2023 Agenda for Change Deal: Non-pay Workstreams

Wes Streeting Excerpts

Wednesday 23rd April 2025 Written Statements

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

Today I am updating the House on work under way to improve the working lives of NHS staff.

The 2023 Agenda for Change (AfC) pay deal, agreed between the previous Government and the NHS Staff Council, included 10 commitments to look at issues that impact NHS staff. Some of these commitments have already been fulfilled; however, five of the commitments involved representatives from the Department, the NHS Staff Council, NHS Employers and NHS England working collaboratively to produce recommendations for Government to consider.

These five commitments included: identifying ways to support the fair and consistent application of the NHS job evaluation scheme (JES), ways to improve nurse career progression, options to tackle violence and aggression against NHS staff, ways to reduce agency spend through the NHS terms and conditions, and options to improve support for newly qualified healthcare registrants.

I have now carefully considered each of the 37 recommend- ations that have been made, in the context of the extremely challenging fiscal situation and other departmental priorities.

I am delighted to inform Members that I will be taking forward 36 out of the 37 recommendations at this time, which will have a considerable and positive impact on the NHS workforce. The full list of recommendations has been published at https://www.nhsemployers.org/articles/nhs-staff-council-joint-statement-2023-non-pay-commitments I will continue to update my colleagues as we work in partnership with NHS Employers to improve the working lives of colleagues across the NHS.

The NHS should always be a great place to work, regardless of job role or location. Staff should be free from fear of violence, aggression or discrimination and I know that the Minister for Secondary Care, my hon. Friend the Member for Bristol South (Karin Smyth), looks forward to working closely with colleagues in the Social Partnership Forum to implement all the recommendations to better protect staff from the risk of violent behaviour. This includes encouraging a reporting culture where all incidents of violence and aggression are reported, the consistent collection of data, and developing a standard approach to post-incident support for all staff that are impacted.

Supporting career progression for our nurses is another important aspect of this work. As a result of these recommendations, our ethnic minority and internationally educated nurses should receive better and more consistent support for their career progression through six-monthly career reviews and more consistent recognition of their overseas experience. In combination, all the recommendations will have a positive impact on the experience of our highly valued nursing staff.

I wanted to take this opportunity to particularly highlight the importance of accurate and consistent application of the NHS job evaluation scheme (JES). Staff should expect to be paid correctly for the work that they are asked to deliver by their employer, as is their contractual right. That is why I am particularly pleased to be accepting the package of recommendations relating to improving local job evaluation practice.

The NHS JES underpins the AfC contract as the mechanism for determining the pay bands for all posts under the NHS terms and conditions (Agenda for Change). It is the responsibility of each NHS employer to comply with the Equality Act 2010 which mandates equal pay for work of equal value.

All NHS organisations should have the necessary resources and skills in place to be confident that they are correctly and robustly applying the NHS JES; however, we know this is not the case. While I know there are some areas where this is working well, this is not consistent across all organisations. I want to be clear that my expectation is that the NHS JES is applied correctly and robustly throughout the whole of the NHS, underpinned by partnership working between employers and trade unions at a local level, to ensure that all staff are paid correctly for the work they are asked to deliver.

Further information and guidance will be developed with the NHS Staff Council to support local partnerships to apply the NHS JES correctly.

These recommendations will restore confidence in the NHS JES and build essential capacity to enable proper application of the scheme. With the roll-out of a new national job evaluation software solution, we are seeking to monitor banding outcomes and improve efficiency by making the current administrative functions easier and more consistent, which will in turn reduce administrative costs locally.

Next steps

I have now instructed officials to work with NHS England, the NHS Staff Council, the Social Partnership Forum and NHS Employers to agree an implementation plan to phase the delivery of the non-pay measures over the next two years. This will minimise the potential impact on resource across the system.

This Government have ambitious plans for the NHS, and we are getting the health service back on its feet through our plan for change, delivering over 2 million extra appointments and cutting hospital waiting lists. A vital part of these plans is to improve the working lives of our NHS staff, and that is why we are announcing this support package to tackle violence and improve career progression opportunities for staff. We recognise that NHS productivity can be impacted by poor workplace experience for staff, which we are addressing through these measures. We are in the process of developing a 10-year health plan and a refreshed long-term workforce plan to set this out comprehensively. This work will ensure that we not only have the right people in the right places to deliver the care patients need, but also that the NHS is a great place to work for our staff.

I am incredibly grateful to all those involved who worked so hard to produce these recommendations.

I will continue to keep Parliament updated on the progress of this work.

[HCWS597]

Clinical Trials and Health Data Research Service

Wes Streeting Excerpts

Tuesday 8th April 2025 Written Statements

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

Today I am updating the House on plans to create a new Health Data Research Service and fast track the set-up of clinical trials to accelerate the development of the medicines and therapies of the future. These changes will improve patient care and help to make Britain the best place in the world for medical research.

We will invest up to £500 million to establish a new Health Data Research Service. This will improve access to data for medical research by providing a secure single access point, meaning a researcher does not have to navigate different systems or make multiple applications for information for the same project. This will unlock the power of NHS data to transform research and lead to breakthroughs that improve care for patients.

The Wellcome Trust will be the first charitable funder supporting this groundbreaking initiative, committing an additional £100 million towards its development. The service will be hosted for at least the first five years at the Wellcome Genome Campus near Cambridge, leveraging the campus’s world-class facilities and expertise.

We will involve the public as we design the service, building trust and understanding through transparent communication and discussion about how patient data is used to deliver health benefits to patients across the UK.

We will work closely with Wellcome and other stakeholders to ensure the successful implementation of a service that will drive faster research that benefits patients sooner.

This Government’s work to make the UK a world-leading destination for commercial interventional clinical trials also supports our clear focus on driving economic growth, alongside improving health outcomes for patients and the public.

We will also accelerate clinical trials and deliver radical improvement in regulatory, set-up and recruitment processes over the next year. This will help to bring down the time it takes to move from the trial being submitted for regulatory approval from over 250 days to 150 days.

We will do this by streamlining approval processes for clinical trials by moving to standardised contracts, with contracting undertaken by a single lead research site. We will reduce the unnecessary duplication of checks that can be best conducted centrally. We will publish NHS trust level set-up performance data for the first time, and continue to work with industry and the Association of the British Pharmaceutical Industry to improve data on our metrics to compare our performance with international competitors.

We will also implement the new clinical trials regulatory framework announced in December 2024 by the Medicines and Healthcare products Regulatory Agency, to speed up trial approvals and encourage innovation in trial design without compromising patient safety.

I will continue to keep Parliament updated on the progress of this work.

[HCWS587]

Mental Health: Expected Spend for 2025-26

Wes Streeting Excerpts

Thursday 27th March 2025 Written Statements

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

I am today publishing this third annual statement, following the one made in March 2024 by my predecessor. The Health and Care Act 2022 introduced a statutory requirement for the Government to publish an annual statement setting out expectations for NHS mental health services spending. The statement aims to strengthen the accountability and transparency on decisions and spending relating to mental health, as part of the Government’s commitment to improve mental health services.

It also supports the Government’s commitment to uphold the mental health investment standard, which requires that integrated care boards’ spending on mental health grows at least in line with growth in overall recurrent funding allocations. This statement covers ICB spend on mental health within scope of the mental health investment standard, as well as national spending on mental health through transformation funding and through NHS England’s specialised commissioning. I am pleased to update the House that we will meet the mental health investment standard for the coming year.

Owing to the statutory requirement to make this statement before Parliament ahead of the new financial year, the figures for 2025-26 are the best current estimate based on projections that take account of the NHS planning guidance allocations, which were published on 30 January 2025. Figures for 2024-25 are based on the month 11 forecast, as full-year spend is not yet available. There have been minor changes to the recurrent baseline in 2023-24 due to final adjustments at year end, while the 2024-25 recurrent mandate now includes the impact of additional funding provided for elective recovery and the 2024-25 pay awards. Our 2025 mandate lays the foundations for longer-term reform and included improving the mental health of the nation as a priority of this Government and for the NHS.

I recently announced changes to the NHS operating model to move power from central Government to local leaders. The Darzi investigation highlighted that there were too many targets set for the NHS, which made it hard for local systems to prioritise their actions or be held properly accountable. We are giving systems greater control and flexibility over how funding is deployed to best meet the needs of their local population. The NHS planning guidance for 2025-26 sets out the first steps for reform and the immediate actions we are asking systems to take to deliver on the three big shifts needed: to move healthcare from hospitals to the community, analogue to digital, and sickness to prevention.

As stated above, I am committed to the mental health investment standard to support this Government’s national mental health objectives and, as outlined in the planning guidance, we expect all integrated care boards to meet the MHIS in 2025-26. Ringfenced funding for mental health will support the delivery of our key priorities, increase the number of children and young people accessing services, reduce local inequalities in access, and improve productivity. This commitment will support the delivery of effective courses of treatment within NHS talking therapies and increase access to individual placement and support, so we can reach those in most need of support while also supporting the Government’s objectives on economic growth.

In financial year 2024-25, mental health spending amounted to £14.9 billion and all 42 integrated care boards are forecasting to meet the mental health investment standard. Real-terms spending on mental health in 2024-25 is forecast to be £695 million higher than in 2023-24.

For 2025-26, mental health spending is forecast to amount to £15.6 billion. This represents another significant uplift in real-terms spending on mental health— £320 million—compared with the previous financial year. Real-terms growth in budgets will enable us to continue the roll-out of our manifesto commitments, including recruiting 8,500 mental health staff, modernising the Mental Health Act, providing access to specialist mental health professionals in every school, and creating a network of community Young Futures hubs.

The proportion of spend is almost exactly the same as it was last year, with a difference of just 0.07%. This is because of significant investment in other areas of healthcare. Much of this investment in other areas, such as investment to improve general practice, will also have secondary benefits for mental health care.

There are also important elements of mental health spending that are not included in these figures. This includes capital spending, where we have committed £75 million of investment to reduce out-of-area placements, as well as prescribing for mental health, spend on continuing healthcare and NHS England’s routine spend on training new mental health staff.

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 25th March 2025 Commons Chamber

[Lloyd Hatton (South Dorset) (Lab)]

1. What steps he is taking to shift care from major hospitals into community hospitals.

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

On behalf of His Majesty’s Government, I congratulate the hon. Member for Strangford (Jim Shannon) on reaching his 70th birthday—I think you said 70th, Mr Speaker, but I am sure you meant 60th.

In response to my hon. Friend the Member for South Dorset (Lloyd Hatton), we promised in opposition to transform the NHS into a neighbourhood health service, and we have hit the ground running. As a first step, we have announced the biggest boost to GP funding in years—an extra £889 million—which will recruit 1,000 more GPs. We are delivering 700,000 extra urgent dental appointments, and we have given adult and children’s hospices a once-in-a-generation £100 million funding boost. At the same time, we are delivering our plan for change and have cut waiting lists for five months in a row. Change has begun, but the best is still to come.

[Lloyd Hatton]

I, too, pass on my best wishes to the hon. Member for Strangford (Jim Shannon).

In South Dorset we urgently need to restore clinics and shift services back into our community hospitals in Weymouth, Portland, Swanage and Wareham. Sadly, the previous Conservative Government hollowed out those community hospitals, meaning that services left our towns to go further and further up the road. Combined with poor transport links, this means that many local people in my patch find it difficult to access the care they need. With that in mind, what steps is the Secretary of State taking to restore clinics and services in our community hospitals, and will he support my campaign to restore the chemotherapy clinic at Wareham community hospital?

[Wes Streeting]

The big thrust of our 10-year plan will be to deliver on the three shifts: from hospital to community, from analogue to digital, and from sickness to prevention. We believe that by moving services closer to people’s homes—and, indeed, into their homes—we will be able to provide faster diagnosis and faster access to treatment, which will be better for patients and for taxpayers. Through the reforms we are making to the structure of NHS England and the governance of the NHS, we are also presiding over the biggest devolution in the history of the NHS, with more powers and decisions taken closer to the communities they serve. In that spirit, I urge my hon. Friend to make representations locally to his integrated care board, as I know he is doing. Ministers will also be open to receiving his representations.

[Sir Oliver Dowden (Hertsmere) (Con)]

Following the Government’s regrettable decision not to fund Watford general hospital’s refurbishment in this Parliament, providing community care facilities in a town such as Borehamwood in my constituency—a significant town without its own dedicated facilities—is more important than ever. Will the Secretary of State undertake to use his offices to urge the ICB and others to get their act together so that we can finally have those facilities in Borehamwood?

[Wes Streeting]

I am very sympathetic to the argument that the right hon. Gentleman makes about the importance of neighbourhood health services in Borehamwood, and indeed in towns and communities across the country. What I am not sympathetic to is a former Deputy Prime Minister complaining about the state of the NHS, which he played a key part in creating when he sat around the Cabinet table.

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

One in three hospital admissions occurs in a person’s last year of life, and 43% of people will die in an NHS hospital. Clearly, that is not acceptable when people are at their frailest. What is my right hon. Friend doing to invest in virtual wards so that we can keep those people at home, and in the district nurse workforce to ensure that district nurses have a proper career structure and that theirs can be a profession of choice once again?

[Wes Streeting]

My hon. Friend is absolutely right about the innovation and the impact of virtual wards. I have seen at first hand the impact they can have—not just in providing better value for taxpayers and freeing up hospital beds for those who genuinely need to be in hospital, but in providing what everyone wants, which is to receive high-quality care in the comfort of their own home wherever possible. That will be a big part of our 10-year plan, and of course, it will be underpinned by really good community nursing and community healthcare teams.

[Lisa Smart (Hazel Grove) (LD)]

Stepping Hill hospital in Hazel Grove has a huge repairs backlog. Patients are having to park miles away to get to the hospital, corridors have been flooded and there have been frequent power cuts. Alongside Stockport council, the local hospital trust and the community, I am calling for an additional site in Stockport town centre, whether that is a diagnostic centre or otherwise. What assurance can the Health Secretary give my constituents that they will be able to get the health services they need closer to them, and what support can he provide?

[Wes Streeting]

I am well aware of the challenges at Stepping Hill hospital and the need for support and investment in services in Stockport, not least thanks to the representations of my hon. Friend the Member for Stockport (Navendu Mishra). We are looking carefully at this situation and are committed to working with leaders locally to try to improve the quality of and access to services to give local people what they deserve.

[Andrew Cooper (Mid Cheshire) (Lab)]

A new state-of-the-art surgical centre is set to open at the Victoria infirmary in Northwich in the next few weeks. The new facility will be a centre of excellence and a regional hub for outstanding cataract care, and it is an excellent example of how we can reduce pressure on our major hospitals, while making the best use of facilities in the heart of our communities. Will the Secretary of State join me in congratulating the Mid Cheshire hospitals trust on completing this project? Can I invite him to join me on a visit to the centre in the coming months?

[Wes Streeting]

I join my hon. Friend in congratulating the local trust on the work it is doing and the impact it is having, and I would be delighted to pay a visit as soon as my diary allows.

[Julia Lopez (Hornchurch and Upminster) (Con)]

The new St George’s NHS hub in Hornchurch has freed up space in Queen’s hospital in Romford to remodel the accident and emergency there. Will the Secretary of State now fund that remodelling, so that our constituents can get better emergency care?

[Wes Streeting]

I am grateful to the hon. Member for raising the need for investment in the accident and emergency at Queen’s hospital in Romford. As she alluded to, that department serves my constituents, too, so this will be a rare occasion at the Dispatch Box where I urge and encourage her to lobby the Minister of State, my hon. Friend the Member for Bristol South (Karin Smyth), because in such decisions I must recuse myself. However, she will know where my sympathies lie.

[Rosie Wrighting (Kettering) (Lab)]

2. What assessment his Department has made of the adequacy of access to NHS dental services.

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

I am grateful to Professor Sullivan for her report. Sex and gender identity are not always the same, and it is important for patients that we record both accurately. I know the House will share my concern at some of the findings from Professor Sullivan’s report, such as trans patients not being invited for cancer screening because of how their gender is recorded. I can assure the House that I am already acting on reports. Last week, I instructed the health service to immediately suspend applications for NHS number changes for under-18s to safeguard children. Taking such action does not prevent the NHS from recording, recognising and respecting trans people’s gender identity.

[Joani Reid]

I thank the Secretary of State for his response, which will give much-needed reassurance to patients across the UK. Any public body that fails to accurately record sex and instead conflates it with gender puts people at serious risk of harm. Unfortunately, this type of organisational capture has been widespread across Scotland, with devastating consequences. Can the Secretary of State assure me that he will raise this issue with his counterparts in the Scottish Government to ensure that NHS Scotland does not put my constituents at risk?

[Wes Streeting]

I will absolutely undertake to share the approach we are taking with my counterparts across the United Kingdom. The approach I have always taken is one that understands the importance of biological sex, that recognises, understands and supports that someone’s gender identity may not always match their biological sex, and that seeks to navigate a way through what has been an extremely toxic and sometimes harmful debate in a way that protects the sex-based rights of women and protects trans people and their identity. I know that my colleagues across Government are taking an equally sensitive approach, and I think it would be in everyone’s interests if we saw a similar approach across the whole of the United Kingdom. It is important not just in the provision of services, but in accurate data and research, that we make that distinction, which does not in any way undermine respect for people’s gender identity.

[Liz Jarvis (Eastleigh) (LD)]

The inquest into the tragic death of a young woman who lived in Eastleigh has highlighted the importance of continuity of specialist care for vulnerable people who move home. My constituent, Alex, is still waiting for an appointment for ongoing specialist care three years after moving to Eastleigh. Will the Minister meet me to discuss the provision of mental healthcare in my constituency?

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

Given the findings of the Sullivan review on patient and health safety, which came about as a result of inaccurate and poor data collection, can the right hon. Gentleman confirm what meetings he has had with Secretary of State for Science, Innovation and Technology to discuss the reliability of the data on sex that is intended to be used by the digital verification platform in the Data (Use and Access) Bill?

[Wes Streeting]

I am grateful to the shadow Minister for her question. I speak to the Science Secretary on too frequent a basis—on a daily basis. He and I are both looking very carefully at the findings of the Sullivan review and working through its implications for both the health and care services, for which I am responsible, and for the Government digital and data services, for which he is responsible.

[Dr Johnson]

The UK Health Security Agency, for which the Secretary of State is responsible, publishes health statistics. This includes data on sexually transmitted infections, which is published by sexual orientation and sex. However, a footnote states that women are defined in the dataset as “women and trans women”, which does somewhat undermine the value of the data. What will the Secretary of State do to ensure that data is not just collected properly, but published and presented in a way that is most clinically useful?

[Wes Streeting]

The shadow Minister raises a good example of how conflation of sex and gender identity is not helpful both in terms of data analysis and of recognising health inequalities. It is also not helpful in making sure that we understand variances between people based on their different backgrounds and characteristics and that we provide targeted, personalised and effective healthcare that deals with healthcare inequalities. That is why we are carefully studying the recommendations made by Professor Sullivan, with a view to making sure that we are meeting the needs of everyone, including the trans community, who I understand, not least because of the way that the debate has been conducted in recent years, are anxious about the implications of the report. However, I genuinely think that the report will lead to better, more inclusive and fairer outcomes for everyone, including the trans community.

[Max Wilkinson (Cheltenham) (LD)]

5. What steps his Department is taking to improve cancer care in the west of England.

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[Sojan Joseph (Ashford) (Lab)]

7. What steps his Department is taking to reduce the number of people waiting for NHS treatment.

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

The 18-week standard for elective care has not been met for almost a decade. That is the legacy of the Conservative party. Our plan for change commits us to cutting waiting lists from 18 months to 18 weeks by the end of this Parliament through a combination of investment and reform. Since we took office, the waiting list has reduced by over 190,000. We achieved our manifesto pledge of 2 million extra appointments seven months early, and waiting lists have fallen five months in a row. A lot done, but a lot more to do. Change has begun, and the best is still to come.

[Sojan Joseph]

I welcome that NHS waiting lists for physical health have fallen for the last five months in a row and that NHS waiting lists are down by almost 200,000 since Labour was elected, but with people who have mental health conditions eight times as likely to have to wait 18 months for treatment, what steps are the Government taking to ensure that we see the same progress in waiting times for both mental and physical health treatments? Can they deliver a parity of esteem that the Opposition failed to achieve in their 14 years in power?

[Wes Streeting]

I am grateful to my hon. Friend for his question and for his long-standing commitment to improving mental health services. Lord Darzi highlighted that those waiting over a year for mental healthcare outnumbered the entire population of Leicester. We are committed to tackling this. We will fix the broken system by recruiting an extra 8,500 mental health workers, introducing access to a specialist in every school and rolling out community Young Futures hubs in England. We will shortly be publishing before Parliament our mental health investment standard report, which will show that when it comes to mental health this Government are putting their money where their mouth is.

[Sir Christopher Chope (Christchurch) (Con)]

Waiting times for patients living in the village of Burton outside Christchurch could be drastically cut if the local integrated care board were to approve the creation of a new branch surgery. That application has been outstanding for more than four months. Will the Secretary of State put a bomb under Dorset ICB and get it to approve it straight away?

[Wes Streeting]

That sounds like an invitation to commit a criminal offence, and I think I will resist the temptation. I am sure that the ICB has heard the hon. Gentleman’s forceful representations, and we will make inquiries to get him an update.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Shrewsbury and Telford hospital trust has some of the longest waiting lists in the country for cancer and A&E, among other areas. It has been receiving national mandated support from NHS England’s recovery support programme. NHS England also provides support to hospital trusts that are struggling with excessive waiting lists through its Getting It Right First Time programme. Given the announcement to abolish NHS England, will the Secretary of State reassure my constituents that there will be continued support for hospital trusts such as Shrewsbury and Telford with unacceptable waiting times, and a clear pathway to improvements for patients who deserve better?

[Wes Streeting]

Yes is the short answer. Removing the duplication, waste and efficiency that came with having two head offices for the NHS will lead to better, more effective and streamlined decision making, but that will not in any way detract from the support that the hon. Member describes. In fact, we should see more support and, crucially, more investment going to the frontline as a result of the savings, efficiencies and improvements that we are making.

[Sarah Hall (Warrington South) (Lab/Co-op)]

8. What recent progress his Department has made on implementing the hub and spoke model for community pharmacy.

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[Anneliese Midgley (Knowsley) (Lab)]

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

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

Since I reported to the House on the Government’s plans to abolish NHS England, hammering the final nail into the coffin of Lord Lansley’s disastrous 2012 reorganisation, the reforms have been welcomed almost universally across Parliament—with the exception of Lord Lansley. I am pleased to report that the new chief executive of NHS England, Sir Jim Mackey, has appointed the transformation team that will deliver better care for patients and better value for taxpayers’ money. We are working closely together as we finalise the 10-year plan for health, which will be published around the spending review in June.

[Anneliese Midgley]

My constituent June is 74 years old and has stage 4 cancer. She had to queue—not phone, but queue—at her GP surgery at 8 am, only not to be given an appointment. What is the Secretary of State doing to stop such dreadful situations?

[Wes Streeting]

I am very sorry to hear of June’s experience. It illustrates why our determination to end the 8 am scramble for appointments is so necessary, starting with a new requirement for practices to make online appointment requests available through core hours, as well as the big uplift we have invested into general practice. I hope that will start to see improvements so that people like June will not be left queuing outside in the cold.

[Mr Speaker]

I call the shadow Secretary of State.

[Edward Argar (Melton and Syston) (Con)]

May I take this opportunity to thank the Secretary of State for his kindness following the death of my father earlier this month? It was very much appreciated.

I welcome the moves to streamline decision making and improve efficiency in the context of the Secretary of State’s NHS England announcement, if he genuinely drives decentralisation to integrated care boards. However, in a written answer on 21 March, the Minister for Secondary Care said:

“We recognise there may be some short-term upfront costs as we undertake the integration of NHS England and the Department”.

For clarity, can the Secretary of State confirm what the quantum of those reorganisation costs will be and the date by which they will have been recouped?

[Wes Streeting]

I am sure that the whole House will want to send our condolences to the right hon. Gentleman following the loss of his father. It is good to see him back in action—if not always back in action.

Given the scale of the job reductions and savings that we are seeking to make, the total quantum will be determined once the final shape of the organisation is determined.

[Edward Argar]

Can I also welcome, as I did in January, the Secretary of State’s commitment to seek to work cross party on the future of social care? He was right and I welcomed that at the time, but like him and many others, we are all keen to see progress. Can he update the House on when he anticipates the cross-party talks that were postponed in February will be rescheduled to take place?

[Wes Streeting]

Baroness Casey will be making contact with all party groups in order to set dates with parties across this House very shortly, and of course she will be kicking off her commission in April, which is now only days away.

[Alan Strickland (Newton Aycliffe and Spennymoor) (Lab)]

T2.   It has been brilliant to meet residents who in recent weeks have had their operation dates brought forward, thanks to the additional evening and weekend appointments that the Labour Government have funded, but we know that too many people are still waiting too long. What more will Ministers be doing to really drive down waiting lists in my community and across the country?

[Wes Streeting]

As my hon. Friend says, we have brought NHS waiting lists down five months in a row, including during the peak winter pressures. We have delivered the 2 million more appointments we promised seven months early, and we published our elective reform plan at the beginning of the new year with the Prime Minister, which sets out the combination of measures, the investment and the reform that will ensure that we deliver the shorter waiting times and the faster access to treatment that my hon. Friend’s constituents and people right across the country deserve. I look forward to keeping him updated.

[Mr Speaker]

We are not going to get everyone in unless we pick up the pace. The Liberal Democrat spokesperson will set a good example.

[Helen Morgan (North Shropshire) (LD)]

In last night’s “Panorama” programme, the Secretary of State was reported to have said that he did not need to wait for a review to put more money into social care, which we agree with. If that is the case, will he explain why the Casey commission will take three years, and will he instead commit to getting it done this year in order to fix the social care crisis straightaway?

[Wes Streeting]

Phase 1 of the Casey commission reports next year and the final Casey report is due by 2028, but the Chancellor has already announced an increase in funding for social care in the Budget, through means that the hon. Lady’s party regrettably seems to oppose.

[Alistair Strathern (Hitchin) (Lab)]

T3.   It is impossible not to be inspired by my constituent Hayley and the bravery of her daughter, Lily, after Lily was diagnosed with an optic pathway glioma at the age of just one. Hayley stepped back from work not just to look after Lily but to make sure she was able to campaign for change. The Government’s commitment to a national cancer plan is welcome, but with brain tumours not typically being staged or screenable, how can we ensure that they are not overlooked as part of the plan’s development?

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[Andrew George (St Ives) (LD)]

T4. In reviewing the NHS workforce plan, will Ministers urgently review the pay and status of registered nurses, who are, after all, the backbone of the NHS? Many are now dependent on food banks, thousands are saddled with student debt, and most will expect never to rise beyond band 5, which is a maximum of £35,000 a year.

[Wes Streeting]

The Chancellor took almost immediate action to deliver the uplift in pay for NHS staff that they deserve. We are working closely with the Royal College of Nursing, Unison and others ensure that we tackle the challenges of low pay in the nursing profession that the hon. Member describes.

[Patricia Ferguson (Glasgow West) (Lab)]

T5. Since being elected, I have been contacted by a number of constituents registered with a GP in Scotland who find themselves unable to get medication for which they have a prescription while visiting England. Will my hon. Friend take steps to encourage NHS England and NHS Scotland to work together to find a solution that works for patients?

[Ian Sollom (St Neots and Mid Cambridgeshire) (LD)]

T7.   In the light of the recently announced 50% staffing reductions across integrated care boards, has the Secretary of State made any assessment of how those cuts to the Cambridgeshire and Peterborough ICB will delay the delivery of essential new primary care services for my rapidly growing constituency, particularly in Northstowe, Cambourne and St Neots, where thousands of constituents are already facing unacceptable difficulties in accessing care?

[Wes Streeting]

Despite the significant uplift announced by the Chancellor at the Budget, system financial returns during the planning round suggested an overspend for the coming year of between £5 billion to £6 billion. When I said I would not tolerate overspending in the NHS, I meant it. When I said I would go after unnecessary administrative costs, duplication and bureaucracy, I meant it. That is what this Government are doing to protect frontline services.

[Jenny Riddell-Carpenter (Suffolk Coastal) (Lab)]

In Saxmundham in my constituency, Dr Havard has led a campaign for 20 years to transform the healthcare centre into a one-stop community healthcare hub. His practice has already expanded services, transforming health locally. Does the Minister agree that the Saxmundham healthcare hub is an excellent example and model for what this Government are trying to do to transform community healthcare?

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[Mr Gagan Mohindra (South West Hertfordshire) (Con)]

My constituents in South West Hertfordshire remain concerned about the significant delay to the redevelopment of Watford general. With the Chancellor already bringing a second emergency Budget before the House tomorrow, and with care homes, hospices and charities facing unsustainable pressure from this Government’s national insurance increases, what reassurances can the Minister give my constituents that the Labour party truly care about healthcare, rather than scoring political points?

[Wes Streeting]

The irony! There is one big difference between what this Government are doing and what the Conservative party did for 14 years, which is that this Government will actually deliver a new Watford general hospital where the Conservative party failed.

[Chris Hinchliff (North East Hertfordshire) (Lab)]

Do Ministers agree that a logical conclusion of the Darzi report is that the national care service that we are committed to creating must be free at the point of use? As Lord Darzi found, as long as the social care system remains means-tested and the NHS is a universally free service, unmet care needs will continue to put unsustainable pressure on our health services.

[Cameron Thomas (Tewkesbury) (LD)]

General practitioners in my constituency have consistently restructured over 10 years of constant systemic and economic pressures. How will the Minister convince the Treasury to exempt GPs from the increase to national insurance contributions, and show my GPs that he has their back?

[Wes Streeting]

It was thanks to the decisions taken by the Chancellor in the Budget that we were able to award £889 million for general practice. That is why the Minister for Care was able to get the GP contract agreed for the first time since the pandemic. Opposition Members cannot continue to welcome the investment and oppose the means. They have to spell out where they would cut services or raise taxes instead.

[Euan Stainbank (Falkirk) (Lab)]

Last year, my constituent Danielle was diagnosed with POTS—postural orthostatic tachycardia syndrome. She found herself unable to get out of bed and unable to speak for long periods. She could not receive care in Scotland. Specialist treatment does not seem to exist for POTS. What more can we do for people like Danielle, and what conversations has the Minister had with counterparts about establishing specialist treatment in Scotland?

[Charlie Dewhirst (Bridlington and The Wolds) (Con)]

I have twice invited Ministers to visit Bridlington district hospital with me to see its much-underutilised potential. In the light of the ongoing challenges faced by coastal and rural health services and the newly announced changes to integrated care boards, may I hope that it will be third time lucky, and extend that invitation once again?

[Wes Streeting]

We are delighted to receive the hon. Gentleman’s representations. We will look carefully at the case he makes and will consider visits as diaries allow.

[Tulip Siddiq (Hampstead and Highgate) (Lab)]

Much to my alarm, the North Central London ICB has recommended the closure of the maternity unit at the Royal Free hospital in my constituency. The Secretary of State knows the Royal Free well. Will he meet me to see how I can save my local maternity unit, which looked after me so well when I had gestational diabetes?

[Daisy Cooper (St Albans) (LD)]

Following my long-running campaign, I am grateful to the Government for finally updating the outdated Treasury rules that were preventing local health boards from spending more money on keeping city centre GP locations. Will the Government now issue guidance to local health boards and NHS trusts to accelerate the pooling of resources, so that we can get more services out of hospitals and on to our high streets, especially as our high streets need extra footfall right now?

[Wes Streeting]

I am grateful to the hon. Member for all the work she has been doing on this issue. She is right: we need more integration of services, and we need to look at where we can share facilities to achieve better care for patients and better value for taxpayers.

[Naz Shah (Bradford West) (Lab)]

The former chair of my local trust, Bradford teaching hospitals NHS foundation trust, Dr Max Mclean, has today secured whistleblowing protection for himself in a landmark victory. Last week marked a year since a non-exec director at the trust was suspended, and a third non-exec director has put in an ET1 form to the employment tribunal. There appears to be a clear culture of targeting and witch-hunting whistleblowers at Bradford teaching hospitals trust. I appreciate the Secretary of State’s team supporting me, but given these recent developments, will he meet me?

[Wes Streeting]

I am grateful to my hon. Friend for raising these serious issues. There are issues of concern here, and she clearly describes a concerning situation for the local community. We need to look carefully at what is happening, and the Minister of State for Health, my hon. Friend the Member for Bristol South (Karin Smyth), would be delighted to meet her.

[Mr Richard Holden (Basildon and Billericay) (Con)]

Smile Dental Centre is in one of the least affluent parts of my community in Basildon. It is looking to expand and provide more NHS dental services, but it has come up against a few issues. Will the Minister, or one of his officials, meet me and Smile Dental Centre to see what we can unblock to deliver more dental health services for local people?

--- Later in debate ---

[Charlie Maynard (Witney) (LD)]

As the Secretary of State will know, in 2018, this House allocated £40 million of funding in memory of Dame Tessa Jowell, who was killed by a brain tumour. Seven years on, less than half of that money has been spent. The money is doing no good sitting in a bank, so will the Secretary of State please commit to spending that money within a decade of Dame Tessa’s death?

[Wes Streeting]

I am grateful to the hon. Gentleman for his question, as it gives me the chance to pay tribute to the late great Baroness Jowell, as well as to the work taking place in her name through the Tessa Jowell Brain Cancer Mission. There have been frustrating delays in getting funding out the door for the purpose for which it is intended. Ministers are looking carefully at this issue, and we want to make more progress more quickly, to ensure that families do not receive the same death sentence that our late friend did.

[Mr Speaker]

That concludes Question Time.

NHS England Update

Wes Streeting Excerpts

Thursday 13th March 2025 Commons Chamber

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

With permission, I would like to make a statement on the future of NHS England.

Since coming into office, this Government have made big strides in fixing our broken NHS. Under the Conservatives, the NHS suffered years of industrial action, costing taxpayers billions and costing patients more than 1 million cancelled operations and appointments. We negotiated an end to the resident doctors strike within three weeks. We have delivered the 2 million extra appointments we promised in our first year, and we did it seven months early. After 14 years of rising waiting lists under the Conservatives, we are finally turning the tide, cutting waiting lists for five months in a row, cutting waiting lists through the winter pressures and cutting waiting lists by 193,000 so far and counting. We have agreed the GP contract with GPs for the first time since the pandemic—our first step to bringing back the family doctor—and we have delivered the biggest uplift in hospice funding for a generation.

However, there should be no doubt about the scale of the challenge ahead. We inherited an NHS going through the worst crisis in its history, so there is no time to waste. We inherited public finances with a £22 billion black hole, so there is no money to waste. The urgency of the crisis means we have to go further and faster to deliver better value for taxpayers and better services for patients—something the Conservative party cannot even begin to speak to a record on.

Lord Darzi’s independent investigation into the national health service traced the current crisis back to the 2012 top-down reorganisation of the NHS by the right hon. Lord Lansley. The Darzi investigation said the reorganisation was “disastrous” and a “calamity without international precedent” that “scorched the earth” for health reform,

“the effects of which are still felt to this day.”

The Health and Social Care Act 2012 established more than 300 new NHS organisations, created a complex and fragmented web of bureaucracy and, to quote the Darzi investigation,

“imprisoned more than a million NHS staff in a broken system”.

Today, we are putting the final nail in the coffin of the Conservatives’ disastrous top-down reorganisation of the NHS.

There are more than twice as many staff working in NHS England and the Department of Health and Social Care today than there were in 2010—twice as many staff as when the NHS delivered the shortest waiting times and the highest patient satisfaction in history. Today, the NHS delivers worse care for patients, but is more expensive than ever before. The budget for NHS England staff and admin alone has soared to £2 billion. Taxpayers are paying more, but getting less. We have been left with two large organisations doing the same roles, with an enormous amount of duplication.

It is especially in times like these, when money is tight, that such bloated and inefficient bureaucracy cannot be justified. However, even if the Conservatives had not left a £22 billion black hole in the public finances, the Prime Minister would still be announcing the changes he is today, because every £1 that is wasted on inefficient bureaucracy—in good times or bad—is £1 that cannot be spent on treating patients faster, nor can it be spent on fixing our crumbling schools, lifting children out of poverty or putting money back into people’s pockets. There is always a duty on Ministers to get as much value for taxpayers’ money as is possible, and I cannot honestly say that it is achievable with the way that my Department and NHS England are set up today, nor can I say that the current set-up is getting the best out of the NHS.

I am sure Members will have heard their local NHS leaders complain about the top-down way in which the NHS is run. It is something I have heard for years. Now that I find myself at the peak of this enormous mountain of accountability, I do not just recognise the complaint; I agree with it. Frontline NHS staff are drowning in the micromanagement they are subjected to by the various and vast layers of bureaucracy.

In the Hewitt review, the former Health Secretary my right hon. Friend Dame Patricia Hewitt reported that one local service was required to send 250 reports and forms to NHS England and the Department of Health and Social Care in a single month. That is time and energy that is not being spent delivering care for patients. The review also concluded that having two organisations doing the same jobs has led to

“tensions, wasted time and needless frictional costs”.

Since coming into office I have sought to correct that, by building a one-team approach between my Department and NHS England, working towards our shared mission of building an NHS fit for the future. Today, the Prime Minister has announced that we are turning one team into one organisation.

I acknowledge that there are talented, committed public servants working at every level of the NHS and my Department, including at NHS England, who I have had the privilege of working with over the past eight months. The reforms we are announcing today are not a reflection on them. They have been set up to fail by a fragmented system that holds them back. The actions we are taking today will change that.

Work has already begun to strip out the duplication between the two organisations, and bring many of NHS England’s functions into the Department. NHS England will have a much clearer focus over this transformation period. It will be in charge of holding local providers to account for the outcomes that really matter: cutting waiting times, and managing their finances responsibly. And it is tasked with realising the untapped potential of our national health service as a single-payer public service: getting a better deal for taxpayers through central procurement; being a better customer to medical technology innovators, to get the latest cutting-edge tech into the hands of staff and patients much faster; and being a better partner to the life sciences sector, to develop the medicines of the future.

Over the next two years, NHS England will be brought into the Department entirely. These reforms will deliver a much leaner top of the NHS, making significant savings of hundreds of millions of pounds a year. That money will flow down to the frontline, to cut waiting times faster and deliver our plan for change. By slashing through the layers of red tape and ending the infantilisation of frontline NHS leaders, we will set local NHS providers free to innovate, develop new productive ways of working, and focus on what matters most: delivering better care for patients.

I cannot count the number of Conservatives who have told me in private that they regret the 2012 reorganisation and wish they had reversed it when in office. But none of them acted. They put it in the “too difficult” box while patients and taxpayers paid the price, because only Labour can reform the NHS. And this Government are proving that only Labour can be trusted to reform the state. The Prime Minister has committed to cutting the number of quangos. Today, we are abolishing the biggest quango in the world.

I am delighted that Sir James Mackey will be leading the transformation team, as the Chief Executive of NHS England. Jim has an outstanding track record of turning around organisations, balancing the books, driving up productivity, and driving down waiting times. He is putting in place a new transformation team to drive change, and alongside Dr Penny Dash as the incoming chair, I am delighted to have such a capable leadership team of radical reformers to lead NHS England with me through this transformation.

I also take this opportunity to place on record my heartfelt thanks to Amanda Pritchard, who has shown an outstanding commitment to our national health service over her decades of service—which I know remains undiminished. She has also been a rock of enormous support, not only in the past eight months, but also in the past few weeks as we have worked together with Jim preparing for this change. I also place on record my thanks to her deputy Julian Kelly, who is one of the most outstanding public servants of his generation, along with the rest of the leadership team departing at the end of the month. They deserve our thanks and best wishes for the future.

Change is hard. There will always be cautious voices warning you to slow down. However broken the status quo is, there will be those who resist any change away from it. But we should be in no doubt: we inherited a national health service going through the worst crisis in its history. Patients are waiting unacceptable lengths of time for an operation, a GP appointment or an ambulance. This Labour Government will never duck the hard yards of reform. We will take on vested interests and change the status quo, so the NHS can once again be there for us when we need it.

The Prime Minister has set an enormously ambitious target for the NHS: to cut waiting times for operations from up to 18 months to a maximum of 18 weeks by the end of this Parliament. That will require us to go further and faster than even the last Labour Government achieved, but patients in our country deserve nothing less. The reform the Prime Minister is setting out today will mean fewer checkers and more doers. It will cut through the complex web of bureaucracy, and devolve more resources and responsibility to the frontline, to deliver better value for taxpayers’ money and a better service for patients. It will set the NHS up to deliver on the three big shifts needed to make the service fit for the future: from hospital to community, analogue to digital, and sickness to prevention.

The NHS is broken, but it is not beaten. Together, we will turn it around. I commend this statement to the House.

--- Later in debate ---

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

I thank the Secretary of State for advance sight of his statement. It is disappointing, once again, that it was not made to the House first; in recent days, there have been numerous media briefings about this potential restructure.

Under new leadership on the Conservative Benches, we believe in a leaner and more efficient state. That means using resources effectively, reducing waste and preventing duplication, spending money where it is most beneficial. After all, the public understandably want to see the focus on patient care and not on backroom managers. Therefore, we are supportive of measures to streamline management, and we do not oppose the principle of taking direct control, but we need to know what steps will be taken to meet targets while all the upheaval happens. We need to know the specifics of what is being planned.

What are the timeframes for the abolition of NHS England? By what date will it be completed? How many people will be moved into different roles? How many people will lose their jobs altogether? How much money is that expected to save? Labour runs the NHS in Wales, which has the highest waiting lists and the longest waiting times in Great Britain. What lessons has Labour learnt from its failure in Wales?

NHS England, as the Secretary of State said, has just lost much of its leadership. Is that because they no longer had confidence in the Secretary of State, or because he did not have confidence in them? Perhaps he can tell the House whether Alan Milburn will keep his job in the upheaval. We also need to be clear that moving people into different roles will not fix the challenges that face the NHS.

The Secretary of State has spoken about taking direct control. That may help him ensure that the NHS stops wasting money on expensive diversity, equity and inclusion staff, and ensures that it provides dignity and privacy for female staff and patients, but what does it mean for clinical prioritisation? Will conditions that are less common and have less glitzy campaigns and fewer celebrity backers suffer because the Secretary of State now has political considerations? Does the Secretary of State have the bandwidth for this, given he has such a busy role already? How does the centralisation of power measure up with the commitment to give more powers to regional bodies and local integrated care boards?

In the first six months after entering office, the Government announced 14 reviews, consultations and calls for evidence, all of which require more staff. Are those jobs at risk, or are other pre-existing roles set to be cut? This announcement comes the same week as Labour’s Employment Rights Bill passes through the Commons. Is the Secretary of State getting a move on because he knows that red tape and bureaucracy will dramatically increase afterwards and make the decisions he has to take more difficult to deliver?

A drive to improve efficiency in the civil service and the management of the health service is welcome, but what about the NHS itself? The Government slimmed down our productivity plan and delivered a 22% pay rise in return for no modernisation or reform. How will those decisions improve efficiency? I asked the Department what proportion of people with a nursing qualification working in the NHS are in patient-facing roles, but the Minister said that they did not know. How can he use the skills and resources effectively if he does not know where those skills and resources are?

The Prime Minister is making a lot of noise about productivity and cutting waste, but he still refuses to set a target for cutting the civil service headcount. Thanks to the decisions he and the Chancellor took at the Budget, the size of the state is growing rapidly, not shrinking, while changes to national insurance contributions have diverted funding away from the frontline into compensating the Treasury. Ultimately, any restructure will be challenged by the Government’s continued failure to tackle immigration. While steps to improve efficiency in the healthcare service are welcome, these words ring hollow across Government.

[Wes Streeting]

I will take the more serious questions from the shadow Minister first. On timeframes, we will work immediately to start bringing teams together, as we have done with the one-team culture we have been building over the past eight months. I want the integration of NHS England into the Department to be complete in two years.

The shadow Minister asks about the reduction in the number of officials. NHS England has 15,300 staff; the Department of Health and Social Care has 3,300. We are looking to reduce the overall headcount across both by 50%, which will deliver hundreds of millions of pounds of savings. The exact figures will be determined by the precise configuration of staff, and we will obviously keep the House updated on that.

The shadow Minister asks about clinical leadership. One change we will be making with the transformation team is to have two medical directors succeeding Professor Sir Stephen Powis, whose departure from NHS England was planned long before these changes. There will be one medical director for primary care and one for secondary care, underpinning our commitment to the shifts we have described. I must say, there are enormous improvements to be made in clinical leadership for patient outcomes, patient safety and productivity, and I am demanding stronger clinical leadership to drive those improvements to productivity. Frankly, many consultants and clinical teams on the frontline will welcome that liberation—they are hungry for change.

The shadow Minister asks about the workforce data and complains that we have not been able to give her the precise answers. I agree: it is frustrating not having that precise information at my fingertips. I would gently remind her, though, on this as on so many things, that her party was in power for 14 years. She cannot very well complain eight months in given that they left us a woeful, embarrassing data architecture and infrastructure.

The shadow Minister asks about efficiency. Once again, she refers to the resident doctors deal as if it was a failure. The actual failure was leaving doctors on the picket line, not on the frontline, and wasting huge amounts of taxpayers’ money, with cancellations and delays to patients’ appointments, operations and procedures. We stopped that within weeks of coming into office. The deal does include reforms to improve productivity—if she is any doubt about the results, she should look at the fact that despite winter pressures, NHS waiting lists have fallen five months in a row.

Once again, we get the facile points about my right hon. Friend Alan Milburn, who is the lead non-executive board member for my Department. I honestly do not know why he bothers to pay for a mortgage; he lives rent-free in the Conservatives’ heads. They need to move on. By the way, just for the record: Alan Milburn has a record on the NHS that the Conservatives cannot even begin to touch.

The shadow Minister asks about confidence. I am delighted to be introducing a new transformation team. Different leadership challenges require different leadership skills. As I say, I have been really pleased to work with Amanda Pritchard for the past eight months, including on this transition; people should have no doubt about the confidence I have in her skills, talents and abilities, and I think she has a lot still to contribute to our NHS. We do not need to ask about confidence in the Conservative party; it is reflected in the scarce numbers on the Opposition Benches.

What is the lesson from Wales? The lesson is that when there is a Conservative Government in Westminster, the national health service suffers in England, Wales, Scotland and Northern Ireland. That is why we are creating a rising tide to lift all ships. I am sure we will see improvements across the United Kingdom. SNP Members, who are not in their place, do not have any excuses now. As I said before the election, all roads lead to Westminster, and the biggest funding settlement since devolution began is going down the road to Holyrood. There are no hiding places there for the SNP. If people want real reform of the NHS in Scotland, they should vote for Scottish Labour under Anas Sarwar and Jackie Baillie.

People can see here in Westminster the difference that new leadership provides. The shadow Minister laughably referred to new leadership in the Conservative party. Well, it is certainly leaner and meaner, but it is the same old Conservative party. The only thing that the Conservatives have shrunk is their own party. The only jobs that they have laid off are those of their poor party staff. The only thing that they are capable of changing—[Interruption.] Well, come to think of it, I do not think that there is anything they are capable of changing. Instead they look over their shoulder at a party leader who cannot even manage a five-aside team, let alone a country. The Conservatives are just so diminished as a party. I appreciate that it must be so painful for them to watch a Labour Government doing the things that they only ever talked about: reducing bloated state bureaucracy; investing in defence; reforming our public services; and bringing down the welfare bill. The public are asking: “What is the point of the Conservative party?” I bet they are glad that they chose change with Labour.

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

I applaud my right hon. Friend for his leadership and for the reduction in waiting lists, which we so desperately need. We all know that there is still a struggle with budgets in the health service—my excellently run Honiton hospital is facing a deficit for the first time in its history—so can he give more detail about how he will reform NHS procurement, so that we can use the purchasing power of the NHS to get more bang for our buck?

--- Later in debate ---

[Wes Streeting]

My hon. Friend is absolutely right about the need to improve procurement. One thing that Attlee and Bevan could not have predicted in 1948 is that the single-payer model of the national health service makes it ideally placed for this world of artificial intelligence, genomics, machine learning and big data. We must unlock that potential so that we have new treatments, new technology, productivity gains and efficiencies, but we also have to get the basics right on procurement. We have to change the culture of profligacy, routine deficits and routine over- spending. That is why, today, the leadership of NHS England has summoned to London chairs and chief executives from across the country to get an immediate grip on the £5 billion to £6 billion deficit that was already being baked in for the 2025-26 financial year. Those chairs and chief executives have just become so accustomed to the idea that Governments will just come in and bail them out.

I said before the election that there would be no release of money in winter, because winter is predictable. The NHS was given additional resources and it must learn to live within its means. Despite howls of outrage before and since the election, I have kept to my word. I said that there would be accountability for people who think that the Government are there to bail them out. Having come from local government, where that culture would never be tolerated, I and this Government are bringing that same financial discipline to the NHS. We will not tolerate deficits. It is important that we get better value for money, while also making sure that, nationally, we are providing support through the procurement platform. That is how we will help the system deliver better value, and we will liberate frontline leaders to focus on the things that really matter, which are services for patients.

[Madam Deputy Speaker (Caroline Nokes)]

I call the Liberal Democrat spokesperson.

[Alison Bennett (Mid Sussex) (LD)]

The Secretary of State’s NHS shake-up is well under way. Many Members would agree that the NHS used to be the envy of the world, but years of Conservative failure have left patients suffering and unable to get the care that they desperately need. I and my Liberal Democrat colleagues therefore welcome steps to reform the NHS.

The new leadership of the NHS has much to do, but can the Secretary of State advise the House whether new legislation will be needed to scrap NHS England given that he told the shadow Minister that it will take two years to complete this merger? When will that new legislation, if it is required, be brought forward?

Any attempt to fix the NHS will ultimately fail if we also do not address the crisis in social care. The Secretary of State must show the same urgency in reforming social care as is being shown on the NHS. Where is that urgency? Long-promised cross-party talks have now been postponed indefinitely with no new date in sight. Care providers are hanging by a thread due to the rising cost of national insurance contributions. Does the Secretary of State agree that any attempt to fix the NHS will prove futile if we ignore the elephant in the NHS waiting room that is the crisis in social care? We will clear our diaries for cross-party talks, so will the Secretary of State give us a date today?

[Wes Streeting]

I am grateful to the Liberal Democrats for those questions. Much of the change needed can be delivered without the need for primary legislation, which is a relief because, as right hon. and hon. Members will have noticed, this Government have come into office with the most ambitious legislative programme of any incoming Government. Time is at a premium, given the business of this House and the other place. We will work immediately to move forward without changes to primary legislation, but we will need to make them. I am working with the Leader of the House and business managers to ensure an appropriate timetable that enables us to do the things that we need to do in a timely way, but that also safeguards the ambitious legislative programme that has already been set out.

The hon. Lady is right to talk about the importance of social care. She asked where the urgency is. It was to be found in the immediate steps that the Chancellor took on coming into office to stabilise the finances of my Department, with an immediate release of funding. It came with the Budget, which delivered an extra £26 billion for the Department for Health and Social Care, protected funding specifically for social care and boosted spending power for local authorities. It came with the biggest expansion of carer’s allowance since the 1970s, and an £86 million increase in the disabled facilities grant not just from next year but released in January for the remainder of this financial year. The urgency is reflected in the Employment Rights Bill, which makes provision for fair pay agreements to deal with the work- force crisis—work with employers and trade unions to prepare for that legislation and the introduction of fair pay agreements is already under way.

I regret that we have not convened cross-party talks. That is genuinely due to practicalities on the part of a number of parties involved. We will be in touch over the next week to make arrangements for Baroness Casey to engage with parties across the House.

[Dr Simon Opher (Stroud) (Lab)]

I thank my right hon. Friend for his excellent statement. As he knows, I am a working GP in Stroud. We clinicians are simply fed up with the micromanagement of our caring clinical role, and many hospital colleagues feel the same. We want to be free to deliver excellent clinical care. Does he think that the abolition of NHSE will reduce the admin task for doctors?

[Wes Streeting]

I do think that is the case. I also think that this is not just about form and function but about the opportunities for productivity gains through modern technology and practices. One of my frustrations is that whenever we talk about the exciting frontiers of life sciences and medical technology—this country’s competitive advantage, and how we need to build on that position— I am greeted with a weary sigh from poor frontline NHS staff, and managers for that matter, who say, “That’s lovely, and we agree with you, but we’d just like a machine that turns on reliably, and it would be nice to use systems that do not require seven passwords to deal with a single patient.” I feel their pain. We will prioritise that investment in technology.

Finally, we do want to liberate the frontline, and I am grateful for the leadership that GPs have shown in agreeing a contract with the Government for the first time since the pandemic, which contains substantial reform to benefit them and, even more importantly, their patients. We also have to liberate management in the NHS. As Lord Darzi said, it is not the case that there are too many managers, but there are layers and layers of bureaucracy between me as the Secretary of State and frontline staff. We have to liberate frontline staff and managers to help them be more effective, to manage their resources more efficiently and, most importantly, to deliver better and safer care.

[Madam Deputy Speaker]

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

[Layla Moran (Oxford West and Abingdon) (LD)]

This is a bold change indeed. The job of my Committee is to help the Secretary of State to do it, so let me start by asking him to come in front of the Committee as quickly as possible—certainly before Easter—because there is a lot of detail that we need to drill down into.

On a more substantive point, the right hon. Member mentioned the financial reset that Sir Jim Mackey announced to integrated care boards just yesterday, which means that they need to cut their running costs by 50%. I am concerned that when my Buckinghamshire, Oxfordshire and Berkshire West ICB struggled with money, the first thing it cut were the place-based teams. If we are to deliver the neighbourhood NHS that the Secretary of State and I both want, those are not the teams to cut. Will he send a signal to ICBs that cost savings should not be at the expense of the broader shifts in the 10-year plan?

[Wes Streeting]

First, I give the Chair of the Select Committee my assurance that I would be delighted to appear in front of her Committee at the earliest opportunity —that means soon. I appreciate that it will want to scrutinise these changes in more detail, and I would welcome the constructive challenge that it offers. I also reassure her that the direction that we are giving to frontline leaders is to deliver the three big shifts in our 10-year plan, and to ensure that as we take immediate steps to bring the finances under control, we do so in a way that lays the firm foundations for the future of the NHS that we need to build.

My cautionary note to Members across the House is that when we ask frontline leaders to reform and to change ways of working, sometimes that requires not just changes to the bureaucracy as it were—the easier and lower hanging fruit—but service reconfiguration in the interests of patient outcomes and better use of taxpayers’ money. Sometimes, they get those changes wrong. I have successfully campaigned against closures of services such as the King George accident and emergency department, which should not have closed and where we won the case on clinical grounds.

Sometimes, let us be honest, the public can get anxious, and Members of Parliament feel duty bound to act as megaphones and amplifiers for public concerns. It is important that we support and engage with local NHS leaders. By all means, we should scrutinise, challenge and ask questions, but we must give local leaders the support to do the task that we are asking of them on behalf of patients and taxpayers. The powers that I have to intervene in those frontline service reconfigurations are ones that I will use only in the most exceptional and necessary cases, and that is why I have not used them once in the past eight months.

[Jen Craft (Thurrock) (Lab)]

The crisis in our NHS goes deep. I am sure that the Secretary of State agrees that it is an existential crisis that poses a threat to the future of the NHS if fundamental change does not happen. While I strongly welcome today’s statement, what assurances can he give me and the House that the right people will be in the right place in leadership positions to drive the fundamental change that is necessary?

[Wes Streeting]

That is an excellent question. We are building an outstanding transformational team with Sir Jim Mackey, which will be announced very shortly. It will bring together some of the best leaders across the country, and expertise from outside the NHS, to drive the scale and pace of transformation that is necessary. My hon. Friend is right to say that it is existential, because we cannot allow the curve of cost and demand to continue to rise to the extent that it is. The NHS’s long-term workforce plan has one in nine people in our country working for the NHS. On the current trajectory, in 50 years’ time, 100% of the public would be working for the NHS. That is clearly not a sustainable position.

I tell people who resist this reform out of love for the NHS not to kill it with kindness. We have to bend the curve of cost and demand to ensure that our health services are sustainable for the long term on the equitable foundations of a public service, free at the point of use, that we will always defend. I also say to my hon. Friends on the Government Back Benches that if we do not get this right, goodness knows what will come next. The Leader of the Opposition says that she wants a debate on the funding model for the NHS. The leader of the Reform party—I am not sure whether he is the Leader of the Opposition yet—says that he is up for anything. I am sure he is. That should worry us.

To those who want to debate the funding model of our NHS and the equitable principle of it being a public service, free at the point of use, I say that we are happy to have that debate but the Government are unequivocal: under Labour, the NHS is not for sale. It will always be a public service, free at the point of use, so that when people fall ill, they never have to worry about the bill.

[Jeremy Hunt (Godalming and Ash) (Con)]

May I commend the boldness of today’s announcement? If the NHS is to be turned around, it will need radical reforms. If the result of today is to replace bureaucratic overcentralisation with political overcentralisation, it will fail. But if we move to the decentralised model that we have for the police and schools, it could be the start of a real transformation.

Will the Secretary of State give the House more detail about the changes he has in mind? Are we going to get rid of the central targets that make the NHS the most micromanaged system in the world and make it impossible for managers to deliver real change on the ground because they are working to about a hundred operational targets? If that is the case, and we are going to decentralise the NHS, does the Secretary of State agree that there remains a vital role for a reformed Care Quality Commission to call out poor care whenever it finds it?

[Wes Streeting]

I am grateful to the right hon. Gentleman for that thoughtful question. Let me say two things to him. First, democratic accountability matters, both in terms of patient outcomes and value for taxpayers’ money. One of the things that I, my Labour and many of my Conservative predecessors have reflected on a lot over many years is what the role of the Secretary of State, and Government, is in a national health service where clinical decisions should always be clinically led. It is the Secretary of State’s responsibility to be the champion for patients and for taxpayers and to ensure that the system as a whole delivers better outcomes for patients and better value for taxpayers.

The argument that I have started, however, which has ruffled some feathers within the NHS and even more so with some of our country’s most loved charities in recent months, is the fallacy that the Secretary of State can or should just fire endless instructions into the system, as if a Secretary of State or, for that matter, an NHS England could just pull some big levers and drive change in such a vast and complex system. That is a falsehood. Of course, we should set national strategic priorities on behalf of the public. We should ensure that there is more transparency and information so that patients, communities and staff can hold the system and themselves to account to improve performance. However, the overcentralisation has to stop.

In future, it will be for the Department and the NHS nationally to do the things that only the national health service can do, providing the enablers for the system as a whole. What we are presiding over and embarking on, however, is the biggest decentralisation of power in the history of our national health service. That will put more power into the hands of frontline leaders and clinicians, but even more fundamental and transformational, more power into the hands of patients. If we get that right, we will have an NHS that can truly be the envy of the world. If people continue to indulge in the fallacy that more targets from the centre or more—or indeed, less—political control is the answer, we will fail.

The right hon. Gentleman also mentioned the CQC. It has got itself into a terrible mess and I know that that is not what he intended when he rightly made the decision to create the Care Quality Commission. That is why Sir Julian Hartley knows that he has our full support, not just in turning around the CQC as it is, but in reforming it so that it can be the best guarantee and safeguard of quality that patients and the public deserve. Dr Penny Dash’s forthcoming review findings will also help to drive that reform agenda at pace.

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

I thank the Secretary of State for making the statement today. I want to echo the thoughts of the hon. Member for Oxford West and Abingdon (Layla Moran) that it would be helpful to see him in front of the Select Committee to outline his vision for NHS England. Will he tell us today how the new structure of the NHS will help us deliver truly excellent social care and also primary care, and what drivers he can use to make that happen?

[Wes Streeting]

It always worries me when my hon. Friend says he wants to see me in front of the Select Committee because he does not pull his punches, despite being on the Government side of the House. Let me reassure him that on primary care, I hope that we are beginning to turn what I think has been a deep anger, frustration and anxiety among primary care leaders about the state of the system as it is and a pessimism about its future into increasing amounts of quiet optimism and hope. I think GPs can see we are walking the talk, with the biggest funding uplift in a generation and the fact that we have worked constructively with GP leaders to reform the contract and agree that further, more radical reform is needed together. We will be embarking on that under the auspices of the 10-year plan. As well as delivering that significant achievement with GPs, the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), is also in the very final stages of work with pharmacists to stabilise the community pharmacy sector, which is vital for the NHS’s future as a neighbourhood service.

May I also reassure my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn) that under the auspices of the 10-year plan for health, notwithstanding Baroness Casey’s work on the long-term future of social care, we have an eye on social care and the relationship between health and social care? People will not, therefore, be waiting until next year for the first Casey report or, indeed, later for the final Casey report on the longer term to see action from this Government on social care, particularly as it relates to the NHS.

[John Glen (Salisbury) (Con)]

I welcome the ambition of the Secretary of State. One area that I ask him to focus on is the future of the UK Health Security Agency. Over the last 15 years, it has evolved from the Health Protection Agency to Public Health England and now to the UKHSA. I found it impossible, both as a Treasury Minister and as a constituency MP, to penetrate the decision-making process around resource allocation, which I now believe is duplicative, as a move to a new site in Essex is being contemplated. That is an area where the Secretary of State can demonstrate to my constituents in Salisbury and at Porton Down that he means business and can resolve the future of UKHSA once and for all.

[Wes Streeting]

I would be delighted to speak further with the right hon. Gentleman, drawing on that valuable experience both as a constituency MP and as a Treasury Minister—always, for the record, my favourite people to work with—

[The Minister for Creative Industries, Arts and Tourism (Chris Bryant)]

What’s wrong with DCMS?

[Wes Streeting]

And my friends at DCMS with their considerable spending power. No, I will stick with the Treasury in my order of favourites, thank you very much. I know where my bread is buttered.

To return to the point made by the right hon. Member for Salisbury (John Glen), I thank Dame Jenny Harries for her leadership of UKHSA. We are recruiting for an outstanding replacement and successor, and that is an opportunity to look in the wider context at some of the first principles. The right hon. Gentleman mentioned the specific, traditional Porton Down versus Harlow decision, which has been running around the system so long that is now used in a case study for senior civil servant recruitment. The worst decision is indecision. It has plagued us for too long and I hope we can soon report back to the House with a decision on that for everyone’s benefit.

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

I welcome the statement today from the Secretary of State. Clearly, there is massive duplication of functions across the many regulatory, national, local and regional NHS bodies and huge room for efficiency.

I want to press the Secretary of State on two points. First, will he assure me that the bonfire of bureaucracy will not stop effective local management of NHS trusts and community settings, as IPPR has found that locally the NHS is poorly and under-managed and clinical staff are backfilling admin and management roles? Secondly, as he mentioned, the roll-out of digital technology has been far too slow, with NHS Digital’s move into NHS England not directing change fast enough, so how will the change ensure that the Department of Health and Social Care grips the digital roll-out, accelerates it and ensures the proper integration of NHS digital functions?

[Wes Streeting]

That is a great question from my hon. Friend. We have to give people the tools to do the job. The Prime Minister set me and my hon. Friends in the Department an enormous challenge on behalf of the public. In turn, I am setting an enormous challenge for NHS leaders at every level, but particularly for frontline NHS leaders. We have to give them the tools to do the job in terms of data platforms and the technology that they are given to work with, ensuring that they have access not just to cutting-edge treatments and medical technology, but to the back-office productivity support that can drive efficiency and improvement and, frankly, liberate managers and frontline staff from the arcane systems they are working with.

Some of the very best people I have met in the last few years, shadowing this portfolio and now holding it in government, are NHS leaders, especially on the frontline. It is my responsibility to give them the tools to do the job. That is not just about financial resources; it means bulldozing through some of the regulatory barriers and overcentralised instructions that stop them making decisions in the best interests of patients, in terms of clinical pathways and value for taxpayers. I have given them an undertaking that I will have their backs, both on the decisions that they will have to take on the frontline and on bulldozing through the national bureaucracy that is tying them up in knots when we need to set them free.

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

I congratulate the Secretary of State on the changes announced today to cut unnecessary waste and bureaucracy. We all know and agree that healthcare should remain free at the point of delivery and, of course, that the NHS needs reform. Just last Saturday, I was in a care home in Boston with a lady—an expert—who knows Melanie Weatherley, and she was telling me about the unnecessary processes within NHS England on the frontline that constrain good care in care homes, impose unnecessary constraints on ambulances and block A&E wards. Will the Secretary of State confirm that the changes and reforms will include unnecessary processes on the frontline in care homes?

[Wes Streeting]

I can certainly give the hon. Gentleman that assurance. We have to cut through the unnecessary red tape that ties leaders and frontline staff up in knots, and we are absolutely determined to do that. Regulatory reform will form a big part of this Department’s agenda and the wider Government’s agenda. As to an NHS free at the point of use, he almost said it with a straight face. I am sure that he meant every word he said. I think he might want to have a word with his party leader, who is his successor and—who knows?—perhaps his predecessor.

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

We must remember that NHS England came out of the Tory Government’s reforms that were intended to privatise the NHS. I want to thank NHS England staff for their work. I am sorry about the way in which they have heard this announcement, because it is their jobs that are being put at risk. We have to ensure, however, that we are not replicating NHS England across the ICBs of our country, and that ICBs are also reformed to transform the NHS through the three shifts that will be placed on them with the publication of the 10-year plan. How will my right hon. Friend ensure that we have the machinery to hold the system to account, but also to put those reforms in place?

[Wes Streeting]

My hon. Friend is absolutely right: if we just replicate NHS England as it is with all the challenges in its set-up in ICBs across the land, we will have failed. Frankly, if we replicate NHS England and the Department as they are today just in one organisation, we will have failed to meet the challenge of change. It needs to feel and act like a completely new organisation, culture and way of working to modernise the state, so that if Disraeli, Gladstone, Churchill or Attlee walked into Whitehall at the end of this Government, it would not look so much like the Government they worked in during the 19th and 20th centuries. That is the reality of Whitehall today; it is not a reflection on the people who work in it, but it shows why it needs to change, and that is also true of the NHS. I look forward to working with ICB leaders to reform their ways of working, clarify their priorities, give them clearer marching orders and ensure that they can deliver.

Finally, my hon. Friend mentions the staff of NHS England—indeed, this affects staff in my Department, too—and I thank her for the care she has shown. Change is always disruptive and it can be scary, and of course that is particularly the case when job losses are involved. I want to acknowledge that on the Floor of the House, as I have to staff across both organisations this morning. I know that the Permanent Secretary and the chief executive of NHS England have done so in recent days, and I will be holding a town hall with staff next week. This really is not a reflection on them. In fact, I think they will recognise in my description of our ways of working the many things that frustrate them. None the less, they are dedicated and talented people, and some of the best people I have ever worked with in any walk of life or career work in this system. I look forward to working with them in the coming weeks and months with the same dedication and professionalism they have always shown, so that we can all look back on this time with pride, knowing that we were part of the team that took the NHS from the worst crisis in its history to getting it back on its feet and making it fit for the future.

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

Does the Secretary of State agree that one of the worst and most intractable problems that the founders of the NHS had to deal with was the involvement of medical practitioners and consultants who were used to receiving a private income in a national service where they would not receive anything like the same remuneration? If he agrees, would he accept that there is a similar situation with NHS dentistry today? The Darzi report said:

“There are enough dentists in England, just not enough dentists willing to do enough NHS work, which impacts provision for the poorest in society.”

How does he think his reforms will help address that particular crisis, on which Members like myself and my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) are being consistently and rightly lobbied by such formidable organisations as the New Forest branch of the women’s institute?

[Wes Streeting]

NHS dentistry is in a terrible state and, in fact, in many parts of the country it barely exists. There are lots of reasons for that, and it is a source of constant astonishment to me that the dentistry budget was underspent year after year despite that situation. The Minister for Care is working with the British Dental Association to reform the contract. I know that Members are frustrated at the pace, and so am I. We are trying to clear an enormous challenge; it is not going to be easy, but we are committed to working with the profession. We are rolling out the 700,000 urgent dentist appointments and supervised toothbrushing, as we promised and as the BDA has welcomed, but we have a lot more to do. That requires working with the profession—not simply tinkering with the system as it is, but fundamentally rethinking it and how we rebuild it into an NHS dentistry service that we can be proud of.

[Jim Dickson (Dartford) (Lab)]

I welcome the statement, particularly the commitment to ensure that as much money in the NHS as possible is spent on the frontline, where it can really affect patient outcomes. Nowhere is that more needed than in my constituency of Dartford, which is the fastest growing town in the UK. That extra population is imposing a huge strain on our local district general hospital at Darent Valley, despite the excellent efforts of the staff there. Could the Secretary of State outline how the changes will support the shift we need to see from services being delivered in the hospital to the community, thereby relieving the strain on hospitals like Darent Valley?

[Wes Streeting]

The frustrating thing is that we are delivering the wrong care in the wrong place at the wrong time, which is delivering poorer outcomes for patients and poorer value for taxpayers. People cannot get a GP appointment, for example, which might cost the NHS £40, and then they end up in accident and emergency, which could cost £400. If people cannot find a bed for a delayed discharge and rehabilitation outside of hospital, they end up stuck in a hospital bed, wasting away at greater cost. In fact, when I was up in Carlisle earlier this year, such intermediate care was being offered by a local social care provider, commissioned by the NHS, at half the cost and of a much better quality than the hospital bed that patients had been discharged from. That shift to the community is about delivering better outcomes for patients and better value for taxpayers, and that will be reflected in our 10-year plan.

[Wera Hobhouse (Bath) (LD)]

I declare an interest as the vice-chair of the newly formed all-party parliamentary group on emergency care. A&E staffing across the country is dangerously low, especially at night, putting unacceptable pressure on staff, who warn persistently about the risks to patient safety. Hundreds of keen applicants are being turned away from emergency medicine training. Last year, there were 359 places for 2,718 applicants. Following this announcement, how quickly will emergency care and A&E departments see changes and have more permanent staff and consultancy places, but especially more training places?

[Wes Streeting]

We will shortly set out our emergency care improvement plan so that we can deliver the year-on-year improvements that people deserve. The long waiting times, not just in emergency departments but in ambulance response times and across the entire system, are completely unacceptable. I refuse to use terms such as “temporary escalation spaces” to describe the true grim reality of corridor care. That is a shameful situation, and I am genuinely sorry that patients are being treated in those conditions and that staff have to suffer the moral injury of working in those conditions. From the moment we came into government, we have worked to ensure that we got through the winter as well as we could. That is reflected in the fact that, despite the winter pressures, waiting lists fell five months in a row throughout the winter.

On the targets and standards challenge set out by the Royal College of Emergency Medicine, ahead of the winter I was very clear with frontline leaders that patient safety must come ahead of performance targets—particularly the four-hour target—but the 12-hour target is absolutely related to patient safety, as I think the royal college would agree. We must work together to get waits of longer than 12 hours down as a priority, because those waits are directly linked to safety and patient outcomes.

[Several hon. Members rose—]

[Amanda Hack (North West Leicestershire) (Lab)]

Two GP practices have told me that they are waiting for section 106 money to be released so that they can improve their facilities, but that it has been stuck between decision-makers. Will the Secretary of State outline how the changes will help to release those kinds of delays and finally allow North West Leicestershire residents to get the facilities that they deserve?

[Wes Streeting]

I am grateful to my hon. Friend for raising that example. She is welcome to contact my office to see if we can expedite that kind of decision-making. In fact, Members will have seen the work that the Deputy Prime Minister is doing to speed up decision-making in local government, which has an impact and a bearing on the NHS. We will work together to speed that up, so that where resources are available, we get them out and deliver change as quickly as possible.

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

My constituents are particularly concerned about the very bureaucratic approvals process for the new hospitals programme—through investment committees, then the regional NHSE team, the a department, then NHS capital assurance, then a joint investment committee, then the Treasury and then, finally, Ministers. Can the Secretary of State guarantee that this decision, which I welcome, will speed up that process, and that the business case for the multi-storey car park at the Queen Elizabeth hospital in King’s Lynn will be approved so that work starts this year?

--- Later in debate ---

[Wes Streeting]

The hon. Gentleman makes a fair challenge on the bureaucratic nature of decision-making. We are working with Treasury Ministers and colleagues across Government to take an axe to that unnecessary bureaucracy. He will be absolutely fuming when he finds out who was responsible for it.

[Dr Allison Gardner (Stoke-on-Trent South) (Lab)]

I am conscious that my former colleagues at NHS England will be concerned about today’s announcement, but I am very confident that the Secretary of State will do all he can to support them. It is an inescapable fact that the 2012 reorganisation led to inefficient layers of management in the NHS, delivering poorer care and greater costs to the taxpayer. How does he plan to cut excessive layers of bureaucracy, get resources to the frontline and, crucially, deliver better care for the people of this country?

[Wes Streeting]

That is a brilliant question. We have put in place a transformation team, led by Sir Jim Mackey, which we will work with to start fundamentally changing the way the NHS works, by shifting more power, resources and responsibility out of Whitehall and closer to the frontline and the communities where decisions are made, and by getting rid of the unnecessary bureaucracy that drives patients and staff to distraction.

[Adrian Ramsay (Waveney Valley) (Green)]

I thank the Secretary of State for his statement. We all want to see a well-run NHS that delivers for patients, but as he knows, patients are being treated in corridors, staff are severely overstretched and too many people cannot get access to a GP or a dentist when they need one. In that context, I was concerned to read in the media last week that there are plans for £7 billion of cuts to services, and for ICBs to be asked to cut costs by 50%. Can he reassure us that, as we go into the new financial year, we will not see cuts to frontline services? When I meet the chief executive of Norfolk and Waveney ICB next week, will I hear that cuts to frontline services are being considered as a result of Government budgets?

[Wes Streeting]

The reports relate to the deficits sent into NHS England ahead of the 2025-26 financial year. Those are completely unaffordable for the NHS and completely unrealistic. Those financial plans are being revised as we speak, which is why leaders have gathered in London today to receive that message and that set of instructions. I am asking frontline leaders to improve services and reform ways of working, and they will have my support in doing that. As for the resources that are going in, I gently point out that the investment that the Chancellor unlocked for the NHS and social care in her Budget dwarfs that which was promised in the Green party’s manifesto.

[Laura Kyrke-Smith (Aylesbury) (Lab)]

I held a public consultation in my constituency on the future of the NHS. Participants were crystal clear that we need to cut bureaucracy and get resources to the frontline. When they talk about the frontline, they mean not just hospitals but people out in the community, and, crucially for my constituency, GP practices. Will the Secretary of State share more about how he intends to make that shift?

--- Later in debate ---

[Wes Streeting]

There are 889 million reasons for GPs to be cheerful. That amount was the allocation for general practice before Christmas, and it has resulted in fruitful negotiations with GP leaders that will deliver the necessary reforms and better access for patients, particularly through online access to modern appointment booking. That is something to which we have become accustomed in every other aspect of our lives, and the NHS should be no different.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

It is an inescapable fact that one top-down reform is being fixed by another—one that will last about two years, according to the statement. Although I wish the reform every success, we must recognise that the experience of the NHS in Wales shows that reform on its own is no guarantee of success. The Secretary of State rightly said that change is hard, and it is inescapable, I am afraid, that while this reform is ongoing, the NHS leadership will be hugely distracted by turf wars, redundancies and the development of new working practices. What steps will he take to prevent that distraction from having a negative effect on frontline services?

[Wes Streeting]

The Government have come in with an ambitious reform agenda. As we embark on that reform, we are cutting NHS waiting lists—we have done that five months in a row. We are reforming the GP contract—those negotiations have successfully concluded. We are about to conclude community pharmacy, too. We have put in place a transformation team who are experienced frontline leaders with demonstrable track records—particularly in the case of Sir Jim Mackey—of delivering those changed outcomes. There will always be people who say that it is too hard, too difficult or a distraction, but that is how we have ended up with this status quo; that is how the Conservative party presided over the longest waiting lists and the lowest patient satisfaction on record while spending staggering amounts of public money. More money and no reform is not the answer; the lesson of the previous Labour Government is that investment plus reform delivers results. That is what this Labour Government are doing.

[Chris Vince (Harlow) (Lab/Co-op)]

I thank the Secretary of State for his statement and pay tribute to NHS professionals in Harlow, particularly those at the Princess Alexandra hospital, for their incredible hard work every single day. Does he agree that NHS staff, who work incredibly hard, are failed by an overly bureaucratic and fragmented system, and that spiralling staff costs are partly a result of the need for additional agency staff?

[Wes Streeting]

We absolutely need to reduce the cost of agency staff in the NHS. That costs the taxpayer billions, and that money could be better spent on ensuring that we have the right staff in the right place, on better terms and conditions, and with permanent contracts. Where we do need flexibility, we should drive it through the NHS bank. We are determined to reform the way that works and deliver better staffing, better outcomes for patients and better value for taxpayers.

[Bob Blackman (Harrow East) (Con)]

I welcome any measures to reduce the bureaucratic overload in the NHS, so I congratulate the Secretary of State on coming forward with his bold plan. We must also take a sledgehammer to the business case process, which frustrates the delivery of services and new buildings for the NHS. Will he consider bringing NHS-owned land into use for new care facilities and step-down hospitals, for example, so that we can free up hospital beds and get people into the care they need at a much lower cost?

[Wes Streeting]

The hon. Member is absolutely right: the estate is vast, it is underutilised, and we need to sweat our assets more effectively. We also need to reform bureaucratic processes. There are lots of reasons why we need to have tough controls on things such as spending, procurement and value for money, to ensure that there is appropriate and effective use of public money. But businesses do not operate in this way; they are able to counter fraud, waste and poor value for money, and they do it much faster. That is what the NHS needs to do. Across the public sector, we need to use our estate far more effectively to deliver better value and better services for the public.

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

I thank the Health Secretary for the announcement he has made. As he rightly says, staff work incredibly hard and deserve our thanks, but we all recognise the huge strain that they and the organisation have been under. The health service is consistently raised as one of the top concerns by residents in my constituency. Can he share how today’s announcement, along with other measures he has previously announced, will build an NHS that is there when people across Cramlington and Killingworth need it?

[Wes Streeting]

We have to deliver improved services for patients in every part of the country. Her constituency and mine, which is on the London-Essex border, will have different needs, contexts and set-ups, and services may need to be shaped differently in order to meet those needs, but the standards should be consistent, the quality should be good and the safety should be guaranteed at all times. That is a far cry from where we are, and I genuinely think that decisions about services for her constituents will be far better taken much closer to her constituents and her community than here in Whitehall. That is why, as we are delivering month by month and year by year improvements in services for patients in every part of the country, we will also deliver the biggest devolution of power in the history of the national health service.

[Tessa Munt (Wells and Mendip Hills) (LD)]

I really welcome the Secretary of State’s statement, and I am particularly keen that he looks at the multiple layers of sign-off and the bureaucracy that sometimes forgets patients are at the other end of it. Hospitals in England have had to rely on charitable fundraising to buy some of the most cutting-edge radiotherapy machines because of NHS England’s policies and bureaucracy. This year, highly advanced machines such as the CyberKnife, which have treated thousands of NHS cancer patients over the past 10 years, will need upgrading, but NHS England is refusing to include them in this year’s funding because they were all bought by charities. The Secretary of State talked about giving people the tools to do the job. Could he change that policy, so that our hospitals do not have to continue relying on charities for the latest technology?

--- Later in debate ---

[Wes Streeting]

This Government committed in our manifesto to doubling the number of diagnostic scanners, and we will deliver that over the course of this Parliament. NHS charities have a valuable role to play. Philanthropy has a valuable role to play as an additional source of support to the NHS. When public funding is as tight as it is, we need to look at how we can maximise the benefits and the impact of bringing together sources of public investment, private investment, voluntary sector and philanthropic investment to deliver the most bang for the buck. Without knowing the details of the specific case the hon. Lady mentions, I would not want to comment too strongly, except to say that we are committed to doubling diagnostic scanners through public funds, but I am not sure I necessarily share the view that NHS charities do not have a role to play.

[Sojan Joseph (Ashford) (Lab)]

I know from my experience of working on the NHS frontline how hard it has become over the years to get basic things done. Nurses and matrons spend hours and hours getting basic changes made to their workplace on the frontline. I therefore welcome my right hon. Friend’s announcement. Will he ensure that by cutting bureaucracy, we can get more resources to where direct patient care takes place, which will help with the retention of nurses and healthcare assistants and see more patients being treated quicker and getting the care they need?

[Wes Streeting]

My hon. Friend is absolutely right. Some of the best innovation and improvements for patients I have seen has been led by frontline clinical teams that have had great executive leaders behind them, giving them the freedom and the tools to do the job. I hope that, as a result of these reforms, not only will we see the results for patients in the data, but staff and patients will feel the outcome and the difference in their experience of working in or being treated by the NHS.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement and for his positivity on getting waiting lists down and making the change that is needed. He referred to Scotland, Wales and Northern Ireland. He will know that we in Northern Ireland are having the very same problems that he is sorting out today for England. I know that he is always keen to see the positivity that comes out of this place being shared right across this nation. Will he have discussions with the relevant Northern Ireland Minister, Mike Nesbitt, in relation to health back home, to ensure that we can follow the directives here, to make our health service in Northern Ireland every bit as good as this one will be?

[Wes Streeting]

I was recently in contact with Mike Nesbitt, offering some of that support and offering to work together to help improve the quality of health services in Northern Ireland, recognising that we have advantages of scale here in England. While recognising the devolution settlement, we want to work closely, just as we are working closely with our friends in the Labour Government in Wales to help them improve their services, and also learning from some of the things that the Welsh NHS does better than England.

[Terry Jermy (South West Norfolk) (Lab)]

I commend this statement and thank the Secretary of State and his Department for the excellent work they are doing. It is not a moment too soon in Norfolk, because we have failing access to dentistry, it is difficult to get a GP appointment, and both the hospitals that serve my constituents have RAAC—reinforced aerated autoclaved concrete. With that in mind, may I invite the Health Secretary to Norfolk to meet healthcare professionals, to discuss the cumulative impact of so many challenges and to discuss how these reforms can help improve patient care?

[Wes Streeting]

I am grateful to my hon. Friend for that question; that was a very kind way of reminding me that I had already made such a commitment and have not followed through, so let me rectify that immediately.

[Louise Jones (North East Derbyshire) (Lab)]

I thank the Secretary of State for the boldness of his statement. It will take courage to bring about the change that my constituents desperately want, and it is great that Labour is showing that courage. My constituents, particularly those in Killamarsh, really struggle with access to GPs. Could the Secretary of State assure me that this will redirect vital resources from bureaucracy to serving those in need on the frontline?

[Wes Streeting]

I can give my hon. Friend that assurance. That is the objective of what we are doing: to make better use of taxpayers’ money so that we can deliver better care for patients. That is not through bloated central bureaucracy, but through more frontline capability and services.

[Kevin McKenna (Sittingbourne and Sheppey) (Lab)]

I draw Members’ attention to my entry in the Register of Members’ Financial Interests. Of the more than 26 years that I worked in the NHS, six and a half were in NHS England, in its brilliant strategy team and with brilliant people. That is why my heart goes out to so many people who will have insecurity about their jobs following this announcement, even though I believe it to be the right one. This comes after years and years of chopping and changing at NHS Improvement and NHS England, as political leadership has switched from one person to another.

One of the things I am concerned about is the need to ensure that clinical leadership is still heard at the centre. As a nurse, I found it harder to get into NHS England. Doctors find it easier in their career structures. Moving NHS England functions into the Department, and moving off NHS terms and conditions, will make it harder for nurses, allied health professionals and other clinicians working in the NHS. What will my right hon. Friend do to ensure that the clinical voice comes right into the centre of Whitehall, along with the patient voice?

[Wes Streeting]

I am extremely grateful to my hon. Friend, and I echo what he said about the talents of people at NHS England. I did not take this decision with the Prime Minister lightly. Indeed, it was not my instinct coming into government, but it has been shaped by what I have seen and experienced over the past eight months. Clinical leadership is vital, and that is not just doctors; it is also nurses and other clinical leadership. We have a brilliant chief nursing officer, who remains in place and will be part of that clinical leadership team. I can assure my hon. Friend that we do not want any political interference in what should be decisions for clinicians. What we need is the right political leadership to give that clinical leadership the tools, power and freedom to do the job that only they can do, and that they do best.

[John Slinger (Rugby) (Lab)]

This welcome reform cannot come quickly enough in Warwickshire where councillors, local health campaigners, I and others have been making the case for a doctor-led urgent treatment centre at our local hospital, the Hospital of St Cross, to complement the excellent nurse-led and GP out of hours service, but many of my constituents are concerned about having to travel to the larger hospital in Coventry and the long waiting times they find there. The integrated care board has a review of urgent care under way in Warwickshire, but I still do not know when it will be completed and my constituents want to know when urgent care at our local hospital will be upgraded. Does my right hon. Friend agree that his reforms to NHS England should equip ICBs more effectively to respond to local needs?

[Wes Streeting]

I am grateful to my hon. Friend for his perseverance in bobbing for so long; they should prescribe it on the NHS. I say to my hon. Friend that this is why I strongly believe in local decision making to make sure services are configured and designed to meet the differing needs of local communities while providing the same standard and quality of care in every part of the country. He also described the frustration of people who will often, including in the future, necessarily be living some distance from their general hospitals; that is why we have to shift out of hospital with the NHS being not just the national health service but a neighbourhood health service, with as many services as possible closer to people’s homes and indeed in people’s homes. That is the exciting future that is up for grabs, and that is the future we will realise thanks to the reforms we are making today. I am delighted they have been greeted with such support right across the House.

GP Contract: 2025-26 Consultation

Wes Streeting Excerpts

Monday 3rd March 2025 Written Statements

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

I wrote to the House on 6 January announcing an £889 million proposed funding uplift to general practice, the largest funding uplift in years. Alongside this, I shared an overview of some proposals for the 2025-26 GP contract consultation.

I am pleased to share that the BMA General Practitioners Committee in England, have voted to accept the 2025-26 GP contract for the first time in four years. As the front door of our NHS, general practice plays a key role in managing pressures across the system and delivering care closer to home. This is an important milestone in the Government’s plan for change, and begins delivery on key manifesto commitments to bring back the family doctor and end the 8 am scramble, marking a step forward in fixing our NHS and resetting relationships with the profession.

Over the formal consultation with the GPCE officer team, changes to the 2025-26 GP contract were discussed with my Department and NHS England officials. I am grateful for their work at pace to collaborate and agree a fair deal for the NHS, for the profession and for patients. The 2025-26 GP contract will deliver increased investment, improvements in patient access and outcomes, reduced bureaucracy, and increased flexibilities for primary care networks to hire the right staff mix for their local population. The GPCE officer team recommended this package to the wider committee, which voted in favour. This signals the beginning of our work together to achieve the “left shift”, moving more care from hospitals into the community, ensuring the focus is on prevention and not sickness.

This package will support bringing back the family doctor by incentivising practices to identify patients who would benefit most from continuity of care. We will also build capacity in general practice by increasing flexibilities in how they recruit staff. This will improve productivity, optimise workforce balance, and support the hiring of more GPs and practice nurses.

We will make progress in moving towards a neighbour-hood health service through a greater focus on prevention and system integration. To achieve this, we will remove 32 outdated targets while strengthening existing targets for cardiovascular disease, supporting the Government’s mission to reduce deaths from the biggest killers. We will also reinforce integration with community pharmacies through better access to records, enhancing patient care co-ordination. To make significant progress on cutting waiting lists, GPs will be encouraged to seek advice from specialists when unsure about making a referral to hospital. Up to £80 million of funding will be made available for doctors to liaise with specialist consultants, which can avoid people being added on to waiting lists unnecessarily.

We will improve digital access by requiring practices to have their online consultation portals switched on throughout core hours, providing parity with walk-in and phoning in. This will ensure patients can reach their practice via the means that suits them best and helping to end the 8 am scramble. To empower patients and increase transparency, we will introduce a patient charter that clearly outlines what patients can expect from general practice and what general practice can expect from patients, improving communication and service use.

Aside from the consultation, we have made significant strides over the last eight months, including the addition of GPs into additional roles reimbursement scheme from October 2024, listening to the profession’s call for action required to tackle GP unemployment. I look forward to continued collaborative working with the general practice profession, as we build a better future for general practice and step back from collective action.

[HCWS486]

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 11th February 2025 Commons Chamber

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

UK leadership on global health is critical to safeguarding our national and international health security, building resilience and creating prosperity. I work closely with my counterparts across Government. I recently met the Foreign Secretary to discuss these issues, which are also high on the agenda of the Minister for Development. The UK has one of the largest vaccination programmes in the world, and our confidence and uptake rates are among the highest globally.

[Monica Harding]

The NHS and the UK reap the benefits of our work in global health. Gavi is one of the UK’s greatest success stories: it has inoculated 1 billion children worldwide, but it has also strengthened our health security, keeping us safe from diseases such as Mpox and Ebola. What leadership will the Secretary of State and his Department take to strengthen organisations such as Gavi to keep us safe here in the UK?

[Wes Streeting]

The hon. Member raises an important point. I know that my ministerial colleagues in the Foreign, Commonwealth and Development Office are looking at the investment cases for Gavi and the Global Fund as part of the spending review. I will ensure that her representations are relayed to the FCDO, and she is very welcome to make those points during oral questions to that Department.

[Mr Speaker]

I call the shadow Minister.

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

There were almost 67,000 cases of serious antimicrobial-resistant infections in the United Kingdom in 2023. War is increasing such infections globally; 80% of patients in one Kyiv hospital in Ukraine are said to have such infections. The Conservative Government had a plan to tackle that. Do the Labour Government plan to follow that plan, are they on track to meet those targets, and if not, what will the Secretary of State do about it?

[Wes Streeting]

I am delighted that Dame Sally Davies continues her work on antimicrobial resistance. That is an absolutely critical issue, and I pay tribute to the previous Government, particularly Minister Quince, for their work on it. It is in the national interest that we maintain not just the national focus but the international focus on antimicrobial resistance, which is why UK leadership in those global fora is so important.

[Dr Johnson]

Another time when it is important to work together is during a pandemic, such as by sharing research. Unfortunately, recent history tells us that when Labour negotiates, Britain loses out. Can the Secretary of State confirm that, whatever emerges from discussions with the World Health Organisation, he will not reduce the UK’s capacity to take decisions in the interests of the British people.

[Wes Streeting]

May I just say how regrettable it is that a sensible shadow Minister is sent along to parrot the absurd lines of her leader?

[Ben Obese-Jecty (Huntingdon) (Con)]

4. If he will take steps to repair Hinchingbrooke hospital before buildings containing reinforced autoclaved aerated concrete reach the end of their lifespan in 2030.

--- Later in debate ---

[Ellie Chowns (North Herefordshire) (Green)]

5. What progress his Department is making in reducing waiting times for elective care.

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

This Government inherited a waiting list with a staggering 7.6 million people on it. Since July, that waiting list has already been reduced by almost 145,000, and ensuring that the NHS once again meets the 18-week standard for elective treatment is at the heart of the Government’s plan for change. Our elective reform plan sets out how we will meet that standard by the end of this Parliament, through a combination of investment and reform that Labour knows from past experience delivers results.

[Ellie Chowns]

I get regular messages from constituents facing terrible waits for care with potentially serious consequences, including a one-year delay for an early dementia referral and an 18-month delay for a cardiology review. Although I understand the case for the short-term, one-off use of spare private capacity to tackle the backlog while the NHS is rebuilt, can the Secretary of State please outline his longer-term thinking regarding privatisation of the national health service? In particular, why is he encouraging the development of long-term relationships with the private sector?

[Wes Streeting]

The NHS has always worked constructively with the independent sector, and I do not believe that ideological hobby horses should come before patients getting faster access to care. This Government are investing in our NHS, and before the hon. Lady complains about that, I would just point out that the Green party’s manifesto on the NHS said that it would require an

“additional annual expenditure of £8bn in the first full year”

of this Parliament, rising to £28 billion later. The Chancellor has just delivered a Budget that delivers £26 billion of additional investment, and the Greens complain about it.

[Deirdre Costigan (Ealing Southall) (Lab)]

I welcome the new Minister, my hon. Friend the Member for West Lancashire (Ashley Dalton), to her place. Hundreds of my constituents are on waiting lists for knee and hip operations, and while the hon. Member for North Herefordshire (Ellie Chowns) says that she would like to see those waiting lists reduced, the Green party has done everything it can to oppose Labour’s plan for change—it opposed our Budget, with its record investment in the NHS, and it opposed our agreement with the independent sector to bring down the backlog. Does the Secretary of State agree that it is time for the Opposition parties to stop wishing for a reduction in waiting lists and start backing Labour’s credible plan to make a real difference?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. As we know from the Greens’ experience in local government, they cannot clear the bins, let alone the waiting lists.

[Mr Speaker]

I call the shadow Minister.

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

The Labour Government’s elective reform plan says that there are plans for 10 straight-to-test pathways. Can the Secretary of State name them, or give one example?

[Wes Streeting]

It is absolutely ridiculous, Mr Speaker. Conservative Members turn up, criticising and carping about this Government’s elective reform plan, but I remind the hon. Gentleman that when his party was in office, it delivered the longest waiting lists in the history of the NHS. If he wants to do a pop quiz, he can use Google.

[Dr Evans]

This is the Secretary of State’s own plan. There was one example in the plan, but as an article in The BMJ on 17 January helpfully pointed out, that one example—which featured Sarah, who had sinus pain and hearing issues—was quietly removed from all online and future drafts after

“a flurry of GPs pointed out that her treatment”

was “wholly inappropriate.” That article went on to say that

“Sarah can pick up her dose of unnecessary radiation along with her weekly shop.”

On this part of the Government’s plan, The BMJ concluded:

“Sarah’s story is one of over-investigation, fragmented and inappropriate care, spurious choice, and a lack of senior decision making at first presentation. Activity for activity’s sake has little to do with high quality care.”

Does the Secretary of State agree with The BMJ, and if not, why not?

[Wes Streeting]

I always believe in holding our hands up when mistakes are made. I am happy to say that the reason that case study was removed from the published elective reform plan is because it was a genuine mistake, for which I accept responsibility as the Secretary of State. Now, maybe the Conservative party might like to accept responsibility for the highest waiting lists and lowest patient satisfaction in history, and finally have the decency to apologise to the country for the mess it left us in.

[James Naish (Rushcliffe) (Lab)]

6. What steps his Department is taking to support hospices.

--- Later in debate ---

[Joe Robertson (Isle of Wight East) (Con)]

12. What steps his Department is taking to help reach the national dementia diagnosis rate target.

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

The dementia diagnosis rate target was not met for the last five years of the Conservative Government, and it declined over the course of the last Parliament. This Government are committed to ensuring that at least two thirds of people living with dementia receive a diagnosis. The Government are investing in dementia research across all areas, from causes, diagnosis and prevention to treatment, care and support, to help people live with this condition.

[Joe Robertson]

Nearly 1 million people are living with dementia—it is the biggest cause of death in the country today—and by the end of the 2030s that figure is set to rise to 1.4 million. Early diagnosis is one of the best things we can do to support people living with dementia, so will the Secretary of State explain why the dementia diagnosis target no longer features in NHS England’s priorities, as published two weeks ago? Will he commit to reinstating both dementia and the commitment to a diagnosis target in NHS England’s priority guidelines?

[Wes Streeting]

I just restated the Government’s commitment to ensuring that at least two thirds of people living with dementia receive a diagnosis. Our investment and reform agenda will speed up diagnostics across the board. Under the last Government, NHS planning guidance was a wish list of fantasy targets, most of which were never met. As the NHS got worse and worse, they piled on more targets to make themselves look busy. This Government are ending the micromanagement, turning our NHS around and clearing up their mess.

[Mr Jonathan Brash (Hartlepool) (Lab)]

My dad was a GP in Hartlepool for over 30 years—the Secretary of State was kind enough to meet him the last time he was in Hartlepool—and he has Alzheimer’s. Every day, I think about why we did not spot the signs early enough to get the treatment that he needed at an earlier stage. The Alzheimer’s Society estimates that only 29% of social care workers have any form of dementia training. Does the Secretary of State agree that it is critical that we up that number and ensure that all social care workers have dementia training, to ensure early diagnosis?

[Wes Streeting]

I am grateful to my hon. Friend for his question—I know how personal this issue is for him. I was delighted to meet his father on my visit to Hartlepool, and wish him very well. I take very seriously what my hon. Friend has said about the importance of workforce training. He mentioned training for health and social care staff, which is important, but I would argue that the point applies more broadly across our society. On 6 September, the Department launched the adult social care learning and development support scheme, which allows eligible employers to claim for funding for certain training courses and qualifications, including relevant dementia training, for eligible care staff. We will continue to keep this under observation and review.

[Sojan Joseph (Ashford) (Lab)]

13. What steps he is taking to help tackle career progression inequalities in nursing.

--- Later in debate ---

[Robin Swann (South Antrim) (UUP)]

14. What steps he is taking to help devolved Administrations reduce waiting lists.

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

I was delighted to work closely with the hon. Gentleman when he was Minister for Health for Northern Ireland, and I am delighted to work with his successor. I have met regularly with my counterparts in Northern Ireland, Scotland and Wales since I took up office. The Chancellor’s recent Budget meant a massive £26 billion-a-year boost for the health and social care services; thanks to the Barnett consequentials, the devolved Administrations will benefit from a major increase in their budgets—the biggest since devolution began.

[Robin Swann]

I thank the Secretary of State for his answer. Just over a year ago, the former Health Secretary wrote to counterparts in the devolved Administrations to offer patients from Wales and Scotland who were experiencing lengthy waits the option of treatment by providers in England. The offer was declined, as it was seen as a political stunt. Would the Secretary of State consider reviewing that offer, but this time including Northern Ireland, so that his call to offer the best of the NHS to the rest of the NHS can be shared across the entire nation?

[Wes Streeting]

I am absolutely committed to our working across the whole of the United Kingdom of Great Britain and Northern Ireland on cross-border working and co-operation, where we can. I have had constructive conversations, particularly with my counterpart in Wales, to that effect, and I would be delighted to work with my counterpart in Northern Ireland in the same spirit. Despite our differing views on the future of the United Kingdom, I have had equally constructive discussions with my counterpart in Scotland, although he may not thank me for mentioning it.

[Brian Leishman (Alloa and Grangemouth) (Lab)]

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

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

Yesterday, we kicked off National HIV Testing Week. Getting tested for HIV is quick, free and confidential. I pay tribute to the leadership of my right hon. and learned Friend the Prime Minister, who became the first leader in the history of the G7 to take an HIV test. As a former member of the independent HIV Commission, I am determined that this Government will deliver on our commitment to end new transmissions of HIV in England by 2030. We will set out our aim shortly in our new action plan, which will be developed by me and my brilliant new Minister, my hon. Friend the Member for West Lancashire (Ashley Dalton).

[Brian Leishman]

Fourteen years of austerity have created a new stratum of society: the in-work poor. Recent talk of ruthless cuts to social security is beyond alarming. Does the Secretary of State agree that having a welfare system that covers the cost of essentials, as proposed by the Trussell Trust and the Joseph Rowntree Foundation, would alleviate hunger and hardship, and therefore relieve considerable strain on the NHS?

[Wes Streeting]

I am a product of the welfare state, and I remember the benefit system putting food in the fridge and money in the electric meter. I also know from lived experience that people who are trapped in the benefits system want to escape. The best way out of poverty is not through social security, important though that is, but through fair, decent work that pays. That is the Government’s agenda.

[Mr Speaker]

Just a reminder that we are on topicals, folks.

[Edward Argar (Melton and Syston) (Con)]

I congratulate the hon. Member for West Lancashire (Ashley Dalton) on her promotion to the Front Bench.

Eating disorders affect over 1.25 million people, and this is the last Health and Social Care Question Time before Eating Disorders Awareness Week, which starts later this month. The Secretary of State will be aware of the amazing work done by the eating disorder charity Beat, which I met a few months ago, and to which I pay tribute. Will he back Beat’s call for broader access to intensive community and day treatment for those with eating disorders—there are limited places currently—and set out a timetable in which that will be delivered?

[Wes Streeting]

I really welcome the shadow Secretary of State’s raising that important issue. Too often, even when patients with eating disorders are in health settings, they do not receive the right care or support at the right time. I would be delighted to receive representations from Beat on how we can improve the situation.

[Edward Argar]

I am grateful to the Secretary of State for that answer. He will know that osteoporosis impacts 3 million people. He is aware of the campaign by the Royal Osteoporosis Society, and the powerful parallel campaign led by The Mail on Sunday and the Daily Mail, for access to fracture liaison services across the country. Pre-election, he committed to support that, and a roll-out plan. People will look for an answer that looks to the future, not the past, so when will he publish the fracture liaison services roll-out plan, to ensure that all who need to access those vital services can, and will he work with campaigners and me to achieve that roll-out before 2030?

[Wes Streeting]

This is unusually consensual today. The Government are committed to rolling out fracture liaison services across every part of the country by 2030. I promised that before the election, and that is what we are delivering. In fact, we have already started by investing in 14 hi-tech DXA—dual-energy x-ray absorptiometry—scanners, which are expected to provide an extra 29,000 scans to ensure that people with bone conditions get diagnosed earlier. I note that the shadow Secretary of State does not want to look to the past—I am not surprised, given the Conservatives’ record—but I am sure that we can work together in the future.

[Joe Morris (Hexham) (Lab)]

T2. For those in villages such as Slaggyford, Kirkhaugh and Mohope, the cottage hospital in Alston is closer than the hospital in Hexham. As my constituent Rowland outlined to me, despite that proximity, ambulance services find themselves restricted by county borders. Rural constituents’ access to healthcare and rapid response services are suffering as a result. Will the Minister meet me to discuss ambulance services in rural areas?

--- Later in debate ---

[Helen Morgan (North Shropshire) (LD)]

I, too, welcome the new Minister to her place. This morning’s oral health survey revealed that more than one in five five-year-olds in England have experienced dental decay, affecting their ability to smile and socialise, as well as causing pain and distress. Will the Secretary of State guarantee the Government’s commitment to tackling the problem, and back Liberal Democrat calls for an emergency scheme that guarantees dental check-ups for children?

[Wes Streeting]

This is an issue that the Government are prioritising. The hon. Member will be aware of the commitment we made to provide 700,000 urgent dentistry appointments. We are ramping up to deliver on that commitment, as well as to deliver supervised toothbrushing in our schools. Further wider-ranging reform is needed; I am working closely with the Minister for Care to rebuild NHS dentistry, after the rot left in it by the Conservatives.

[Matthew Patrick (Wirral West) (Lab)]

T8. As we heard from my right hon. Friend the Secretary of State, this is National HIV Testing Week. In the Liverpool city region, Steve Rotheram is forming plans to end new HIV cases by 2030, and the Royal Liverpool university hospital is starting opt-out testing. As my right hon. Friend said, this week, our Prime Minister became the first leader in, I think, the G20 to take an HIV test. What plans does my right hon. Friend have to ensure that there is more HIV testing beyond this important week?

[Christine Jardine (Edinburgh West) (LD)]

T3. The charity that organised the campaign “The Darker Side of Pink” estimates that 31 women lose their battle against metastatic breast cancer every day, which means that more than 20,000 have died since I first raised this matter two years ago during Prime Minister’s Question Time. What will the Government do to increase awareness, understanding, the availability of drugs and screening for women facing this challenge?

[Wes Streeting]

The hon. Member is right to raise this serious and important issue. We want to ensure that we improve diagnostics, access to treatment and research, and I can think of no better person to lead the work on this area of the national cancer strategy than my hon. Friend the Minister for Secondary Care, who has lived experience, and who demonstrates that people can live well with cancer.

[Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)]

T9. Women across the country, including my constituent Lisa from Haxey, are struggling to access vital hormone replacement therapy medications, such as Estradot patches. Owing to a 30-year-long medical condition, Lisa had her ovaries removed and now faces severe health consequences because of these ongoing medication shortages, and there is no resolution expected soon. Given the repeated supply issues with HRT in recent years, what actions is the Minister taking to ensure a consistent and reliable supply of those essential medicines?

[Mr Gagan Mohindra (South West Hertfordshire) (Con)]

T4. My constituent James, from Abbots Langley, wrote to me on the subject of the Chancellor’s recent talk about pushing infrastructure projects, such as the Heathrow airport expansion. Why is the Health Secretary not pushing for this infrastructure funding to be spent on the new Watford General hospital, a project that has cross-party support, is shovel-ready and will save lives?

[Wes Streeting]

If the hon. Member is so committed to that project, perhaps he can explain why his party did so little about it in government.

[Peter Lamb (Crawley) (Lab)]

Since April, Crawley’s urgent treatment centre has been temporarily closed overnight because of low staffing levels. What do the Government intend to do to ensure that normal services are resumed for communities such as mine?

[Jim Shannon (Strangford) (DUP)]

T5. There are 153,000 people in the United Kingdom living with Parkinson’s, and one in 137 will be diagnosed during their lifetimes. There are 18,000 new cases every year, 4,200 of them in Northern Ireland. Does the Secretary of State agree that it is time we had a Parkinson’s charity, not just for England but for Scotland, Wales and Northern Ireland as well? As I always say, let us do it better together.

[Wes Streeting]

Where have I heard that before? The hon. Member knows that I will agree with him on the matter of the Union, but I also believe that we should work cross-border wherever we can, especially when it comes to important issues such as Parkinson’s. We have to make better breakthroughs in research, treatment and, hopefully, finding a cure.

[Catherine Atkinson (Derby North) (Lab)]

After 14 years of Conservative government, 77% of people in Derby cannot access an NHS dentist. Can the Minister tell us what caused the rot to set in and how we can fill the cavities in provision?

--- Later in debate ---

[Vikki Slade (Mid Dorset and North Poole) (LD)]

T10. Some 44,066 children—one in six—are waiting more than a year for medical treatment, compared with one in 100 adults. Waits are at their worst in community medicine. In Dorset, there are waits of up to two years in child development, and delays of a year are normal for child and adolescent mental health services. Fifty-three per cent of all community health referrals take more than a year. Will the Minister confirm whether the 18-week target will apply to community referrals and not just hospitals? If not, when can we expect a target, so that children are not badly affected?

[Wes Streeting]

The hon. Member is absolutely right to put the spotlight on paediatric health. Mental health is important for children and young people, but physical health is too. This Government are committed to dramatically reducing waiting lists and returning to the 18-week standard by the end of this Parliament, but we should aim to go even harder after those childhood waiting lists, because many children waiting in pain and agony are losing valuable years of their childhood that they will never get back.

[Tonia Antoniazzi (Gower) (Lab)]

The Government know how hard I have worked as co-chair of the all-party parliamentary group for medical cannabis on or under prescription. I am pleased to hear that there is a trial, but I urge the Minister and her team to make sure that it actually goes ahead, as others have not because of Brexit, covid and elections. Can she please meet me to ensure that the APPG and I are kept up to date on the work of the NHS?

[Lee Anderson (Ashfield) (Reform)]

The new Health Minister has stated that it is okay for a human being to present as a llama. If I have a family member who presents as a llama and suddenly becomes ill in the middle of the night, should I send for a doctor, a vet or a straitjacket?

[Wes Streeting]

I can say to the hon. Member that my hon. Friend the Minister believes in treating every human being with the dignity and respect they deserve—even the hon. Gentleman.

[Josh MacAlister (Whitehaven and Workington) (Lab)]

Shortly after the election, the new Government announced £4.3 million for a new community mental health hub in Whitehaven. Unfortunately, the local mental health trust followed that decision by announcing the closure of the Yewdale ward for acute mental health services. Does the Minister agree that we need to get early intervention right before we close acute services, and will he bring together a meeting to scrutinise that decision?

[Robbie Moore (Keighley and Ilkley) (Con)]

Insomnia affects many patients, including my constituents, who are being advised by their GPs to try cognitive behavioural therapy as an alternative to medication. However, digital CBT programmes are not available on the NHS, leaving many without access to drug-free treatment. Will the Minister outline what steps the Government are taking to ensure that patients have access to digital therapies, so that more people can get access to evidence-based, drug-free support?

[Wes Streeting]

The hon. Gentleman hit the nail on the head when he mentioned the importance of evidence-based treatment. As part of the Government’s shift from hospital to the community, from analogue to digital and from sickness to prevention, the NHS absolutely should be in this space, and we are considering those issues as we develop our 10-year plan for health.

[Daniel Francis (Bexleyheath and Crayford) (Lab)]

The NHS South East London integrated care board provides services to my constituents, and I have discussed some ways in which we could better deliver services by redeveloping the Erith community hospital site in Northumberland Heath. Is the Minister able to provide an outline of the Government’s plan to provide capital funding for expanding community services like those at Erith hospital?

[Steve Darling (Torbay) (LD)]

Health authorities in Devon are set to trial the relocation of a vital coronary service from Torbay to Exeter, which is 24 miles away. Will the Minister meet me and fellow south Devon MPs who have grave concerns about the impact on patient safety?

[Wes Streeting]

It is important that people are able to get the right care in the right place at the right time, and I recognise the challenges, particularly in geographies such as Devon and Cornwall, which have more rural and remote communities. In the first instance, I encourage the hon. Gentleman to take this issue up with local health leaders and his integrated care board, but Ministers are always open to receiving representations beyond that if he needs further reassurance.

NHS England and NHS Operational Planning Guidance 2025-26

Wes Streeting Excerpts

Thursday 30th January 2025 Written Statements

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

I am today laying in Parliament the Government mandate for NHS England, and NHS England is publishing the operational planning guidance for the NHS.

This Government won the election to deliver change. The mandate and operational planning guidance mark a significant step on a long journey to get the NHS back on its feet, and drive the reform that is needed to make it fit for the future.

The mandate and operational planning guidance address the urgent challenges facing the NHS, as highlighted by the Darzi investigation. They put the NHS on the road to recovery and reflect patient priorities: cutting waiting times, improving access to primary care and improving urgent and emergency care. They reflect the need for the NHS to live within its means, and ensure that investment in the NHS, against a challenging economic and fiscal backdrop, is matched with reform to the operating model and a sharp focus on improving efficiency and productivity.

Patients need high-quality elective care delivered in a timely fashion, and should have choice and control over their care. I am re-focusing the NHS on making progress towards the 18-week standard, and the steps to achieve this were set out in our elective reform plan. This mandate supports the modernisation of primary and community care that will help patients get timely access to a GP appointment. The mandate is the start of us delivering our manifesto commitment to provide 700,000 urgent dental appointments to address our dentistry crisis.

Right now, patients are not receiving urgent and emergency care when they need it. Today’s changes will put patients at the centre of delivery, focusing on safety, experience and outcomes, and we will tackle variation in services delivered across the country, bringing the best of the NHS to the rest of the NHS. These changes come ahead of publishing, in 2025, our strategy to fix urgent and emergency care.

Patients’ priorities will be delivered through a new operating model, which will devolve power closer to the frontline and allow the best performing providers and integrated care boards to earn more autonomy to provide services needed by their local communities—all while ensuring a focus on efficiency and productivity to support the NHS to live within its means.

This year’s operational planning guidance puts these objectives into practice with fewer targets, giving local systems greater control and flexibility over how local funding is deployed to best meet the needs of the people they serve. I am instructing the NHS to focus on the fundamentals and get back to basics. We are giving local leaders clear directions to prioritise cutting elective care waiting lists, improve A&E and ambulance wait times, improve access to GPs and urgent dental care, and solve the mental health crisis.

2025-26 must be a year of financial reset for the NHS. The budget settlement for the NHS is welcome and we will ensure it is spent wisely, through financial rigour, to deliver services for patients. NHS providers are being asked to undertake a 1 % reduction in cost base, while raising their productivity and efficiency by 4%.

Making decisions like these are never easy, but when I joined the Department, I pledged to make sure that every penny was spent in a way that provides the best value for the patients. Together we will bring reform to the NHS and get it back on its feet.

[HCWS400]

New Hospital Programme Review

Wes Streeting Excerpts

Monday 20th January 2025 Commons Chamber

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

With permission, Mr Speaker, I would like to make a statement on the new hospital programme.

Of all the damage that the Conservative party did during their time in office—the broken public finances, the broken economy, the broken NHS—perhaps the most egregious was the broken trust between the British people and their Government, not just through their scandals or by breaking the rules they imposed on the rest of the country, but by making promises that they never intended to keep.

In 2019, the Conservatives told the British people that they would build 40 new hospitals over the coming decade, but there were never 40 new schemes and many of them were extensions or refurbishments. Put simply, they were not all new, some of them were not hospitals, and there were not 40 of them. Five years passed, start dates were delayed, spades remained out of the ground, and it became clear the announcement was a work of fiction.

Yet what did the Conservative party manifesto at last year’s general election say on the matter? It said:

“We will invest in more and better facilities, continuing to deliver 40 new hospitals by 2030”.

They repeated the promise even though the Department of Health and Social Care was putting contracts out to tender for hospital building that ran until 2035. They repeated that commitment even after the National Audit Office found that the Government

“will not now deliver 40 new hospitals by 2030.”

They repeated it even though the Government’s own infrastructure watchdog deemed it to be “unachievable.” No one thought that the promise would be met, yet the Conservative party made it anyway time and again.

Despite knowing this, when I walked into the Department of Health and Social Care on 5 July, what I discovered shocked me. The scheme was not just years behind schedule; the money provided by the previous Government was due to run out in March, just weeks from today. On 25 May 2023, the then Health and Social Care Secretary, the right hon. Member for North East Cambridgeshire (Steve Barclay), stood at this Dispatch Box and told the House:

“Today’s announcement confirms more than £20 billion of investment”.—[Official Report, 25 May 2023; Vol. 733, c. 480.]

The truth is that no funding had been set aside for future years; the money simply was not there. This was a programme built on the shaky foundation of false hope.

If I was shocked by what I discovered, patients ought to be furious—not just because the promises made to them were never going to be kept, but because they can see when they go into hospital how badly the health service needs new buildings. The NHS is quite literally crumbling. Lord Darzi’s independent investigation found that the NHS was starved of capital investment by the previous Government. Its outdated estate has hit productivity, with services disrupted at 13 hospitals every day during 2022-23. I have visited hospitals where the roof has fallen in and where pipes regularly leak and even freeze over in winter. The Conservatives literally did not fix the roof when the sun was shining.

On Thursday, the Infrastructure and Projects Authority published its annual report for 2023-24. Its assessment of the new hospital programme read:

“There are major issues with project definition, schedule, budget, quality and/or benefits delivery, which at this stage do not appear to be manageable or resolvable. The project may need re-scoping and/or its overall viability reassessed.”

That is what this Government have done.

Our review of the new hospital programme and the announcement I am making today will do two things: first, it will put the programme on a firm footing with sustainable funding, so that all the projects can be delivered; and, secondly, it will give patients an honest, realistic and deliverable timetable that they can believe in. This Labour Government are rebuilding our NHS, and as we do so, we will also rebuild trust in politics.

The seven hospitals built wholly or mostly from reinforced autoclaved aerated concrete—RAAC—were outside the scope of the review. These will be rebuilt at pace to protect people’s safety. Also out of scope were the hospitals already under construction or with an approved business case, where building works have continued without delay.

Working closely with my right hon. Friend the Chief Secretary to the Treasury, we have secured five-year waves of investment, backed by £15 billion of investment over consecutive waves, averaging £3 billion a year. That funding is in addition to the £1 billion that the Chancellor announced at the Budget to tackle dangerous RAAC and the backlog of critical maintenance, repairs and upgrades across the NHS estate. It is also in addition to the £1.5 billion we are investing in new surgical hubs, diagnostic scanners and beds. Together, it forms part of the £13.6 billion of capital investment announced at the Budget, which is the largest capital investment in our national health service since Labour was last in office.

I will now set out the new timetable. Projects in wave zero are already in the advanced stages of development and will be completed within the next three years. These are: the Bamburgh unit, phase 3 of the care environment development and re-provision, or CEDAR programme; the national rehabilitation centre in Nottinghamshire; Oriel eye hospital; Royal Bournemouth hospital; St Ann’s hospital; Alumhurst Road children’s mental health unit; and Dorset county hospital.

Wave 1 schemes will begin construction between 2025 and 2030. These include the seven RAAC hospitals: Leighton hospital; West Suffolk hospital; Frimley Park hospital; Hinchingbrooke hospital; Queen Elizabeth hospital; James Paget hospital; and Airedale general hospital. The other wave 1 schemes are: Poole hospital, Milton Keynes hospital; the 3Ts hospital—trauma, tertiary and training—in Brighton; the women and children’s hospital, Cornwall; Derriford emergency care hospital; Cambridge cancer research hospital; Shotley Bridge community hospital; North Manchester general hospital; and Hillingdon hospital.

Wave 2 schemes will now begin main construction between 2030 and 2035. They are: Leicester general hospital and Leicester royal infirmary; Watford general hospital, the specialist and emergency care hospital in Sutton; Kettering general hospital; Leeds general infirmary; Musgrove Park hospital; Princess Alexandra hospital; Torbay hospital; and Whipps Cross hospital, where I should declare an interest, as it serves my constituency.

Wave 3 includes nine schemes that will start construction between 2035 and 2039: St Mary’s hospital in London; Charing Cross hospital and Hammersmith hospital; North Devon district hospital; Eastbourne district general hospital, Conquest hospital and Bexhill hospital; Hampshire hospitals; Royal Berkshire hospital; Royal Preston hospital; the Royal Lancaster infirmary; and the Queen’s medical centre and Nottingham city hospital.

Following this statement, further details of the hospital building programme will be published on my Department’s website and a copy of the report will be placed in the House of Commons Library. In addition, the Minister for Secondary Care will hold meetings tomorrow, to which MPs of all parties are invited, to answer any further questions about these projects.

To ensure that every penny of taxpayers’ money is well spent and every hospital is delivered as quickly as possible, we will shortly launch a new framework for the construction of the new schemes. This will be a different way of contracting by working in partnership with industry to mitigate cost, schedule and delivery risks and saving money through a standardised design approach. That will speed up the process of opening new hospitals and provide a foundation for a collaborative supply-chain partnership. We will also appoint a programme delivery partner in the coming weeks to support the delivery of crucial hospital infrastructure across the country and provide programme, project and commercial expertise.

I know that patients in some parts of the country will be disappointed by this new timetable—they are right to be. They were led up the garden path by three Conservative Prime Ministers, all promising hospitals with no credible plan for funding to deliver them, and by Conservative MPs, who stood on a manifesto promise they knew could never be kept. We will not treat the British people with the same contempt. We will never play fast and loose with the public’s trust.

The plan that we have laid out today is honest, funded and can actually be delivered. It is a serious, credible plan to build the hospitals that our NHS needs. It is part of the biggest capital investment that the NHS has seen since Labour was last in office, delivering not just more hospitals but new surgical hubs, community diagnostic centres, AI-enabled scanners, radiotherapy machines, modern technology, new mental health crisis centres and upgrades to hundreds of GP estates. It will take time, but this Labour Government are determined to rebuild our NHS and rebuild trust in politics. I commend this statement to the House.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Secretary of State.

[Edward Argar (Melton and Syston) (Con)]

I am grateful, as always, to the Secretary of State for his typical courtesy in giving me advance sight of his statement. Labour was prepared to make all sorts of promises in opposition to win power—it promised not to raise taxes on working people, it said that it would not cut the winter fuel payment, and it promised to deliver the new hospital programme—but just as working people, pensioners, farmers and businesses have found, this is a Labour Government of broken promises. They have cynically betrayed the trust of the British people.

The Secretary of State and the Chancellor travelled the country to meet candidates who were promising a new hospital in their local area. In fact, despite my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins) calling them out in this very place in May last year, warning that Labour had said in the small print of its health missions that it was planning to pause all this capital investment, the Secretary of State was quoted in the Evening Standard in June last year to have said:

“We are committed to delivering the New Hospitals Programme”.

Those are seemingly hollow words now that those hospitals are at risk, with the investment and upgrades they deserve pushed back potentially to start in some cases as late as 2039. Voters put their trust in the Labour party to deliver on its promises, yet today they have been let down.

In response to claims that that is perhaps because of Labour’s economic inheritance, that simply does not reflect reality. Before the Secretary of State warms to the theme of the mythical £22 billion black hole, he will know that the Office for Budget Responsibility has simply failed to recognise that figure. Let us also be clear that, due to the Labour party and the Chancellor’s financial mismanagement at the Budget and the rise in gilts, the BBC recently estimated that the cost of borrowing could be £10 billion higher over this Parliament. Just imagine what the Secretary of State could have announced today if the Chancellor of the Exchequer had not caused that.

To govern is to choose: what to spend money on, what to invest in, and what not to invest in. The Secretary of State rightly pointed out that the Darzi review highlighted the need for more capital investment in the NHS, yet he has decided not to prioritise the delivery of these new hospitals in a rapid fashion. He will also know how the Treasury allocates funding, with cash earmarked to the end of a spending review period but not going across it until that comprehensive spending review formally concludes—that is what his Government are now doing.

The Secretary of State will be aware that the previous Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), was very clear about the £20 billion anticipated in the next CSR to fund this. Let me be clear: we prioritised the delivery of these new hospitals, as my right hon. Friend did in his statement on RAAC on 25 May 2023, setting out the Government’s commitment to fund them. This Secretary of State has not replicated that.

We had a clear plan, with that funding commitment to be formalised at the CSR, to approve, build and complete new hospitals to a definition akin to that used by Tony Blair when building new hospitals, which were already being designed to a standardised approach with modern methods of construction. The Secretary of State has put that progress at risk. Will he confirm that in his CSR discussions with the Chancellor of the of the Exchequer about the capital departmental expenditure limit—CDEL—allocation for his Department, he will prioritise the new hospital programme? When will the Secretary of State set out to local people in each area exactly when construction will start? I declare an interest: University Hospitals of Leicester NHS trust serves my constituents. In each case, when will the doors actually open?

If the Chancellor fails to get the economy growing and starts looking yet again for cuts to fill the hole that she created with her Budget, will the Secretary of State rule out any further delays? What is his assessment of the effect of his lengthening the programme’s timescales on costs, given inflationary pressures? Are all other previously approved capital projects and programmes safe from review? Can he possibly update the House—via the Library if not here—on his latest assessment of the impact of RAAC in those hospitals, which rightly he is continuing to prioritise?

Today’s announcement will come as a bitter blow to trusts, staff and, crucially, patients, who believed the Labour party and will now be left waiting even longer for vital investment. Yet again, before the election, they talked the talk, but patients lose out when this Government fail to deliver. In yet again kicking the can down the road, as is increasingly their habit, they have sadly betrayed the trust of the British people.

[Wes Streeting]

This weekend the Leader of the Opposition said that she will be honest about the mistakes of the Conservative Government. It seems that the shadow Health Secretary did not get the memo. If the Leader of the Opposition is serious about showing some contrition, she might want to start here. In 2020 the Department of Health and Social Care requested funds from the Treasury to rebuild the seven RAAC hospitals. That request was denied, setting back the necessary rebuild of those hospitals by years. The shadow Secretary of State will remember this, as he was a Minister in the Department at the time. Which of his colleagues was a Treasury Minister when it blocked the rebuild of the RAAC hospitals? The Leader of the Opposition. That is her record. She should apologise.

Once again, like the arsonist returning to the scene of the crime to criticise the fire brigade for not responding fast enough, the Conservatives have the audacity to come here and talk about a failure to deliver, when promise after promise was broken. The shadow Secretary of State was the Chief Secretary to the Treasury who had to come in to clean up the mess caused by Liz Truss’s mini-Budget. That is what crashing the economy looks like. They still have not had the decency, even under new leadership, to apologise.

If the shadow Health Secretary genuinely believes that all these projects could be delivered by 2030—the commitment in the Conservatives’ manifesto—I invite him to publish today their plan for doing it. How would he ensure the funding, labour supply, building materials and planning to build the remaining projects in the next five years? Which capital programmes would he cut? Which taxes would he increase? He knows as well as anyone that those are the choices that face Government.

While he is doing that, can the shadow Health Secretary tell us what he can see that the National Audit Office, the Infrastructure and Projects Authority and the eyes in my head cannot see? What was the Conservatives’ plan past March, when the money runs out? What taxes would they have raised? I wonder what capital projects they would have cut in order to invest even more than we are in hospital buildings—the biggest capital investment since Labour was last in office.

While he is answering those questions, the shadow Healthy Secretary might want to reflect, with the shadow Cabinet and with Members on the Benches behind him, on the other messes that this Government are having to clear up. As I look around the Cabinet table, I see an Education Secretary dealing with crumbling schools, a Justice Secretary without enough prison places, a Defence Secretary dealing with a more dangerous world, a Transport Secretary having to rebuild our crumbling infrastructure, and a Deputy Prime Minister building the homes we need—in short, dealing with multiple crises of the Conservatives’ making. There is a massive rebuilding job to do in Britain, and we are getting on with it.

[Dame Siobhain McDonagh (Mitcham and Morden) (Lab)]

I think my point will be unlike that of any other Member in the House. The specialist emergency care hospital in Sutton is in tier 2 of these schemes. Can I say to the Secretary of State, as I have said to every Health Secretary over the past 25 years, that no one wants this? We want the services at St Helier hospital to remain at St Helier, where the people who are poorest and most ill need them. Will he look at this £500 million-pound scheme to see if it is really necessary?

[Wes Streeting]

My hon. Friend is absolutely right: I think that will be a unique representation this afternoon. I can already hear the vultures swooping, looking for that capital allocation and slot in the pipeline. She has made the case repeatedly, forcefully and with conviction that these services should remain in a community with high levels of deprivation and high need. I know that the Minister for Secondary Care, my hon. Friend the Member for Bristol South (Karin Smyth), has already committed to meeting her, and we are very happy to have those conversations with her.

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

[Dr Danny Chambers (Winchester) (LD)]

In Hampshire and across the country in 2019 and 2024, Conservative MPs stood on the promise of delivering new hospitals, including one for Hampshire. However, it turned out that there was never any funding for that, and that those were just false promises to try to get votes. I have fought tirelessly to save and improve Winchester’s A&E and consultant-led maternity unit. With the announcement that construction of a proposed new hospital in Hampshire will not even start until between 2037 and 2039, we absolutely need to ensure that the current services are invested in and improved so that they remain fit for purpose.

Given that the new hospital programme is delayed, it is more urgent than ever to increase capacity by fixing social care, so that those who are well enough to leave hospital can be cared for in the community, thus freeing up beds immediately. We cannot endure both insufficient social care packages and crumbling hospitals. Given this delay to the new hospital programme, will the Secretary of State commit to prioritising more social care packages now, rather than waiting three years for a review to be complete?

Although the Health Secretary is not responsible for the state of the NHS or the state of the economy, which the Government inherited, the new hospital programme was seen as part of the solution to the crisis in the NHS, and people across the sector have warned that delaying the programme will only mean more treatments cancelled and more money wasted plugging holes in hospital buildings that are no longer fit for purpose. We are therefore concerned that one of the biggest announcements to affect the NHS over the next few years is coming out right now, during Donald Trump’s inauguration, because it will not get the media attention it deserves. Liberal Democrats therefore urge the Health Secretary to promise to release a full impact assessment on how the delays to the new hospital programme will affect patients and NHS staff.

[Wes Streeting]

I will take those points in turn. With enormous respect for the momentous democratic event taking place in Washington today, I do not think that the new President, last time I checked, had declared an interest in any of our hospital schemes. I am sure he will forgive us for getting on with the job of British government, even as the American handover takes place.

I committed some time ago to coming to the House in the new year. I have kept that promise and I dare say that the decisions that we are taking and setting out today will receive good coverage. I reassure the hon. Gentleman, and other Members across the House with an interest in particular schemes, that my hon. Friend the Minister for Secondary Care and officials from the programme team will be happy to meet as early as tomorrow to take questions on individual schemes.

The hon. Gentleman raises broader challenges for the NHS and social care pressures in our country. That is why the Chancellor prioritised investment in our NHS and social care services in the Budget, with £26 billion of additional funding for my Department of Health and Social Care. On social care specifically, we have taken a number of actions in our first six months: fair pay agreements for care professionals, the biggest expansion of the carer’s allowance since the 1970s and an uplift in funding for local authorities, including specific ringfenced funding for social care. We will be setting out further reforms throughout this year, as well as phase 1 of the Casey commission reporting next year for the duration for this Parliament.

Opposition Members cannot have it both ways. They cannot keep on welcoming the investment and opposing the means of raising it. If they do not support the Chancellor’s Budget, which is their democratic right, they have to say which services they would cut or which alternative taxes they would raise. Welcome to opposition, folks. We’ve been there. Enjoy the ride: you’ll be there for some time.

Finally, let me just say this to the Liberal Democrats, who have constructively raised a range of challenges. This is at the heart of the challenge facing this Government. The hon. Gentleman is right to mention the capital challenges facing the secondary care estate. The same is true of the primary care estate and of the community and mental health estates. As I have spelled out, every single one of my Cabinet colleagues also has significant capital pressures. That is the consequence of 14 years of under-investment in our public infrastructure and in our public services, which means that we are paying a hell of a lot more for the Conservatives’ failure than we would have if they had built on, rather than demolished, Labour’s record of the shortest waiting times and the highest patient satisfaction in history.

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

Today’s announcement is welcome for my constituents. It confirms that we are keeping the promises we made in 2023 to deliver Hillingdon hospital in the first term of a Labour Government. I thank my right hon. Friend for that commitment. We also know that, shamefully, my predecessor and his predecessor misled my constituents. My predecessor stood here, almost where I am standing today, and told my constituents that Hillingdon hospital was fully funded and that construction had started. We now know that that simply was not true. Does my right hon. Friend agree that it is vital that today’s statement outlines a fully funded programme that is deliverable and an honest assessment of when hospitals will be delivered? Can he confirm that that is the case?

[Wes Streeting]

First, I thank my hon. Friend for his strong representations on behalf of his constituents, not just since his election, but before it. Between the by-election and his election to this place, he did not give up; he continued to fight for his community.

I stood outside Hillingdon hospital, having had a good look around at the state of the hospital and the plans for the reconstruction of the site. I am delighted to have kept my promise and this Government’s promise, so that construction at Hillingdon hospital will begin in 2027-28. My hon. Friend is quite right to say that his predecessor and his predecessor’s predecessor made claims about Hillingdon hospital that were not true. This Government will not make those mistakes. We will keep our promise. What we have set out for all schemes in the new hospital programme is a credible, realistic, funded timetable that this Government, for as long as there is a Labour Government, will actually deliver.

[Madam Deputy Speaker (Judith Cummins)]

I call the Father of the House.

[Sir Edward Leigh (Gainsborough) (Con)]

Will the Secretary of State forgive me if I give the House a few seconds’ respite from the blame game by trying to make a positive suggestion? Everyone accepts that the real problem facing our hospitals is the number of frail and elderly people who do not need to be in hospital and should be in some sort of care facility. Does the Secretary of State agree that while building brand-new, all-singing, all-dancing hospitals is very expensive, there is a future for smaller cottage hospitals such as the one in Gainsborough and a case for opening other facilities so we can move elderly, frail people out of those big hospitals into a caring environment and free up space?

[Wes Streeting]

I thank the right hon. Gentleman for a rare constructive contribution from the Conservative Benches—not rare from him, for he is regularly constructive; it is the rest of the Conservative party that we have a problem with. Let me reassure him that one thing we are determined to do is deliver a shift in the centre of gravity, out of hospitals and into communities, with care closer to home and indeed in people’s homes. As I saw on a visit to Carlisle over the new year, good intermediate step-down accommodation sometimes provides better-quality and more appropriate care and better value for the taxpayer. That intermediate care facility in Carlisle, funded through the NHS by a social care setting, was providing great-quality rehabilitation in a nicer environment at half the cost of the NHS beds up the road. This Government will deliver both better care and better value for taxpayers.

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

I am really glad that my right hon. Friend has a grip on the hospital building programme and has developed a pipeline for scheduling the new hospitals. York is not on the list, but given that it was one of the cheapest hospitals to build, it will certainly need to be there in 10 to 15 years. How will my right hon. Friend review hospitals that are not on the list and schedule them into future programmes?

[Wes Streeting]

We keep a regular eye on the capital needs of the NHS across the board. Subject to the usual constraints on resources, supply chain construction industry capacity and so on, we will continue to do so. We are determined not to repeat the mistakes of our predecessors, but to ensure that the promises we make are promises we can keep.

[Sir Roger Gale (Herne Bay and Sandwich) (Con)]

Before the general election was called, there was a clear indication from the Government that they intended to fund the—only—£25 million reconstruction of the maternity unit at the QEQM hospital in Margate, which emerged from the Bill Kirkup report. I will be grateful if the Secretary of State can tell me whether it is his intention to ensure that that funding is made available.

The right hon. Gentleman referred to the number of houses that the Secretary of State for Housing, Communities and Local Government is determined to see built. Could he explain, for the sake of East Kent, how the primary and secondary healthcare services will be provided to meet the needs of the people who will live in those houses?

[Wes Streeting]

I am very aware of the challenges in East Kent and the challenges of providing good-quality care and the facilities that people need. I am sure that Ministers will be happy to receive representations from the right hon. Gentleman.

The right hon. Gentleman asks about the Government’s commitment to building 1.5 million more homes. Let me reassure him and the House that the Deputy Prime Minister and I, as well as other members of the Cabinet, are discussing very carefully how we can make sure that alongside the new homes that our country needs, we have the infrastructure and the public services that people deserve.

[Ben Coleman (Chelsea and Fulham) (Lab)]

My predecessor in Chelsea and Fulham claimed to have secured funding for Charing Cross hospital. That claim went out on election literature throughout the constituency. At the time, I doubted it. Today’s announcement confirms beyond any doubt that the money was not there. What he was saying was not true.

I welcome the honesty and realism of the Government’s statement today. It is about time the British people had a Government playing straight with them and telling them the truth. [Interruption.] Instead of laughing and jeering from the Conservative Benches, which is of no use to my constituents in Chelsea and Fulham who were promised the money for Charing Cross hospital when it was never there, I would like to see some contrition. On a more positive note, can the Secretary of State assure my constituents that the timetable that he has set out will be met?

--- Later in debate ---

[Wes Streeting]

I can give my hon. Friend that assurance. I thank him for the very strong representations that he has made on behalf of his local trust since his election to this House. I am afraid that the extent to which promises were made about this scheme that could not be kept is shameful. I can reassure him that pre-construction work will take place between 2030 and 2035. As he knows, this is not a straightforward project, but it is one to which we are very much committed, with construction due to start around 2036. I am very happy to continue to work with my hon. Friend and with neighbouring right hon. and hon. Members to make sure that the trust is supported during that period, given the day-to-day challenges that it faces.

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

The acute hospital that serves most of my constituency is the Royal Lancaster infirmary. It is an overcrowded Victorian hospital; parts of it are falling to bits, it has inadequate parking and it is at the wrong end of a one-way system. With the Secretary of State’s help, the local hospital trust has acquired an almost perfect site for a rebuild. The trust has designed the new hospital and even begun consulting the public on it, so today’s announcement that we face a 10-year wait until a spade is dug into the ground will come as something of a bombshell. Will he reconsider the timescale? The longer we leave it, the more the cost will spiral and, I am afraid, the less likely it is that people will have confidence that it will even happen at all.

[Wes Streeting]

On the hon. Gentleman’s final point, I can well understand why people across the country will be cynical about commitments made on hospitals, given the experience that they had under our Conservative predecessors. Even if not every decision that we are taking is universally popular, I hope that people will appreciate our up-front candour and honesty in not trying to pull the wool over their eyes, and in setting out in today’s report, in terms, the timetable for pre-construction work and for starting construction.

In the particular case that the hon. Gentleman raises, I hope that the fact that land was acquired by this Government in December 2024 signals our absolute commitment to the scheme. If we were not committed to the scheme, we would not have made the land purchase up front ahead of pre-construction works, which are planned for 2030. We did so because we absolutely accept the case that he makes about the desirability of the site and the need for investment and the new hospital locally. In addition to the representations from the hon. Gentleman, my hon. Friend the Member for Lancaster and Wyre (Cat Smith) wins the award for being the first MP to collar me straight after the election to say, “Buy this land and do it now.”

[Liz Twist (Blaydon and Consett) (Lab)]

After years of broken Tory promises on new hospitals, can the Secretary of State confirm today that, following this review, my constituents in Blaydon and Consett can at last be confident that we have an honest, realistic and deliverable timetable that they can believe in?

[Wes Streeting]

I am grateful to my hon. Friend for the representations that she has consistently made since before the general election. I think her constituents will particularly welcome the investment in Shotley Bridge community hospital, which will be in wave 1, with construction starting in 2026-27. I know that that is not the only need for health and care provision in her constituency; we will continue to work together to make sure that her constituents experience an improving NHS, as opposed to being lumbered with the broken one that was left behind by the Conservatives.

[Damian Hinds (East Hampshire) (Con)]

This announcement will come as a terrible blow to the people served by Basingstoke and North Hampshire hospital, particularly after the very personal commitment made by the now Prime Minister in June 2024. We assume from what the Secretary of State has said today that, come the spending review, the Government will set out detailed capital budgets stretching into the 2040s. Can he tell us in the meantime what his announcement will do to his projections for operating costs, for repairs and maintenance costs and for the provision of stopgap facilities where they are needed?

[Wes Streeting]

Given that the right hon. Gentleman served in the Cabinet under successive Conservative Governments, he has some brass neck, frankly, in turning up today and complaining in the way that he has. He wants to talk about the costs placed on the country, but he should look in the mirror and consider the costs that he and his colleagues in government lumbered this country with when they imposed over a decade of austerity, of Trussonomics and the worst sort of kamikaze ideological project that this country has experienced in modern times.

I would just remind the right hon. Gentleman—[Interruption.] I remind him and those on the Conservative Benches who are living in an alternate reality where they bear no responsibility for their actions of only months ago, that the National Audit Office said:

“By the definition the government used in 2020, it will not now deliver 40 new hospitals by 2030.”

The Infrastructure and Projects Authority gave the scheme a red rating, saying that

“the project appears to be unachievable… The project may need re-scoping and/or its overall viability reassessed.”

What on earth does he think that record did for NHS managers, given the stop-start, stop-start? What on earth does he think that did to communities who were seeking certainty and assuming that the promises made by the Conservatives would be kept? They said in their manifesto only last July that they would deliver 40 new hospitals by 2030. Well, according to the NAO’s definition and the IPA’s report, that promise was never going to be kept. They knew it. They did not care. They just said what they wanted to try to win votes, and that is disgraceful.

[Several hon. Members rose—]

[Graham Stringer (Blackley and Middleton South) (Lab)]

My right hon. Friend’s statement stands in sharp contrast to that made on 25 May 2023 by the previous Secretary of State, when he completely forgot to put in his statement, both written and verbal, North Manchester general hospital. I am pleased that North Manchester general hospital is today in the first wave, but I would be grateful if my right hon. Friend could spell out in detail when the work will continue, because in one of the areas of the country with the worst health outcomes, it is not only a hospital scheme; it is an urban regeneration scheme, and some work has started. Will that work be allowed to continue? Can he give me some details, please?

[Wes Streeting]

My hon. Friend is right about the sorry state that North Manchester general hospital has been left in by our Conservative predecessors, not least the critical infrastructure risk at that hospital. Most of the existing estate dates back to the 1870s, and NHS leaders, managers and staff are having to deal with multiple day-to-day operational issues, including poor fabric and fire safety, ventilation, asbestos and water management issues. That is why I am delighted to confirm to my hon. Friend that the work will continue and construction will start in 2027-28. I am looking forward to working with him, other Greater Manchester MPs, the leader of the city council and the Mayor of Greater Manchester to make sure that this project delivers for the health and the wider economic benefits and needs of the people of Greater Manchester.

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

Given how Government finance works, the Secretary of State knows that he has, in effect, cancelled the replacement of Basingstoke and North Hampshire hospital. That is despite, as my right hon. Friend the Member for East Hampshire (Damian Hinds) said, the now Prime Minister going there during the election campaign and making a specific, unequivocal and unconditional promise that the hospital would be replaced by 2030. Sadly, it looks like that will now not be the case. I am sure the hon. Member for Basingstoke (Luke Murphy), who is in the Chamber, will be considering his position, given the promises he made.

Are we able to rescue something from this wreckage by purchasing the site? As the Secretary of State will know, we are now likely to lose the land. It is a critical site, so can we please buy it before it slips from our grasp?

[Wes Streeting]

We are happy to receive sensible representations from Members about their projects, as we have from my hon. Friend the Member for Basingstoke (Luke Murphy). It is a bit rich for Conservative Members to talk about understanding how public finances work.

[Anna Dixon (Shipley) (Lab)]

Last autumn, I met the Secretary of State to discuss the rebuild of the RAAC-infested Airedale general hospital. I reiterate my thanks on behalf of my constituents, who are being treated in wards with propped-up ceilings, for his and the ministerial team’s commitment to ensuring that this vital new hospital goes ahead with a deliverable timetable and a sustainable funding plan.

Does my right hon. Friend agree that the previous Government’s commitment to delivering 40 new hospitals by 2030 was, as the NAO concluded, disingenuous and “unrealistic”?

--- Later in debate ---

[Wes Streeting]

I am grateful to my hon. Friend for her question. We are very fortunate to have in the House someone with her experience of social care and health issues. She has already done an outstanding job representing her constituents, who I know will not only welcome the news that Airedale general hospital will begin construction in 2027-28 but will be appalled that, as a RAAC hospital, work could have been well under way had the Department’s request for funding not been denied by the woman who is now the leader of the Conservative party.

[Andrew George (St Ives) (LD)]

I sympathise with the Secretary of State for having to pull these projects out of the fire of non-funding, and I thank him for the announcement on the women and children’s hospital in Cornwall. I know that all my parliamentary colleagues in Cornwall will be delighted at today’s news. I sympathise with colleagues who find themselves in waves 2 and 3. What can the Secretary of State do to crack on with the enabling work to ensure that this project is delivered in double-quick time? It is desperately needed, and a 2030 finish date will be challenging for Cornwall. It would be much appreciated if it could be brought forward.

[Wes Streeting]

I am grateful for the way in which the hon. Gentleman poses his question. I can confirm that pre-construction work is ongoing, with construction due to start between 2027 and 2029.

A lot has been said about what my party said before the election, and I will give Opposition Members a role model in how to do honesty ahead of an election. I stood outside the Royal Cornwall hospital and was asked by local media whether I would commit to a specific timetable, and I said, “We have committed to the new hospitals programme. We are committed to seeing through the new women and children’s hospital at the Royal Cornwall, and I know that enabling work is under way. Beyond that, we are going to take an honest look at the books.” That is the approach I took as shadow Health and Social Care Secretary, and that is how to do it—to under-promise and then over-deliver.

[Alex Sobel (Leeds Central and Headingley) (Lab/Co-op)]

Leeds general infirmary received outline planning permission in 2020. Two Conservative Prime Ministers came to Leeds and promised that we would get our new hospital, despite knowing that the funding was not there in the Treasury.

I thank my right hon. Friend for visiting the LGI. Now that we know we are in wave 2, will he meet me and the chief executive to talk about one of the largest maintenance backlogs in the NHS, how we are going to cope in the intervening period, and how we are going to move forward and hit wave 2 running to get our hospital built before we need to close down our children’s services, which are at risk?

[Wes Streeting]

I am grateful to my hon. Friend for highlighting the extent to which Leeds general infirmary was let down over 14 years of Conservative Government, with initial under-investment followed by total inactivity, apart from a big pile of dirt outside the hospital, which I went to see with the then shadow Chancellor. The Chancellor and I are both committed to the project: we know how important it is. We have had to phase the programme so we can say it is genuinely affordable, deliverable and credible on this timetable. I reassure my hon. Friend that pre-construction work will take place over 2030 to 2032, with construction due to start in 2033 to 2035. We would be delighted to receive representations from MPs from his city and across the region about the support we provide to the trust in the meantime.

[Robbie Moore (Keighley and Ilkley) (Con)]

Airedale hospital has some of the worst RAAC of all the hospitals on the new hospital programme. All the surveys have said that given the risk profile associated with RAAC, parts of the hospital will have no life expectancy beyond 2030, which is why the completion date of 2030 was so important. With funds having been allocated to the project for it to be delivered, it is disappointing to hear today that the start date will be between 2025 and 2030. When is it likely that the new, rebuilt Airedale hospital will open? Will the Health Secretary provide the trust with confidence that additional funds will be available to help with the mitigation that needs to take place before the new hospital can open, to keep the existing hospital operational?

[Wes Streeting]

If the hon. Gentleman is disappointed with this Government, he will be absolutely furious when he finds out who was in power before. In fact, he is a dead ringer for the guy I used to see on the Conservative Benches cheering on and voting for every calamitous decision the Conservative Government took, including crashing the economy and supporting the now Leader of the Opposition when she rejected appeals to fund RAAC hospitals. We are prioritising those hospitals and going as fast as we can. The rebuilding will happen under a Labour Government, but it did not happen under the Tories, did it?

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

I welcome the honesty with which my right hon. Friend is approaching this matter, because Governments should not make false promises. I had the chance to visit a couple of the RAAC hospitals, and the Public Accounts Committee, which I used to chair, examined Hospital 2.0, the standardised approach he talked about. It contained some quite startling assumptions, so will he assure me and the House that he has looked into those in detail and that we are absolutely sure about the dates of delivery?

[Wes Streeting]

I reassure my hon. Friend that the approach we are taking, particularly the steps in the coming weeks on the outline for key delivery and the appointment of a partner, give me the confidence and assurance to know that the timetable we have set out is affordable and credible. I am always happy to receive advice and representations from my hon. Friend, who knows a huge amount about what she speaks about.

[Mr Lee Dillon (Newbury) (LD)]

In a few weeks’ time, I will celebrate my 42nd birthday. I was born at the Royal Berkshire hospital in Newbury, and given the Secretary of State’s announcement today, I will be celebrating my 60th birthday when the new hospital is due to open. Will the Secretary of State talk us through how operational budgets will be increased at hospitals such as the Royal Berkshire, which currently has a backlog of repairs of over £200 million that could stop operations and procedures happening? How will the Government ensure that money is in place while we wait 14 years for our new hospital?

[Wes Streeting]

I will be getting to 42 slightly earlier than the hon. Gentleman, as it is my 42nd birthday is tomorrow—I look forward to the cards in the post.

More seriously, on the phasing of the programme, we have taken an approach that ensures that we can stand up and look his constituents and others in the eye, and say that we have an affordable programme that can be delivered according to the timetable that is set out. I know people will be disappointed by the length of time it will take and I am genuinely sorry that they were led up the garden path by our predecessors. That is why we have taken an approach that says that honesty is the best policy. We would rather be up front about the length of time and in the meantime ensure we are delivering the investment and reform needed to reduce waiting times and improve primary, community and social care services, so even as work continues to prepare for the Royal Berkshire hospital scheme, his constituents and others across Berkshire will begin to experience an improving NHS under Labour, as opposed to the broken one they experienced under the Conservatives.

[Olivia Bailey (Reading West and Mid Berkshire) (Lab)]

While I welcome the firm commitment that the Secretary of State has made to a new Royal Berkshire hospital, my constituents will share my disappointment at the delay to its construction. I agree that the blame for the delay lies squarely with the Conservatives, who promised new hospitals without setting aside the money to pay for them, but will my right hon. Friend visit the Royal Berkshire hospital to discuss the interim capital funding that we will need as we wait for wave 3, and to see for himself how important it is that our new hospital is built as soon as possible?

[Wes Streeting]

No one has fought harder for the Royal Berkshire hospital scheme than my hon. Friend, and our hon. Friends the Members for Earley and Woodley (Yuan Yang) and for Reading Central (Matt Rodda), who are sitting beside her. They have worked incredibly hard as a team to make the case for investment in health and social care across Berkshire. I would be delighted to visit, because she is right that even as people wait for this particular hospital scheme there is a lot that we can, must and will do to improve health and social care services across her constituency and across Berkshire. I look forward to working with my hon. Friends to achieve that.

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

The Health Secretary has recognised the urgency of replacing the Queen Elizabeth hospital in King’s Lynn due to the RAAC safety issues. My constituents and I are grateful for that; it reflects the position of the last Conservative Government. In his statement, he said that he was working at pace to rebuild QEH, so will he instruct the NHS to expedite the business case approvals for the new multi-storey car park, which is the key enabling project, and will he commit to the 2030 deadline, which is the end of life of the hospital?

[Wes Streeting]

We recognise the challenge of RAAC in the Queen Elizabeth hospital in King’s Lynn, and took that approach from the outset. I can confirm that the programme will start construction in 2027-28. It is due to complete in 2032-33 but will be prioritised for expedition as a RAAC scheme. If we can go faster, we will. Today I am setting out a credible timetable. If we are able to under-promise and over-deliver, I will be delighted, but I reassure the hon. Gentleman that we are going as far and as fast as we can, given the safety challenges. If he is not happy with the pace, he should reflect on the fact that one of the local MPs was a former Prime Minister. She had the chance to get on with it. I hope I do not get a legal letter, but she did not deliver, did she?

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

For nearly 25 years, I have been part of campaigns to either save or rebuild Whipps Cross hospital. For the last 10 years, I have stood shoulder to shoulder with the Secretary of State, so I know—let me put this on the record for him, because he cannot say it—his pain and frustration that we are now talking about eight years to restart the building works that have already started at Whipps Cross, and which will finally deliver the new hospital that we need and a thousand new homes in our community. It is devastating to us all, but we can see from the list that some hospitals have moved between the different waves. Given that, and given the examples of funding sources that can be put together, will he organise an urgent meeting—we know about his conflict of interest—for all MPs whose constituents use Whipps Cross, to look at the criteria and possible new sources of funding? I know that he will agree that we owe it to our constituents not to give up fighting for the hospital that our community so desperately needs.

[Wes Streeting]

As my hon. Friend says, I must declare an interest, as Whipps Cross hospital and Barts health NHS trust serve my constituents. I would be delighted to lead a delegation with her to lobby the Minister of State for health, my hon. Friend the Member for Bristol South (Karin Smyth), who has to take decisions on schemes that affect my constituency. It would be nice to be on the other side of exchanges for the first time in a while. Let me reassure the constituents of my hon. Friend the Member for Walthamstow (Ms Creasy), and my own, that pre-construction work on Whipps Cross hospital is due to begin in 2029 to 2031, with construction beginning in 2032 to 2034. My constituents know me well enough to know that if we could go faster, we would do so. On alternative investment vehicles and means of raising additional capital investment—not to mention learning from some of the less successful initiatives of the past—I would be delighted to work with Treasury colleagues and Government Members on how we can get more capital investment, but for reasons that she will well understand, we need to tread carefully on that point.

[Steve Darling (Torbay) (LD)]

The Secretary of State inherited Torbay hospital where we have had almost 700 sewage leaks, many of which have impacted clinical areas of the hospital and, sadly, that is set to continue. The hospital operates at 98% bed capacity, which only results in poorer services for residents, and that is set to continue. Will he reflect on the fact that many people in Torbay will fear they have suffered the impact of the national insurance hikes in our low-wage economy, but without seeing much of the gains for our hospital?

--- Later in debate ---

[Wes Streeting]

I say two things to the hon. Gentleman. First, we recognise the need for investment in Torbay hospital. We are committed to it, and that is what this programme commits us to deliver, with pre-construction work beginning from 2030 to 2032 and construction beginning in 2033 to 2035. Secondly, I say to him and other Opposition Members who oppose the decision that the Chancellor took in the Budget that they cannot welcome the investment on one hand and oppose the means of raising it on the other—unless, of course, they spell out which services they would cut or which alternative taxes they would increase. That is the challenge we face. The Chancellor has had to do a hell of a lot of heavy lifting to clean up the mess left by the Conservatives, and I support her decisions.

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

I thank the Secretary of State—he is doing what he should be doing and what should have been done before: telling truth to the people and the Commons. I will not waste any time. I urge the Secretary of State to get his appropriate Minister, if not himself, to visit Whiston hospital and St Helens local authority. They will show him how things can work better than at present with proper integrated health and social care. I ask him to please pay a visit. It is worth it; he cannot afford not to go.

[Wes Streeting]

There’s an offer I can’t refuse. My hon. Friend is a great champion of health and care services in her community and has enormous experience in local government. We are always looking for best practice. We want to take the best of the NHS to the rest of the NHS, and we would be delighted to hear more about the success in her community.

[Mr Gagan Mohindra (South West Hertfordshire) (Con)]

As the Secretary of State will be aware, I and MPs from surrounding constituencies wrote to him at the beginning of December to talk about Watford general hospital. I am sure that I speak on behalf of the two Labour MPs, one Lib Dem and a Conservative colleague when I say we are disappointed that he has decided to delay reconstruction of Watford general until at least 2030. Notwithstanding my public disappointment and given that all six of us campaigned actively on investment in Watford general, the statement says that further details will be provided in the hospital building programme. If there are assumptions there that we wish to challenge—such as build cost—do we go to the Secretary of State or the Minister of State with those questions?

[Wes Streeting]

The Minister of State, my hon. Friend the Member for Bristol South (Karin Smyth), will be holding briefings tomorrow for Members from across the House and is happy to receive further questions. The hon. Member seems to be saying on the one hand to go faster, and on the other that he wants to challenge underlying assumptions in the scheme. He cannot have it both ways. As I said to some of his hon. Friends, if he is disappointed with this Government as we clean up the mess they left behind, goodness knows the self-loathing he felt when they were in government.

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

I feel doubly blessed this afternoon because the West Suffolk hospital in my constituency is to be rebuilt and the James Paget hospital where I have worked for 30 years is to be rebuilt. Does the Secretary of State agree that our primary care estate is in a terrible situation and that we must also invest in general practice facilities?

[Wes Streeting]

With that track record, my hon. Friend might want to tell us this week’s lottery numbers while he is here. In all seriousness, he makes a good point. Although today’s statement is about the new hospital programme, the challenges across the health and social care estate are enormous. That is why the Chancellor committed at Budget to the capital investment that will deliver not only this programme but a significant investment in the general practice estate. We have an enormous array of capital challenges in health and social care. I ask Members on both sides of the House to bear in mind that while I have to struggle to weigh up the competing priorities across the health and social care budget, the Chancellor and the Chief Secretary to the Treasury have to do so not only for health and social care, but for education, transport, defence, justice, the police estate—right across the board, we have inherited a country left in an enormous hole. We are taking the necessary decisions to get our country out of that hole and beat a path to a better future.

[Greg Smith (Mid Buckinghamshire) (Con)]

One of the hospitals that my constituents and wider Buckinghamshire residents rely on for treatment is Wycombe hospital. It is not a RAAC hospital, but severe maintenance issues in the ageing tower mean that it is losing about 2,000 hours of operating time per year. In the spirit of the transparency that the Secretary of State speaks of, will he tell the House where the elongation of the new hospital programme leaves the works at Wycombe hospital, and will he meet me to discuss constructively how to move that work forward so that Wycombe can get the new surgical hub that it needs?

[Wes Streeting]

I am always open to constructive representations. As I said in my statement, the capital envelope that the Chancellor has given my Department—the biggest since Labour was last in office—includes funding for exactly those sorts of maintenance, backlog and disrepair challenges in the NHS estate. It is not just about new units or hospitals; it is also about ensuring that the current estate can deliver the quality of care and the value for money that our constituents deserve. I would be happy to take representations from the hon. Gentleman.

[Mr Mark Sewards (Leeds South West and Morley) (Lab)]

The Conservatives made promises about 40 new hospitals that they knew they could not build and deliver, and now it turns out that they knew they could not pay for them by 2030. It is little wonder that trust in politics is so low at the moment. It is also little wonder, given the unedifying display from Conservative Front Benchers today, that they are sat on the Opposition Benches. It falls on this Government to take the decisions that the Conservatives ducked when they were in power. Given that trust is so low, what reassurances can the Secretary of State give my constituents that the Leeds general infirmary will be delivered according to the timetable that he has set out today?

[Wes Streeting]

I am grateful to my hon. Friend for his representation and for his outstanding work for the people of Leeds since his election. I can reassure his constituents that this is a credible and funded timetable that we can stick to—and I am determined to ensure that we do. As for promises made by the Conservatives, we saw the crocodile tears from the Leader of the Opposition this weekend. She says that she will admit that the Conservatives got things wrong, but she never, ever gives a specific example. In fact, we have heard more about steak sandwiches than humble pie since the election.

[Daisy Cooper (St Albans) (LD)]

The previous Conservative Government promises the people of west Hertfordshire that we would have a new hospital, and they even claimed that it was fully funded, so our sense of betrayal is incredibly acute. Today, the Labour Government have announced that the rebuild start for Watford general hospital has been pushed back by seven to nine years, without Ministers having even visited the hospital, even though it is shovel-ready. We have the land, we have the planning permission and we have done the enabling work, so can the Secretary of State say why 23 hospitals are ahead of Watford general, and what money will be made available for repair bills, which will inevitably pile up, possibly for the best part of a decade, while our hospital is left to crumble?

[Wes Streeting]

I can well understand the hon. Member’s anger on behalf of her St Albans constituents, who are invested in this project, as are the constituents of my hon. Friends the Members for Watford (Matt Turmaine) and for Hemel Hempstead (David Taylor). She will be able to see in the report, which we are placing online and in the Library, the methodology that we followed to assess prioritisation and ordering of schemes, which was about affordability, deliverability and the other factors that she would expect us to take into account. That is how we reached today’s decision. I can reassure her and her constituents that pre-construction work will begin from 2028 to 2030, with construction beginning in 2031 to 2033. Those of her constituents who are angry about the delays do not need to be told where the blame lies. That is why they returned a Liberal Democrat MP instead of a Conservative.

[Several hon. Members rose—]

[Rosie Wrighting (Kettering) (Lab)]

My predecessor told my constituents that the work on Kettering general hospital was ready to go. It is shameful that, in reality, the Conservatives had no credible plan, and the money was going to run out in March this year. Does the Secretary of State agree that people in Kettering are right to be angry at the previous Government for breaking their promises, and can he reassure my constituents that they will see a realistic, deliverable timeframe for the rebuild of our hospital?

[Wes Streeting]

I am grateful to my hon. Friend, who has raised this issue consistently and persistently with me since she was elected. I can reassure her and her constituents that pre-construction work will begin from 2028 to 2030, with construction starting in 2031 and lasting until 2032. I am extremely sorry that my hon. Friend’s constituents were led up the garden path; I rather feel that they have already rumbled the Conservatives by sending her to Parliament, but for as long as there is a Labour Government, we will deliver for the people of Kettering.

[Lincoln Jopp (Spelthorne) (Con)]

I will say it, because no one else has: many happy returns for tomorrow. I genuinely thought that you were in your mid-30s—that the Secretary of State was in his mid-30s.

--- Later in debate ---

[Lincoln Jopp]

I also congratulate the Secretary of State on coming to the Chamber with such a massive capital expenditure announcement and eliciting a saving with his answer to the first question from the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh).

One of the plans that went by the board in May, for reasons I have not quite got to the bottom of, was for the Staines health and wellbeing centre, which is one of only six community diagnostic hubs that NHS England has allocated in England. The funding got pulled in May; will the Secretary of State please have another look at it?

[Wes Streeting]

I thank the hon. Gentleman very much for that question. I think he is going to go far in this place, Madam Deputy Speaker, and I would be delighted to look favourably on his representations about his local facilities.

[Sojan Joseph (Ashford) (Lab)]

My local hospital was not selected for the new hospital programme. While I am happy for colleagues who have received some certainty today on when work on their local hospital will start, does the Secretary of State recognise that there are hospitals the length and breadth of this country that are falling apart, and that staff and patients deserve better? Will he commit to considering a wider estate plan for the rest of the NHS estate, especially in east Kent?

[Wes Streeting]

I am grateful to my hon. Friend for his question, and for the outstanding work he has done representing his constituents since his election. He makes the really important point that, of the record investment that the Chancellor and the Chief Secretary to the Treasury have given to my Department for capital investment—the biggest allocation since Labour was last in government—£3 billion a year is allocated for the new hospitals programme. Eagle-eyed people have noticed that a sum much larger than £3 billion a year is available for capital investment, precisely because there is a need for improvement and modernisation of the existing estate right across the health and social care estate, as I know from the representations that are piling into my inbox from my constituents who use Queen’s hospital in Romford. I can assure my hon. Friend that we are looking across the board at the capital need in the NHS and social care and prioritising accordingly, and I would be delighted to receive his representations.

[Ben Obese-Jecty (Huntingdon) (Con)]

Hinchingbrooke hospital in Huntingdon is one of the RAAC hospitals for which funding has already been approved. That hospital will not be allocated grid space until quarter 1 of 2028, but it will need it by Q1 2027 in order to keep the build on track. Additionally, traffic around the hospital is frequently gridlocked. A vital new access road is part of the plans, but the land where it would go is owned by Cambridgeshire constabulary and National Highways, who are yet to give up the additional land they acquired via compulsory purchase order when constructing Views Common Road. Will the Health Secretary meet me in order to work through those blockers—given that they are all being caused by Government agencies—and meet Hinchingbrooke hospital’s 2030 delivery date, and can he confirm that the 2030 date is still the target?

[Wes Streeting]

I am grateful to the hon. Member for his representations. This Government are on the side of the builders, not the blockers. I can confirm to him that we are determined to start Hinchingbrooke in 2027-28. We work closely with the local project team, but we would be delighted to receive representations about his frustrations with the delivery of that project.

[Chris Curtis (Milton Keynes North) (Lab)]

The last time the Secretary of State came to the Chamber to talk about the new hospital programme, I shared the story of taking my 93-year-old grandmother to accident and emergency at Milton Keynes hospital, only to be told when we got there that the wait time was nine and a half hours. I am afraid to say she was back there again earlier this month, and despite the tireless efforts of our incredible NHS staff, the brutal reality of 14 years of Tory neglect means she did not get the care she desperately needed and deserved. However, it is not just my family; this is the lived experience of countless people across my constituency. On behalf of my grandmother, my family, my friends and my neighbours, I thank the Secretary of State for doing what the previous Government failed to do, which is securing the extra funding needed for the new hospital in Milton Keynes. Can I ask that he continues to work with me and the other MPs across Milton Keynes to ensure we get spades in the ground as soon as possible?

[Wes Streeting]

I am extremely grateful to my hon. Friend, who has done so much with his parliamentary neighbours in Milton Keynes and Bletchley to get this scheme delivered and going as fast as possible. He underlines how important this is: it is not just about bricks and mortar; it is about people’s lives and life chances. He really brought that home with his powerful contribution. I can reassure him that pre-construction work is ongoing, with construction due to begin in 2027-28, which I know will be welcomed by people who use the hospital right across Milton Keynes and beyond.

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

My former constituency neighbour Councillor Steve Tuckwell chaired the planning committee that granted permission for the new Hillingdon hospital, which serves my constituents. For full disclosure, my wife works there as an NHS doctor. Those of us who are local residents saw pre-construction works under way, including sewerage, electrics and demolition and strip-out beginning in the building. Will the Secretary of State apologise to my constituents affected by this for the delay that he has introduced to this project? Will he consider lobbying the Chancellor and the Prime Minister to cancel the Chagos islands deal, the cost of which alone would fund 10 new NHS hospitals?

[Wes Streeting]

It is truly extraordinary that we have a Conservative Member standing up and criticising a Labour Government for delivering the Hillingdon hospital project, which will begin construction—not pre-works, but delivering—in 2027-28, as I promised the people of Hillingdon. That is what we are delivering, and people should judge the contrast between a Labour Government who are delivering and not just Conservative Members, but a Conservative Prime Minister, who made promises on the 40 hospitals, did not follow through and walked away, leaving us to pick up the pieces.

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

First, I say happy birthday to the Secretary of State for tomorrow. I cannot think of a better birthday present than to give the people of Milton Keynes a new women’s and children’s hospital. We are a growing city, and nowhere is it more needed in terms of population per bed. Will he reassure my constituents that the money has been found and allocated, because they feel they were taken for mugs after the scheme was announced by the previous Government and the previous MPs more than four times, but was never funded and never delivered?

[Wes Streeting]

I am grateful to my hon. Friend for her birthday wishes, even after I announced the timetable that I know she and her constituents wanted. On a serious note, I think people will see the contrast between sending Conservative Members from Milton Keynes, with inaction and broken promises, and sending Labour Members from Milton Keynes who are delivering. I am delighted with the work and improvements we will be able to deliver for her constituents. I hope Members right across the House, whichever wave their hospital is in, know that this Government have set out a timetable that is credible and deliverable, and a funding package that will be delivered for as long as there is a Labour Government.

[Ian Roome (North Devon) (LD)]

My constituents in North Devon were let down by the previous Government, and they will be utterly dismayed to find that the remotest hospital in England has been passed over again for essential repairs—it is now beyond 2035. Does the Department understand that if critical care and operating theatre facilities begin to fail within the next five years, as expected, there is no alternative critical care for patients for over 40 miles? I invite the Secretary of State to come to see for himself why investment is needed now, and to visit North Devon district hospital because it has not had a ministerial visit from this Government.

[Wes Streeting]

I am grateful to the hon. Member for his question. I can tell his constituents that, since his arrival, he has been absolutely dogged in pursuit of health and care investment in his community. I say to his constituents that we will deliver against this timetable. The funding is there, and it will be there for as long as there is a Labour Government. In the meantime, we would be happy to work with him to make sure that rural communities such as his receive the investment they need, and my hon. Friend the Minister for Secondary Care or I would be delighted to visit at some point soon.

[Luke Murphy (Basingstoke) (Lab)]

There is no doubt but that this statement will be met with a deal of anger and frustration by my constituents. The hospital in Basingstoke is badly needed, and they are not getting the healthcare they deserve. The right hon. Member for North West Hampshire (Kit Malthouse) called on me to consider my position. I would call on him, were he still in his place, to consider his connection with reality, because there is absolutely no doubt where the blame for that anger and frustration should lie, and that is with Conservative Members. [Interruption.] They repeatedly told my constituents that the hospital was funded; it was not. They told us it would be delivered by 2030, but they themselves delayed this fictitious plan until 2033, and the right hon. Member has the gall to ask me to consider my position. I am surprised he could make it to the Chamber today, so weighed down he must have been by his brass neck.

That brings me to my question. I welcome the clarity that the Secretary of State has brought to the scheme and to the House today. A number of the hospitals in cohort 4, which includes Basingstoke hospital, have been moved forward, such as the hospitals in Milton Keynes and Kettering. I am of course delighted for my colleagues, but I would be interested to know why they have been moved, but Basingstoke is where it is. What confidence can the Secretary of State give my constituents that under our plan, unlike the previous Government’s, they can be confident that Basingstoke hospital will be delivered as we have set out?

[Wes Streeting]

I am grateful to my hon. Friend for his question. I am not surprised that Conservative Members tried to shout him down. They want to silence criticism of their record because they are ashamed of it. That is a simple fact. He is absolutely right about his parliamentary neighbour, who sat around the Cabinet table of the notorious Liz Truss, even as she crashed the economy, and then has the temerity to turn up and lecture other people about the sound management of public money. These people have no shame whatsoever, and they will have no credibility until they sincerely and honestly apologise to the country for the mess they made.

I am very happy to talk through with my hon. Friend and his constituents why his project has been phased as it has. There are a number of constraining factors—not just resources, but other factors such as allocation of land, planning and so on—but I reassure his constituents that we will deliver. I also reassure his constituents that, since his arrival in this place, he has been absolutely dogged and determined in speaking up for them and lobbying on their behalf.

[Rebecca Paul (Reigate) (Con)]

I welcome the Secretary of State’s clarification on the timing of the new Sutton specialist hospital, which will serve my constituency. I am really pleased that the project is going ahead, although the delay is disappointing. The current situation at Epsom and St Helier university hospitals NHS trust is not sustainable. The trust currently runs duplicate services across two sites, which makes staffing incredibly difficult. The physical estate is deteriorating faster than it can be fixed, and some of the buildings are older than the NHS itself. Could the Secretary of State set out how he intends to reduce waiting lists in Reigate, Redhill, Banstead and our villages in the short term in the light of the delay to this project?

--- Later in debate ---

[Wes Streeting]

I can reassure the hon. Member that the hospital is due to start construction from 2032 to 2034 —although my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) had other ideas. On cutting waiting times, just earlier this month the Prime Minister and I published this Government’s elective reform plan so that we can deliver the 18-week standard for referral to treatment, which has not been met for a decade. Had the hon. Member been here during the last Parliament, she would have been absolutely shocked at where the Conservatives led us: from the shortest waiting times and the highest patient satisfaction under Labour to the highest waiting lists and lowest patient satisfaction on record.

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

Trust in the delivery of healthcare for my constituents has been damaged by 14 years of failed NHS policies and fake Tory promises for new hospitals—the Tories knew full well that they did not have the money to deliver them. They visited Whipps Cross five times for announcements but delivered nothing—not a brick, not a penny, and certainly no hospital. Although the delay confirmed today is disappointing, we welcome the honesty and the work to mitigate the impacts of Tory failure.

The campaign for Whipps Cross hospital is not over, however. As the Secretary of State’s team knows, we will continue to make other Departments aware of the impact on their housing programmes and continue to seek their support on his behalf. I am grateful for his remarks earlier about meeting to look at alternative funding methods. Will the Secretary of State confirm that funding for remediation and maintenance works will be made available to get our hospital to its wave 2 start line?

[Wes Streeting]

I am grateful to my parliamentary neighbour for his representation and reassure him and his constituents—and mine, for that matter—that thanks to the capital allocation at the Budget provided by the Chancellor and the Chief Secretary to the Treasury, who is in his place, we will be investing more in capital than at any point since Labour was last in office, because we recognise the capital funding pressures right across the NHS estate. We are determined to meet those pressures and clear up the mess that the Conservatives left behind.

I know that across the House and the country there will be real anger at the promises made by the Conservatives when people see that the timetable was a work of fiction and the money was not there. I hope it is of some reassurance to know that this Secretary of State represents a community that is also feeling let down by the actions of the Conservatives, as does the Chancellor of the Exchequer. The way in which we have phased this scheme, and the fact that both our schemes are in wave 2, should reassure people that we are doing as much as we can as fast as we can within the constraints. I hope that people will take some comfort from the honesty, credibility and affordability of the timetable we are setting out today. As long as there is a Labour Government, the new hospital programme will be delivered.

Health and Social Care: Winter Update

Wes Streeting Excerpts

Wednesday 15th January 2025 Commons Chamber

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

With permission, Madam Deputy Speaker, I would like to make a statement on winter pressures.

I start by saying that my thoughts, and I am sure the thoughts of the whole House, are with the nurse who was stabbed in a horrific attack at Royal Oldham hospital on Saturday. Nurses are the backbone of our NHS. They should be able to care for their patients without fear of abuse or violence. As she goes through treatment for her injuries, we pray for her speedy and full recovery and that she will be left to recover in peace.

I want to thank our NHS and social care staff for their remarkable effort, stamina and care in the most challenging of circumstances. Over the past few weeks, I have seen at first hand that staff are doing their level best in hospitals and care homes across our country—in the south-west, Essex, London, South Yorkshire and the north-west. Even when patients are left waiting far longer than they should be, and in conditions they should never be made to endure, they are still at pains to stress that the staff are doing their best.

I said on day one in this job that I would never gloss over problems in the health service and I would not pretend that everything is going well when it is not. The experience of patients this winter is unacceptable. I visited one A&E department over Christmas where I was told on the way in that I was lucky as I had come on a quiet day. Yet, as I walked through the hospital, I saw patients on trolleys lining the corridors where they were being treated, without the dignity or safety they should expect as a minimum. I saw frail elderly people on beds in the emergency department, many with dementia, crying out in pain and confusion because, ultimately, they were in the wrong place for their care needs. That was supposedly a good day.

The King’s Fund has said:

“The NHS is facing a toxic cocktail of pressures this winter”,

and it is right. Fourteen years of under-investment and a lack of effective reform have combined with a tidal wave of rising pressures. This has been the busiest year on record for our ambulance and accident and emergency services. We have had severe cold snaps, with temperatures as low as minus 15° in some parts of England. There are 5,100 patients in hospital beds with flu—more than three times the number at this point last year. Alongside the impact on patients, the rise in respiratory infections saw 53,000 NHS staff forced off work sick in the first week of the year. The result has been patients let down by ambulances that do not arrive on time, A&E departments that leave them waiting 12 hours or more, and the continued normalisation of corridor care. This is not the level of care staff want for their patients, and it is not the level of care this Government will ever accept for patients.

I said coming into this winter that 14 years of failure cannot be turned around in six months. It will take time to fix our broken NHS. Since July, we have done everything we can to prepare the NHS for winter. Following four months of silence from the previous Government, I called the British Medical Association on day one, met it in week one, and within three weeks negotiated a deal to end the junior doctors’ strike with a new deal for resident doctors. For the first winter in three years, staff are on the frontline, not the picket line. The Chancellor made immediate in-year investment in the NHS to fill the black hole we inherited and prevent us from having to cut back on services.

We have introduced the respiratory syncytial virus vaccine, and more than a million people and counting are protected against that virus. In total, 29 million vaccines have been delivered for flu, covid-19 and RSV, and more patients are protected against flu than at this stage last winter. If anyone is yet to get themselves vaccinated, it is not too late to protect themselves, their family and the NHS. They can check if they are eligible and book through their local GP or pharmacy.

We are working hand in hand with NHS England and care leaders, and I continue to meet regularly with senior leaders in social care, NHS England and the UK Health Security Agency. We have an excellent national operations centre running seven days a week. Its data allows us to zoom in—not just on individual hospitals but on individual patient waiting times—to respond in real time to spikes in pressures, and to manage threats as they emerge. The NHS is now using critical incidents proactively to focus minds and get the system responding to de-escalate and steer back to safer waters. I am happy to report that there is currently one live critical incident, down from 24 last week.

However, I do not pretend that that is good enough. It will take time to get back to the standards that patients deserve, but it can be done. That will require a big shift in the focus of healthcare—out of the hospital and into the community—to free up beds for emergency patients and to prevent people from having to call an ambulance or go to A&E in the first place. That is the reform agenda that the Government are enacting.

In recent weeks, we have announced steps to begin rebuilding general practice, and immediate and long-term action in social care. When we came into office, we inherited a situation in which qualified GPs could not get a job, while patients could not get a GP. That is why, within weeks, I found just shy of £100 million to recruit 1,000 more GPs by April. We have recruited hundreds of GPs to the frontline already, and we will recruit hundreds more in the months to come. We have announced an extra £889 million in funding for general practice, which is the biggest funding uplift in years, alongside a package of reforms to bust bureaucracy, slash unnecessary targets and give GPs more time to spend with their patients—our first step towards bringing back the family doctor.

Ten days ago, I visited a care home in Carlisle that was offering intermediate step-down care for NHS hospitals. It was able to give patients en suite bathroom facilities in care homes, with rehab, all at half the price it was costing the taxpayer to keep patients in a hospital bed up the road. That is better for patients and less expensive for taxpayers. Yet there are 12,000 patients in hospital beds today who do not need to be there but cannot be discharged because appropriate care is not available. That is why the Government are making up to £3.7 billion of extra funding available for local authorities that provide social care. It is why we are delivering an extra 7,800 home adaptations through the disabled facilities grant this year and next year. It is why we have delivered the biggest increase in carer’s allowance since the 1970s, worth an extra £2,300 to family carers. It is why are introducing fair-pay agreements to tackle the 131,000 vacancies in social care. And it is why we have appointed Baroness Louise Casey to help build a national consensus on the long-term solutions for social care.

From visiting emergency departments, monitoring the performance of the NHS over this winter and noting the variation in performance across the country, I know that we can clearly get our ambulance and A&E services working better. Before the spring, we will set out the lessons learned from this winter and the improvements that we will put in place ahead of next winter.

Finally, let me be clear on corridor care, which became normalised in NHS hospitals under the previous Government: I will never accept or tolerate patients being treated in corridors. It is unsafe, undignified and a cruel consequence of 14 years of failure on the NHS, and I am determined to consign it to the history books. I cannot and will not promise that patients will not be treated in corridors next year. It will take time to undo the damage that has been done to our NHS, but that is this Government’s ambition.

Annual winter pressures should not automatically lead to an annual winter crisis—indeed, there were no annual winter crises by the end of the previous Labour Government. That is why this Government are investing an extra £26 billion in our health and care services, and undertaking the fundamental reform that both services need. That will take time, but we will deliver an NHS and a national care service that provide people with care where and when they need it. I commend this statement to the House.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Secretary of State.

[Edward Argar (Melton and Syston) (Con)]

As ever, I am grateful to the Secretary of State for his typical courtesy in giving me advance sight of his statement. May I join him in saying that our thoughts are with the nurse in Oldham who was so viciously attacked? Like him, we wish her a full and speedy recovery. May I also echo his words of gratitude to NHS and social care staff for all they do to help and support patients and our constituents?

We last heard from Ministers on winter pressures just before Christmas. Yet, as the Secretary of State has set out, the situation has continued to grow more severe. We have all heard about those pressures in the media and from patients, constituents and staff. Indeed, I will take this opportunity to acknowledge the work of the hon. Member for Tooting (Dr Allin-Khan), who I know has been on the frontline and has, I suspect, seen those pressures—the unacceptably long waits in A&Es for ambulances, and corridor care and its impact on patients—at first hand. When someone calls an ambulance, they need to know that it will come, but it cannot if it is sitting in a hospital car park. At my local hospital in Leicester, for example, over 36% of ambulances handing over had a one hour-plus wait, and I am sure that that is replicated around the country.

The Secretary of State highlights that the number of patients in hospital with flu is triple what it was a year ago, yet it appears that the rate of flu vaccine uptake for over-65s, at-risk groups and healthcare workers is lower than last year. He wants more people to be vaccinated, and I share that view, but will he set out in more detail what he is doing to further drive vaccine rates and ensure that vaccines are available for all those who need and want them?

As the Secretary of State said, more than two dozen hospitals declared critical incidents last week. Although I welcome the fact that the vast bulk of those incidents have been stood down, will he set out what support and additional resource is being offered not only to hospitals that have reached the point of declaring critical incidents, but to others that continue to face pressures?

Last year, the Government provided additional funding for hospitals and social care to boost capacity and, vitally, the number of beds in hospitals, as well as to tackle delayed discharges. Will the Secretary of State set out in more detail what he is doing in a similar vein? Will he update the House on how many people currently in acute settings are fit for discharge but have not been discharged for a variety of reasons?

The Secretary of State mentioned pay, and said that he had negotiated a deal. I say gently to him that what he did was not negotiation but capitulation to an inflation-busting pay rise.

None of these pressures comes as a surprise to me or to the Secretary of State. He was open and candid, as he often is, in acknowledging that there would be a winter crisis this year. NHS England directors were warning that they did not have the resources needed to surge capacity or increase social care packages now, which the Conservative Government provided in previous years. The royal colleges said that nothing had been done to mitigate a winter crisis, and NHS organisations said that they needed more support to prevent ambulance delays, overcrowded A&Es and people being stuck in hospital beds because of a lack of community and social care. He knows—we have spoken about it before—the importance of flow from ambulance to A&E, and from A&E to a bed or to discharge. What extra steps is he taking to increase the number of care packages now rather than in the future, and will he consider allowing community hospitals, such as mine in Melton Mowbray, to play a greater role in providing care to local communities in order to ease pressure on acute settings?

Those concerns were all raised in September and October. My predecessor as shadow Secretary of State, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), asked about them, yet the Secretary of State failed to provide an update to the House until Ministers came to the House just before Christmas. Indeed, I recently asked a named day question about when the Secretary of State started chairing his weekly winter preparedness meetings. Despite, one hopes, a quick look at his diary giving the answer, I received a holding answer. I only got the correct answer after that holding answer had been sent to me, stating that it was in December. Can he say on which date in December the first of those meetings was held?

Before Christmas, I and the Conservatives called for a winter-specific bed increase plan. We still have not had one. Will the Secretary of State set out what he is doing to increase the number of beds and the amount of capacity now?

While the Secretary of State talks the talk, he has not done the work ahead of this winter. Will he now reassure patients and staff that he will urgently boost capacity, resources and support to ensure our constituents get the care they need when they need it?

[Wes Streeting]

Where to begin, Madam Deputy Speaker? The shadow Health Secretary does a really good line in diagnosing the problem as if these are somehow new facts to him, or to the country. In fact, one does not have to be a Minister of long service in this House, or indeed a Member of long service, to remember that only a short matter of months ago, the shadow Secretary of State was a Minister in the Department. Time and again, he asks questions about the state of the crisis and the challenge in the NHS without showing a shred of responsibility for that crisis, which he played a part in creating.

It is not just the shadow Secretary of State but every one of his predecessors who had a hand in creating the situation that Lord Darzi spelled out: underinvestment and botched reform. It is the situation we see today, with pretty much every part of our health and care services—be it primary care, community care, mental health services, secondary care or social care—under extraordinary and historic pressures. It is all very well criticising from the Opposition Benches, but the shadow Secretary of State demonstrates the same pattern of behaviour as his predecessor: acting like the arsonist criticising the fire brigade for not doing enough, quickly enough, to put out the fire they started. It is truly shameful.

I turn to the questions raised by the shadow Secretary of State. On delayed discharges, in December—the latest data we have—12,000 on average per day were medically fit for discharge but unable to be discharged. Bed numbers are broadly the same as they were this time last year: 102,546, versus 102,226 under the previous Government. That actually says something about what we have experienced in our weekly updates: the work that is taking place between health and social care services to improve the flow of patients is having some effect when we take into account our ability to flex bed numbers up and down against the backdrop of higher occupancy from flu, the added challenge of norovirus, and the other seasonal conditions that we see at this time of year.

The shadow Secretary of State asked about vaccination uptake. As I said in my statement, there have been more flu vaccinations this year than there were last year, but he raised the important issue of vaccination rates among NHS staff. Those rates are lower than we would like or expect, and we have to do some work with staff to understand why that is the case and how we can encourage further uptake. As I said, if staff are suffering with flu having not been vaccinated, not only is that a really unpleasant experience for them, it is an unpleasant experience for their colleagues if staff are off sick, and indeed for patients who are waiting longer.

On critical incidents, the shadow Secretary of State asked about the support that is being provided to NHS organisations. NHS England regional teams are working closely with integrated care boards to ensure appropriate responses are in place to address and mitigate the issues identified within each declared critical incident, all of which will have variations. We have also seen NHS England—rightly, in my view—using the critical incident tool proactively to ensure we can provide wider system support to emergency departments that are under particular pressure.

The shadow Secretary of State asked about additional funding for winter. When I was shadow Health and Social Care Secretary, I was very clear about my cynicism regarding the pattern of behaviour we saw from our predecessors. Year after year, they would arrive in the middle of winter—often after the winter peak—with a gimmicky package of last-minute funding that delivered too little, too late without making any real difference on the frontline, all to give the impression that they were doing something to mitigate the crisis in the NHS, in which they played a serious part. I said that we would not do that, and we are not doing it. As soon as we came into office, looked at the books and saw the black hole, the Chancellor released additional funding for the NHS in-year to ensure that it had the resources it needed not to cut back. Thanks to the decisions taken by the Chancellor, the NHS has received more than £2 billion more in-year than it would have received if the Conservatives had remained in power, so we do not need any lectures on funding. Indeed, they continue to oppose the £26 billion we provided for the NHS.

Finally, the shadow Secretary of State accuses us of capitulation to frontline doctors who were out on strike because of the way they were treated by our Conservative predecessors. I just say to resident doctors who are following these proceedings, and to patients who can see the state of the NHS today and wish it were better, that we are now left in no doubt. Had the country kept the Conservatives in power, doctors would have been on the picket lines instead of the frontlines this winter; taxpayers would have continued to pay a heavy price for failure; and patients would continue to pay the price through delayed, rearranged or cancelled operations, appointments and procedures. It is proof positive that even after it was booted out of office, the Conservative party has not listened, has not learned, and is not fit to govern.

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

For years, like many in this House, I have seen a regular stream of local people in my surgeries and inbox who have been waiting far too long for NHS treatment. What shocks me the most, though, is when I see the same local people turn up in A&E when I am doing my shifts, having deteriorated and in even worse pain than before. Locally, there are 66,000 cases of people who have had to wait over 18 weeks for treatment, so does my colleague the Secretary of State agree that we need an urgent and emergency care plan to deliver much-needed year-on-year improvements?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend, and thank her for the work she has been doing this winter on the NHS frontline, providing support to her colleagues at her local hospital—literally rolling her sleeves up and looking after people. She is absolutely right that we need an urgent and emergency care plan to make sure we see continued year-on-year improvements. I can reassure my hon. Friend that that plan is already being written; we are learning the lessons from this winter in order to apply them next winter. As I should have said to the shadow Secretary of State, the right hon. Member for Melton and Syston (Edward Argar), I took the same approach when I was shadow Secretary of State: the very first meetings I held on winter planning were ahead of the general election in access talks with the Department. The first briefing I received on winter preparation was on my first day in office. Throughout the past six months heading into winter, I continued to talk to staff in the Department, NHS England and social care leaders to ensure that we were as well prepared for this winter as we could be. Right now, we are learning the lessons to prepare for next winter.

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I associate myself with the comments of the Secretary of State and the shadow Secretary of State regarding the abhorrent attack in Oldham.

The pressure on our hospitals this winter brutally demonstrates the scale of action needed after years of Conservative neglect of the NHS. Across England last month, 71% of A&E patients were seen within four hours, but that statistic varies wildly depending on where one happens to live. At Shrewsbury and Telford emergency departments last month, ambulances had to wait an average of over two hours to hand over their patients. Just 50% of patients were seen within four hours, and nearly 1,500 patients were left stuck on a trolley for more than 12 hours.

Statistics like these often fail to have much impact now, because we have heard them so regularly—particularly since winter crises have become normalised—but it is very important that we consider who is behind them. It is patients such as my constituent Emma, who having been diagnosed with sepsis spent 48 hours in a fit-to-sit area and then 12 hours on a trolley in an X-ray corridor before finally being admitted, alongside a horrifying delay in the medication required to deal with her life-threatening condition. Yet we often have to wait weeks for data that fully explains what is happening in our hospitals, and no official data is collected about the number of critical incidents. This leaves patients potentially ill-informed, and it makes scrutiny and support in this place, in particular, difficult to provide.

Will the Secretary of State commit to introducing faster and more detailed reporting about the live state of play in our emergency departments, including the number of critical incidents and the temporary escalation spaces, and give a timeline for reporting that information? Will he publish information that shows the impact that delays are having—for example, by looking at the number of deaths in emergency departments—and will he act on the long-term Liberal Democrat request to publish localised data on ambulance delays so that support is provided in areas, such as Shropshire, where it is most needed?

[Wes Streeting]

I thank the Liberal Democrat spokesperson for her usual constructive contribution to proceedings. She is absolutely right to raise the issue of variation in performance across different parts of the country. It is not acceptable, and one thing we will be doing as a Government is to ensure that, as well as creating a rising tide that lifts all ships, we raise the floor in performance so that we see far less unwarranted and unwanted regional variation. She talked about the Shrewsbury and Telford trust, which has had a number of challenges over many years. We have seen some signs of improvement as recently as this week, and we continue to support local leaders as they strive to improve the performance of their system overall.

The hon. Member raises some good and interesting questions about the frequency with which we publish data. It is right that we ensure that data is properly validated so that accurate data is put into the public domain, even as NHS England’s control room monitors live reporting into the centre. I will take into account what she said about her requests both for more live data—collected and published data—about critical incidents and for more localised data in individual trusts, including ambulance services, to monitor variations in response times within a region. Although the points she has raised are interesting, I add the caveat that we would not want to burden the system with more reporting requirements if that causes a distraction from improvement. I tend to lean towards more transparency in data and reporting, however, and I will take into account the representations she has made as we put together our urgent and emergency care plan.

[Melanie Ward (Cowdenbeath and Kirkcaldy) (Lab)]

At the Victoria hospital in Kirkcaldy, paramedics have had to establish a makeshift ward outside as ambulances queue up outside A&E. The number of people presenting in December 2024 was roughly the same as in December 2019, but there has been an increase of almost 300% in those waiting over four hours at A&E. Does the Secretary of State agree that this is a dreadful indictment of 18 years of SNP rule in Scotland, and that the SNP Government must use some of the additional £4.9 billion from the UK Labour Budget to get a grip? My constituents deserve so much better than this.

[Wes Streeting]

I thank my hon. Friend for that question. The conditions she describes at her local hospital are truly shocking. As I have said, and this is often quoted by the SNP, all roads lead to Westminster, and I am happy to report that up that road from Westminster to Holyrood lies a record uplift in funding for the Scottish Government. They have no excuses for inaction. They need to grip the crisis in the NHS in Scotland, as we are here. The difference, as my hon. Friend states, is that they have a record of 18 years that they cannot defend, and I hope people will consider that record very carefully when they decide who should govern in Scotland at the next set of Scottish elections.

[Madam Deputy Speaker (Judith Cummins)]

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

[Layla Moran (Oxford West and Abingdon) (LD)]

May I press the Secretary of State on that data point? It is not just the Liberal Democrats making these representations; the Royal College of Nursing, the Royal College of Physicians, the Royal College of Emergency Medicine, HealthWatch, the British Medical Association, Age UK and many others also want the data. This matters, because the situation causes moral injury to staff and compromises patient safety—and the problem is not just corridor care; it encroaches on to other wards. Will the Secretary of State commit to releasing that data before the NHS England board meeting on 4 February? In addition, what assessment has he made of the impact of this winter on less urgent care, and on elective waiting lists?

[Wes Streeting]

I am grateful to the Chair of the Select Committee for her questions. I cannot give her a commitment to publish those statistics ahead of the next NHS England board, but I can give her an undertaking to go away and look carefully at the rhythm and pace at which we publish performance data, to make sure that we are being as transparent as we can, as fast as we can. That, I think, should be the principle that underpins our approach to the publication of data. She is right to talk about wider system pressures as a result of what we see in emergency departments. We will wait to review the performance of the NHS overall until we exit winter. I think we have seen some effective protection of elective activity throughout this winter, but that will of course vary from provider to provider.

The hon. Member mentioned a whole number of organisations calling for more data transparency. I, too, welcome the very public representations that we have heard from the Royal College of Emergency Medicine and others about the need to tackle corridor care. Let me assure her and all those who have made representations that we are absolutely determined to turn this situation around, and not just improve the performance of urgent and emergency care, but get a better system working. Ultimately, it is through ensuring better patient flows, and ensuring that people get the right care in the right place at the right time, that we will finally get this country out of the cycle, created by our Conservative predecessors, of winter crises.

[Several hon. Members rose—]

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

Triaging patients into virtual wards will not only protect the front door of the NHS, but be far better for patients. What is the Secretary of State doing to hold integrated care boards to account and ensure that they are putting money into primary care, as opposed to where everyone always looks, which is secondary care?

[Wes Streeting]

That is an excellent question from my hon. Friend. This Government have been walking the talk on primary care since we came into office. There was an immediate release of funding, within weeks, for 1,000 GPs, who are to be employed on the frontline by this April, and an £889 million uplift in funding for general practice that we announced prior to Christmas. I think that care in the home and care closer to home will be how we not only get the NHS back on its feet, but make sure it is fit for the future. That shift from hospital to community is one of the three big shifts that will lie at the heart of our 10-year plan for the national health service.

[Joe Robertson (Isle of Wight East) (Con)]

The Secretary of State referred to social care in his update on winter pressures, and he is of course right that social care has an important role to play in taking pressure off hospitals. However, surely he can understand the frustration that the sector and those in receipt of social care feel about his pushing the issue into a three-year review, which Sir Andrew Dilnot says is an inappropriately long time. Why will it take so long? Please can he put pressure on the review? I am sure that Baroness Casey is well capable of doing it in a shorter time.

[Wes Streeting]

I am happy to report that people will not have to wait three years for action on social care. In fact, we have seen lots of it in the last six months. We have had the biggest expansion of carer’s allowance since the 1970s; the legislation for fair pay agreements in the Employment Rights Bill, brought in within the first 100 days of this Government; the uplift in funding provided by the Chancellor through her Budget; and the expansion of the disabled facilities grant. There will be more for us to do this year, including reform to make the better care fund more effective. Baroness Casey’s first report will in fact be next year. It will set out the action required on social care throughout this Parliament. I hope that reassures people right across the House and, more importantly, right across the country that social care is a priority for this Government. We will seek to do better than our predecessors of all parties—I have made this point before—because we have to tackle this generational challenge facing our country.

[Deirdre Costigan (Ealing Southall) (Lab)]

I was shocked when a young man came to my last constituency surgery to ask me as his MP to help him get a GP appointment. Morning after morning, he had spent hours queuing on the phone, and he was desperate. If my constituents cannot see a GP, they end up in A&E instead. How is the Secretary of State continuing to work to undo the Conservatives’ abject failure to fix the GP crisis, which is fuelling winter pressure on hospitals?

[Wes Streeting]

My hon. Friend is absolutely right about the challenge caused by the Conservatives’ failure on general practice, which has placed pressure not just on stretched GPs, of whom there were thousands fewer when the Conservatives left office than in 2015, but on other parts of the system. That is not just worse for patients—it is certainly not a pleasant experience at the moment to be sat waiting in A&E for treatment—but more expensive for the taxpayer, because while it costs £40 for a doctor’s appointment, it can cost £400 for accident and emergency attendance. That is the legacy of the Conservative Government: things are worse for patients and more expensive for taxpayers. That is the rotten legacy that we are seeking to overturn.

[Greg Smith (Mid Buckinghamshire) (Con)]

Last week, the UK Health Security Agency warned of elderly people suffering from heart attacks, strokes and chest infections as a result of the recent severe cold weather. Is the Secretary of State any closer to admitting that taking away the winter fuel payment from some of our most vulnerable pensioners was not just cruel, but life threatening?

[Wes Streeting]

It is irresponsible, as well as inaccurate, to suggest that the Government have taken winter fuel payments away from vulnerable pensioners. In fact, it is thanks to the decisions taken by the Chancellor that winter fuel payments were protected for the poorest pensioners. They continue to be worth £200 to eligible households, or £300 to eligible households in which there is someone aged 80 or over. We also continue to stand behind vulnerable households by delivering the £150 warm home discount for low-income households and providing £742 million to enable the extension of the household support fund. Of course, over 12 million pensioners will see their basic or new state pension increase by 4.1%, thanks to the Government’s commitment to the triple lock.

This is a running theme from Conservative Members. They seem to welcome the investment in health and social care that the Government are providing at the same time as opposing it. They cannot have it both ways. If they do not support the decisions taken by the Chancellor, they have to admit that had the Conservatives remained in power, this winter, they would have been cutting the health and social care services that pensioners really rely on.

[Several hon. Members rose—]

[Mrs Sharon Hodgson (Washington and Gateshead South) (Lab)]

Under the last Conservative Government, strikes cost the taxpayer millions of pounds and 1.5 million appointments were cancelled, so may I thank the Secretary of State sincerely for making it his day one priority to sort that out? He called the junior doctors and found a deal within three weeks, ending the strikes. All of us across the House thank him for sorting that out. For the first winter in three years, staff will be on the frontline, not the picket line, as the Secretary of State so rightly said. Does he agree that that is just one example of what Labour Governments do in office? We always have a laser focus on making the NHS better, unlike the Conservatives, who seem to have a laser focus on making it fail.

[Wes Streeting]

I strongly agree with my hon. Friend. The way that Conservative Members continue to behave should send a message to every resident doctor, and indeed every member of health and social care staff, in the country. Every single one of them will know that thanks to the decision the country took back in July, we have a Government who are committed to the NHS and social care. Had the Conservatives remained in power, we would be going even deeper into the already deep hole that they left the country in. We must never go back there again.

[Andrew George (St Ives) (LD)]

I accept that the Government are clearly not the architect of the current unacceptable state of affairs. However, may I encourage the Secretary of State to reflect again on our exchange at the Health and Social Care Committee just a month ago, when he resisted the recommendation of the president of the Royal College of Emergency Medicine that we invest in more beds to accommodate additional admissions to hospital? That would ease a return to normality, reduce the need for corridor care, and ease the pressures in emergency departments.

[Wes Streeting]

Throughout the winter, NHS providers have continued to flex bed capacity to meet demand. The important thing is that our approach to investment and reform delivers the system-wide improvements that help us to break out of the annual cycle of winter crises. There has been criticism of the Government’s focus on elective recovery—for example, people have asked if that is at the expense of urgent and emergency care—but I will not allow a status quo to settle in which the NHS is in effect reduced to a blue-light, emergency service. The Government will improve urgent and emergency care, elective recovery, primary care, community services and social care, because that is what we need to meet the health and care needs of people in this century, and that is what we will deliver.

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

Winter pressures have caused the cancellation of thousands of operations, including many of my own lists. Does the Secretary of State agree that the opening of the dedicated Clare Marx surgical centre in Colchester, serving patients in Essex and Suffolk, is an extremely welcome development?

[Wes Streeting]

I thank my hon. Friend for his question, and for the expertise and experience that he brings to the House. We absolutely need to ensure that we are innovating in our service provision, and are shifting the centre of gravity out of hospitals and towards care and treatment closer to home—indeed, in people’s homes. As we have set out in recent weeks, since the investment announced in the Budget and particularly in the elective reform plan, this Government will continue to innovate, in order to provide services that deliver not only great value for the taxpayer but, even more importantly, great outcomes for patients.

[Nick Timothy (West Suffolk) (Con)]

Research shows that ambulance response times in Haverhill in my constituency are twice those in Cambridge. We would like a new, co-located and purpose-built blue-light facility; the police and the ambulance service could use it to serve the town effectively, and it would hopefully save money. May I invite a Minister from the Department to come to Haverhill to meet me, the East of England ambulance service, Suffolk police and local councillors to discuss those plans?

[Wes Streeting]

I confirm that we are absolutely up for looking at co-location of different public services, to deliver both better integration and co-operation between different services—particularly the blue-light services that the hon. Gentleman mentioned—and better value for taxpayers. I will ensure that one of my ministerial colleagues makes contact with him.

[Preet Kaur Gill (Birmingham Edgbaston) (Lab/Co-op)]

The Health Secretary will know that University Hospitals Birmingham in my constituency recently declared a critical incident, which I am pleased has now been stepped down. Does he share my view that shifting the focus of healthcare from hospital to community as we rebuild our NHS would have a consequential impact on the number of people in hospitals, which are under immense pressure?

[Wes Streeting]

My hon. Friend is absolutely right. May I, through her, thank health and care staff in her city for the work they are doing to get the people of Birmingham through this particularly challenging winter? What we really need to do to make our health and care system more effective and more sustainable is shift the centre of gravity out of hospital and into the community. We need better and faster access to diagnostics and treatment, as well as a bigger focus on prevention—primary prevention to keep us all healthy and active, and secondary prevention so that fewer people need to call on health services, and particularly emergency departments, which are stretched at this time of year.

[Sarah Olney (Richmond Park) (LD)]

I was pleased to hear what the Secretary of State said about vaccine roll-out, particularly of the RSV vaccine. I am even more pleased that my constituents in Richmond Park are diligent in taking up all vaccines, but they have been puzzled to find that the RSV vaccine is limited to those between 75 and 79 years of age. What plans are there are to extend the roll-out to those aged 80 and above?

[Wes Streeting]

I am grateful to the hon. Member for her question and for showing off her constituents’ uptake—that is exactly what we want. Perhaps ahead of next winter, we should launch a parliamentary competition: who can boost uptake most in their constituencies? We will think about the prize.

More seriously, I am always glad when the pressure is to expand access to vaccines—that is exactly the sort of pressure that we want. We follow advice from the Joint Committee on Vaccination and Immunisation. We will review the experience this winter, and the JCVI will review evidence and data this winter and make recommendations, which we will take into account.

[Alistair Strathern (Hitchin) (Lab)]

The dire state that the last Government left the NHS in was all too apparent, tragically, to many of my constituents who needed it last winter. My 85-year-old constituent admitted with breathing difficulties had to wait over 30 hours in a chair because there were no beds available, and they were far from alone in that indignity and prolonged suffering. They should not have to tolerate it, and I certainly will not as their MP. I welcome this Government’s action and leadership on ending the doctors’ strike and investing in more appointments, but what more will the Secretary of State do to ensure that, next winter, many more of my constituents are not suffering from the same challenges?

[Wes Streeting]

I am extremely grateful to my hon. Friend for the spirit of his question. That is exactly how this Government are approaching planning for next winter. I want year-on-year improvement in NHS performance, particularly our response to winter pressures. Of course, there are seasonal variations in infectious diseases, inclement weather and all sorts of other pressures that can impact on NHS services, but the system should be resilient enough to withstand pressures in any given winter. It will take time to get back there, but that is why the Government are already planning for next winter, learning from experience—what has worked well and what has not—so that we can continue to deliver for the people of this country and improve the national health service and social care services.

[Mr Joshua Reynolds (Maidenhead) (LD)]

One thing we could do to improve the situation in Maidenhead is to reopen the walk-in urgent care centre at St Mark’s hospital so that we can keep people out of the big hospitals and A&E and, as the Secretary of State said, help people get care closer to home. Will he meet me to discuss how we can work together to get the walk-in urgent care centre at St Mark’s back open?

[Wes Streeting]

I welcome the hon. Member’s question, and I agree with the thrust of his question that we need healthcare to shift from hospital into the community, with care closer to, and in, people’s homes. The configuration of services locally is a matter for local NHS leaders. I encourage him in the first instance to be in touch with his local integrated care board. If he gets a particularly unsatisfactory or unreasonable answer, he should feel free to raise it with Ministers.

[Kevin McKenna (Sittingbourne and Sheppey) (Lab)]

I associate myself with the comments about the nursing colleague who was so brutally attacked in Oldham. I am thinking of her and her team at this time.

I have been thinking back to when I was starting out as a junior nurse. We faced the same problem—it was just after Labour had taken over from a Conservative Government, and the backwash of winter crises caused by that failed Government was very similar in the first few years. Improving staff pay and the NHS plan made a difference. What else has my right hon. Gentleman learned from the successes of his forebears about tackling this winter crisis now and tackling such crises in future?

[Wes Streeting]

My hon. Friend brings expertise and experience to the House, and I am particularly grateful for his support and concern for the colleagues of the nurse who was so brutally attacked in Oldham, because I know that they will be acutely affected. In fact, the NHS workforce right across the country will have felt the shiver down the spine that I felt when I read about that horrific case.

My hon. Friend is right that I am fortunate to be able to call on every single one of my Labour predecessors, from Alan Milburn to Andy Burnham, to ask for their advice, experience and insight. As our great late friend John Prescott said, we need

“traditional values in a modern setting”.

I am bringing that modernising tradition to our approach to investment and reform, because the combination of both delivers results. That is how the last Labour Government delivered the shortest waiting times and the highest patient satisfaction in history.

[Lisa Smart (Hazel Grove) (LD)]

The Secretary of State will know that Stepping Hill hospital in Hazel Grove has a repairs backlog reported to be £130 million. That means that local teams at Stepping Hill are under even more pressure to tackle the winter crisis. His colleague the Minister for Secondary Care, the hon. Member for Bristol South (Karin Smyth), wrote to me and my constituency neighbour, my hon. Friend the Member for Cheadle (Mr Morrison), in October to agree that she was deeply concerned about the condition of healthcare infrastructure at the hospital. Following the Budget, when should we expect clarity on funding per hospital so that my constituents and Stepping Hill patients get the hospital that they deserve?

[Wes Streeting]

I am grateful to the hon. Member for raising those concerns on the Floor of the House. Thanks to the decisions that the Chancellor took in the Budget, the Department has an additional £26 billion available for investment in our health and social care services, including estates. I cannot promise to fix the backlog that has built up over the past 14 years in a single budget year, but I can confirm that we will publish our mandate for NHS England and, following that, planning guidance and financial allocations, very shortly.

[Mrs Sureena Brackenridge (Wolverhampton North East) (Lab)]

Under the Tories’ watch, our NHS became in danger of normalising failure, with patients treated in corridors, horrendous A&E waits and hospitals at risk of being gridlocked as they struggle to discharge patients. Will the Secretary of State continue to be up front and open about the challenges, and ensure that the NHS recovers year on year under his watch?

[Wes Streeting]

When I was sitting on the Opposition Benches at the tail end of the last Parliament, I saw my predecessor at this Dispatch Box telling us all the wonderful things that she thought the Government were doing and achieving. It was like hearing about a completely different national health service and social care system in another country. I arrived in July and was honest on day one that the NHS is broken but not beaten, and that these are crises of historic proportions that we will never sweep under the carpet, nor will we hide problems to spare political blushes. In the coming months and years, I will continue to be honest about where we have not yet fixed problems, and clear about the action that we are taking to get the NHS back on its feet and fit for the future and to build a national care service worthy of the name.

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

I think we all share the Secretary of State’s aspiration to move healthcare out of hospitals and into the community. However, the two GP surgeries that I visited in Skegness just before Christmas are concerned that the impact of the national insurance increases on their staffing budgets will be around £100,000 per surgery, which will force them to reduce staffing capacity and, therefore, appointment capacity. What will the Secretary of State do to help those GP surgeries in that situation? There seems to be a conflict between the sensible aspiration and the practical reality.

[Wes Streeting]

There are 889 million reasons why GPs should be reassured about their financial sustainability for the year ahead—the £889 million allocation for general practice that I spelled out before Christmas, to provide reassurance to GPs when planning for the financial year ahead. I have been heartened by the response from GPs to that announcement, and I gently say to people who criticise the means of raising it that without the decisions that the Chancellor took in the Budget, we would not be able to invest £26 billion in our health and care services. We cannot have people welcoming the investment but criticising the means of raising it. If people do not support the Chancellor’s decision—a perfectly reasonable political position to take—they will have to spell out what services they would cut or what taxes they would raise.

[Laurence Turner (Birmingham Northfield) (Lab)]

I echo the Secretary of State’s comments and those of my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill) on recognising the endeavours of health and care staff during last week’s extremely difficult critical incidents, and I also recognise the effect of contingency planning that had taken place, including the provision of additional beds at West Heath hospital in my constituency.

With respect to the central support the Secretary of State referred to, is he willing to make summaries of the support provided by NHS England to local trusts this year and in previous years?

[Wes Streeting]

I would be very happy to write to my hon. Friend to set out the support provided by NHS England to health and care services for his community, and I would be delighted to receive via him feedback from his health and care providers about what Government support they would like next winter and in future years.

[Clive Jones (Wokingham) (LD)]

I declare my interest as a governor of the Royal Berkshire hospital, and I have a family member who has shares in a medical company.

The Secretary of State has a really tough job of clearing up the mess left in the NHS by the Conservatives, but some of the Royal Berkshire hospital estate is not fit for purpose and especially not fit to cope with the winter crisis. Can he confirm that a proper level of funding will be available to rebuild the Royal Berkshire hospital and that there will be no increase in the seven-year delay announced by the Conservatives in April this year? That will help with future winter crises.

[Wes Streeting]

I will take that as another representation from the hon. Gentleman on the new hospital programme, and I reassure him we will be setting out our review and its conclusions shortly.

[Sally Jameson (Doncaster Central) (Lab/Co-op)]

As part of making the NHS fit for the future, moving some patient care from hospital to the community will be pivotal. In Doncaster, mayor Ros Jones and the council are already well on the way with this and they are setting up “Health on the High Street”, which is good not just for patients but for footfall in the city centre. Will my right hon. Friend set out what his Department is doing to support areas such as Doncaster in delivering on this strategy?

[Wes Streeting]

I am delighted to hear of the work Ros is doing as mayor to support health and care services and to take health and care to where people are. I hate hearing that there are hard-to-reach communities; there are no hard-to-reach communities. There are underserved communities and, in our determination to tackle health inequalities, to get care closer to people’s homes and indeed in people’s homes, to do earlier diagnosis and to provide faster access to treatment, we need to make sure that we take health and care services to where people are rather than expecting people to always come to us.

[Alison Bennett (Mid Sussex) (LD)]

I fear that corridor care has already become normalised and, as the Secretary of State says, it will be some time before we get back on the right path. This week there have been reports of a north London hospital advertising for dedicated corridor care nurses. I also think about my constituent who is a doctor at the Royal Sussex begging X-ray teams to give her a consultation room so she does not have to do intimate exams out in the corridor. What reassurance can the Secretary of State give the NHS workforce that things are going to get better?

[Wes Streeting]

I am really grateful to the hon. Member for raising that question and for the example she gave of the Whittington advertisement for staff specifically to deliver corridor care. I make no criticism of the trust itself in trying to make sure it has the right staff in place to deliver the best care possible in the present circumstances. It is not the fault of the Whittington that there is corridor care; it is a legacy of 14 years of Conservative failure. I would also say that my reaction to seeing that advertisement was the same as hers: it was proof that corridor care has been normalised. I want to reassure her, the House and patients across the country that this Government will not accept corridor care as normal care. We will not tolerate it as being acceptable care. We will do everything we can as fast as we can to consign corridor care to the history books and I reassure the staff working in the NHS in these intolerable conditions that we will work with them to deliver the investment and the reform needed to get the NHS back on its feet and make it fit for the future.

[Mr Richard Quigley (Isle of Wight West) (Lab)]

Despite the Conservative party’s best efforts to ruin our NHS, will the Secretary of State join me in paying tribute to the hard-working NHS and social care staff in my constituency who, despite enormous winter pressure, are doing their best to go above and beyond to provide exceptional care and keep the NHS on its feet?

[Wes Streeting]

I thank staff on the Isle of Wight for everything they are doing to support communities across the island against a challenging backdrop. Since my hon. Friend arrived in the House he has been an extremely strong, loud and effective voice for the people of his constituency and across the Isle of Wight, and I look forward to working with him and health and care leaders on the Isle of Wight to make sure that they see their health and care services improving as a result of their decision to send a Labour Member of Parliament and a Labour Government here to serve our NHS and his communities.