Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 11th July 2023 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

The Minister is aware, I know, of the outstanding campaigning work that my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) is doing, not least because of the experience of her sister—our late great friend Margaret McDonagh—with glioblastomas. Over decades now, we have seen no improvements in outcomes, no drug trials of any seriousness and no mandatory training of oncologists. I have learned through experience that, when the McDonaghs come knocking, it is best to say yes, and if anyone says no, they will be hit by this unstoppable steamroller. With that cautionary note in mind, might the Minister be prepared to meet me, my hon. Friend and relevant stakeholders across the Department, NHS England and the National Institute for Health and Care Excellence to see what more can be done? There are challenges, I know, but what more can be done to make sure that, for families such as my hon. Friend’s and Margaret’s, and for thousands of others each year, glioblastomas are not simply a death sentence?

[Will Quince]

I thank the hon. Member for that question and join him in paying tribute to the hon. Member for Mitcham and Morden (Siobhain McDonagh), especially after the tragic loss of her sister, for all the work that she has done in campaigning on this issue. I have spent significant time on the issue and I have met her, the hon. Member for Leicester West (Liz Kendall), campaigners, charities and other hon. Members from across the House. Funding for research is available and, having spoken with the Secretary of State, I know that he is as keen as I am to work with colleagues from across the House. There are issues that transcend party politics and this is certainly one of them. I would be very happy to meet the shadow Secretary of State, the National Institute for Health and Care Research, NHS England, the Tessa Jowell Brain Cancer Mission and clinical specialists to find a way forward.

--- Later in debate ---

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

Last week, the Health Secretary said that he was willing to offer doctors a higher pay rise. Last night, the Chancellor slapped him down, saying that any increased offer will have to be paid for by cuts. How can the Health Secretary negotiate an end to the NHS strikes when he cannot even negotiate with his own Chancellor?

[Steve Barclay]

We have been clear throughout that Government decisions on the pay review bodies’ recommendations are taken on a cross-Government basis. The agreement that we reached with the largest group of NHS staff, those on “Agenda for Change”, has demonstrated that we are willing to work constructively with trade union colleagues, but the demand from junior doctors for a 35% increase is not affordable—indeed, the hon. Gentleman himself has said that he does not support it.

[Wes Streeting]

But the worst strikes in the history of the NHS are still to come. The impact of the junior doctors’ strikes and the consultants’ strikes will be devastating for patients. The Secretary of State has failed to stop these strikes for seven months. He has lost the confidence of nurses, radiologists, junior doctors and consultants, and he cannot even successfully negotiate with his Chancellor, so what is his plan to stop these strikes going ahead?

[Steve Barclay]

The hon. Gentleman’s message is not even consistent with what he said at the weekend in the media: that he was not in a position to offer more money to the NHS, and that the shadow Chancellor had made that clear—in a vain attempt to demonstrate some sort of fiscal responsibility. The hon. Gentleman has been clear that he does not support the 35% demand from doctors in training. We are demonstrating that we are working constructively with groups such as the “Agenda for Change” group—the largest staff group, made up of over 1 million staff—with which we have reached a deal. We have also been responding constructively to the British Medical Association’s principal demand for consultants, which was for changes to pension taxation. We are willing to engage constructively with trade union colleagues, but the 35% demand is not affordable. He needs to decide on his position. Which is it: his position at the weekend that the Opposition are not offering more money, or his position today, which seems to be that they will?

Electronic Cigarettes

Wes Streeting Excerpts

Thursday 29th June 2023 Westminster Hall

[Wes Streeting (Ilford North) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Latham, and to respond to the points made in the course of this afternoon’s debate on behalf of the official Opposition. I thank the hon. Member for Sleaford and North Hykeham (Dr Johnson) not just for securing the debate, but for the enormous amount of campaigning work that she is doing on this issue and for the wide-ranging and detailed scene-setting speech she gave at the beginning, which highlighted the extent of the challenge and the severity of the risk to children’s health.

Sadly, I think the hon. Lady has more work to do on her colleagues in the Government when it comes to her proposal to ban disposable vapes. The Secretary of State for Health and Social Care gave a speech this week on

“recasting prevention from a Conservative perspective”—

whatever that means—in which he argued that bans are left wing and an affront to personal freedom. I look forward to finding out what that means for the Government’s drugs policy, but let me be the first to welcome the hon. Lady—our new comrade—to the left. The lyrics to “The Red Flag” are in the post.

I will address the point raised by the right hon. Member for Calder Valley (Craig Whittaker). The central argument put forward by the vaping industry is that, at their most effective, e-cigarettes are a useful tool for driving down smoking rates. As Dr Javed Khan highlighted in his 2030 smokefree review, if we want to create a smokefree Britain, using vapes and other smoking cessation aids will be essential in reaching that ambition, but we should be under no illusion: although vapes are unquestionably less harmful than cigarettes, they are none the less harmful products.

I share the deep concerns that Members have expressed about the impact that the vaping industry is having on children, because it is not targeting children to get them off cigarettes, but to get them on nicotine. I do not care what the industry leaders told the Health and Social Care Committee yesterday; frankly, they are insulting the public’s intelligence. If someone walks down pretty much any high street in our country today, they will be able to buy brightly coloured vapes and e-liquids with names such as Vimto Breeze, Mango Ice, or indeed Unicorns. There is no doubt that these products are being designed, packaged, marketed and sold deliberately to children.

It is no wonder that there has been an explosion of under-age vaping in recent years. Action on Smoking and Health estimates that in just the last three years, under-age vaping has increased by 50%, which shows that the vast majority of kids are being exposed to e-cigarette promotions. In this debate today, we have heard about the impact of illicit goods and the harmful substances that many of these products, which are often sold to children, contain. I personally have heard horrifying stories about the extent of their promotion on popular social media platforms, where children are able to buy them with ease, although, frankly, they can also chance their arm quite successfully on our high streets.

The effects of these products should seriously trouble us all. Teachers have to monitor toilets in schools where children congregate to vape; children make up excuses to leave their classroom in order to satisfy their nicotine cravings; and children in primary school, aged nine or younger, end up in hospital because of the impact of vaping. Paediatric chest physicians report that children are being put in intensive care units for conditions such as lung bleeding, lung collapse and lungs filling up with fat. One girl who started vaping while she was at school told the BBC last week that she has:

“no control over it. I start to get shaky and it’s almost all I can think of.”

I have seen some people warning of a “moral panic” about under-age vaping, but children who are addicted to a drug are unable to focus in the classroom, and it affects their behaviour in other ways, too. We cannot sit back and allow a new generation of kids to get hooked on nicotine.

I recognise that this concern is shared by Members across the House, but I have to say that it is hard to swallow the comments of Ministers, including the Prime Minister, who try to grab headlines today by promising a crackdown on under-age vaping at some time in the future, because they had a chance to vote for such a crackdown two years ago. Labour tabled an amendment to the Health and Care Act 2022 to ban the marketing of vapes to under-18s, and it was Conservative Members who voted it down. I hope that Ministers have had a genuine change of heart, but either way there will be action on this issue after the general election. The next Labour Government will come down like a ton of bricks on companies pushing nicotine to children and we will ban the branding and advertising of vapes to children.

I want to press the Minister on the Government’s progress towards their Smokefree 2030 target, which Cancer Research UK estimates they are set to miss by nine years. That will result in thousands of additional deaths due to the health impacts of tobacco and pile more and more pressure on an already overburdened national health service. Cancer Research UK also estimates that, on current trends, smoking will cause one million cancer cases by 2040. What are the Government planning to do to get us back on track?

What has happened to the Government’s tobacco control plan, which was promised in December 2021? Prevention is better than cure, so the next Labour Government will shift the NHS from being a service focused only on treating sickness to one that prevents ill health in the first place, because that approach is better for patients and less expensive for the taxpayer. We would make all hospital trusts integrate smoking cessation interventions into routine care and we would expect every trust to have a named lead on smoking cessation. This would come alongside work with councils to improve access to e-cigarettes as a stop-smoking aid, and a clamp- down on the pervasive myths peddled by the tobacco industry that smoking reduces stress and anxiety.

That is Labour’s plan to build a healthier society; that is Labour putting the vaping industry on notice that we will not sit idly by and allow a generation of young people to become addicted to nicotine. Where is the Government’s plan?

Lung Cancer Screening

Wes Streeting Excerpts

Monday 26th June 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

Before I begin, I would like to take this opportunity to pay tribute to the life of Margaret McDonagh, Baroness McDonagh of Mitcham and Morden. Margaret was the first women general secretary of the Labour party and the best: a political organiser second to none; kind, compassionate and made of steel. I am one of so many people throughout the Labour party and the Labour movement who benefited from Margaret’s kindness, generosity and wisdom. She was a friend, a mentor and a political hero. It breaks my heart that so many glioblastoma victims like Margaret have no hope of treatment and that a diagnosis means a death sentence. So, in sending, I am sure, condolences from across the House to Margaret’s sister, my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh), the best tribute we could make to Margaret and the best condolences we could offer her sister and family, is to unite across the House and resolve to do everything we can to make the breakthrough discoveries we need so that other people like Margaret do not receive this devastating death sentence.

I also join the Secretary of State in paying tribute to the late James Brokenshire, who was unbelievably kind to me when I went through my own cancer diagnosis—even more generous given what he was going through, which was so much worse.

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

Lung cancer patients in this country are less likely to survive than patients in most European countries. Why? Because patients today find it impossible to get a GP appointment. On receiving an urgent referral, they wait too long for a scan. On receiving a cancer diagnosis, they wait months for treatment. And before the Government blame covid, the target for patients to start treatment within 62 days of referral has not been hit

since 2015.

The Secretary of State was not joking when he said that he is not announcing anything new today. The programme announced today will not be fully rolled out until 2030. So, after 13 years in Government, they are not announcing action today and not even for the next Parliament, but for the one after that. I thank the Health Secretary for making commitments for a second-term Starmer Government to deliver.

On the workforce, the problem with the plan is that the NHS simply does not have the staff to deliver it. The Prime Minister and the Health Secretary have been all over the media setting out the upcoming workforce plan, although they have not yet said a word to the House. Is this why it will take seven years to roll out the screening programme, because they have no plan to bring down NHS waiting lists today? We have been waiting almost as long as we have been waiting for the right hon. Member for Mid Bedfordshire (Ms Dorries) to hand in her resignation and call a by-election.

While the Health Secretary writes the Labour party’s 2028 manifesto, junior doctors who treat lung cancer patients are due to walk out on strike for five days. More than 650,000 operations and appointments have already been cancelled due to NHS strike action. Is it not time for the Health Secretary to accept he has failed, step aside and call in the Prime Minister to finally meet junior doctors? If the Prime Minister has time to negotiate gongs for Conservative cronies with Boris Johnson, he has time to meet junior doctors.

Today we learnt that the National Cancer Research Institute announced it will be closing after 22 years, due to

“uncertainty in the wider economic and research environment.”

There is still so much we do not know about cancers and so many treatments still to be discovered and developed, yet clinical trials have fallen off a cliff in recent years.

What impact does the Health Secretary expect the closure to have on cancer clinical trials?

After 13 years of Conservative rule, the verdict is in. A report published today by the King’s Fund reveals that the NHS has fewer CT and MRI scanners than other advanced countries, and

“strikingly low numbers of…clinical staff”.

That explains why the King’s Fund also found that the NHS was hit harder during the pandemic than other healthcare systems. It is not just that the Government did not fix the roof when the sun was shining; they dismantled the roof and ripped up the floorboards. It also helps to explain why patients in this country are less likely to survive treatable conditions, such as breast cancer and stroke, than those in comparable nations, and why we have one of the lowest levels of life expectancy. The King’s Fund summed it up with something of an understatement, saying that the NHS had “seen better days.” Is it not the case that the longer the Conservatives are in office, the longer patients will wait?

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. Before I call the Secretary of State, let me say to the hon. Member for Ilford North (Wes Streeting) that I think the whole House will join him, and me, in sending condolences to the hon. Member for Mitcham and Morden (Siobhain McDonagh).

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 6th June 2023 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

First, I congratulate the Health Secretary on his recent write-up as the next Leader of the Opposition. According to the i newspaper, his supporters are calling him “Mr Consistent”. Is that because of the consistent rise in waiting lists since he became Health Secretary, the consistently longer waiting times that patients are facing, or the consistent delay to the NHS workforce plan?

[Steve Barclay]

The point of consistency is that we gave a manifesto commitment to have 26,000 additional roles in primary care, and we have delivered that. We made a commitment to the largest ever hospital building programme, and we have announced over £20 billion of investment in it. The Government are standing by their manifesto commitments—that is what we are delivering.

[Wes Streeting]

I am sure that will do it.

I want to turn to the most recent reports about the NHS workforce plan, because apparently not only is that plan delayed, but we now read in the media that it is unfunded. Labour will pay for our workforce plan by abolishing the non-dom tax status. [Interruption.] Conservative Members do not like it, Mr Speaker, but it is the only tax they have been unwilling to put up. We have a plan, and we have said how we will pay for it. How will the Health Secretary fund his plan when it eventually arrives? Will it be cuts to the NHS, more borrowing, or even more broken promises?

[Steve Barclay]

The hon. Gentleman is recycling this question almost as often as he recycles the non-dom funding. As I said at the last Health and Social Care Question Time, it is like the 1p on income tax that the Lib Dems used to promise, which was applied to every scheme going.

We touched on this issue at the last Question Time, and indeed at the one before: we have a commitment to a long-term workforce plan. The Chancellor made that commitment in the autumn statement, but it is a complex piece of work that NHS England is working on. It is important that we get the reforms in that plan right, and that is what we are committed to doing.

New Hospitals

Wes Streeting Excerpts

Thursday 25th May 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

Normally, I would thank the Secretary of State for advance sight of his statement, but by the time it arrived we were already in the Chamber. But it is all right; we will manage. I just thought, “What an astonishing coincidence that so many Conservative Members, whom the Secretary of State name-checked, happened to find their way to the Chamber at precisely the right moment.” It is almost as if they knew in advance. But no, I shall just assume that they sped to the Chamber faster than the Home Secretary down the motorway. I think we can assume that, with today’s migration figures, the Government have concluded that today is a good day to bury bad news. I will come on to respond to the statement, but I just wonder whether, at this stage in the lifecycle of 13 years of Conservative Government, the public might have just begun to see through the over-promising and under-delivering.

The NHS estate is crumbling after 13 years of Conservative neglect. Across England, backlog maintenance costs have more than doubled, from £4.7 billion in 2011-12 to £10.2 billion in 2021-22, and we see the consequences of that. Leeds Teaching Hospital saw more than 100 raw sewage leaks last year. Let us not beat about the bush, we are talking about urine and faeces leaking into wards and patient rooms. Hampshire Hospitals NHS Foundation Trust was forced to suspend some services because of an uncontrollable rat infestation. One of the Health Secretary’s own local hospitals in King’s Lynn has earned itself a special accolade—the most propped hospital in the country. More than 4,000 steel and timber support props are supporting its dilapidated roof—enough to extend for six miles. We have leaking sewage, rat infestations and collapsing roofs. We are in this mess because of Conservative neglect and mismanagement. They literally did not fix the roof while the sun was shining and now patient safety is at risk. Indeed, on the RAAC hospitals in particular, the Secretary of State said in his statement:

“An independent assessment shows they are not safe to operate beyond 2030.”

Indeed, what a relief to those communities that, finally, the Secretary of State has come forward to confirm that they will at least be built. I hope that will be done at speed so that we can make sure that at least one group of hospitals is built by 2030.

Turning to his wider promise, I genuinely expected that the Secretary of State might come to the House today and be upfront about the fact that, whatever promises the former Prime Minister, the right hon. Member for Uxbridge and South Ruislip (Boris Johnson), made in 2019, the pledge to build 40 new hospitals by 2030 will simply not happen. It was a straightforward commitment—40 new hospitals—but since it was made we have become familiar with the idea that they were not new and, astonishingly, they were not even new hospitals. In fact, since that general election we have had more new Health Secretaries than we have had new hospitals. Indeed, we have a case in point—like the new hospitals, some of them are not even new.

In August 2021 we discovered the Government’s definition of a “new” hospital when a departmental memo on key media lines to use when talking about the programme advised that fix-ups and paint jobs should be included. Then in November of that same year, the Government’s own infrastructure watchdog called the programme “unachievable.” So what has changed? In February this year it was revealed that only 10 of the projects even had planning permission. Just last week the BBC reported that the building work is yet to start on 33 of the 40 projects promised. In fact, most are still waiting to hear what their final budget will be, and none of the six that were supposed to be ready for 2025 has full planning permission or funding yet.

This matters, because people in those places were made a promise. The Secretary of State has the audacity to repeat that promise today when—even if the will is there and, as he says, the money is there—it is hard to see or understand how, practically, he will be able to deliver 40 new hospitals by 2030. Will he now come clean and admit that this is just another example of the Conservatives over-promising and under-delivering? The fact is that, thanks to the dither and delay and the churn of personnel from one Health Secretary to another and one Prime Minister to another, the programme has been hit with delays and uncertainty for years. As a result, the costs have soared, and it is less likely that the hospitals will ever be built, letting down taxpayers and letting down patients.

The Secretary of State has also tried to instil this sense of jeopardy that, if there were a change of Government and they were a Labour Government, hospital building would somehow become less likely. He quoted the Leader of the Opposition accurately, but he did not seem to understand the meaning. It is quite right to say that, before we commit any more money to capital projects, we will want to make sure that these projects are feasible, are good value for money and will deliver the improvement that patients need.

However, if I have understood the Secretary of State’s statement correctly, the hospitals that he has announced are all fully funded. I cannot wait to see the detail behind “fully funded”, but surely if we are accepting him at face value and these are fully funded, there will not be the need for any more money from a Labour Government to fund these 40 new hospitals. Therefore, there is no risk or jeopardy at all, assuming that the money is there and the case stacks up. That is why we requested a National Audit Office investigation into the programme and why we will set up an office of value for money to make sure that we get value for every penny of taxpayers’ money spent.

The Conservatives have dithered so much that it has been reported that the programme is now expected to cost twice as much as originally estimated—an eye-watering £35 billion. Does the Health Secretary recognise that figure? If he does not, will he commit to publishing the latest estimate that his Department has made of the true cost of the programme? If it is fully funded, can he explain exactly where that money has come from?

This is not just about cost, but about the very real threat to patient safety, which this irresponsible Government are presiding over day in, day out. In December, the Health Secretary acknowledged the enormous concerns about reinforced autoclaved aerated concrete used in certain hospitals, and the safety implications of this. He committed to eradicating it from the NHS estate. Why has it taken him six months to get to this point? I wonder how many of the new hospitals have been kicked into the long grass, beyond 2030, as a result of the decision that his Department has made today.

In conclusion, is it not time for the Health Secretary to come clean with the House and with the public and admit that the only place that these 40 “new” hospitals will exist by 2030 is in the former Prime Minister’s imagination? In fact, what we have heard today is a plan on paper, but it is one that will never see reality in practice.

[Steve Barclay]

It is a very strange approach to complain about Members coming to the Chamber. The hon. Gentleman almost sinks his own point with his opening gambit. We are here because of the campaigning of Conservative Members for new hospitals. That is why, when they see that there is a statement on new hospitals as part of that campaign, it is no surprise that they are in the Chamber. It is pretty odd to complain about Members coming to the Chamber because they are interested in what is happening in their own constituencies.

It is equally strange for the Opposition to appear to be complaining about a plan that they have been calling for over recent weeks. The shadow Secretary of State has repeatedly said that he wants to see the new hospitals programme plan. We have set that out in the statement today, to which he says he is concerned that we only have a plan. A plan on the Government side beats no plan on the Opposition side.

The hon. Gentleman also seems, slightly oddly, not to welcome a commitment to over £20 billion of investment in the NHS estate. He seems to have an objection to me giving a commitment to address the issues of RAAC hospitals, which NHS leaders themselves have said should be prioritised and which independent reports have said create a risk beyond 2030, and coming to the Chamber after discussions with Treasury colleagues and others across Government to confirm that we now have funding to address the seven RAAC hospitals that he has called for action on.

The shadow Secretary of State then seems to have an objection about speed, yet the whole thrust of my statement was about how we are changing our methodology through the use of modern methods of construction, learning from what has been done in the education sector, the justice sector and the private sector about delivering construction schemes at pace. That gives more confidence on cost; it stops local chief executives changing the specifications once designs are under way; it allows things to be built more quickly; it allows us to benefit from technology, with construction in factories as opposed to more conventional construction; and it allows us to deliver schemes more quickly.

It is for that reason that Conservative Members campaigned so strongly for it, none more so than my right hon. Friend the Member for Pendle (Andrew Stephenson), who has been an assiduous champion of the case for Airedale General Hospital. As the statement sets out, we are committed to addressing the RAAC hospitals, and fixing them has in turn unblocked something that was causing delay to the programme for the enabling works for cohort 3, in particular.

Cohort 2, where schemes are well advanced, will also now be able to proceed. We also updated the House on the more bespoke approach being taken to some of cohort 4. The shadow Secretary of State is right to talk about a sense of jeopardy, because those on the Opposition Front Bench have said they want to pause, review and stop the schemes we will be proceeding with. That is the real risk to the new hospitals programme. We have a new approach. We have a clear plan. It is the Labour party that wants to stop it.

Patient Choice

Wes Streeting Excerpts

Thursday 25th May 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

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

[Steve Barclay]

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

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

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

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

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

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

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

Recovering Access to Primary Care

Wes Streeting Excerpts

Tuesday 9th May 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

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

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

[Steve Barclay]

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

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

The Boots chief executive says that this is

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

The Company Chemists Association says that it is a

“real vote of confidence for the future profession”.

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

“a real game-changer for patients”,

and that is what our focus has been.

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

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

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

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

Oral Answers

Wes Streeting Excerpts

Tuesday 25th April 2023 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

The Conservatives have cut 2,000 GPs since 2015 and now too many patients cannot get an appointment when they need one: 3,000 patients are waiting a month to see a GP in Dover; 3,500 are doing so in Mansfield; 3,500 are doing so in North Lincolnshire; and 5,000 are waiting a month in Swindon. So why will the Government not adopt Labour’s plan to double the number of medical school places, paid for by abolishing the non-dom tax status, so that patients have the doctors they need to get treated on time?

[Will Quince]

I recognise the pressures on the system, but Labour has spent the non-dom money 10 times over. We are taking real action on this issue: real-terms spending on general practice is up by more than a fifth since 2016; as I said, we are investing £1.5 billion to create an additional 50 million GP appointments; we have recruited more than 25,000 additional primary care staff; and there are 2,167 more doctors in general practice; and we have the highest number ever in training.

--- Later in debate ---

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

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

[Steve Barclay]

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

[Wes Streeting]

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

[Steve Barclay]

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

NHS Strikes

Wes Streeting Excerpts

Monday 17th April 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

[Wes Streeting]

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

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

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

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

[Steve Barclay]

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

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

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

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

Junior Doctors’ Strikes

Wes Streeting Excerpts

Thursday 30th March 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

[Wes Streeting]

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

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

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

[Steve Barclay]

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

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

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