Regulation of NHS Managers: Consultation
Wes Streeting Excerpts(1 week ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
Ensuring strong and accountable NHS leadership will be critical to fixing a broken NHS and delivering our health mission. We know the important role that high-quality leadership plays in fostering a positive, compassionate, and transparent culture within the NHS while ensuring that local organisations are anchors of growth and opportunity in the areas that they serve.
Currently, NHS managers and leaders are not a regulated profession. Today, I am announcing that the Department of Health and Social Care is launching a 12-week consultation on options for the regulation of NHS managers, as part of a programme of work to meet the Government’s manifesto commitment to introduce professional standards for, and regulation of, NHS managers. This issue, and the related question of the duty of candour, has been variously highlighted by the Kark review (2019), the infected blood inquiry (2024) and the ongoing Thirlwall inquiry into events at the Countess of Chester hospital.
It is essential that managers are also supported with the skills they need to deliver transformation and increase productivity in the NHS, which is why today’s consultation forms part of a wider programme of leadership and management development work to equip the NHS with the leaders needed to deliver our 10-year plan. This includes establishing a college of executive and clinical leadership to champion and enhance the support available to NHS leaders, and asking Sir Gordon Messenger, through the 10-year plan process, to look at how we can accelerate efforts to develop more systematic talent management in the NHS.
This consultation seeks views from all partners, including health and care organisations, regulators, professional bodies, health and care managers and senior leaders, the public, patients, and other health and care staff, on the most effective way to strengthen oversight and accountability of NHS managers.We are seeking views on:
the type of regulation that may be most appropriate for managers
which managers should be in scope for any future regulatory system
what kind of body should exercise such a regulatory function
what types of standards managers should be required to demonstrate as part of a future system of regulation
the sequencing of the introduction of a regulatory regime for NHS managers, alongside work that is already being undertaken by NHS England to support their development
a new professional duty of candour to cover NHS managers, and making managers accountable for responding to concerns about patient safety.
We are today also publishing a separate report on the findings of the Department’s call for evidence—launched in April 2024—on the existing statutory duty of candour on providers, which is a key step to fulfilling a recommendation from the infected blood inquiry. We will use the findings of our consultation on manager regulation, and the call for evidence, to help inform the final response to the Department’s review of the statutory duty of candour.
Views from partners will be critical in informing further policy decisions during the next phase of this work to support and improve NHS leadership. We will publish our findings and set out next steps following the closure of the consultation.
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Tobacco and Vapes Bill
Wes Streeting ExcerptsTuesday 26th November 2024
(1 week ago)
Commons ChamberRead Full debate Tobacco and Vapes Bill 2024-26 View all Tobacco and Vapes Bill 2024-26 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Wes Streeting)
I beg to move, That the Bill be now read a Second time.
Today, across the UK, 350 young people aged 25 and under will take up smoking. It is a decision that the vast majority will later regret. They will try to quit again and again, but most will not be able to break their addiction. They will suffer strokes, diabetes, heart disease, cancer, stillbirth, dementia or asthma as a direct result of smoking. For two in three of those young people, the habit they are beginning today will eventually kill them.
Smoking takes 80,000 lives a year and causes one in four deaths from cancer in England, a hospital admission almost every minute and 100 GP appointments an hour. It is the leading cause of sickness, disability and death in our country. And today, Members of this House can consign it to the history books.
The Bill before the House will raise the legal age of the purchase of tobacco by one year every year, creating the first smokefree generation and, eventually, a smokefree nation. The Bill will enable the Government to extend the current indoor smoking ban to certain outdoor settings, and we will consult on banning smoking outside schools and hospitals and in playgrounds, protecting children and vulnerable people from the harms of second-hand smoke.
The Bill will come down on the vaping industry like a ton of bricks, to prevent a new generation of children and young people from getting hooked on nicotine. Taken together, these measures add up to the most significant public health intervention in a generation. They are a giant leap in this Government’s mission to build a healthy society and, in doing so, they will help to build a more healthy economy too.
Sir Desmond Swayne (New Forest West) (Con)
Can the Secretary of State imagine the plight of a shop assistant, some decades hence, when a middle-aged or elderly person presents themselves seeking to buy a packet of cigarettes? Is that shop assistant really expected to demand their bone fides?
Wes Streeting
I can not only imagine it, but I recently experienced a similar situation. There I was in Barkingside Sainsbury’s one evening, only weeks ago, buying a bottle of wine to have with dinner and, to my surprise, I was asked for my ID. I am afraid it is just a burden that those of us with youthful vim and vigour in our early 40s have to bear, and it is a price I am willing to pay—for good moisturiser. However, there is a serious point. Along with many others that I am sure we will encounter during the passage of the Bill, this is one of the cynical arguments being deployed by the mendacious smoking lobby, which would have us believe that, decades hence, there will be people who are at the margins—one aged 41 and one aged 40, for example—being asked for ID on the sale of cigarettes. The point is that the Bill will create a smokefree generation. Young people growing up in our country today will not be smokers, because we will have stopped the start. We will do everything we can to support adults who are currently smoking, because the vast majority want to break the habit but struggle to do so.
Simon Hoare (North Dorset) (Con)
If only proof of age was still asked of me.
The Secretary of State knows that I support the Bill and will vote for it this evening, but he will know that rural pubs are increasingly marginal in their operations. He has referred to further powers, post consultation, that may stop smoking outside in particular places once the Bill is on the statute book. Will he put the minds of rural MPs, from across the House, at rest by saying that he does not envisage at any point, either now or post-Royal Assent, the inclusion of a ban on smoking outside rural pubs? That would be a further nail in their business model at a time when we need them.
Wes Streeting
I was going to address that point later in my speech, but let me address it now. It is not often that a Government comment on leaks or welcome the events following a leak; I do not want to encourage future leaks, either. However, it is well known and a matter of accurate reporting, in this case, that we were considering an extension of the ban on outdoor smoking to include outdoor hospitality, including pubs, as the hon. Gentleman mentioned. Because of that leak, representations were heard from Members from across the House, including the hon. Gentleman, my hon. Friend the Member for Great Grimsby and Cleethorpes (Melanie Onn) and others. We took those representations very seriously because we know the hospitality industry has been through a torrid time, and not just in rural communities. I accept that rural pubs face a big challenge, but even high street pubs in towns and cities are struggling.
Our approach to public health always has to weigh up the upside benefits to public health against the downside consequences elsewhere. It is not in the national interest to see our high streets further suffer, so I reassure the hon. Member for North Dorset (Simon Hoare) and the hospitality industry—although I think it feels reassured on this already—that we will not be consulting on extending the powers to outdoor hospitality spaces. I hope that reassures people, as we embark on consultation on the measures that I am outlining today, that the Government listen, engage and consult seriously. Consultation is genuine with this Government.
Chris Vince (Harlow) (Lab/Co-op)
I will not comment on how young I look, but I still get asked for ID when buying non-alcoholic wine.
It is 10 years since the smoking ban came into operation and there are 1.9 million fewer smokers in the UK. Does that show the Secretary of State the difference that a Government that take the matter seriously can make?
Wes Streeting
My hon. Friend is absolutely right. I am really proud of the impact that the last Labour Government made in reducing smoking harms and the prevalence of smoking in our country.
That brings me on to the next point that I wanted to make. President Truman famously said that it is amazing what you can accomplish
“if you do not care who gets the credit.”
When I first sat down with Rachel Sylvester of The Times in January 2023 and flew a kite to start a debate that a Labour Government might introduce a ban on children and young people today ever buying cigarettes, of the type introduced by our sister party in New Zealand, I was not necessarily convinced my own side would buy it, but I thought it was a debate worth having. I never imagined, in a million years, that I would tune into a Conservative party conference speech by a Conservative Prime Minister announcing his intention to legislate for such a ban. I will do something I do not often do with Conservative party conference speeches and quote extensively—and approvingly—what the then Prime Minister said.
“As Prime Minister I have an obligation to do what I think is the right thing for our country in the long term. And as Conservatives, we have never shirked that responsibility.”
I say that bit through gritted teeth.
“We have always been at the front of society, leading it—”
Who wrote this?
“And when we have the tools at our disposal…to do for our children what we all, in our heart of hearts, know is right, we must act, we must lead…we must put the next generation first.”
In that spirit, I pay tribute to the former Prime Minister, the right hon. Member for Richmond and Northallerton (Rishi Sunak), for picking up the proposal and running with it despite opposition from his own party. That took courage. While we have taken steps to improve this Bill compared with the one put forward by the previous Government, I hope that hon. and right hon. Members on the Conservative Benches will follow his lead, showing that the one nation tradition still has a constituency in the modern Conservative party, and vote for this Bill in the national interest.
The Darzi investigation into the NHS set out the twin challenges facing me, my Department and this Government. The national health service is broken; it is going through the worst crisis in its history. At the point we came into office, waiting lists stood at 7.6 million. We had worse cancer survival rates than most comparable countries, ambulances not arriving on time, the number of GPs falling and dentistry deserts across the country.
Some of the most shocking findings in Lord Darzi’s report, however, were about not the sickness in our NHS, but the sickness in our nation. Children are less healthy today than they were a decade ago. Life expectancy was extended by three and a half years over the course of the last Labour Government, but in the past 14 years, it has grown by just four months. Brits now live shorter lives than people in any other country in western Europe, and we spend fewer years living in good health, becoming sicker sooner. Those are huge costs, borne by all of us as individuals. It means less time in which we are able to live our lives to the full, to do all the things we love and to spend time with the people we love. Sickness is forcing many of us out of work long before retirement age, leaving us dependent on welfare, ridding us of the purpose and belonging that work provides, and for everyone else, it means higher costs to us as taxpayers. Our sick society is holding back our economy, and that is why we should act.
Layla Moran (Oxford West and Abingdon) (LD)
Will the Secretary of State give way?
Layla Moran
In the spirit of cross-party working, I want to congratulate Members on the Conservative Benches for deciding, when the former Prime Minister put this policy forward, that it was a priority. It shows how important it is that No. 10 gets behind this kind of thing, and I hope we learn that lesson for the Government’s missions.
I gently say, however, that it is not just the evil tobacco lobby that has concerns about the age escalator. I completely agree with everything that the Secretary of State says, but if smoking is that much of an issue, why are we not just banning it for those under an age of, say, 25? That would have been another way to go. What is the thinking behind an age escalator, as opposed to a ban for those under a particular age so that people do not need new ID every time?
Wes Streeting
I recognise that there are people who have the freedom and the liberty to smoke today, the vast majority of whom, by the way, want to stop and struggle to do so. That is why we are announcing support to enable people to do that, with £70 million of investment in smoking cessation services. That is important, but for a future where people are no longer able to smoke, a phased approach is the right thing to do. It is also essential for the health of the individual, the nation and our economy.
Since 2018, our productivity has dropped by £25 billion due to worsening health alone. Some 900,000 more people are off work than would have been on pre-pandemic trends. That is more people than are employed by Tesco, Sainsbury’s and Asda put together. Smoking alone accounts for more than £18 billion in lost productivity. The rising tide of ill health, coupled with our ageing society, presents an existential challenge to our health service. If we do not act now, ever-increasing demands for healthcare threaten to overwhelm and bankrupt the NHS. That is the choice that we face.
Andrew Rosindell (Romford) (Con)
Surely the Secretary of State realises that banning things rarely works. When tobacco was banned in South Africa during the covid pandemic, 95% of the trade went underground. Surely we should be promoting the concept of freedom with responsibility and allowing people to make choices about their own lives. I am glad that he goes shopping in Barkingside—he should go and speak to the shopkeepers in Collier Row, where local retailers will lose a lot of potential business if the ban comes in.
Wes Streeting
I am grateful for the intervention, because I anticipate that there will be similar arguments made from the Opposition Benches, particularly from a right-wing libertarian perspective. I want to engage seriously with those arguments.
Wes Streeting
I will just respond to the point made by the hon. Member for Romford (Andrew Rosindell).
There is no liberty in addiction; there is no freedom in addiction. The logical extension of the libertarian argument the hon. Gentleman puts forward would be the end of the ban on indoor smoking. If we should take a live and let live approach, why not legalise cannabis? Why not legalise cocaine? We prescribe certain harmful substances, and there is, I think, an unanswerable case on tobacco because it is uniquely addictive and uniquely harmful. That is why we will take a tougher approach with this harmful substance than we would with something such as alcohol, or other harms such as gambling.
Jonathan Davies
The Secretary of State stole my line when he said that there is no freedom in addiction. I just want to thank him for his pragmatic approach to the hospitality industry, which has made representations to me on this matter. May I also impress on him that vapes are a valuable quitting aid for many adults, but many young people are now taking to vaping when they have never actually smoked at all? Can he say a little bit more about how we will address that?
Wes Streeting
I will certainly come on to the action that we are taking on vaping, and the case for it. I welcome the contribution that my hon. Friend has made in his first few months as a Member of this House. He brings enormous expertise and experience, particularly on health, which we very much value here in the Chamber.
One choice would be to continue paying an ever heavier price for failure. That is the road that we were heading down, under the previous Government. Our NHS already takes £4 for every £10 spent by the Government day to day. We are on course to go from being a nation with a national health service to a health service with a nation attached to it. It is projected that by the end of this Parliament, 4.3 million people will be on sickness benefit if we fail to act. Smoking could cause 300,000 patients to be diagnosed with cancer over the next five years, including 3,000 for whom that is the result of exposure to second-hand smoke. That is what happens if we only ever treat the symptoms of ill health. We end up spending more on the NHS than ever before, but with worse care for patients, a ballooning welfare bill due to more and more people being out of work, stagnant economic growth, and the heaviest tax burden in 70 years. In short, we will be paying more, but getting less.
Britain is like a ship with a hole. We are constantly battling to chuck enough water overboard to keep us afloat, as more and more floods in. We must break out of this cycle. Britain can break out of this cycle, but only if we are serious about tackling the causes of ill health, and shift our focus from treating the symptoms to preventing them. Plugging the hole in the ship is how we get back to growth, how we reduce the burden of taxation, and how we ensure that this Government can intrude more lightly on people’s lives.
Sir Christopher Chope (Christchurch) (Con)
The argument that the Secretary of State puts forward is essentially one for banning smoking altogether. What he said earlier was misleading; he suggested that people of a particular age group will not be able to smoke. They will not be able to buy cigarettes, but they can still smoke. They can cadge cigarettes off other people. Is this not a half-baked measure?
Wes Streeting
I am sure that the hon. Gentleman was not accusing me of misleading the House. The argument that he puts forward is used against all sorts of laws and prohibitions. Most people in this country are law-abiding citizens who follow the law. In my constituency today, there will be people dumping fridges and mattresses on street corners—fly-tipping—because they are irresponsible and not law-abiding citizens. We will not always catch them, either through closed-circuit television or local authority enforcement, but that does not mean that we should not tackle them when they do those things.
By phasing in a generational smoking ban, we are taking a measured and reasonable way of creating a smokefree country. That is the right way to proceed, and it is sensible. I know that he does not agree, but he must accept the trade-off—the choices that he is making for the Opposition. First, he is accepting that people will pay a higher price for their healthcare, either through taxes, if he still believes in the national health service, or through the cost to the individual of their healthcare. Secondly, he must concede that, through the harm caused by smoking, he is fuelling welfare dependency. My right hon. Friend the Secretary of State for Work and Pensions had a point when she said earlier that Labour is the party of work, and the Conservatives are the party of welfare. That is the logical conclusion of the hon. Gentleman’s opposition.
Anna Dixon (Shipley) (Lab)
I congratulate my right hon. Friend on introducing this once-in-a generation public health measure. As he acknowledges, too many people are dying young from the effects of smoking. They are losing out on being grandparents and on the opportunity to live a long and healthy life. Smoking is a leading cause of health inequality, so does he agree that the proposals will help close the shocking gap in life expectancy between the rich and poor?
Wes Streeting
My hon. Friend is absolutely right. I am afraid that one of my first experiences of death was watching my grandmother die a very long, slow, painful death from lung cancer as a result of a life of chain smoking. That is the consequence of this cruel addiction. People who start smoking come to regret it. They struggle to stop, and I am afraid that the stolen years that they could have spent with children and grandchildren are only part of the cost. Part of my argument today, particularly to some Opposition Members, is about better use of public money and reducing the taxation burden. Other arguments, too, may have some currency with Members who might be opposed to these measures for libertarian reasons. We should not forget for a moment the impact of this cruel addiction and the harms caused by smoking on people’s quality of life, family life, and memories.
Wes Streeting
I must make progress, otherwise we will not hear from anyone else in this debate—and I think that it will be a debate.
Taking action requires a reforming Government who are unafraid to take on the orthodoxies of both the right and the left. As I said, my right hon. Friend the Work and Pensions Secretary is today proposing radical reforms to the welfare system. Earlier this month, I set out a package of reforms to drive better productivity in the NHS. Today, we are proposing the biggest public health reform in a generation: phasing out smoking for the next generation by raising the legal age at which tobacco can be sold by one year every year, so that anyone aged 15 and under today will never legally be sold cigarettes. That will phase out smoking altogether.
Almost 20 years ago, the last Labour Government introduced the ban on smoking indoors in public places, as my hon. Friend the Member for Harlow (Chris Vince) said. We heard many of the same arguments, frankly, from opponents of that measure as we hear from opponents of the Bill today. They are free to correct me if I am wrong, but I do not think that Opposition Members who oppose the Bill are also proposing scrapping the indoor smoking ban. We have political consensus on the issue because of its success. The year after the ban came into force in 2007, hospital admissions for heart attacks dropped by 1,200. Admissions for children with asthma had been rising by 5% a year before the ban. After it was introduced, admissions fell by 18% in just three years. Since 2007, smoking rates have been cut by over a third, and as our understanding of second-hand smoke grew, the ban sparked a cultural change. People no longer thought it acceptable to smoke in front of their children, and many stepped outside, even in their own homes. It is time to build on that success.
No smoker intends to cause harm to others, but that is unintentionally what they do through second-hand smoke. The harms from second-hand smoke are less than from actively smoking, but the evidence shows they are still substantial. If people can smell smoke, they are inhaling it. Smoke near schools and playgrounds exposes children to smoke. Hospitals, by definition, have high numbers of medically vulnerable people on their grounds. The Bill will allow Government to extend the ban on indoor smoking to certain outdoor settings, and we will consult on banning smoking outside schools, playgrounds and hospitals to protect children and the most vulnerable.
As we act to prevent harms from smoking, we must also tackle the rising problem of youth vaping. It has more than doubled in the last five years, and one in four 11 to 15-year-olds tried vaping last year. A new generation of children is getting hooked on nicotine, and there should be no doubt about the cause, and no illusion that this has happened by accident. On any high street in the country, we can see shop windows filled with brightly coloured packaging for vapes, with flavours like blue razz lemonade and tongue twisters sour apple. Those products are designed, made, packaged, marketed and sold deliberately to children. This industry has cynically targeted its harmful products to kids.
Action is long overdue. We promised to stamp out youth vaping in our manifesto, and the Bill delivers the change that we promised. It will close loopholes that allow vapes to be sold or given away to children, provide powers to regulate the flavours, packaging and display of vapes, and introduce on-the-spot fines of £200 for under-age sales. Just as we took action on the advertising and sponsorship of tobacco products, we will bring the law into line for vaping products, too.
Wera Hobhouse
I do not know whether the Secretary of State will still be in the Chamber when I talk about Spice-spiked vapes. I see a gap in the Bill: it does not talk about refills. The harmful practice of spiking vapes with Spice comes from the refills. I hope that the Government will listen to my concerns and be flexible, as they have already shown themselves to be in other places. Perhaps, during the passage of the Bill, we can include something about refills. Would he agree to that?
Wes Streeting
We want to work in a genuinely collaborative and cross-party way, and I know that is true right across the House. As I look at the Opposition Benches, including Conservative Benches, I see long-standing campaigners for action on smoking and vaping. We want to listen and engage.
I feel strongly about the matter, as does the Prime Minister. In our manifesto, we set out Labour’s mission to improve the health of the nation. We will be far better served as a country if this is a truly national mission, and if we come together in common cause for action on public health.
Wes Streeting
In that spirit, I will give way to the hon. Gentleman—and then to some of my hon. Friends.
Sir Julian Lewis (New Forest East) (Con)
Can the Secretary of State tell us if there is any place for vapes as a step-down, in the context of the addictive aspects of tobacco? I seem to remember that when vaping first came along, it was heralded as a way to help wean people from their tobacco addictions. Sadly, it has turned into something else, as he describes, and starts children on the road towards nicotine addiction, but does it have a role as a step-down?
Wes Streeting
The right hon. Member is right to make that distinction. As a stop-smoking tool, vaping has a part to play. For smokers, vaping is a better alternative—a route away from smoking. We do not want to throw the baby out with the bathwater. What we are interested in tackling is the scourge of youth vaping and the extent to which young people have been cynically addicted. It is important to say that we do not yet know the full extent of the harms caused by vaping, but we do know two things: first, it is better to vape than to smoke—that is why we are striking the balance in this legislation—and secondly, vapes are harmful. Ask any teacher in the country; they will talk about the signs of nicotine addiction that they see in their pupils, and about having to monitor school toilets to stop children congregating to vape. It is urgent and necessary to act today to protect this generation of kids from a new addiction, and that is exactly what we will do.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
As an ear, nose and throat surgeon, I can attest to the absolutely desperate trouble that cigarettes have caused over many generations. Implementing this measure is one of the best things that this Parliament could possibly do, and I expect that the measure will be widely supported all over the House. I am grateful to my right hon. Friend for introducing it.
Wes Streeting
I am grateful to my hon. Friend for that intervention, not least because of the expertise that he brings to the House as a clinician. We are well served by his expertise in debates on the health of the nation.
Opposite me sit many opponents of the Bill and of the Government’s prevention agenda. I acknowledge that their opposition is based on genuine, sincere beliefs about the limits of government and the size of the state, but I appeal to them by saying that the Bill is in the national interest and, ironically, in their ideological interest.
Robin Swann (South Antrim) (UUP)
I thank the Secretary of State for making a number of times the point that this is a truly national Bill that applies across the United Kingdom. I thank him for including Northern Ireland, Scotland and Wales in the measures. When we in this place consider measures to promote health, we should do so equally for the entirety of the United Kingdom.
Wes Streeting
That is a very helpful intervention because it gives me the opportunity to say thank you to my counterparts in Wales, Scotland and Northern Ireland. This is a genuinely four-nations Bill, and through it, we have an opportunity to create a smokefree generation in every corner of our country.
I say to people who have an ideological objection to the Bill that if they believe in lower taxes, as they say they do, and in maintaining a national health service, as they say they do, they cannot duck this simple equation: an ageing population plus a sicker society equals more spending on the NHS, paid through higher taxes. The Bill is just one measure, but it will make a significant difference to the health of our society, and to the balance of that equation.
The question that opponents of the Bill must answer is this: if they want our health and care services to continue having to spend £3 billion every year on the symptoms of smoking, are they willing to accept that that means higher taxes or higher healthcare charges for their constituents? Are they happy for their constituents to shoulder the welfare bill for smokers falling out of the workforce? Those are the consequences of what we are voting on today. Higher taxes and higher welfare are not the Labour way.
There are arguments about liberty from those who oppose based on libertarian belief. They say that the state should not deny individuals the choice to smoke if they want to, but three quarters of smokers want to stop and wish they had never started. It takes a smoker an average of 30 attempts to quit before they manage it. By definition, an addict is not free; there is no choice, no liberty and no freedom in addiction. Nor is choice afforded to anyone inhaling second-hand smoke. Tobacco is not only highly addictive but uniquely harmful. Yes, some smokers can quit, but most who want to cannot. Those who have help to quit are three times more likely to succeed. That is why the Government are, as I said, investing £70 million in smoking cessation services—an investment that will pay for itself several times over—but prevention is better than cure, and that is why we are taking action, through the Bill, to stop the start.
In conclusion, this Bill marks the start of a decade in which we will shift the focus of healthcare from treatment to prevention; take serious action on not just smoking, but obesity; reform the NHS, so that it catches problems earlier and gives patients the tools that they need to stay out of hospital; harness the revolution taking place in life sciences; and fundamentally transform the NHS, so that it predicts illness and prevents it from ever taking hold. That is the future available to us, and it is the future we must realise if we are going to put our welfare system, health service and public finances on a sustainable footing. It starts with this Bill. Smokers are more likely to need NHS services, be admitted to hospital, drop out of the workforce and on to welfare, and need social care years earlier than if they did not smoke. By taking the measures set out in the Bill, we are putting the UK on the road to becoming smokefree, building a healthier, wealthier nation with a health service fit for the future and leading the world as we do so. I commend this Bill to the House.
Madam Deputy Speaker (Caroline Nokes)
I call the shadow Secretary of State.
Independent Review of the Physician and Anaesthesia Associate Professions
Wes Streeting Excerpts(1 week, 6 days ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Wes Streeting)
The Government have commissioned Professor Gillian Leng CBE to lead an independent review into the physician and anaesthesia associate professions. This will consider how they are currently used and how they can be integrated safely into health teams to deliver the best possible care.
The review will consider the safety, cost-effectiveness and efficiency of roles, alongside the lessons that can be learned from how they have been deployed in the NHS. The conclusions of the review will inform future reforms, which will be vital to the delivery of the 10-year health plan. This review marks an important step: to reset the discussion by stepping back and taking stock of the evidence.
The review will report in spring 2025 and will gather the available evidence and data on the physician associate (PA) and anaesthesia associate (AA) professions from the UK and globally, engaging with these professionals, patients, the public, doctors and other professions, employers, and researchers. It will review the safety of the roles, patient experience, the contribution the roles can make to more productive use of professional time in multidisciplinary teams, and whether these roles deliver good quality, efficient and safe patient care in a range of settings.
PAs and AAs support doctors to manage patients, increasing the capacity of health care services and freeing up doctors to focus on specialist cases. The roles should always work under the supervision of a doctor, but concerns have been raised by the medical professional about blurred lines of responsibility and whether, in some cases, PAs and AAs are being used to replace doctors. The public has every right to be confident they are seeing the most appropriate healthcare professional.
Regulation of PAs and AAs by the General Medical Council will begin in December 2024 and will help to ensure all PAs and AAs meet the high standards we expect of every healthcare professional. However, we do not have a comprehensive view of how these roles are being deployed, or how effectively, and the review will address this gap. The conclusion will provide clarity to patients and healthcare professionals and inform our 10-year health plan.
Terms of reference for the review will be published on www.gov.uk in due course. Following completion of the review, we will publish our findings and update the House on next steps.
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Oral Answers to Questions
Wes Streeting Excerpts(2 weeks ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Sam Carling (North West Cambridgeshire) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
Mr Speaker, I associate myself with your remarks about the war in Ukraine. I know the whole House stands with Ukraine as it defends its freedom and democracy. This is precisely why the Prime Minister’s leadership at the G20, and in other international fora, is vital in standing up not just for our national interests but for our values across the world.
Over the past decade, the Conservatives’ mismanagement has left the NHS with 1,400 fewer full-time equivalent GPs than in 2015, hundreds of practice closures, the loss of over 1,000 community pharmacies, and NHS dentistry a distant memory, which is why this Government took immediate action to employ 1,000 more GPs. Through the additional roles reimbursement scheme, through the Chancellor’s Budget measures and through our 10-year plan, we will shift the focus of healthcare out of hospitals and into the community.
Josh Simons
In my Makerfield constituency, Wigan council and my local NHS trust are working closely together to pioneer a health system focused on prevention and delivered through neighbourhood health centres, but they need help. What is the Secretary of State doing to improve access to primary care, especially data-driven preventive care, through neighbourhood health centres?
Wes Streeting
I agree with my hon. Friend on the importance of prevention at a local level. We are trialling neighbourhood health centres across the country to bring together a range of services, ensuring that healthcare is closer to home and that patients receive the care they deserve. This is part of our broader ambition to move towards a neighbourhood health service, with care delivered close to home. I would be delighted to meet my hon. Friend to hear more about what is going well in his community and what further action we need to take.
Chris Vince
Does the Secretary of State agree that access to primary care is hugely important to supporting accident and emergency departments at hospitals like the Princess Alexandra in Harlow? Does he also agree that access to primary care is about not just GPs but dentists? Finally, what are the Government’s plans to support dental surgeries such as the aptly named Harlow dental surgery, which I visited last week?
Wes Streeting
My hon. Friend is right that many of the pressures on our hospitals, such as the Princess Alexandra in Harlow, are a result of pressures in other parts of the health and social care system. It is outrageous that the biggest reason for five to nine-year-olds presenting to hospital is tooth decay, which is why we need to get NHS dentistry back on its feet, along with the rest of the NHS.
My hon. Friend the Minister for Care and I have regularly met the British Dental Association since the general election to consider how the dental contract can be reformed to retain dentists and rebuild NHS dental services.
Sam Carling
In my local area of Cambridgeshire and Peterborough, GPs are reporting feeling increasingly burnt out, with working conditions becoming more extreme. The number of patients per fully qualified GP in my area has increased by nearly 400 since December 2016, a higher increase than the national average. Can the Secretary of State tell me what his Department is doing to make the situation more sustainable while improving access to primary care?
Wes Streeting
General practice is a valued part of the NHS, and GPs are a vital part of our NHS family. In fact, they are delivering more appointments than ever before, and we recognise the significant pressures they face. At the same time, we know that patients are struggling to see their GP, which is why we have invested an additional £82 million into the ARRS to recruit 1,000 more newly qualified GPs this year. This will take pressure off general practice, and we will be announcing further budget allocations in the not-too-distant future to set out what further support we will provide for general practice.
Layla Moran (Oxford West and Abingdon) (LD)
Last week, I visited Summertown health centre. Staff there implored me to say to the Government that the issue is not just more money—we welcome the £100 million that has been allocated for capital investment in primary care—but the snarled-up process at integrated care board level and getting investment to the right places quickly. What will the Secretary of State’s Government do to ensure ICBs deliver that money to where it is needed, and fast?
Wes Streeting
The Chair of the Health and Social Care Committee is right that investment is vital, but so is reform. We tasked ICBs with leading the development of the new neighbourhood health service. We are removing their responsibility for performance management of trusts in order to free up their focus, so that primary and community services have the attention that is desperately needed. In the coming weeks, we will be talking to the British Medical Association and the Royal College of General Practitioners about how we ensure the investment announced by the Chancellor leads to improved patient care and a reformed neighbourhood health service.
Lewis Cocking (Broxbourne) (Con)
Goff’s Oak, in my constituency of Broxbourne, has seen a lot of development. What steps is the Secretary of State taking to ensure that GP surgeries are delivered before hundreds of new homes are built?
Wes Streeting
Of course we need to deliver both new homes and GP surgeries, but the previous Conservative Government delivered neither. We have a housing crisis and an NHS crisis in this country; I would have thought Conservative Members might have shown some humility and responsibility for those facts before challenging a Government who have been in office for only four months.
Andrew George (St Ives) (LD)
In Cornwall, only 25% of delayed discharges from hospital are because of lack of social care packages, with the remainder involving the significant degree of support needed from primary and community NHS services. The Royal College of Nursing has pointed out that there has been a 45% reduction in district nurses in the last decade, so what can the Government do to replace those essential roles at a primary care level?
Wes Streeting
The hon. Gentleman is right. Last weekend, I was up in Middlesbrough with local Members, where we saw a great example of hospital at home delivered by the community nursing team and the community health trust. We have to do a lot more in that space to ensure we provide care closer to peoples’ homes—indeed, often in the home—keeping them out of hospital and close to home, which is better for them and better value for the taxpayer.
Wes Streeting
I can reassure health and care providers that we will be setting out allocations long before April next year. I recognise that people need to plan ahead of the new financial year. When deciding allocations, we take into account the range of pressures on different parts of the system. People have heard what I have said already about the need to shift out of hospital into primary and community services. The shadow Minister talks about choices; Conservative Members seem to welcome the £26 billion investment, but oppose the means of raising it. I am afraid they cannot do both. If they support the investment, they need to support the way in which we raise the money; if they do not support the way in which we raise the money, they need to spell out how they would raise it or be honest about the fact that if they were still in government, they would continue to preside over a mismanaged decline.
Dr Evans
One GP described the situation as “Schrödinger’s primary care”: GPs are seen as private contractors, so not exempt from the NI increases, but they are exempt from the small business relief because they are deemed to be “public”. Did the Department of Health team knowingly go along with the Treasury team’s plan to tax primary care without mitigation, leading to cuts? Or did it not understand or spot the complexity of what is going on, so mitigations have to be put in place now? Which is it?
Wes Streeting
I was terribly impolite; I should have welcomed the shadow Minister to his place in response to his first question.
Conservative Members seem to welcome the £26 billion investment and are happy to tell us how it should be spent, but they oppose the means of raising it. They cannot do all those things. They need to be honest with the country: either they support the investment in the NHS or they say they would cut it. Which is it?
Tessa Munt (Wells and Mendip Hills) (LD)
Wendy Chamberlain (North East Fife) (LD)
The Secretary of State for Health and Social Care (Wes Streeting)
The leadership shown by the Chancellor has enabled her and the Government to fix the foundations of the public finances and fill the £22 billion black hole left by the previous Government. The decisions that she took meant that she was able to provide this Department with an extra £26 billion and a real-terms increase in core local government spending power by about 3.2%. That was the right decision for the right reasons in the national interest, and I am taking into consideration pressures on all parts of health and social care before making final allocations for the year ahead.
Wendy Chamberlain
In North East Fife, we have a particular issue with access to dental surgeries, especially with the recent closure of a surgery in Leven. Difficulties stem from recruitment from abroad as a result of visa changes and also simply from practices going private and coming out of the system. Obviously, the NHS is devolved in Scotland, but does the Secretary of State agree that putting staffing under further strain from increasing national insurance contributions will only make things worse for dentists? What in his conversations is he doing to ensure that dentists get the support that they need?
Wes Streeting
It is because the Chancellor took the decisions that she did in the Budget that my Department has received £26 billion to reform and improve health and social care. As I said before the general election, all parts of the United Kingdom suffered under the previous Conservative Government, which is why I am sure that Members from across Scotland will welcome the extra £1.5 billion this year and £3.4 billion next year—the biggest funding increase since devolution. I am sure that the SNP Government will welcome the increase, and they certainly have no excuses now for not acting.
Rachael Maskell (York Central) (Lab/Co-op)
Fourteen years of neglect have left hospices in a perilous condition. They are dealing with the rise in national insurance contributions, pay and other cost pressures, so I welcome the fact that the Secretary of State is putting in place measures to ensure that the funding recovers. Will he assure me that integrated care boards not only will pass on that recovery from the increased costs to hospices, but will help them catch up from the Tory years of neglect of the whole sector?
Wes Streeting
I am grateful to my hon. Friend for her question. I am looking carefully at the pressures on hospices. In fact, only last Friday I visited Saint Francis hospice, which serves my constituents and people right across east London and west and south Essex. I saw at first hand the brilliant work it is doing on end of life care, but also the pressures it is under, and I am taking those pressures into account before deciding allocations for the year ahead.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I have tried repeatedly through written parliamentary questions to get an answer to this without success, so I will try asking it face to face: will the Secretary of State tell the House how much his Chancellor’s changes to national insurance contributions will cost the NHS?
Wes Streeting
The hon. Member talks about the employer national insurance contributions as if they were a burden on the NHS. It is thanks to the decisions taken by the Chancellor that we can invest £26 billion in health and social care. The Conservatives welcome the investment but oppose the means of raising it. Do they support the investment or not? They cannot duck the question; they have to answer.
Dr Johnson
The right hon. Member speaks of ducking questions, but it is worrying that three weeks after the Budget he still does not know, or will not tell the House, how much it will cost the NHS. Of course, changes to national insurance contributions affect not just the NHS directly, but suppliers, contractors, charities and other NHS care providers. I know you are a great supporter of your local air ambulance service, Mr Speaker, as I am of the Lincs & Notts air ambulance, which now needs to raise £70,000 extra just to fund this Government’s ill-advised changes to NICs. That £70,000 is a lot of cakes to sell, cars to wash and fun runs to complete, and that is just one example of pressures placed on lifesaving services right across the country. Will the Minister confirm that he will meet the Chancellor, explain the disastrous effects of the policy and insist that she reverses it?
Wes Streeting
Again, we have not yet announced how we are allocating the budget for the year ahead, but I remind the Conservatives that it is thanks to the choices the Chancellor made in her Budget that she is able to invest £26 billion in health and social care. Would they cut the £26 billion this Labour Government are investing in the NHS? If not, how would they pay for it? Welcome to opposition.
Wes Streeting
I am grateful to the Liberal Democrat spokesperson for her question. I pay tribute to the children’s hospice in her constituency and, indeed, to Haven House children’s hospice, which serves my constituency.
Wes Streeting
And indeed your very own local hospice, Mr Speaker—I am sure that will appear on the record. I am particularly thankful for the advocacy we have received from Hospice UK and charities such as Together for Short Lives and others that are making their voices heard about the pressures on the system. I say to all hospices across the country that I am taking those pressures into account before deciding allocations for the year ahead, because I want to ensure that everyone, whatever their age, receives access to the timely and good-quality end of life care, palliative care and, of course, support for people with life-limiting conditions that all of them deserve.
Antonia Bance (Tipton and Wednesbury) (Lab)
Kevin Bonavia (Stevenage) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
Before the election, we made it clear that investment and reform were needed in the NHS. The Chancellor announced the investment in the Budget, and since the general election we have confirmed the introduction of new league tables of NHS providers, with high-performing providers being given greater freedom over funding and flexibility. We are sending turnaround teams into struggling hospitals, giving the best performers greater freedoms over funding to modernise technology and equipment. We are creating a new college of executive and clinical leadership that will help to attract, keep and support the best NHS leaders. We are banning NHS trusts from using agencies to hire temporary entry-level workers in bands 2 and 3, such as healthcare assistants and domestic support workers. We are sending crack teams of top clinicians to areas with long waiting lists and high economic inactivity to improve the productivity of their clinics, and we are running a GP red tape challenge to slash bureaucracy. I could go on, because this is a Government who are walking the talk on NHS reform.
Wes Streeting
I would be delighted to meet my hon. Friend and other Members from across Medway to discuss the challenges that their part of the south-east faces, and to explain why our predecessors made promises they could not keep, with timetables that were completely fictitious and funding that runs out in March. I am really sorry for the way that communities were let down by the previous Government. This Government will not make the same mistakes.
Kevin Bonavia
I am grateful to my right hon. Friend for his earlier answer. Last week, I spoke to one of my constituents, Norman Phillips, who has been an unpaid carer for his wife Ros for the past 18 years. Like many unpaid carers across Stevenage, Norman has been put through absolute hell by the previous Tory Government’s complete inaction on social care for over 14 years. Does the Secretary of State agree that unpaid carers such as Norman play a vital role in providing care, and that unpaid carers need to be at the heart of any reforms to the social care system—reforms that are much needed?
Wes Streeting
I, too, pay tribute to Norman and to family carers like him, who play such a vital role supporting loved ones. Through the carer’s allowance uplift in the Budget, the Chancellor announced the largest increase to the weekly earnings limit since the introduction of carer’s allowance in 1976. As well as that investment, we will have a 10-year plan for social care, and I see the care workforce, care providers and family carers as all being important partners in building that plan.
Jeremy Hunt (Godalming and Ash) (Con)
I welcome the Secretary of State’s plans to reform the NHS, but may I caution against the idea that the answer is to fire more incompetent managers? The problem is not bad management: it is micromanagement from the centre that sees hospitals managed with more than 100 targets by NHS England, making ours one of the most micromanaged healthcare systems in the world. Will the Secretary of State’s plans allow managers more autonomy, helping them to innovate, save money and improve care for patients?
Wes Streeting
I am happy to confirm that it is my view that, when there are too many targets and everything is being measured, nothing ends up being measured. We need to give more freedom and autonomy to good leaders, including clinical leaders and managers in the NHS who are coming up with some of the best productivity gains in the system. That is why we have announced new support for, and investment in, the college of leadership for both clinical and executive leaders in the NHS. I would be delighted to meet the right hon. Gentleman to discuss those issues. He was a great Chair of the Health and Social Care Select Committee, but back in July, we saw a great example of how we can improve things by sacking bad managers.
Bob Blackman (Harrow East) (Con)
One of the lessons from the pandemic is the importance of NHS communications. Last week, I joined victims of the sodium valproate scandal to hand in a petition. They tried to download from the website the Medicines and Healthcare products Regulatory Agency’s yellow card adverse drug reactions literature, but were unable to do so. Will the Secretary of State look at this as a matter of urgency? People need to be warned about the risks of taking certain drugs.
Wes Streeting
As the hon. Gentleman knows, I am a great champion of patient power, and a key part of giving patients more power and control over their healthcare is better access to information. That is why, as well as improvements to the NHS app—which will provide far easier interaction with the NHS for patients—I am working with my right hon. Friend the Secretary of State for Science, Innovation and Technology to make sure all the information held by Government is more accessible for our citizens, particularly where that includes vital safety information and guidance, as the hon. Gentleman has mentioned.
Pamela Nash (Motherwell, Wishaw and Carluke) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
Thanks to the decisions that the Chancellor took in the Budget, we are able to provide an additional £26 billion to give the NHS the funding it needs. This will support the NHS in England, enabling it to deliver an extra 40,000 appointments a week to cut waiting lists. Of course, for my hon. Friend and her constituents, the Budget has given Scotland the biggest real-terms increase in funding through the Barnett formula since devolution began. I hope the Scottish Government will use that investment to deliver improved services for the Scottish people.
Pamela Nash
The Labour party is the party of the NHS, and the significant additional investment announced in the recent Budget has reaffirmed that. The Secretary of State has made it very clear in this question session that the benefits of that additional funding must be felt across the UK. Will he join me in urging the Scottish Government to ensure that that funding reaches the frontline and creates the badly needed additional appointments in GP, dental and hospital services that my constituents and people across Scotland badly need?
Wes Streeting
I am grateful to my hon. Friend for her question. It is thanks to the people of Scotland sending 37 Labour Members of Parliament here at the last election—not only have they shown that they value the NHS and are demanding change, but they voted for change—that we are now delivering that change through the Budget. I say to Scottish Government Ministers that, as they know, I said before the election that all roads lead to Westminster and that we all suffered under the Conservative Government, but this year that road is carrying an extra £1.5 billion to the Scottish Government and next year it will carry an extra £3.4 billion to the Scottish Government, so they have no excuse not to act.
Saqib Bhatti (Meriden and Solihull East) (Con)
Approximately 220,000 people currently reside in the Solihull borough, and if Government planning reforms go through, the number will increase significantly. My hon. Friend the Member for Solihull West and Shirley (Dr Shastri-Hurst) and I have written to the Health Secretary about the need for infrastructure and A&E services at Solihull hospital. Will he agree to meet us to see how we can make this Budget work for the people of Solihull?
Wes Streeting
I know, not least because of the mismanagement of the NHS during the last 14 years, that communities right across the country, including the hon. Gentleman’s constituents in Solihull, are struggling with poor services and crumbling estates. We would be happy to receive representations from him, but he has to level with his constituents. If he wants money to be spent in his community, he must support the investment and be honest about the fact that he supports the means of raising it. If he does not support the means of raising it, he should tell us where that investment would come from.
Mr Speaker
We have been very slow to get to topicals, so let us see if we can speed it up. Dan Tomlinson will set a good example.
Dan Tomlinson (Chipping Barnet) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
This weekend, we launched the first in-person consultation as part of change.nhs.uk, the biggest national conversation about the future of the NHS we have ever seen. We know that the Leader of the Opposition wants a conversation about whether the NHS is free at the point of use, and I can tell her, from that first conversation, that no one agreed with her.
Dan Tomlinson
Earlier this month, I visited Barnet hospital to see the way in which it is changing the emergency care department so that more patients can be seen more quickly, freeing up capacity in accident and emergency. What steps are the Government taking to ensure that trusts such as the Royal Free and others across the country get the support they need, through investment and reform, to improve patient care?
Wes Streeting
I am grateful to my hon. Friend for his question. The Royal Free hospital saved my life when I went through kidney cancer, so it holds a special place in my heart. Thanks to the Chancellor’s decision and the investment she put into the NHS at the Budget, and the reform my Department is delivering, we will deliver the change and improvement that his constituents and mine, and the rest of the country, deserve.
Wes Streeting
It is thanks to this Government and the action we have taken that, for the first time in three years, we go into winter without the spectre of national strikes looming over the NHS, and with NHS staff on the frontline not the picket line. It is thanks to the priority this Government have given to prevention that we have already delivered almost 15 million covid-19 and flu vaccinations, alongside the new RSV—respiratory syncytial virus—vaccination to help vulnerable groups for the first time. The shadow Secretary of State mentions the winter fuel allowance. This Government are protecting support for the poorest pensioners to protect them not just this winter, but every winter, and over the coming years the value of the pension will of course rise with the cost of living.
Edward Argar
I am grateful for that response but, just as my hon. Friends have highlighted in respect of the damaging impact of increases in employer national insurance contributions on GPs, hospices and care providers, I fear it was another example of the Government simply not answering the question and not having a plan yet. Either the Government have not done their homework and, as with the impact of NICs increases, they have not thought this through and do not know, or worse, they do not care—which is it?
Wes Streeting
This Government are prepared for winter and we are already standing up the operational response to winter pressures. On funding, the right hon. Gentleman was in government just before the general election. Is he saying that his Government did not provide enough funding for the NHS this winter? If not, why not? If he does accept that it is enough money, he will surely welcome the extra investment that the Chancellor is putting into the NHS from next year.
Dr Lauren Sullivan (Gravesham) (Lab)
Paulette Hamilton (Birmingham Erdington) (Lab)
Wes Streeting
We all know that general practice is under enormous pressure, and that will be a big part of this Government’s agenda. I reassure my hon. Friend that our view is that there should be patient choice, patient control and different courses for different horses. I value online and over-the-phone appointments, but they will not be right for everyone on every occasion. Patients should have a voice and a say.
Lincoln Jopp (Spelthorne) (Con)
Wes Streeting
I would say to GPs who are thinking about staffing for the next financial year that they should hold tight and wait for funding allocations shortly, so that they can make informed decisions about staffing and care for patients.
Damien Egan (Bristol North East) (Lab)
Charlie Maynard (Witney) (LD)
Wes Streeting
I might resist the invitation to give a specific date today, but the hon. Gentleman makes a valuable point about the ease of use of the NHS app, and I will write to him further on that point.
Mark Ferguson (Gateshead Central and Whickham) (Lab)
Sarah Olney (Richmond Park) (LD)
Wes Streeting
We have not yet announced allocations for general practice for the year ahead, and we are taking into account all the pressures that general practice is under.
Dr Beccy Cooper (Worthing West) (Lab)
Martin Wrigley (Newton Abbot) (LD)
Wes Streeting
I am in no doubt about the state that general practice was left in by our Conservative predecessors. That is why, in making decisions about funding allocations for the year ahead, we are taking into account all the pressures that general practice is under, as we clean up the mess left by the Conservatives.
Alice Macdonald (Norwich North) (Lab/Co-op)
In summer 2023, I spoke to Rachel, who suffers from endometriosis. She was told that she might have to wait 18 months for urgent surgery. She is still waiting. In fact, she has had the menopause induced to help tackle her symptoms. Can the Minister tell me what the Government are doing to improve the diagnosis and treatment of women, including Rachel, who have had to wait far too long?
Stuart Anderson (South Shropshire) (Con)
Ludlow community hospital in my constituency provides a great service for the local community, but it is restricted by its location and its building. There is a business model that would be more cost-effective in the long term that involves moving the facility to the eco park. Will the Secretary of State meet me, healthcare stakeholders and the league of friends in Ludlow to take that forward?
Wes Streeting
The hon. Member is welcome to make representations to the Department for the capital investment that he is calling for, but he should welcome the means of providing it, which was the Chancellor’s decision in the Budget.
Neil Coyle (Bermondsey and Old Southwark) (Lab)
I welcome Ministers’ leadership in attacking the record waiting times inherited from the Tories. Will they in turn recognise Guy’s and St Thomas’ efforts to reduce delays, especially in the ear, nose and throat and paediatric spinal surgery teams? Will the Secretary of State outline measures to protect our NHS from cyber-attacks, which was another issue neglected by the last Government but is affecting patients in Southwark?
Wes Streeting
I am grateful to my hon. Friend for the question and pay tribute to the work being done by Guy’s and St Thomas’. He is right to raise cyber-security. That is why the capital investment announced by the Chancellor is welcome and necessary, and joint working across Government, including with security colleagues and my right hon. Friend the Secretary of State for Science, Innovation and Technology, is vital to keep patients’ data and information safe and to keep critical systems running.
Mr Lee Dillon (Newbury) (LD)
When the Secretary of State reviews GP funding, will he also consider the burden that sits on GP practices when they have to hold the lease for their surgeries and what role integrated care boards could have in holding that risk, which is stopping the recruitment of GPs to join practices as partners?
David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)
Opt-out testing for HIV at A&E has been a great success since it was announced last year, particularly in identifying those who were not aware they had the disease and among difficult-to-reach communities. Can the Health Secretary confirm whether the programme will continue?
Wes Streeting
Opt-out HIV testing has been a great success so far. Of course, we will make further announcements on its future in due course. I would like to say, as a former member of the HIV commission that made the representations to the previous Government, that he has me at a real advantage—or disadvantage, depending on the side of the spending fence. I very much welcomed the approach taken by the previous Government, which this Government plan to continue.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
Will the Secretary of State explain what plans he has—if any—to limit the scope of practice of anaesthetic associates and physician associates, about whom there has been such publicity lately?
Wes Streeting
Indeed there has. Medical associate roles can and do play a valuable role in freeing up other clinicians’ time to do the things that only they can do, but there are legitimate concerns within the professions about scope of practice, doctor substitution and transparency for patients. We need to grip that and address it. We will have a further announcement to make about that shortly.
Mr Richard Holden (Basildon and Billericay) (Con)
South Green surgery in my constituency has been given notice by its landlord that it has to move by the end of March next year. Will the Secretary of State meet me to see what we can do to ensure that other facilities can be provided if available, or to do the best for those local patients?
Wes Streeting
That would be a matter for the right hon. Gentleman’s ICB. I know that he is new to the area, so I am happy to make some introductions.
Karl Turner (Kingston upon Hull East) (Lab)
My constituent Craig Eskrett was diagnosed with motor neurone disease 12 months ago. He says that the services are there in the local NHS trust, but there is a distinct lack of co-ordination. Will the Minister meet me to discuss what improvements can be made to co-ordinate those services for sufferers of MND?
Richard Foord (Honiton and Sidmouth) (LD)
At the weekend in Devon, I met a psychiatric nurse who previously worked in London and has been recruited to the south-west. She does not have a start date, and is still subject to routine checks after waiting months. Can the Secretary of State expedite these routine checks, given waiting lists for mental health?
Wes Streeting
Absolutely. That is a good example of why investment needs to be matched with reform to speed things up, improve productivity and get staff to the frontline, where they want to be.
Harpreet Uppal (Huddersfield) (Lab)
Last week, the chief executive of Forget Me Not children’s hospice visited Parliament with local dad Steve, whose son is supported by the hospice. The hospice provides vital services to families such as Steve’s, but its services are at risk in the longer term without sustainable funding, including the NHS England children’s hospice grant. Can the Health Secretary take urgent steps to improve funding for hospices?
Wes Streeting
I am grateful for the steps that my hon. Friend is taking to make representations on behalf of her local children’s hospice, both on the Floor of the House and outside the Chamber. I recognise the pressure she describes. We are determined to help hospices to overcome them.
Jim Shannon (Strangford) (DUP)
Can the Secretary of State confirm what assessment has been made of the number of women waiting for endometriosis surgery across the United Kingdom? What has been done to reduce waiting lists?
Wes Streeting
As my hon. Friend the Minister for Secondary Care said, the wait for women with common conditions such as endometriosis is far too long. That is why we are taking steps to cut waiting times and stop the merry-go-round of repeat visits to the same clinician to get the same answer, until someone finally listens to what a woman has to say.
Income Tax (Charge)
Wes Streeting Excerpts(4 weeks ago)
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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
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.
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.
Edward Argar
I will make a little progress, but then I will happily give way to my hon. Friend.
Apart from the press releases and the reviews, where is the action? We need to see where the £22 billion will be spent. What plans does the Secretary of State have for additional investment for the NHS this winter? He knows, as I knew when I was a Minister, that winter in the NHS is always challenging. I look forward to him setting out what additional investment he plans.
Edward Argar
I will give way to my hon. Friend the Member for Hamble Valley (Paul Holmes) in a second. Nice try, Secretary of State.
Is the right hon. Gentleman directing where that NHS funding goes himself, or will it be for his officials or NHS England to set the priorities for that, and who will be held accountable for ensuring that it is prioritised in the right places?
Ten-year Health Plan
Wes Streeting Excerpts(1 month, 1 week ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
Our NHS is broken, but not beaten, and we have made it our mission to fix the NHS. But we cannot do it without the help of the people who use it, and so today I am launching Change NHS: A health service fit for the future—a national conversation to develop the 10-year Health Plan. This is the next chapter of the NHS’s story and how we will make it fit for the future.
One of my first acts as Secretary of State was to commission an immediate investigation into the performance of the NHS in England, to start an open and honest conversation about the state of our health service and the reforms needed to ensure its longevity, and that it is fit for the future.
On 12 September, Lord Darzi published his independent review, which revealed the scale of the challenge we face. Our NHS is under rising pressure; we are diagnosing ill health too late and not doing enough to prevent it in the first place. It is too hard for people to get an appointment, hospitals are overcrowded, NHS workers are overstretched and costs are escalating.
I am determined to reverse record levels of public dissatisfaction with the NHS and deliver a health service that is there for everyone who needs it. We have already taken important steps, starting with plans to fix the front door of the NHS by providing funding to support the recruitment of an additional 1,000 GPs by the end of the financial year and settling the pay dispute with resident doctors.
For decades, there has been broad consensus that to overcome the challenges facing the NHS, we must focus on providing more care in the community, so hospitals are able to treat the sickest patients, make better use of technology, and do more to prevent ill health. Despite this consensus, successive Governments have failed to deliver.
We need a different approach to make these crucial shifts and deliver an NHS fit for the future. I want the public and staff to be at the centre of reimagining the NHS, as well as experts from across the health and care landscape. The best ideas are not going to come from above. They have to come from all of us. So, from today, everyone can provide their experience and views at www.change.nhs.uk to help us fix our broken NHS.
[HCWS147]
Access to Primary Healthcare
Wes Streeting Excerpts(1 month, 2 weeks ago)
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Dr Johnson
I thank the hon. Gentleman for his intervention. I have talked about the challenges the NHS faces. I will come shortly to the achievements of the Labour Government so far in the Department of Health and Social Care.
Turning back to technology, I was saying that I agree with the Secretary of State on how technology can improve NHS services. Over the last few years, in my professional capacity, I have seen improvements in making communication between primary and secondary care and within secondary care much more efficient. As a patient, I have used the askmyGP service, which is an excellent way to communicate with a GP, particularly for working people. I have also used the NHS app, which millions of people have downloaded and which has huge potential. I hope he intends to build on that potential and harness the benefit of AI for diagnostics in particular.
The Secretary of State and I also agree on the importance of prevention. It is vital to make the NHS accessible to those who need it, but it is even better if people stay healthy in the first place. Before the election, he was supportive of measures to protect children from the dangers of vaping—measures I campaigned for actively. In fact, he was quite critical that it had not been done sooner, as in some respects was I. Given that the legislation has already been written and that it passed both Second Reading and Committee stage with the support of his friends on the Labour Benches, why is it taking him so long to produce a tobacco and vapes Bill? Can he guarantee that he will deliver it, like a present, in time for Christmas—for clarity, I am hoping for this Christmas?
The Secretary of State for Health and Social Care (Wes Streeting)
Have you been naughty or nice?
Dr Johnson
I have been a good girl, thank you, Secretary of State.
Furthermore, can the Secretary of State explain how cancelling dozens of new hospitals will reduce pressure on general practice? Can he explain how cutting the winter fuel payment for millions of pensioners will help the NHS? The End Fuel Poverty Coalition predicts that Labour’s winter fuel payment cut will result in an additional 262,000 pensioners needing NHS treatment because they are cold, resulting in a great deal of suffering and millions of pounds of additional cost to the NHS. Does he agree with that assessment? I have asked repeatedly, in both oral and written questions, if the Government will conduct a proper impact assessment of the policy on the NHS and on the wellbeing of vulnerable older people. Will he commit to producing and publishing such as report?
Further on the issue of prevention, the right hon. Gentleman will know that folic acid supplementation can prevent neural tube disorders, such as spina bifida and anencephaly. The previous Government brought forward regulations on the matter. What conversations has the Secretary of State had with the Department for Environment, Food and Rural Affairs about ensuring that that work is continued?
Our approach to dentistry was also underlined by prevention. We introduced the Health and Care Act 2022, which gave the Secretary of State the power to introduce water fluoridation schemes. Those powers have since been used to extend existing schemes, particularly in the north-east of England. Does the Secretary of State intend to continue that work and exercise the powers the previous Government gave him? He knows that I am passionate about dentistry. I have raised the issue many times in the House, including by securing an Adjournment debate on dentistry in Lincolnshire. It troubles me greatly that children are coming to hospital for multiple dental extractions due to rotten teeth. It is worth noting that the issue is not a shortage of dentists overall or, as the hon. Member for North Shropshire (Helen Morgan) says, a shortage of money, but a shortage of dentists doing NHS work rather than private work specifically.
The previous Government were encouraging dentists to take up NHS work with a range of measures, including golden hellos for dentists in underserved areas, dental vans going out to rural communities, and tie-ins for new dental graduates. We were also in the process of broader contract reform after a small change in the units of dental activity rate when we went into the election. Let us look at Labour-run Wales in comparison. Wales is delivering only 58% of pre-pandemic dental activity. It is burdened with the highest proportion of NHS dental practices not accepting adult patients and the longest waiting lists in the UK. One in four Welsh residents is currently on a waiting list. The new Secretary of State for Wales has said that the Government “will take inspiration from” Labour-run Wales on dentistry. Given their woeful record in office, I sincerely hope that that is not the case.
Before the election, when I listened to the Secretary of State for Health and Social Care say that Labour had a plan to reform and modernise the NHS, I believed him, but in Monday’s debate on the Lord Darzi report, we uncovered that his plan was not really a plan at all, but a list of desired outcomes and a proposal to make a plan if he got into office. It is unclear how long this plan will take to develop. The Minister for Secondary Care said that it is a listening exercise like we have never seen before, but how much will that cost, and had Labour not been listening already?
Oral Answers to Questions
Wes Streeting Excerpts(1 month, 2 weeks ago)
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Karl Turner (Kingston upon Hull East) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
Waiting times are wholly inadequate in our country. That is because the previous Conservative Government took a golden inheritance of the shortest waiting times and the highest patient satisfaction in history and left behind the worst crisis in the NHS’s history. What is more, they accept no responsibility and cannot even bring themselves to say sorry.
Karl Turner
I pay tribute to my own family GP, Dr Islam at the East Hull family practice, who goes above and beyond for his patients. However, I know that GPs are troubled by the amount of time patients have to wait to see them. The disparity between GP numbers in different areas is utterly shocking. In Kingston upon Thames, for example, a GP looks after 1,800 patients, but in Kingston upon Hull it is more than double that number. What is my right hon. Friend doing to sort out the Tory mess of the last 14 years?
Wes Streeting
May I first, through my hon. Friend, say thank you to Dr Islam and to GPs right across the country who, against the backdrop of the extraordinary challenges they are working through, have none the less managed to deliver more appointments now than when there were thousands more GPs? My hon. Friend is right to point out that we do not have enough GPs in this country. That is why, within weeks of taking office, this Government found just shy of £100 million to put into the frontline to employ 1,000 more GPs who will be seeing patients before the end of this financial year. That will make a real difference, and the shadow Secretary of State should have the humility and to grace accept that.
Priti Patel (Witham) (Con)
Patient waiting times are reduced dramatically through the recruitment and retention of more GPs, so will the Secretary of State welcome the work of the Anglia Ruskin medical school in Essex, and perhaps have a conversation with myself and neighbouring MPs about how that medical school could be expanded to do much more to support the recruitment and training of more MPs—more GPs in Essex?
Wes Streeting
I am sure that the right hon. Lady does want more Conservative MPs in Essex. She has raised an entirely constructive point, which I strongly welcome. This Government are committed, as we were in opposition, to doubling the number of medical school places, and that means real opportunities for local medical schools such as hers. As ever, I would of course be delighted to meet her to talk about what more can do with her local university.
Abtisam Mohamed (Sheffield Central) (Lab)
The news that we are recruiting more GPs is very welcome. I spent an afternoon shadowing a local GP and saw just how stretched the services were. Will the Secretary of State give a commitment that we are moving towards investment in primary care services and moving from a national health service to a focus on neighbourhood health services?
Wes Streeting
I am grateful to my hon. Friend for raising that question. When in opposition, I was delighted to spend time with a whole group of GPs from across Sheffield who showed us what primary care reform could look like. We are committed to increasing primary care as a proportion of the NHS’s budget, which will be important, and also to building exactly the kind of neighbourhood health service she describes, with more care closer to people’s homes. General practice has a key role to play in that.
Layla Moran (Oxford West and Abingdon) (LD)
What we measure is often what we end up improving, and one of the great assets of Lord Darzi’s report is the technical annex with its 330 analyses. It is incredibly useful; it is a baseline. Will the Secretary of State make sure that it is updated yearly?
Wes Streeting
That is a great constructive challenge. I am absolutely committed to transparency and to keeping that dataset updated in the way that the hon. Lady requests. We are not going to get everything right and sometimes we are not going to make progress as fast as we would like, but where that is the case we are never going to duck it or pretend that things are better than they are. The reason that we will succeed where the previous Government failed is that we are willing to face up to the challenges in the NHS rather than pretend that they do not exist.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
The Prime Minister has repeatedly stressed the importance of preventing people from taking up smoking, as one of his priorities to improve the nation’s health, reduce waiting lists and lessen demand on the NHS, and we agree. The Government like to talk about the record of their first 100 days in office but, according to data from Action on Smoking and Health, 280 children under the age of 16 take up smoking in England each day. That is 28,000 children in England during the Secretary of State’s first 100 days. Why has he not yet reintroduced our Tobacco and Vapes Bill? How many children need to take up smoking before he makes this a priority?
Wes Streeting
Perhaps the shadow Minister would like to give us the figures for the entire 14 years that his party was in government. By the way, just to set the record straight, not only did I propose the measures in that Bill during an interview with The Times earlier last year, but if it was such a priority for the Opposition, why did they leave the Bill unfinished? Why had it only had its Second Reading? And why did we go into the general election with that Bill unpassed? I will tell him why: because his party was divided on the issue, and the then Prime Minister was too weak to stand up to his own right-wingers who are now calling the shots in his party. The smoking Bill will be back, it will be stronger and, unlike the previous Government, we will deliver it.
Helen Morgan (North Shropshire) (LD)
My constituent Mel Lycett has terminal cancer. After repeated visits to her GP, she was referred to a two-week urgent pathway in May. She was not diagnosed until the end of July, and she still has not started treatment. Every single target for her diagnosis and treatment was missed. That is not uncommon in Shropshire, and it is not uncommon in the rest of the country. Can the Secretary of State reassure me of what he is doing to deal with this terrible legacy left behind by the Conservative Government? How will he ensure that cancer patients are treated in a timely manner?
Wes Streeting
I welcome the hon. Lady to her role. I am afraid that this case is just one of countless stories of people whose lives might have been saved had the NHS been there for them when they needed it. It is bad enough when people receive a late diagnosis that equates to a death sentence; it is worse still when people in that position are not given the fighting chance of urgent, life-extending treatment.
The inheritance we have received is truly shameful. I assure the hon. Lady, as a cancer survivor myself—because the NHS was there for me when I needed it—that we will work tirelessly through a national cancer plan to make sure that we deliver the cancer waiting time standards that the last Labour Government met, and that are sorely needed today.
Johanna Baxter (Paisley and Renfrewshire South) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
I must declare an interest, because Whipps Cross hospital serves my constituents, as well as those of the right hon. Gentleman. On that basis, I am well aware that we desperately need the proposed redevelopment of the hospital. That is why, in common with so many Members across the House, I am furious that the previous Government’s new hospitals programme had a timetable that was a work of fiction and money that will run out in March. The assurance I can give to the right hon. Gentleman, his constituents, my constituents, and the constituents of every right hon. and hon. Member across the House whose constituents are waiting for news on the new hospitals programme, is that we will deliver on a timetable that is credible and a programme that is funded, giving our constituents the clarity and consistency they deserve, and rebuilding by placing the Government among our construction industry supply chain.
Sir Iain Duncan Smith
The Secretary of State knows that we have campaigned together for the redevelopment of Whipps Cross hospital, and whether that is delivered by a Labour or Conservative Government makes no difference to me. I want to drag him to the reality of a specific point about the hospital: it was granted £1.2 million towards undertaking a business case, which it received in August, but that money has run out. A total of £5 million is required to be ready when the decision is made; if it is not available, the hospital will lose the architects and builders. Will he go back to the Department and ensure that the hospital receives that money, so that managers can be ready with the full, detailed business case the moment the decision is made? Otherwise, it will cost £50 million extra over the next year to get the architects and builders back. I beg the Secretary of State—I literally beg him—to look at that carefully.
Wes Streeting
I am grateful to the right hon. Gentleman for his question. Those practical considerations are very much part of the review. I say to the poor project managers across the country who have had to deal with the previous Government’s stop-start approach that we are not going to make that mistake. We are going to come forward with a credible plan that is also funded, not the work of fiction or the £22 billion black hole that the shadow Secretary of State left in her wake.
Mr Calvin Bailey (Leyton and Wanstead) (Lab)
Whipps Cross hospital is in my constituency and it is my constituents who have had to endure five years of the previous Government organising photo opportunity after photo opportunity, not putting the contracts in place for the project to be up and running and ready to go. Does my right hon. Friend agree that only a fully costed, long-term approach from this Labour Government can deliver the modern healthcare that my constituents need?
Wes Streeting
My hon. Friend, my constituency neighbour, is absolutely right. He has been doing an outstanding job of representing the people of Leyton and Wanstead since his arrival. What our constituents, and indeed constituents right across the country, deserve is honesty, clarity and consistency. That is how we will turn the new hospitals programme from a press release into reality and how, in doing so, we will restore trust in politics and, for businesses, the construction industry and the supply chain, restore confidence in public sector procurement.
Mr Peter Bedford (Mid Leicestershire) (Con)
Many Leicestershire residents are concerned about the Government’s review of the new hospitals programme, which would have seen two new hospitals, a midwifery-led unit and a multi-storey car park in the city. What representations has the Minister made to the Chancellor to retain this vital investment for the NHS in Leicestershire?
Wes Streeting
The hon. Gentleman asks what representations I am making to retain the funding. If only that were the case. The funding was not there. The Conservative party went into the general election with a programme timetable that was a work of fiction and a claim to have a funded programme that was simply not true. What we arrived to find was a timetable that was a load of rubbish and a £22 billion hole in the public finances that the party hid from the country because it did not want to confront the hard truths. This Government are facing the facts and answering the challenges.
Ms Stella Creasy (Walthamstow) (Lab/Co-op)
I am probably the only MP in this current Chamber who has recently used Whipps Cross hospital, which also serves my community in Walthamstow, because I had both my children there, so I know at first hand how desperately it needs redevelopment and how poor the facilities are that the amazing staff are having to use. Does my right hon. Friend agree that finally getting this project moving under a Labour Government will also deliver thousands of much-needed homes in our local community? It is a win-win situation, which is why it is such a travesty that, for years, Conservative Ministers came and took photos, but we never saw any diggers or spades in the ground. Does he agree that Labour can change that?
Wes Streeting
My hon. Friend is absolutely right. This is about not just the necessary hospital projects, but the growth that will come through construction, getting these projects up and running and, of course, the role that the NHS plays as an economic anchor institution in communities, as some of these projects will necessarily unlock new housing sites and a local transport infrastructure. We are mindful of all of that. The most important thing is that we come forward with a timetable that is credible and a programme that is funded, and that is exactly what we will do.
Chris McDonald (Stockton North) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
Today, I am publishing the full findings of Dr Penny Dash’s review of the Care Quality Commission. Her interim report made it clear that the CQC was not fit for purpose, with fewer inspections being carried out, urgent follow-ups being neglected and patient safety being put at risk. Today, she makes seven recommendations for improvement, and I have made sure that the CQC has begun urgently putting them into practice. We are also publishing a review of the CQC’s deeply flawed single assessment framework today. Sir Julian Hartley will shortly begin as its new chief executive, with my full support.
Chris McDonald
My constituent Mark has been unable to find an NHS dentist for his 19-month-old child, even at the seventh time of trying. My right hon. Friend well understands the crisis he has inherited. Will he meet me to discuss the shortage of dentistry in Stockton North and across Teesside?
Wes Streeting
I am sorry for my hon. Friend’s constituents, and so many others who are dealing with the consequences of the Conservatives’ failure on dentistry. I would be delighted to meet him to discuss the challenges in his area.
Victoria Atkins (Louth and Horncastle) (Con)
I congratulate all nominees and winners in the NHS parliamentary awards yesterday. Their success was richly deserved, and the awards were a very good example of the House coming together to celebrate those who work so hard in our health service and social care services.
In the past five weeks, I have asked the Secretary of State 29 questions at this Dispatch Box, yet he has managed to answer only one. For the rest, he has tried to bluster his way out of his policy decisions, as we have seen this morning. Let us try again. When will be the first week in which we see delivery of his promised 40,000 more appointments?
Wes Streeting
After the performances I had to put up with when the right hon. Lady was at the Government Dispatch Box, she has some brass neck complaining at the Opposition Dispatch Box that I am not answering her questions. She will know that we are working at pace to stand up 40,000 more appointments every week as our first step, as promised in our manifesto, and we will deliver. More than that, we will go into the next election with a record of which the right hon. Lady can only dream.
Victoria Atkins
After 14 years of opposition—two and a half of which the Secretary of State spent on the Front Bench and travelling around the world, funded by other Governments, to look at their healthcare systems—and more than 100 days in government, the right hon. Gentleman does not even know the start date of his own flagship policy. He is no Action Man; he is Anchorman.
Let us deal with Labour’s cruel decision to slash winter fuel payments, which will add pressure not only to patients, but to the NHS. The NHS’s deputy chief operating officer—
Mr Speaker
Order. I gave the right hon. Lady a hint to come to an end and not to carry on fully. It is unfair to Back Benchers, who I am trying to represent. I want a short answer.
Wes Streeting
The shadow Secretary of State questions the budget for this winter, but it was set by her Government. Is that finally an admission of failure on her part? Something else that we will have this winter, which we did not have last winter or the previous winter is no—
Helen Morgan (North Shropshire) (LD)
In England, 4.4 million children have not seen a dentist for at least a year. Meanwhile, in Shropshire, Telford and Wrekin integrated health board, £1 million of dental funding went unspent in 2022-23. The system is clearly broken. When can we expect the Secretary of State to fix it?
Wes Streeting
It is precisely because of the situation the hon. Member describes—the poor services and, ironically, the underspends in the dentistry budget—that we will work not only to stand up the 700,000 urgent and emergency dental appointments we promised, but to do the prevention work for children in our schools.
Mr Tanmanjeet Singh Dhesi (Slough) (Lab)
Bob Blackman (Harrow East) (Con)
Wes Streeting
Whatever stage the Bill got to, it was not completed, was it? We will bring back a tobacco and vapes Bill that is stronger than the Conservatives’ and I look forward to seeing if they support it.
Rebecca Long Bailey (Salford) (Ind)
Olly Glover (Didcot and Wantage) (LD)
Wes Streeting
I absolutely take the point the hon. Gentleman is making about the importance of place-based leadership. That is why one thing we will be looking to do, as part of the 10-year plan process, is to clarify roles and responsibilities in different parts of the system to ensure that we have better strategic place-based leadership.
Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)
Jerome Mayhew (Broadland and Fakenham) (Con)
Labour’s cut to the winter fuel payment will cause 262,000 cold pensioners to seek NHS treatment, according to the End Fuel Poverty Coalition. Do the Government agree with those figures, and if not, what are their own estimates?
Wes Streeting
The decision on the winter fuel allowance is not one that the Government took lightly, but we inherited a £22 billion hole in the nation’s finances. We continue to stand behind vulnerable households by increasing the state pension with the triple lock, delivering the warm home discount and extending the household support fund to support the most vulnerable pensioners.
Rachael Maskell (York Central) (Lab/Co-op)
Esther McVey (Tatton) (Con)
Can the Secretary of State update the House on the status of Alan Milburn? Does he still attend meetings in the Department and have access to confidential information? Does he now have an official role in the Department? Does he still have private sector interests in the healthcare sector?
Wes Streeting
The right hon. Alan Milburn is alive, he is safe and we are treating him well.
Mary Kelly Foy (City of Durham) (Lab)
October is Breast Cancer Awareness Month, and I stand here today as someone who was diagnosed, treated and cured of breast cancer this year by the amazing staff in the north-east, but not enough women are taking up their breast screening appointments. Will the Minister do more to raise awareness of, and access to, breast screening appointments, and may I urge all women to check themselves regularly?
Simon Hoare (North Dorset) (Con)
A significant impediment to improving adult social care is the split of budget and responsibility and policy between the Secretary of State’s Department and the Ministry of Housing, Communities and Local Government. Will he and colleagues work to remove that hurdle, to have better outcomes more cost-effectively delivered to improve the lives of all our constituents?
Wes Streeting
The hon. Gentleman is right to raise that risk. I assure him and the House that I and the Deputy Prime Minister, herself a former care worker, are working in lockstep to align strategy, policy and delivery.
Care Quality Commission: Report on Operational Effectiveness
Wes Streeting Excerpts(1 month, 2 weeks ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Wes Streeting)
The full findings of the review into the operational effectiveness of the Care Quality Commission (CQC), conducted by Dr Penny Dash, have today been published on www.gov.uk. I would like to place on record my sincere thanks to Dr Dash for the swift and thorough job she has done on the review.
An interim report of Dr Dash’s work, published in July 2024, summarised her emerging findings to allow for early conversations on the necessary changes to improve the CQC. Those findings were shocking, and led to my conclusion that the organisation was not fit for purpose. This full report expands on that work and incorporates feedback from recent discussions with user groups and a larger number of staff.
The findings of the review highlight 10 key conclusions and provide specific recommendations for improvement, which I fully support. Notably, the review recommends that the CQC should:
Rapidly improve its operational performance.
Rebuild expertise within the organisation and relationships with providers in order to resurrect credibility.
Review the single assessment framework to make it fit for purpose.
Clarify how ratings of providers are calculated and make the results more transparent.
Continue to evolve and improve its assessments of local authorities.
Formally pause its assessments of integrated care systems (ICSs).
The review also recommends that the Department of Health and Social Care should strengthen its arrangements for sponsorship of the CQC, a recommendation upon which my Department has already acted.
Significant work is already under way to act on these findings. Last week, the CQC announced that Sir Julian Hartley will be appointed as the new chief executive of the CQC. This is a significant step forward as Sir Julian’s experience of turning around large, complex health organisations will be vital as the CQC embarks on its improvement plan. He will be supported by sector expertise through the appointment of a number of chief inspectors.
Following the publication of the interim report, the CQC commissioned Professor Sir Mike Richards to undertake a review of the single assessment framework. Findings from the first part of Sir Mike’s report will also be published by the CQC today so that both reports can be read together.
In response to the recommendations that are additional to the interim report, we are working with the CQC and the adult social care sector to ensure that local authority assessments evolve in a way that maximises their value in driving outcomes for people who draw on care and support, and their carers. I agree with Dr Dash’s recommendation to pause ICS assessments, which have not yet launched, to allow the CQC to focus on getting the basics right before introducing new functions. I am working on next steps.
By implementing Dr Dash’s recommendations, the CQC will be better positioned to fulfil its mandate of ensuring that everyone receives safe, high-quality care. A strong regulator is critical to the safety and effectiveness of our health and care system, and I am personally determined that its performance improves so that it can regain the confidence of both the public, and the health and care system.
Following the conclusion of this review, I have asked Dr Dash to lead a review of patient safety in the wider health and care landscape in England, for which I am also publishing the terms of reference today on www.gov.uk. The primary task of this review is to assess whether the current range and combination of patient safety organisations delivers effective leadership, listening, learning, and regulation to the health and care system in relation to patient and user safety.
Subject to the outcome of this second review, I will also ask Dr Dash to conduct a third review on quality and its governance. Further detail on this third review will be forthcoming in due course.
[HCWS133]
Fuller Inquiry: Response to Phase 1 Report
Wes Streeting Excerpts(1 month, 2 weeks ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
On 28 November 2023, the report of phase 1 of the Fuller Independent Inquiry was published. Phase 1 of the inquiry looked into how David Fuller’s appalling crimes in the mortuaries at Maidstone and Tunbridge Wells NHS trust remained undetected for so long.
I wish to express my deepest sympathies to the victims’ families and reassure them that lessons will be learnt.
The inquiry found highly concerning failings in the trust’s running, management, and oversight of the mortuaries, and that it was due to this uncontrolled environment that David Fuller was able to offend undetected. Management, governance and regulation failures, alongside poor compliance with standard policies and procedures, and a persistent lack of curiosity, all contributed to the creation of the environment in which David Fuller was able to offend for 15 years without ever being suspected or caught.
The 17 recommendations—16 for the trust and the remaining one for Kent county council and East Sussex county council—made by the inquiry in phase 1 aim to prevent anything similar happening again at the trust.
Today I am updating the House on the response to those recommendations. The trust published an assurance statement in February 2024 on the implementation of the recommendations from the phase 1 report. This sets out the progress made to implement the inquiry’s recommendations.
The range of actions taken by the trust include requiring that non-mortuary staff and contractors are always accompanied by another staff member when visiting the mortuaries; controlling access to mortuaries using swipe cards; mandating contractors to renew security clearances every three years; and installing CCTV coverage monitoring access to and from mortuary areas. The trust board is also providing greater oversight and assurance of legally regulated activity in the mortuary.
I am also reassured that NHS England’s south-east regional team held monthly oversight meetings with the trust between November 2023 and April 2024—in partnership with Kent and Medway integrated care board—to ensure progress against the inquiry’s recommendations and to review evidence of the trust’s progress in delivering its action plan. Ongoing compliance with the inquiry’s recommendations will be monitored by NHS England through regular regional oversight meetings with the trust, and through other channels as appropriate.
Kent county council and East Sussex county council have reviewed contractual arrangements with the trust and confirmed that the contracts include terms requiring that licensing and regulatory requirements are met to ensure the deceased are at all times treated with dignity and respect.
Phase 2 of the independent inquiry will consider whether procedures and practices in hospital and non-hospital settings, where deceased people are kept, are sufficient to safeguard the security and dignity of the deceased.
In light of the disturbing events in Hull earlier this year, which brought into sharp focus the lack of regulation and oversight in the funeral sector, we have agreed that the inquiry will today publish an interim report on the findings from its funeral sector module. This will provide recommendations on safeguarding the security and dignity of the deceased in that sector.
The Government are committed to preventing any similar atrocities happening again and ensuring that the deceased are safeguarded and treated with dignity.
[HCWS132]