynn is keen to make progress with its plans. Will he meet me and the trust so that we can unlock the funding and get that hospital ready by 2030?

[Wes Streeting]

That is a commitment that we have made and a commitment that we will keep. I am happy to ensure that the hon. Member can meet the relevant Minister and project team as we get under way on delivering that project.

I did actually go back to check the pledges made by the Conservative party in its 2024 manifesto just to see how extensive the work of fiction was, only to find that the manifesto page on its website now reads “page not found”. The truth is, had the Conservatives won the election, it would have been deleted just as quickly.

That was not all I was told when I became Secretary of State in July. Despite 18 months of strikes in the NHS, there was no funding put aside to end the junior doctors’ dispute. What is more, the previous Health Secretary had not met the resident doctors since March—the Conservatives had given up even attempting to end the strikes. People should remember that this winter. For all the challenges that the NHS will face, this will be the first winter in three years when NHS staff will be on the frontline, not the picket line. That is the difference that a Labour Budget makes.

I was told that GPs would be qualifying this year with no jobs to go into. The Government found the funding and we are hiring an extra 1,000 GPs this year. That is the difference that a Labour Budget makes.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

On the Budget, GPs, hospices and care homes have been found to be either exempt or not exempt from the national insurance contributions. Will he clarify whether hospices, care homes and primary care are exempt or not? That really matters to their costs.

[Wes Streeting]

I am grateful for that intervention for two reasons. First, it gives me an opportunity to say to GPs, hospices and other parts of the health and care system that will be affected by employers’ national insurance contribution changes that I am well aware of the pressures, we have not made allocations for the year ahead, and I will take those representations seriously.

Secondly, it gives me a chance to ask the hon. Member and the Opposition: do they support the investment or not? Are they choosing to invest in the NHS or not? They are now confronted with the hard reality of opposition. Just as when we were in opposition we had to set out how much every single one of our policies would cost and how those would be funded, they have to do that now. If they oppose the investment, they have to tell us where they would make the cuts in the NHS. If they oppose the investment, they have to tell us where they would make the cuts in school budgets. Those are the choices that we have made, and we stand by those choices. The Opposition will have to set out their choices, too.

I was told that because the Conservatives had run up huge deficits in NHS finances, I would not be able to deliver the 40,000 extra appointments a week that we had promised. In fact, I was told that we would have to cut 20,000 appointments a week instead. The Chancellor and I were not prepared to see waiting lists rise further. She put the funding in, and an extra 40,000 patients will be treated by the NHS each week. That is the difference that a Labour Budget makes.

[Jim Shannon (Strangford) (DUP)]

It would be churlish of anybody in the House not to welcome the £22 billion that has been allocated to the NHS. Everyone across this great United Kingdom of Great Britain and Northern Ireland will benefit from that.

A number of my GP surgeries have contacted me about their national insurance contributions, which they see as a catalyst to perhaps not being able to deliver what they want to do for their patients. I understand that the Labour party and Government are looking at that in a consensual way. Can the Secretary of State please give me the latest position so that I can go back to my GPs and tell them, “This has been looked at and there will be something coming”?

[Wes Streeting]

I am grateful for that intervention. It is of course for the devolved Administrations to decide how to use the Barnett consequentials that the generous uplift in funding provided by the Chancellor will provide. We make no bones about it: we had to make some difficult choices in the Budget to plug the £22 billion black hole that we inherited, to deliver on our promises and to ensure that we are fixing the foundations of our economy and our public services. We have asked businesses and some of the wealthiest to make a contribution. I say to people right across the House that they cannot welcome the investment at the same time as opposing the means to raise it. If they do, they have to explain how they would find the money.

[Mr Toby Perkins (Chesterfield) (Lab)]

I congratulate my right hon. Friend on his success in getting this extra money for our national health service, which is incredibly needed. He spoke about the extra GPs that he is taking on. The doctors’ surgery in Staveley in my constituency has told me that surgeries in the most deprived communities see patients two or three times a year more than those in wealthier areas. Will he say something about how we ensure that the extra GPs we get look in particular at those more deprived communities that have greater health inequalities and need more appointments?

[Wes Streeting]

My hon. Friend is absolutely right about equity and fairness of access. The Government are determined to close the gap in healthy life expectancy and health inequalities that blight our nation. GPs and primary care are an important part of doing that. Unless we fix the front door to the NHS in primary care, we will not solve our NHS crisis. Unless we address the crisis in social care, we will not fix the NHS crisis. We will be able to do that only if we do so right across the country.

[Jeremy Corbyn (Islington North) (Ind)]

I fully understand the crisis that the Secretary of State inherited. He will be aware that most hospitals are running at a deficit, many have substantial debts and many are spending up to 15% of their income on servicing private finance initiatives. Is his Department prepared to make some kind of intervention to reduce that burden, perhaps by taking over the PFIs directly in order for our hospitals to be able to spend more on what they are there for, which is, of course, patient care?

[Wes Streeting]

I am grateful for that intervention. The right hon. Gentleman is absolutely right that we walked into a position of enormous deficits in the NHS, and an enormous black hole in the public finances was left by the last Government. That is why we have had to make some difficult choices. That is why we have to learn from the mistakes of the past and not repeat them in future. We are doing as much as we can as fast as we can. That is why it was important that the Chancellor made the bold choices she did in her Budget, so that, as well as plugging the black hole, we are fixing the foundations. Thanks to the fiscal rules adopted by the Chancellor, we will ensure that the Government do not repeat the waste, the profligacy and the irresponsible spending of our Conservative predecessors.

[Andrew George (St Ives) (LD)]

Will the Secretary of State give way?

[Wes Streeting]

I will make some more progress.

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

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

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

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

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

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

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

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

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

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

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

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

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

[Paul Holmes (Hamble Valley) (Con)]

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

[Wes Streeting]

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

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

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

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

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

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

“combination of austerity and capital starvation”.

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

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

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[Edward Argar]

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

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

[Wes Streeting]

On that point.

[Edward Argar]

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

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