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.

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 7th January 2025 Commons Chamber

[Calum Miller (Bicester and Woodstock) (LD)]

10. What recent steps he has taken to increase access to GP appointments.

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

Today there are 1,399 fewer full-time equivalent GPs than in 2015, and NHS dentistry is at death’s door. This Government will fix the front door to the NHS. We have announced an additional £889 million in funding for general practice in 2025-26—the biggest boost in years—and we have already started hiring an extra 1,000 GPs on the frontline. Our 10-year health plan will shift the focus of healthcare out of hospital and into the community.

[Nesil Caliskan]

I thank the Secretary of State for his answer on the critical issue of access to GPs in primary healthcare. My constituency of Barking is woefully under-served by primary healthcare, and especially by GPs. On average, each GP looks after 2,000 patients; the national average is 1,600. In particular, the area of Barking Riverside has no GP services. Will the Secretary of State meet me to discuss this matter, so that the thousands of homes that are being built will also have a primary healthcare facility on site?

[Mr Speaker]

Order. I remind Members to look towards the Chair, because I cannot hear what is being said. I call the Secretary of State—I hope he heard the question.

[Wes Streeting]

Thank you, Mr Speaker. I would be delighted for my hon. Friend to meet me or the relevant Minister. The NHS has a statutory duty to ensure sufficient services in each local area, including general practice, and it is vital that we also take into account population growth and demographic changes. I strongly support the Deputy Prime Minister’s commitment to delivering 1.5 million new homes, and she and I know that that must be accompanied by local healthcare facilities. We are working together to achieve just that.

[Alistair Strathern]

I really welcome this Government’s focus on making sure everyone can see a GP when they need one. The crisis in GP provision nationally has been exacerbated by the failure under the last Government to ensure that primary care investment has kept pace with housing growth. With such a low share of integrated care board capital funding allocated to primary care by the last Government, how can we make sure we do much better in ensuring that GP capacity expands at the same time as local growth?

[Wes Streeting]

My hon. Friend has been raising these issues with me since before he was elected to this place on behalf of the communities he represents. As I said to my hon. Friend the Member for Barking (Nesil Caliskan), we must make sure that additional housing—which is desperately needed—is accompanied by health and care services. The Deputy Prime Minister and I are working together to achieve just that, and thanks to the decisions taken by the Chancellor in the Budget, we are able to invest in the health and care services that this country needs and deserves.

[Calum Miller]

Woodstock surgery in my constituency is not fit for purpose. In September, heavy rain fell and caused the roof to collapse, causing the surgery to close. The nurse literally sees patients in a broom cupboard. The GPs want to increase their capacity to see more patients, but have been unable to access sufficient capital from the integrated care board. Will the Secretary of State meet me and the Woodstock GPs to discuss how the reforms announced yesterday will help them build a new surgery, so that they can see patients faster?

[Wes Streeting]

I am grateful to the hon. Member for that question. I am incredibly sorry about the awful conditions in which staff in that practice are having to see patients and in which the patients it serves are having to be seen—that is the epitome of the broken general practice system that we inherited. Thanks to the decisions taken by the Chancellor in the Budget, we are able to invest in the capital estate need in the NHS. That will take time, and we would be delighted to hear more about that individual case to see how the ICB and the NHS can assist.

[Mr Speaker]

I call the Chair of the Select Committee.

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

Following the theme raised by my hon. Friend and neighbour, the hon. Member for Bicester and Woodstock (Calum Miller), may I make a plea for Summertown health centre? They are my doctors, by the way, so I declare an interest. They operate in an old Victorian building and are desperate to move to new premises. That health centre was at the top of the priority list, but the ICB says that there is no money, and the doctors say that there is no pot that they can bid into in order to get this seen to. Will the Secretary of State meet me as well? Clearly, £102 million spread across 50 projects in the country is not going to be sufficient. Can we get creative about how we can get new premises built for Summertown health centre?

[Wes Streeting]

Of course I will meet the hon. Lady. It would be daft of me to say no to the Chair of the Select Committee; otherwise, she will see me in less pleasant circumstances. In all seriousness, we are looking creatively at this issue. There are enormous capital pressures right across the NHS estate. We are regularly lobbied on new hospitals, for example, but we are also lobbied on general practice, the mental health estate and the rest. We will do as much as we can as fast as we can, thinking creatively about how we can get more capital investment in, and I would be happy to discuss that further with the hon. Lady.

[Claire Hazelgrove (Filton and Bradley Stoke) (Lab)]

When I am out regularly knocking on doors and listening to people across the constituency, one of the issues residents raise with me most frequently is the challenge in even being able to book a GP’s appointment. Could the Secretary of State please set out what his plans are for ending that 8 am phone scramble, including for those who do not use apps and websites as confidently?

[Wes Streeting]

I am grateful to my hon. Friend for that question. As the Prime Minister set out in our elective reform plan yesterday, we are determined to make sure that accessing NHS services, including general practice, dentistry and other primary care services, is as easy and convenient as accessing any other services at the touch of a button via our smartphones. We have committed to that in the elective reform plan, which will bring benefits right across the NHS as we modernise. Of course, she is right to mention those who may not be digitally connected or may not want to access services in that way. That is why I believe very strongly in patient choice—different courses for different horses. People like me booking via the app will free up telephone lines for those who prefer to access services that way.

[Seamus Logan (Aberdeenshire North and Moray East) (SNP)]

Is the Secretary of State aware that the increase to employer national insurance is actually reducing patient access to primary care? I met GP representatives in Aberdeenshire and Aberdeen recently, and they told me of two ways in which that is happening: first, they are having to let staff go; and secondly, some GPs are considering meeting these costs from their own pockets. Will he consider an exemption for GP practices from these charges?

[Wes Streeting]

That was a rare admission of failure in this House by the SNP. I am very sorry to hear that general practice in Scotland is in such a sorry state, because here in England we are investing £889 million in general practice, the biggest uplift in years. That is in addition to the funding I have found to employ 1,000 more GPs on the frontline before April, because we are prioritising general practice. As for the decisions the Chancellor took in the Budget, as I said before the election, all roads lead to Westminster. Thanks to the decision a Labour Chancellor has made here in Westminster, coming down that road from Westminster to Holyrood are the resources the SNP Government need to deliver the priorities of the Scottish people. If they cannot, Anas Sarwar and Jackie Baillie stand ready to deliver.

[Mr Speaker]

I call the shadow Minister.

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

To improve access, the Government have announced a planned expansion of advice and guidance, and GPs will be paid £20 per advice and guidance request they make for further expert advice from consultants. How do the Government expect this expansion to take place? Will they be mandating it given that the current position of the British Medical Association, under its collective action, is that GPs should

“Stop engaging with the e-Referral Advice & Guidance pathway”?

[Wes Streeting]

I think the shadow Minister will find that GPs welcome the £889 million uplift announced just before Christmas. That is the biggest boost to general practice in years. It is part of this Government’s agenda to fix the front door to the NHS and recognise the dire state that GPs were left under. Of course, with that investment comes reform. I think GPs would be delighted to manage more of their patients in the community if given the tools to do the job, and that is something this Government are committed to doing.

[Dr Evans]

Going back to advice and guidance, GPs use advice and guidance when they have come to the summit of their knowledge and need specialist input. For example, as a GP, I may see a rheumatology patient and ask for advice from a rheumatologist, who may advise specialist blood tests. The problem is that, as the inquiry clinician, I am legally responsible for those blood tests and have to pay for them out of the primary care budget. Do the Government propose that the £20 will cover subsequent follow-ups and the cost of suggested tests? Given the expansion of advice and guidance, will the Government be looking at a legal framework change in accountability for clinicians making requests?

[Wes Streeting]

First, as the shadow Minister has said, advice and guidance happens in general practice, and we want to see more of it. We have to give GPs the tools to do the job, and that is what we are doing. My hon. Friend the Minister for Care will be talking to the BMA shortly in the context of contract negotiations in the usual way. What the shadow Minister neglects to mention is that these reforms and improvements to general practice are made possible thanks to the £889 million we are putting in, which is investment that he and his party oppose.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Dentistry is a key part of primary care, yet an estimated 5 million people in England have been left without an NHS dentist. That is why today a petition is being handed in at Downing Street signed by more than a quarter of a million people. We have moved on from the election, but we do not yet have a timetable for when the negotiations for a new NHS dental contract will begin and when another 700,000 extra urgent appointments will be rolled out. Can the Secretary of State confirm the timetable for those improvements? What specifically are the Government’s plans for the new patient premium, and will he offer assurances to dentists that any changes to the current model will be outlined in detail to them as soon as possible?

[Wes Streeting]

We are looking at two things, the first of which is making sure we deliver what we said in our manifesto, including the 700,000 urgent appointments. We are determined to deliver those as fast as we can and my hon. Friend the Minister for Care is having discussions with the British Dental Association to that effect. He is also looking closely, as am I, at the money that is already going into NHS dentistry—how that money could be better spent and how it is that year after year, despite people’s teeth rotting to the extent that they are having to pull them out themselves or children having to attend A&E to have their teeth pulled out, we saw consistent underspends in the dentistry budget under our predecessors. We are determined to give dentists the tools to do the job so that patients can see a dentist when they need one.

[Dan Carden (Liverpool Walton) (Lab)]

4. What steps his Department is taking to support drug and alcohol addiction treatment services.

--- Later in debate ---

[Elaine Stewart (Ayr, Carrick and Cumnock) (Lab)]

6. What steps his Department is taking to help reduce NHS waiting times.

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

This Government are delivering on our commitment to cut NHS waiting lists and end the Tory backlog. We have taken immediate action with an additional £1.8 billion to support elective activity this year. That funding will support the delivery of our first step of 40,000 extra elective appointments a week. With investment must come reform, and the elective reform plan, published yesterday and announced by the Prime Minister, sets out how we will cut NHS waits to the 18-week standard, increase productivity, reform the system and improve patients’ choice and control over their healthcare.

[Elaine Stewart]

Almost one in six Scots is stuck on an NHS waiting list. People are borrowing money and remortgaging their homes to go private, because they cannot bear the pain. With an SNP Government who have abandoned the principles of an NHS free at the point of entry, does my right hon. Friend agree that Scotland’s health service needs a new direction?

[Wes Streeting]

I strongly agree with my hon. Friend. As I said during the general election campaign—it was quoted regularly by the SNP—all roads lead to Westminster. Down that road from Westminster is a record increase in funding for the Scottish Government through the Barnett formula. I know the Scottish Government published their own NHS recovery plan just before Christmas, and I look forward to reading it, although I know some have expressed concerns about the lack of detail in the plans to drive down waiting times. The Scottish people can therefore compare and contrast with the ambition of our elective reform plan, which was announced by the Prime Minister yesterday, and then decide at the next Scottish elections who they trust to govern: the SNP with its rotten record, or a Labour Government who will get on and deliver.

[David Davis (Goole and Pocklington) (Con)]

The Secretary of State knows that I wrote to him before Christmas about the planned ward closures and degradation of services at Goole and district general hospital. Doing so will take beds, facilities and employees away from the national health service, which will do nothing but undermine his real attempts to reduce waiting lists and all the plans he announced yesterday. Will he look at the trust-level decision systems that lead to such catastrophic decisions that will undermine every aspect of NHS strategy and all that he is trying to do?

[Wes Streeting]

I thank the right hon. Gentleman for writing to me before Christmas. I recognise the pressures that have been placed on NHS commissioners in recent years and the pressure that that has put on service configurations. I tend to support the devolution of decision making, with decisions about service reconfigurations taken closer to the communities they serve. I recognise also that commissioners do not always get it right, which is why engagement with Members of Parliament and other democratically elected representatives is important. Ministerial oversight is important, too. We will look seriously at the issues he raises and talk to NHS leaders, and I know he will be doing the same. This Government are determined to give NHS leaders the tools to do the job, so that we can get the right care in the right place at the right time, with a better experience for patients and better value for taxpayers.

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

I am sure my right hon. Friend will share my delight at the fact that in our growing community of Thanet, the NHS is looking to open the Thanet integrated hub in one of the most deprived parts of Kent. However, Tory-run Kent county council has put in spurious objections to the development. Does he share my concern that such unnecessary objections block access to healthcare and make it harder for the Government and the NHS to cut waiting lists?

[Wes Streeting]

I am grateful to my hon. Friend for the work she is doing to improve health and care services for her constituents. The Government are giving health and care providers the tools to do the job. Of course, change will take time, and it is therefore crucial that we all pull together locally and nationally. For the avoidance of doubt, the Government are on the side of the builders, not the blockers.

[Josh Babarinde (Eastbourne) (LD)]

The NHS Confederation has said that for the Government to be able to drive down waiting lists,

“the pause to the delivery of the new hospitals programme must be as short as possible and NHS leaders need clarity about timelines.”

With that in mind, will the Secretary of State tell leaders at Eastbourne district general hospital, as well as our community in Eastbourne, precisely when the new hospital programme review will be completed so that we can get cracking with our upgrades?

[Wes Streeting]

I thank the hon. Member for that question. I agree with him about the need for clarity as well as consistency. We undertook the review into the new hospital programme because the previous Government’s timetable was a work of fiction and the money was not there. I hope to report to him and to the House shortly on that, with the undertaking that the timetable we publish and the funding provided by the Chancellor in the Budget and at the spending review will mean that we will provide not just clarity but consistency, which is important for NHS leaders, important for patients and important for the construction industry partners we need to work with.

[Mr Speaker]

I call the shadow Minister.

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

Thank you, Mr Deputy Speaker. [Interruption.] I am sorry—that is the last time I will get called. Thank you, Mr Speaker.

Yesterday, in relation to the elective backlog, the Secretary of State said:

“Where we can treat working people faster, we will, and we make no apology for doing so.”—[Official Report, 6 January 2025; Vol. 759, c. 597.]

Labour politicians have struggled to define what they mean by working people, but his words have caused anxiety. Will he reassure those with disabilities that prevent them from working and retired elderly people who have worked all their lives that they will not be pushed to the back of the queue and that treatment will continue to be provided in the NHS on the basis of clinical need?

[Wes Streeting]

Of course, clinical need is paramount and must always drive decision making about who to treat when and the order in which people are treated. That is why I find the question posed so deeply disingenuous. [Interruption.] We inherited NHS waiting lists at record levels and waiting times that are frankly shameful. The shadow Minister should be apologising for her party’s record, and she should also apologise for the two-tier healthcare system that sees those who can afford it paying to go private and those who cannot afford it—working-class people—being left behind. That is the two-tier system that the Government are determined to end.

[Mr Speaker]

Order. Can we be a bit careful with the language we are using?

[Dr Johnson]

The Secretary of State needs to be careful with the words he uses, as you said, Mr Speaker, because his words did cause anxiety among people. It was not a disingenuous question; it was a genuine question to make sure that people are reassured.

It will not have escaped the Secretary of State’s notice that it is cold outside. Removal of the winter fuel allowance has reduced elderly people’s ability to follow the advice that he gave last week, which was to turn the heating on. What assessment has he made of the number of additional admissions caused by his removal of the winter fuel allowance? What effect is that having on the Government’s ability to deliver their reduction in elective backlogs?

[Wes Streeting]

What the shadow Minister neglects to mention is that the Chancellor has protected the winter fuel allowance for the poorest pensioners, and she has also put in place the warm home discount to assist people with their energy bills throughout the winter. If the shadow Minister does not support the decisions that the Chancellor took at the Budget and ahead of the Budget to raise vital investment for our health and care services, that is fair enough, but then she needs to tell people which NHS services she would cut or which other taxes she would increase.

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

7. Whether he has made an assessment of the effectiveness of improvements made to the Care Quality Commission.

--- Later in debate ---

[Martin Rhodes (Glasgow North) (Lab)]

12. What discussions he has had with Cabinet colleagues on staff salaries in the care sector.

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

This Government recognise the crisis in social care that we inherited, which is why over the past six months we have taken steps through the Budget to increase investment in social care, deliver the biggest expansion of the carer’s allowance since the 1970s and invest in the disabled facilities grant. Of course, as my hon. Friend alludes to, we cannot deliver great social care without the workers who deliver it. That is why I am proud that within our first 100 days, the care worker-turned-Deputy Prime Minister included fair pay agreements in her landmark Employment Rights Bill, so we can give our care staff not just the pay they deserve, but the professional status, recognising the hard work they do as care professionals. That is a crucial step on our path to building a national care service.

[Martin Rhodes]

Does the Secretary of State agree that the SNP’s National Care Service (Scotland) Bill was a missed opportunity to improve pay and conditions for social care workers, particularly when compared with Labour’s Employment Rights Bill, which creates the fair pay agreement for social care workers?

[Wes Streeting]

I agree with my hon. Friend. I am proud that this Government have taken quick action within our first 100 days. Thanks to the Employment Rights Bill, which is UK-wide legislation, this Labour Government in Westminster are giving the Scottish Government the tools they need to do the job of establishing fair pay for care staff. If they do not do it, Anas Sarwar and Jackie Baillie will.

[Martin Vickers (Brigg and Immingham) (Con)]

In north-east Lincolnshire, a social enterprise employs 800 staff providing health and social care. I have been approached by many staff who are unhappy that they have not benefited from the increases that NHS staff have gained. They have the support of the Royal College of Nursing and are looking for the Government to provide Care Plus Group, which employs them, with the resources to ensure that they are recompensed to the same level. What is the Secretary of State able to pass on to them?

[Wes Streeting]

I am grateful to the hon. Member for that question. With our fair pay agreements, we will be bringing together government, public and private sector employers and staff trade unions to negotiate the future for fair pay agreements that will benefit care workers across the system and give them the professional status and career progression they deserve. The Chancellor, through the Budget, also took steps to ensure that we could invest in our social care services. I am deeply saddened that the Conservative party has not supported that investment.

[Mr Speaker]

I call Dame Emily Thornberry—congratulations!

--- Later in debate ---

[Calum Miller (Bicester and Woodstock) (LD)]

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

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

We have been busy announcing investment in hospices, an uplift in funding for general practice, action through disabled facilities grants and a new independent commission on adult social care, and yesterday the Prime Minister announced the elective care reform plan. As I have said, however, the NHS is experiencing a period of significant winter challenge. The number of beds occupied by people with flu has been much higher than the number last year, and is continuing to rise. An average of just over 4,200 beds were occupied by flu patients at the end of December, surpassing the peak of about 2,500 reported last year. We monitor the situation closely, working hand in hand with NHS England and care leaders, and I continue to chair weekly meetings with senior leaders in social care, NHS England and the UK Health Security Agency.

[Calum Miller]

I am sure the Secretary of State will share my shock and anger about the number of young people in my constituency who are waiting more than four years for a first assessment by child and adult mental health services. Can he confirm that yesterday’s commitment by the Prime Minister that patients would not wait more than 18 weeks for a first appointment will apply to CAMHS in Oxfordshire?

[Wes Streeting]

We are determined to improve children and young people’s experience of both mental and physical health services, and we are determined to do more to ensure that mental health and paediatric waits are put under the spotlight and given the same attention as the overall elective backlog. I am sure we will have more to say about that when we publish the 10-year plan.

[Adam Jogee (Newcastle-under-Lyme) (Lab)]

T2. I pay tribute to my constituents Sheila and Joe Ward, who have long campaigned for vaccine-injured people and bereaved families following the death of their husband and father. The vaccine damage payment scheme has received 16,824 claims. When can people who are still mourning the loss of loved ones expect to receive the compensation that they deserve?

--- Later in debate ---

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

The Prime Minister’s announcement yesterday of his elective recovery plan mirrored that of Sir Saijd Javid in 2022, but one aspect was different. Our plan explicitly recognised the importance of the workforce being in place to deliver the 9 million extra tests and interpret the results, and it set out proposals to increase that workforce further. What plans has the Secretary of State to boost the workforce in community diagnostic centres specifically, over and above the plans that he inherited from us, to ensure that his elective recovery plan is deliverable?

[Wes Streeting]

The shadow Secretary of State is right to say that we need staff in place to do the job. The additional funding announced by the Chancellor in the Budget is central to the delivery of this plan—I note that he opposes that funding, which is deeply regrettable—but we need to improve productivity as well. That is why the plan sets out steps to free up patient appointments that are unnecessary or of low clinical value, but, crucially, staff time in productivity gains is also important, so as well as making the most of the additional investment, we are making the most of delivering value for taxpayers’ money—

[Mr Speaker]

Order. Please help me a little bit. You have had a good run today—don’t spoil it.

[Edward Argar]

On hospices, while the Secretary of State’s pre-Christmas hospice funding announcement was, of course, welcome, the vast bulk of it was in fact non-recurring capital funding, which cannot be used to help them cover the hiked employer national insurance tax on hospices’ most precious asset: their staff. What steps is he taking to ensure that they receive recurring revenue funding, to enable them to cover the additional costs?

[Wes Streeting]

The £100 million capital investment we set out before Christmas is the biggest boost to hospice funding in a generation, and it comes on top of the £26 million that we announced for the children and young people’s hospice grant. The right hon. Gentleman cannot welcome the investment and keep opposing the means of raising it. Would he cut services or raise other taxes? He has got to answer.

[Tristan Osborne (Chatham and Aylesford) (Lab)]

T5. Pharmacy First is an incredibly popular service that has allowed many residents in Chatham and Aylesford to be referred for illnesses or urgent repeat medicine supplies. Can the Minister indicate whether there warrants a further review and expansion of this offering, to include further access to medicines, including those to treat common dental conditions with bacterial infections, so that patients with these very painful emergency needs can seek immediate over-the-counter appointments?

--- Later in debate ---

[Rosie Duffield (Canterbury) (Ind)]

T4. Since 2017 I have been raising the crisis facing East Kent hospitals university NHS foundation trust. Seven different Health Secretaries across those seven years have promised much but delivered nothing at all. Patients continue to face unacceptably long waits on trolleys in corridors, and last month the Kent Online paper compared these conditions to a war zone, with an average of 40 very ill patients a day facing more than 12-hour waits. Will the Secretary of State meet me and the CEO of our trust, who is desperate for even the most basic diagnostic equipment, to ensure that this does not continue to be the case for another seven years?

[Wes Streeting]

Yes, I or the Minister of State for Health would be delighted to meet the hon. Member. She is right to describe the scale of challenge in urgent and emergency care. Of course, there are other challenges in east Kent, particularly in maternity services, which I am acutely aware of too, and I would be delighted to work with her to help solve some of those challenges in her community.

[Natasha Irons (Croydon East) (Lab)]

T7. The Family Dental Practice in my constituency has faced significant challenges caused by dental contracts introduced by the previous Government. The pilot scheme it took part in caused long-lasting operational financial damages to the practice. How will the Secretary of State support such practices, and will he consider measures such as rebasing the unit of dental activity targets to help them overcome these challenges?

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

One in five social care jobs in Cumbria are currently unfilled, and the consequences are unbearable for those who are vulnerable; indeed, they are causing pressure on the rest of the NHS. Will the Secretary of State look carefully at the specific needs of rural communities such as ours, where it is so much harder to recruit and retain social care workers?

[Wes Streeting]

I was in Cumbria recently, and I was struck by the fact that the care home I visited in Carlisle is delivering great intermediate care for the NHS at half the price of a hospital bed—a really good example of how social care often delivers better value and better care. However, the hon. Gentleman is right about the recruitment challenges. We are determined to work with local training providers and the local university to make sure that we recruit social care workers, grow our own in Cumbria and keep them in Cumbria.

[Mohammad Yasin (Bedford) (Lab)]

T8. The East of England ambulance service NHS trust remains at the highest escalation level—level 4—as call handlers in Bedford remain under immense pressure after responding to 39,000 calls between Christmas and new year. Despite the unprecedented demand, the trust is considering closing the Bedford emergency operation centre, putting nearly 200 jobs at risk. Given that resources are already stretched to the limit in Bedford, does the Secretary of State agree that we must keep experienced staff who have helped to save countless lives in the region?

[Greg Smith (Mid Buckinghamshire) (Con)]

Will the additional money announced for hospices before Christmas cover the full cost of the increase in employer’s national insurance contributions or not?

[Wes Streeting]

The Conservatives cannot, on the one hand, welcome the investment and, on the other hand, condemn the means of raising it. Would they cut NHS and care services, or would they raise other taxes? They have to answer.

[Cat Smith (Lancaster and Wyre) (Lab)]

T9. I thank my right hon. Friend for securing the land purchase for the new hospital in Lancaster. Will he meet me to discuss how a new hospital will transform health outcomes for my constituents?

[Wes Streeting]

I would be delighted to meet my hon. Friend. She was literally the first person to lobby me immediately after the general election, about her hospital, having already lobbied me before. I am delighted that, thanks to her efforts, we have been able to deliver for her community; indeed, thanks to your efforts, Mr Speaker, we have done so for yours too. I would be delighted to meet her.

[Mike Martin (Tunbridge Wells) (LD)]

Becky’s son Will was a normal, happy teenager until he suffered multiple covid infections. His mother tried to find out what was wrong with him, but she found that there were no paediatric long covid care services in Kent. Will the Minister update the House on whether Kent, with a population of 2 million, will ever get a paediatric long covid service?

--- Later in debate ---

[Rishi Sunak (Richmond and Northallerton) (Con)]

Prostate cancer is the most common cancer in men, yet it has no national screening programme. We worked on this issue in government, and I thank the Secretary of State for taking an interest in this area. Will he join me in commending Prostate Cancer Research’s excellent new report and urge his team to consider the findings, not least on increasing screening of at-risk groups so that we can not just save the NHS money but, more importantly, save thousands of lives?

[Wes Streeting]

I welcome the former Prime Minister’s question, and he is right to commend the research. We are actively looking at it. Given that he is here and that we are currently taking through the Tobacco and Vapes Bill, I thank him for his leadership on that issue.

[Deirdre Costigan (Ealing Southall) (Lab)]

The last Government treated mental health as a Cinderella service, with my constituents waiting days in A&E to be admitted to hospital mental health wards. The Solace Centre in Ealing Southall provides help and support in the community for those with mental health problems, at a fraction of the cost of a hospital stay. How does the Minister intend to move more mental health services from hospital to the community, and to create more great services like the Solace Centre?

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

Will the Secretary of State confirm what is being done to ensure that patients with rare and complex conditions, such as functional neurologic disorder and achalasia, can access consistent and co-ordinated care, including referrals to the multidisciplinary teams they need for the different symptoms they experience?

[Wes Streeting]

The hon. Member is right to raise cases where there are multiple comorbidities or complex conditions requiring a range of care services. That is why we need to design services around the patient, not expect patients to contort themselves around the services. Our approach to neighbourhood health services should make a real difference in that regard, but we have to go further and faster on health and care integration, and we absolutely will.

[Mr Speaker]

Order. I call Kevin McKenna to ask the final question.

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

I strongly welcome yesterday’s announcement about using initiatives such as community diagnostic centres to move services closer to the public. In the Isle of Sheppey, we are particularly exposed as a coastal community, but thankfully a new CDC will really help. Unfortunately, my experience in the NHS over the past few years shows that while the previous Government talked the talk about shifting care to the community, they failed to deliver. Will the Secretary of State set out what steps will be taken, so I can show my constituents that this shift will actually happen?

[Wes Streeting]

I am delighted to have my hon. Friend and his experience in the House, standing up for his community and giving us his advice and wisdom as we develop our 10-year plan. We are already walking the talk on the shift to community, not least through the big uplift in funding for general practice announced before Christmas. Many people assume our elective reform plan is just about hospital waiting lists, but a big part of it is about delivering the left shift by asking and funding general practice to do more to manage patients in the community.

General Practice: Investment and Reform Package 2025-26

Wes Streeting Excerpts

Monday 6th January 2025 Written Statements

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

General practice is the cornerstone of our national health service, providing essential care to communities day in, day out, managing pressures across the healthcare system, and playing a pivotal role in delivering care closer to home.

On Friday 20 December 2024, I wrote to general practices to update them on proposals for the GP contract for 2025-26. I was pleased to confirm that general practice will receive a funding uplift of £889 million in 2025-26, representing a 7.2% cash growth and estimated real terms growth of 4.8%. This marks the largest funding uplift for general practice since the start of the five- year framework and demonstrates this Government’s commitment to delivering a neighbourhood health service—one of our key manifesto pledges.

I fully recognise the financial pressures general practice has faced in recent years. Despite the challenging fiscal backdrop this Government inherited, we have made the necessary decision to ensure additional resources are allocated to primary care. This uplift to general practice reflects this Government’s commitment to bring back the family doctor, end the 8 am scramble and put general practice at the heart of the neighbourhood health service. It will support critical reforms which will make it easier for patients to get an appointment with the same doctor—particularly those with long- term conditions—and help us shift from treatment to prevention, by going harder on tackling the biggest killers. I also wanted to take the opportunity to reassure newly qualified GPs employed through the ARRS scheme, announced last year, that they will continue to be supported throughout 2025-26 to sustain care delivery.

General practice is central to our plans for health service reform with the patient at the centre. This funding uplift represents a vital step towards the “left shift” in care, ensuring that primary and community care receive a greater share of NHS funding and are able to deliver more care closer to home. There are already hundreds more full-time GPs in post than when the Government took office, reflecting the progress made in strengthening the workforce and meaningful progress towards improving access and outcomes for all.

Alongside the announcement of the funding uplift, the consultation with the General Practitioners Committee in England (GPC England) of the British Medical Association (BMA) on the 2025-26 GP contract began in December. This consultation provides a forum to discuss important proposed changes aimed at improving patient care and experience, by reducing inefficiencies, streamlining processes, and enabling general practice to deliver improved patient outcomes. The final reforms will be announced following the conclusion of the consultation in 2025, and I will keep the House updated.

These actions reflect our commitment to addressing the immediate pressures facing general practice while also laying the foundations for long-term reform. Through increased investment and meaningful changes, we expect GPs to deliver better access, improved continuity of care, and strengthened support for elective recovery.

[HCWS351]

Health and Adult Social Care Reform

Wes Streeting Excerpts

Monday 6th January 2025 Commons Chamber

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

A happy new year to you, Mr Speaker, and to everyone across the House. With your permission, I will give an update on health and adult social care reform.

I start by paying tribute to the NHS and social care staff who worked throughout the Christmas break, including by staffing our hospitals, ambulance services, care homes and call centres on Christmas day and throughout the new year. From visiting hospitals and residential care homes in the south-west of England, Essex, London, South Yorkshire and the north-west over the past two weeks, I know the extent of the pressures they are dealing with. They are going above and beyond to keep the NHS standing, to provide people with the social care they need and to give patients and care users the best care they possibly can against the most challenging backdrop.

We have seen more than three times as many patients hospitalised with flu this winter compared with last year, in a service with no slack left to give. Since coming into office, the Government have been doing everything we can to prepare the NHS for winter, including by ending the resident doctors’ strikes. This is the first winter in three years when staff are on the frontline, not the picket line. The Chancellor made an additional £1.8 billion available in-year to fill the black hole left by the previous Government, and we introduced the new respiratory syncytial virus vaccine to protect more than 1.2 million people against the virus.

But I am not going to pretend for a second that the experience of patients this winter is acceptable. The Government have been honest about the state of the NHS since the election, and we will continue to be. The NHS is broken but not beaten. It will take time to fix, but it can be done. That is why the Chancellor made an additional £1.8 billion available in-year to fill the black hole left by the previous Government and to enable us to deliver on our first steps to cut NHS waiting times. That is why we are undertaking fundamental reform, and it is why we are acting on social care.

These are the honest facts. The social care system in this country is failing, leaving hundreds of thousands of disabled and elderly people without the care they need. The failure of social care is piling enormous pressures on the NHS. In November, more than 12,400 hospital patients a day were well enough to leave but had to stay overnight because they were not able to be discharged. We have an ageing society: by 2050, there will be 4 million more people aged 65 and over in England. If we do nothing, social care costs are expected to double over two decades.

Of course, there is plenty of blame to go around. In 2009, when Andy Burnham established cross-party talks on social care, the Conservatives pulled out and leaked details of the talks to attack Labour. In 2017, it was Labour who torpedoed Theresa May’s proposals. And in 2022, the right hon. Member for Richmond and Northallerton (Rishi Sunak) as Chancellor delayed Boris Johnson’s cap on care costs, and then defunded them as Prime Minister. There has not been a shortage of good ideas in the past 15 years, but a lack of good politics. It is time all of us across the House do things differently.

I have written to my opposite numbers and the leaders of all UK-wide parties represented in the House to invite them to help break out of the cycle of political failure. I hope all of us across the House will put aside our ideological and partisan differences, and work together on this, to finally find a way through to a long-term plan that can build the broad consensus we need.

We do not need to agree on everything, but in April we will launch an independent commission on building a national care service. I am delighted that it will be headed by one of our country’s leading social reformers, and Whitehall’s greatest doer, Baroness Louise Casey. Baroness Casey has served Labour, Conservative and Liberal Democrat Governments. She is a trusted, independent figure, who will take views from all parties and, crucially, the public as she seeks to build a cross-party and national consensus on the future of social care. She will get things done. Her first report will be published next year, making a series of recommendations that can be implemented straight away throughout this Parliament, and her final report will come later in this Parliament.

In the meantime, we are stabilising the social care system today. We have legislated for the first ever fair pay agreement for social care, to tackle the workforce crisis—the 131,000 vacancies we see today. In the Budget, the Chancellor provided the biggest increase in carer’s allowance since the 1970s, worth £2,300 a year to family carers, and an extra £3.7 billion for local authorities.

On Friday, I visited the home of Keith and Elaine in Carlisle. I saw at first hand how extended doorways and the installation of accessible kitchen and bathroom facilities have changed their lives, thanks to the disabled facilities grant, allowing them to live with renewed dignity, independence and happiness. That is why I announced last week the immediate release of £86 million through the disabled facilities grant, to provide an extra 7,800 home adaptations before April, changing the lives of thousands more disabled people for the better, just as Keith and Elaine have experienced.

We are not hanging around on reform either. We are introducing new standards to help people who use care, their families and providers to choose the most effective new technology as it comes on the market. We are joining up care and medical records, so NHS and care staff have the full picture they need to provide the best possible care. And we are training care workers to perform more health interventions to help people stay well and at home. A lot done, a huge amount more to do and, if this House gets this right, the best is yet to come.

Turning to the elective reform plan the Prime Minister has launched today, the Government inherited NHS waiting lists at 7.6 million. The NHS standard, that patients should wait no longer than 18 weeks for treatment, has not been met for a decade. Millions of patients are forced to put their lives on hold while they wait. In his investigation, Lord Darzi listed the causes of this crisis: the undoing of new Labour’s reforms, the disastrous top-down reorganisation, and slashing GPs and community health services, all of which have led to a dramatic drop in hospital productivity. Lord Darzi has diagnosed the condition; now this Labour Government are prescribing the cure.

In November, the Prime Minister set out the Government’s plan for change—a plan to dig this country out of the hole it was left in and an act of resistance against the status quo of managed decline. It committed to cutting maximum waiting times from 18 months today to 18 weeks by the end of this Parliament. Today, we are setting out how we will hit that ambitious target, so that once again the NHS is there for us when we need it. This will demand faster improvement than even the last Labour Government achieved. That means doing things differently. It had to be a plan for investment and reform. Investment and reform is what Labour promised before the election. Investment and reform is what we are delivering. Our elective reform plan will cut waste and inefficiency, ramp up the number of appointments, scans and operations that the NHS performs, and give NHS patients greater choice, control and convenience.

Any patient using the NHS can see the waste and inefficiency in the service when they use it. Staff feel it holding them back every day. When the Government announced significant investment in the Budget, I said that it would come with reform, so that every pound was well spent, and here it is. Resources will be diverted from hospitals to GPs, to get hundreds of thousands more patients cared for faster in the community. Patients will have the choice of whether they want or need follow-up appointments, saving a million pointless appointments a year. GPs will be able to directly refer patients for tests and scans, cutting out the middle man and speeding up diagnoses for patients across a wide range of conditions. For years, restaurants have been texting customers reminders of their bookings, giving them the chance to cancel or rearrange, to cut down on no-shows. The NHS will learn from the hospitality sector, do the same for patients, and cut around a million missed appointments every year as a result.

In opposition, we said that investment in new and more productive ways of working would make a significant dent in waiting times. Today, we are announcing 17 new and expanded surgical hubs to run like Formula 1 pitstops and bust through the backlog. Community diagnostic centres will open at evenings and weekends so that patients do not have to take a time off work for their appointment, and can get diagnosed faster. We are rewarding trusts that cut waiting times fastest with extra capital investment as an incentive, and we are publishing a new agreement with the independent sector—the first of its kind for 25 years—to cut waiting times.

Over the past 14 years, a two-tier healthcare system emerged in this country. People who can afford it are increasingly going private to skip the queue, while those who cannot are left behind. Working people are going into debt, and others are running fundraisers to pay to get an operation. Those stories belong in pre-war Britain. They should shame the Conservative party. I am determined to end two-tier healthcare in this country, so that whether you are the richest or poorest person in Britain, you get timely, quality treatment, free at the point of use. This new agreement will see more NHS patients able to choose to be treated in a private hospital where there is capacity, paid for by the state. More capacity will be available for people in working-class areas of the country, and for women stuck on gynaecology waiting lists. Where we can treat working people faster, we will, and we make no apology for doing so.

Working-class patients in this country deserve the same choice, control and convenience as the wealthy expect—indeed, as we all expect from other apps and services that we use every day, but not the NHS. That is why we are also modernising the NHS app to put patients in the driving seat for their own care. If customers can choose when their Deliveroo meal will arrive, and be kept informed until it is dropped off, why should patients not be afforded the same service by the NHS? With this plan, they will be. Patients will be able to manage their appointments, book tests and scans, view results as soon as they are ready, and choose where they will be treated. We will cut down on letters that arrive in the post after an appointment, and give power back to the patient.

In the past six months, we have ended the resident doctors’ strike and invested billions more in our health service, with the biggest investment in hospices and end of life care for a generation. We are delivering investment and reform in general practice to fix the front door to the NHS and bring back the family doctor, and we have started to get NHS waiting lists falling. This plan for investment and reform will press down harder on the accelerator and will change our NHS and the experience of millions of patients. It will put the NHS on the road to recovery, and I commend this statement to the House.

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

I am grateful to the Secretary of State for his typical courtesy in early sight of his statement, as well for his call last week. Indeed, it was earlier sight than I am used to because I was able to read most of it in the media before coming here, which was not unhelpful.

I echo the Secretary of State’s comments in thanking and paying tribute to NHS and social care staff up and down the country, including those in my university hospitals of Leicester NHS trust, GPs and, indeed, all those in Chorley hospital, Mr Speaker, for all they have done over the festive period. They work full-on day in, day out every day of the year, but they particularly feel the pressure over the festive period when they are not able to spend it with their families, so it is important that we across the Chamber share our recognition of that.

The Secretary of State set out clearly the challenges facing the system. We all know that clinical care, the NHS and social care must work well and as a whole for our health and care system to function, so it is right that his statement addresses both those issues. He also highlighted the challenges we face as an ageing society. We are all living longer, which is a good thing, but that brings challenges of care and more complex needs. Of course, that comes on top of the ongoing challenges of the legacy of the pandemic, which are still with us in many ways.

In his comments, the Secretary of State referred to previous reforms. He opted not to reflect another point in Lord Darzi’s report: his positive remarks about our 2022 reforms, which the Secretary of State knows I took through this House and which laid the foundations on which he is now able to build. Given the serious and cross-party work we have done certainly on social care, I highlight that the challenge is real, and we must address both challenges swiftly.

Before turning to the long term, I turn to the immediate and ask the Secretary of State a few questions about winter and the challenges the NHS is facing. We heard from the Minister before Christmas about the work being done for extra co-ordination and new data, but what extra capacity in beds specifically for the winter period has the Secretary of State put in place to help ease pressure? What additional capacity has he put into A&E? We always recognised that winter is challenging, and we always put in extra resource, support and capacity, so I would be grateful for an update.

I would be grateful for an update from the Secretary of State on the pressure being felt in respect of the “quad-demic” of various challenges faced by the sector. Also, how many critical incidents have trusts declared since 1 December? I would be grateful if he could update us on the pressures being felt and the response to them in the light of the winter weather. In my Melton and Syston constituency in Leicestershire and in many constituencies across the country, we have seen extensive flooding, which has had an impact on our ambulance services in particular.

Turning to reform and elective recovery, I want to support the Secretary of State where he is doing the right thing, and it is important that he is keen to pursue a bold and innovative agenda. It is in all our interests that he is bold, but I call for him to be more ambitious. Those are not words often spoken about him, and I suspect certainly not in No. 10, but I call for him to be bolder and to go further. That is because, as with so much from the Prime Minister with multiple relaunches of previous announcements, what we see here is yet another relaunch of a previous announcement. The difference is the former Secretary of State Sir Sajid Javid’s announcement from 2022 has been reheated and re-served up today. We delivered 160 community diagnostic centres with 9 million additional appointments, and we delivered 18 surgical hubs. How will the Secretary of State’s plan go beyond that? We worked with the independent sector to allow it to be used to help tackle backlogs. We improved technology and the kit available, with £6 billion of investment. The NHS app created during the pandemic was designed and redesigned by my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay) and his team to allow for regular updates. Again, it is right that the Secretary of State is updating the app, but how is he radically changing what was already in place? I certainly already receive text updates—as, I suspect, do others—on treatments and appointments, so my challenge to the Secretary of State is this: what is he doing that is fundamentally different?

The key underpinning point in the former Secretary of State’s plan was on workforce, because none of this can be delivered without the staff to deliver and interpret tests. He set out his plan to grow the workforce, and we have record numbers of doctors and nurses, and increased medical school places. What is this Secretary of State’s plan to grow the workforce and deliver on his ambitions?

Turning to social care, the Secretary of State will know—because I have said it publicly—that I will work constructively with him and the commission. He is right to highlight the challenges that Governments of all complexions have faced, including a Royal Commission, two Green Papers and a comprehensive spending review that did not deliver under Tony Blair and Gordon Brown. Similarly, Theresa May’s reforms did not deliver. We proposed reforms that were due to come in this year, but the Chancellor scrapped them. I think it is important that we look to the future and at how we can work constructively on social care.

I say to the Secretary of State that we will enter into discussions with him and the commission in that spirit, but I challenge him on the pace of his ambitions. The sector is already under pressure, and that has been added to by the national insurance increases, which it does not yet know how it will pay. The real challenge for him is: why 2028? The sector is crying out for a faster pace—be bolder; be more ambitious—and we will work with him to deliver it. It takes a year-plus to deliver a diagnosis—we know the challenges. He has had 14 years in opposition; he should have a plan now.

We will call out the Secretary of State when he gets it wrong or simply re-announces what is already happening, but he is right in his approach to social care and finding a way forward, and we will work constructively for the good of patients and all our constituents. Many of them already feel let down by promises broken by the Labour party over just the past six months, so I ask him not to break this promise, and to work with us, across the House, to deliver the change that our constituents deserve and expect us to work on together to deliver.

[Wes Streeting]

It seems to be the Conservative line across the board now to say, “You’ve had 14 years in opposition, so why haven’t you sorted it all out in six months?” I say gently that the Conservatives had 14 years in government, and it will take longer than six months to clean up their mess. Honestly, their contributions to discussions in this House might have more credibility and a stronger landing zone if they at least acknowledged their part in the deep mess and malaise that they have created over the past 14 years.

None the less, on social care, I very sincerely and warmly welcome the Conservative party’s support for the independent commission. It is important, as a matter of principle, to try to establish in broad terms the level of consensus about what social care should look like and how it should be delivered to meet the needs of older and disabled people in the 21st century, with changing demography, changing challenges, changing pressures and a changing pace of technology, and about the balance of provision between the individual, the family and the state, and the balance of financial contributions for social care between the individual, the family and the state.

Of course, those issues will inevitably be contested across the party political divide from one election to the next, but just as we have had broad consensus on the national health service since 1948, just as we have had broad consensus on state education since Rab Butler’s reforms, and just as we have mostly had broad consensus for much of the past century on how public services should be delivered, so too should we try to establish the same consensus on social care. That is not to say that we should agree on everything, but we should agree on as much as possible, because whether it was Gordon Brown and Andy Burnham in 2010 or Theresa May in 2017, we can see the extent to which party political wrangling, rancour and sometimes opportunism has sunk well-meaning attempts to grasp the nettle of reform.

On the question of pace, I reassure people that in our first six months we have already legislated for fair pay agreements, delivered the biggest expansion of carer’s allowance since the 1970s, and immediately injected £86 million into the disabled facilities grant, with another £86 million to follow from April—£711 million in total over the next year—as well as the increased spending power for local government in the Budget and £880 million for social care specifically. With respect to the people who are saying, “Go faster”, I urge them to bear in mind that we have already done quite a lot in six months. We do not pretend that we have solved all the problems—we have not nearly solved all the problems—but that is not a bad start for a Government who are determined to show that we understand the pressures in social care today and are willing to deliver.

The Dilnot proposals were very good technical responses to a question that Andrew Dilnot was set by David Cameron, but we should reflect on why it was that every single Prime Minister since Lord Cameron, including Lord Cameron himself, did not implement those reforms. There has always been something else in health and social care that has been more pressing and urgent. I am sure that Baroness Casey will consider the Dilnot proposals alongside all the other challenges and potential solutions to the wider issues in social care, but we are determined to respond at pace. That is why the first phase of the Casey commission will report next year, setting out an action plan throughout this Parliament. I hope that we can achieve broad consensus on those actions too.

Turning to the winter situation, the right hon. Gentleman has asked what capacity there is. According to the latest figures, there are 1,300 more acute beds this year than last year. Of course, those figures flex up and down depending on pressures, but the pressures are enormous. The number of beds occupied by flu patients is much higher than this time last year—somewhere between three and four times higher. The number of adult beds closed due to norovirus has reduced in the latest figures, but it is still above last year, when 485 beds were closed—the latest figure is 666. On ambulance responses, we have seen many more call-outs this year. There has been a 3.8% increase in emergency admissions compared with the same period last year, with the highest November on record for A&E attendances. Ambulance response times are nowhere near where we would want them to be because of the enormity of the pressure, which is why I have been out on the frontline, including over the Christmas period. We are not just looking at what we can do to mitigate challenges this year; we are already beginning to plan for next year, because I want to see year-on-year continuous improvement in urgent and emergency care.

I now turn to the challenges on the reform plans we have proposed and set out today. Starting with the workforce, one of the reasons we have emphasised the importance of not just investment but reform is the need to free up the staff capacity that we already have in the NHS to best effect. That means dealing with the number of non-attendances by sending reminders to patients and giving them ease and convenience in rebooking. It is why we are getting rid of unnecessary, low-clinical-value out-patient appointments, with the consent of patients in every case. It is why we are asking general practitioners to do more to manage cases in the community with more advice and guidance, and funding them to do so, working with colleagues in secondary care to ease pressure on hospitals.

Today’s reform plan answers the challenge we have heard from people across the NHS: how do we tackle the elective backlog without doing so at the expense of general practice, urgent and emergency care, community care or social care? The truth is that this is a systemic challenge, and we will only be able to deal with the challenge in the elective backlog by also acting on urgent and emergency care, general practice, community care, and delayed discharges in social care. We are taking a system-wide approach to meeting this essential target.

A number of things are different from under the previous Government. For example, on the deal with those in the independent sector, giving them the stability and certainty of working with this Government gives them the confidence to open and invest in new capital estate and new kit, particularly in parts of the country that are relatively underserved by the independent sector. We have insisted they do that with their own staff and resources, and that they put their money where their mouth is in relation to training new staff to deal with some of those pressures. That is how we will ensure that we will not be taking Peter from the NHS hospital to treat Paul up the road at the independent hospital.

Finally—I am happy to take more questions on the detail of the plan—the shadow Secretary of State asked what is different from 2022? In fact, I think he asked me to commend my predecessor Sir Sajid Javid for his work in 2022. In the bipartisan spirit of the new year, let me commend the work that he and Sir Sajid Javid did in trying to undo Lord Lansley’s disastrous top-down reorganisation, and that was a very good thing to do. There will be a very big difference between this Government and our Conservative predecessors: real delivery, shorter waiting times and an NHS fit for the future.

[Deirdre Costigan (Ealing Southall) (Lab)]

Does the Secretary of State agree that his plan to transform adult social care services has already started with Labour’s Employment Rights Bill ensuring that social care workers will get fair national pay and conditions, and increased access to training and progression? Does he further agree that we will never have a quality social care service in this country if we do not value the people delivering it properly, as this Labour Government intend to do?

[Wes Streeting]

My hon. Friend is absolutely rightly. The Employment Rights Bill, introduced in our first 100 days, contains provisions for a new fair pay agreement for care workers, and who better to be leading the charge on that than the care worker turned Deputy Prime Minister, my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner).

[Mr Speaker]

I call the Liberal Democrats spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I add my thanks to those of the Secretary of State and the shadow Secretary of State to all those who worked in our health and care services over Christmas and the new year.

Our health and social care system is in crisis, so the Liberal Democrats are broadly supportive of the measures that the Government have announced today. However, we do have some concerns, not least that action on social care may arrive too late and that the focus on elective care may come at the expense of emergency care. The Liberal Democrats have long called for cross-party talks on social care, so we are glad that the Government have listened and we look forward to working constructively with the Secretary of State and other UK-wide parties as the review develops. However, carers, care providers and councils are on the brink of bankruptcy and they need solutions right now, not in three years’ time. There have been many such reviews, and what is needed now is action on the recommendations they have made.

It is absolutely crucial that waiting times for elective care are cut radically, so the action announced today to speed up scans and treatment is very positive. A waiting list of more than 6 million people is one of the worst legacies left by the Conservatives, but those legacies include overcrowded A&Es and unacceptable ambulance delays, which can mean the difference between life and death, as people in North Shropshire know only too well. Emergency care is under immense pressure at the moment—one visit to Shrewsbury hospital demonstrates that—and we need bold action if we are to ensure that this is the last ever winter crisis.

As the MP for a rural area, I hear every week from constituents suffering because of the crisis, so they will be following today’s developments closely. Many of my constituents are elderly—far more than average—and they are the people most likely to need the NHS and the most likely to be digitally excluded. According to Age UK, around 29% of people aged 75 and over do not use the internet, and around a third do not have a smartphone. They deserve as much choice and control as everybody else, so can the Secretary of State outline how those without access to the NHS app will be able to benefit from the same options and information as those who do have access?

Will the Secretary of State consider fast-tracking the social care review so that the sector can get the urgent attention it needs? Will he commit to rescuing our emergency services by supporting Liberal Democrat calls to make the NHS winter-proof with a new winter taskforce that builds resilience in hospital wards, A&E departments and patient discharging? Finally, will he define what a working-class area is, because the health and care crisis is acute in rural Britain and we cannot afford to be left behind?

[Wes Streeting]

I thank the Liberal Democrats for their support for the commission and for the way in which their party has put the issue of social care much higher up the political agenda, particularly during the general election campaign. That has been very helpful to me in the last six months and to the Government, and we look forward to working with the Liberal Democrats to build as broad a consensus as we can on the solutions to the social care crisis.

As I have mentioned, we have hit the ground running in a number of respects, including the biggest expansion of carer’s allowance since the 1970s. On investment in health and social care, I just point out that the £26 billion the Chancellor allocated to the Department of Health and Social Care alone at the Budget dwarfed what the Liberal Democrats promised in their manifesto. I know that not all the funding decisions the Chancellor and the Government have made in the last six months for the desperately needed investment in our public services have been popular, but I respectfully say to people who disagree with the decisions the Chancellor has made that they need to spell out which services they would cut or which other taxes they would increase, because those are the choices. We have made our choices; we stand by them. What people cannot do is welcome the investment but not say how they would fund it if they oppose what we have done. The Prime Minister, the Chancellor and the entire Government have been willing to make unpopular choices in the last six months because we believe they are the right choices to get Britain out of the hole it was left in by our predecessors. People will not thank us for resorting to the short-termist, sticking-plaster, government-by-gimmick politics that plagued this House during the last Parliament.

I turn to some of the other issues that the hon. Lady mentioned. We will make further proposals on urgent and emergency care reform. I want to take the best of the NHS to the rest of the NHS, whether it is “hear and treat” over-the-phone triage—a more appropriate community response that is often faster than ambulance response times—or getting ambulances and ambulance handover speeded up at all our hospitals with the “release to respond” approach. We have seen that working successfully in some parts of the country, but it needs to be consistently rolled out.

The hon. Lady talked about patient choice for those who are digitally disconnected or do not want to organise their lives around their smartphones. That is why I believe very strongly in choice—different courses for different horses. Those of us who do not book appointments over the phone free up the line so that those who prefer doing their business and booking appointments by phone can get through.

The hon. Lady asked us to fast-track the social care work. The first phase of Louise Casey’s commission will report next year, but we are of course willing to talk to parties across the House about how we move forward.

The hon. Lady urges us to set up an urgent and emergency care taskforce. Let me reassure her that the Minister of State for Health my hon. Friend the Member for Bristol South (Karin Smyth) and I have every week—and often more frequently—convened health and care leaders virtually and in the Department to keep a grip on what is going on, to provide as much central support as possible, and to respond to crises as they emerge. If only that was just about setting up a taskforce. We already have one; what we need is sustained improvement from one year to the next and that is what we are determined to deliver.

[Several hon. Members rose—]

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

Mr Speaker, I take that personally, in a positive way.

This is a very encouraging statement. It is great to start the new year with some good news and to be so clear that we are keeping our promises as a Government. It is also very good that we are taking the necessary time to create this cross-party consensus on social care while keeping the show so firmly on the road. Carers will be supported to carry out more health tasks, as they do already in my constituency with wound dressing and medicine management. The problem is they do not have any possibility of career progression. [Interruption.] I am sorry, Mr Speaker, I forgot your initial encouragement; I will bring this to a close.

Does the Secretary of State agree that as carers are encouraged to do more health tasks, they need proper opportunities for career progression even within the NHS, in collaboration with local authorities?

[Wes Streeting]

Brevity was not my hon. Friend’s new year’s resolution, but at your encouraging, Mr Speaker, it is mine. We will provide more training to care professionals to deliver a wider range of tasks in the home, making better use of their skills and the career progression that my hon. Friend describes. Crucially, that career progression must be in status and in pay. That is what we will work with the staff to deliver.

[Mr Speaker]

I call the Father of the House.

[Sir Edward Leigh (Gainsborough) (Con)]

I welcome the consensual parts of the Secretary of State’s statement, but I wonder whether we have been entirely honest with the public about the sheer unaffordability of the cap proposed by Dilnot. I do not absolve my own Government from this: maybe we should start telling the truth to the public. Does the Secretary of State think we need a new social compact on bringing in social insurance so that people can plan for their entire life? They would know that they will have to pay more in taxes during their life for their old age, but at least they would have certain rights.

[Wes Streeting]

The right hon. Gentleman is right to say that we need a debate as a country about the balance of financial contribution between the individual, the family and the state. I well understand why David Cameron was so concerned about catastrophic care costs and people having to sell their homes to pay for their care and the problem he was trying to solve. With every Government since, the issue has been seen as less urgent than others, but that does not mean it does not matter or that we should not consider it as part of the Casey commission. We need to consider all these issues in the round and, as much as we can, build a consensus not just in this House, but throughout the country about the balance of financial contribution and what is fair, equitable and sustainable.

[Jen Craft (Thurrock) (Lab)]

Just before Christmas, one of my constituents visited my surgery and gave me pause to reflect on the massive, often lifelong impact on loved ones who have someone in the social care system, and the devastating impact on their ability to work and to live healthy, fulfilling lives. Does the Secretary of State agree that the commission will lay the foundation for real change so that people in the social care system and their families can live the healthy, fulfilling lives they deserve?

[Wes Streeting]

I strongly agree with my hon. Friend, who has done much already in the past six months to champion social care. Whether people are in residential care home settings or we are doing everything we can to ensure that they can stay in their own homes, everyone deserves to live comfortably, well supported, with independence and with dignity. That is why the steps we are taking, particularly through the disabled facilities grant, will be immediately impactful on thousands of people across the country in just the next three months. We have so much more to do, and that is why I am genuinely excited by the work of the commission.

[Mr Speaker]

I call the Chair of the Select Committee.

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

Given that the Health and Social Care Committee’s first inquiry is “Adult social care reform: the cost of inaction”, we welcome any action. As the name of the inquiry suggests, we are concerned about the length of time taken, because every year without reform costs money, not only to the NHS, but to the wider economy and in people’s lives. We have Andrew Dilnot in front of us on Wednesday, and it is 14 years since his report, which has been put into legislation twice. I ask the Secretary of State to be specific: what will stop the next iteration of the Committee having Louise Casey in front of it in 15 years’ time? What will be different this time, so that we get that cross-party consensus and it sticks?

[Wes Streeting]

That is a great question. First, I will put on my shin pads and crash helmet if Andrew Dilnot is in front of the hon. Lady’s Select Committee this week. I can well understand his frustration. He is a decent man who did an excellent piece of work. It must be frustrating to see one Government after the next not implementing something that was welcomed. The issue for us as an incoming Government is that the money was not there, and even if it had been, the system had not been set up to deliver for the October 2025 deadline. We chose to act on other immediate pressures in other areas, because we saw those needs as more pressing. That does not mean for a moment that I think Andrew Dilnot’s work is no longer valuable—I think it might well be. However, we have to consider the issues in the round and come up with a clear and sustainable plan that we can stick to.

On why the Casey commission will be different and will work, it is important to have as much political consensus around the House as possible. The national consensus and getting the public on board will be important. Anyone who has ever met Louise Casey will know she is a difficult woman to say no to. I have no doubt that if Louise Casey says something needs to be done, this Government and future Governments—whoever is in government—will make sure that it happens.

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

Happy new year, Mr Speaker. Yesterday and over the Christmas recess I was working shifts in my local A&E at St George’s in Tooting. Up and down the country, doctors like me were seeing older and disabled patients who could not be discharged from hospital due to a lack of good, affordable social care in the community, so I welcome the steps that have been outlined. What steps will the Secretary of State outline to ameliorate the imminent pressures sooner?

--- Later in debate ---

[Wes Streeting]

I thank my hon. Friend for the work that she does on the NHS frontline, particularly when Parliament is in recess but often alongside her everyday work as a Member of this House. It is truly above and beyond the call of duty. She sees at first hand the pressures and failures that the NHS is experiencing.

My hon. Friend is right about delayed discharge. In fact, when I was at Burnrigg Court, a residential care home in Carlisle, last week, I saw wonderful ensuite room facilities with people in intermediate NHS care—there are NHS-funded beds in those care homes—and those people were in better settings at half the costs of the hospital beds they left behind. Delivering better care in the right place at the right time is often not only great for patients but better value for taxpayers. That is why I will be reforming the better care fund to ensure that we make good use of NHS and social care budgets together to get people out of hospital as quickly as possible, freeing up vital bed capacity for others.

[Paul Holmes (Hamble Valley) (Con)]

I congratulate the Secretary of State on taking community diagnostic hubs and expanding their hours, which is something that the last Conservative Government established. Will he outline what impact that will have on his workforce plan and expand on that? Have the unions accepted the extra hours—they are not excessive by any stretch—that he has proposed? Will he have a serious conversation with me, please, about Fareham community hospital, which has space for a community diagnostic centre that would be welcomed by my constituents in Hamble Valley?

[Wes Streeting]

Persistence pays off: I would be happy to receive representations from the hon. Member about his local hospital and the potential to provide more community diagnostics. On the workforce, when we were consulting on this in opposition, we found a real willingness on the part of NHS staff to put in the extra hours, so long as they are fairly remunerated, which they will be. I am grateful for the investment that the Chancellor has provided to enable us to do that.

NHS staff want to see progress to beat the backlog. They are as frustrated as anyone else—and demoralised, actually, at work—seeing people waiting for so long, so I have no doubt about their willingness to assist. I am looking forward to working with NHS staff across the country so that we can all feel that together we are delivering an improving NHS.

[Several hon. Members rose—]

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

I thank NHS staff for working under severe duress over this winter. One way of ensuring better patient flows is to have better rehabilitation, so will my right hon. Friend say what he is doing to improve rehabilitation access not only in acute sectors but out in the community?

[Wes Streeting]

Further to the previous question, we will be refreshing and updating the NHS workforce plan alongside the long-term plan that we will publish in May, and my hon. Friend is right that rehab is key not just to good recovery but to prevention of future demand on the NHS. I saw a great example of that rehabilitation delivered in social care settings only last week. Whether in the NHS or in social care, we definitely need to do more on rehabilitation, because rehabilitation is often secondary prevention.

[Ellie Chowns (North Herefordshire) (Green)]

I agree with the Secretary of State that community-based services are crucial. My local NHS trust contacted me in the week before Christmas about Hereford community diagnostic centre, which is currently in the process of being built. It was told to be ambitious with this project, but in December it was told that only a sixth of the funding that it needs is available. Does today’s announcement mean that the Government will fully fund Hereford community diagnostic centre?

[Wes Streeting]

We will certainly write to the hon. Member with further information about Hereford CDC. On capital investment, I say to her and to other right hon. and hon. Members that we were very pleased with what the Chancellor was able to deliver in the Budget. We recognise that the stop-start we saw on a number of capital programmes under our predecessors was frustrating and we are determined not to repeat that. That is why we are setting out clear and consistent proposals for capital investment in the NHS.

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

Last summer we celebrated the 25th anniversary of the elective orthopaedic centre in south-west London. The driving force behind that was Professor Richard Field, who came to my surgery every week after the 1997 election. With the help of the Prime Minister Tony Blair and the late Health Secretary Frank Dobson, he made it real. It has the lowest blood use rate for hip and knee replacements, the shortest stays and lowest levels of infection. Will my right hon. Friend congratulate Professor Richard Field and agree that his elective hubs are the way to cut waiting lists?

[Wes Streeting]

I warmly congratulate Professor Richard Field on his clinical leadership, which has made a difference to countless lives, not only in my hon. Friend’s part of London but because of the national example that he set, which many others followed. That confirms my strong conviction that the best innovations will come from great clinicians. It is our determination to make sure that senior leadership in the NHS and in government back great clinical leadership and innovation, and take the best of the NHS to the rest of the NHS.

[Graham Stuart (Beverley and Holderness) (Con)]

The Secretary of State said that 12,000 patients had to stay in hospital beds because of a lack of social care, yet we have it kicked down the road once again. What will Louise Casey tell us that we do not already know about the tough political trade-offs that have led successive Governments to fail to create a truly coherent health and social care system, and what will he do to make sure that we meet needs today, as he exemplified in November?

[Wes Streeting]

Once again, the arsonist is complaining that the fire brigade is not doing a quick enough job. We are a bit sick of it on the Government Benches, but we are at least rolling up our sleeves, getting on with the job and making improvements, and we will continue to do that. I heard the same complaints about Darzi: “What can Darzi tell us that we did not already know?” Quite a lot, actually. The Conservatives should hang their heads in shame for it.

[Nadia Whittome (Nottingham East) (Lab)]

I thank the Secretary of State for his clear commitment to action. There are 131,000 vacancies in the social care sector, and low wages are the prime culprit. Last year, Unison found that three quarters of care staff who do home visits continue not to be paid for journey times between appointments. Will my right hon. Friend commit to ensuring both a £15-an-hour minimum wage in the social care sector, and paid travel time as a contractual requirement?

[Wes Streeting]

I thank my hon. Friend for that question. I am a proud member of Unison, and I am proud of its work to stand up for its workforce in the social care sector. She and Unison are absolutely right to argue that fair pay is essential to recruitment and retention. That is why I am delighted that the Deputy Prime Minister included fair pay agreements in the Employment Rights Bill in the first 100 days. I am looking forward to working with Unison, GMB and others to negotiate the first ever fair pay agreements for care professionals in this country.

[Alison Bennett (Mid Sussex) (LD)]

I would appreciate it if the Secretary of State could unpack a phrase in his statement. He said:

“Where we can treat working people faster, we will”.

That phrase is ripe for misinterpretation. Please could he explain what that means? Does it mean stay-at-home mums waiting for an appointment, and family carers, 26% of whom are on waiting lists?

[Wes Streeting]

It does. I was talking about the fact that working class people are often left behind in a two-tier system where those who can afford it pay to go private, and those who cannot are left behind. It is the determination of this Government to bring back to life the essential Bevanite principle of an NHS that is there for everyone when they need it: healthcare available to all on the basis of need, not on ability to pay.

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

I welcome the commission, which hopefully will lead to some certainty on the future of social care. However, a 2023 National Audit Office report found that 17% of local authority directors of social services were concerned about their ability to meet statutory obligations last year, and a further 18% are concerned about their ability this year. I have concerns about what will be done to fix the immediate crisis in social care. Will my right hon. Friend outline what he will do to guarantee the sustainability of our care system now, while we await the further structural reforms that we dearly need?

[Wes Streeting]

I am grateful to my hon. Friend for his question. That is why in the Budget the Chancellor delivered a big uplift in the spending power of local authorities, with £880 million ringfenced specifically for social care. We are also delivering through measures such as the disabled facilities grant to deal immediately with the pressures—[Interruption.] It is no good the right hon. Member for Beverley and Holderness (Graham Stuart) complaining. He voted against the investment, so he cannot very well complain about it.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The previous Labour Government did a hatchet job on community hospitals, including in Wiltshire, with a consequent uptick in the amount of delayed discharges in the acute sector, notably at Bath, Salisbury and the Great Western in Swindon. Will the Casey commission look at that and find ways of unpicking the damage that was done?

[Wes Streeting]

The previous Labour Government delivered the shortest waiting times and the highest patient satisfaction in history.

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

There are very worrying reports of cash-strapped universities reducing the numbers of clinical academics; indeed, some are being made redundant at a time when there is increased demand for doctors. Does the Secretary of State agree that this is an extremely concerning development?

[Wes Streeting]

Clinical academics have an important role to play in the national health service and in innovation in medicine. My right hon. Friend the Secretary of State for Education is focused on university finances, and I think universities should ensure that they prioritise efficiently and effectively, making best use of the resources available to them. I would gently say that universities have not struggled as much as other parts of the public sector over the past 14 years.

[Llinos Medi (Ynys Môn) (PC)]

During 14 years of austerity, the NHS has been starved of the resources it badly needs. Four months ago, the Secretary of State for Wales made a big announcement about cross-border NHS partnership to tackle waiting lists; however, the First Minister of Wales later poured cold water over the idea, and today’s plan for England does not mention Wales. Was this so-called partnership ever real, or was it just another empty promise?

[Wes Streeting]

By definition, an elective recovery plan for England does not include Wales. However, I can assure the hon. Lady that we have a great working relationship with Jeremy Miles, the Health Minister in the Welsh Government, and with the First Minister herself. Not only are we providing support to the Welsh Government on elective reform to help them to cut waiting lists and waiting times, but we are receiving advice from the Welsh Government on areas where health and social care services are doing better than in England. Together, we will create a rising tide that lifts all ships across the UK.

[Jo White (Bassetlaw) (Lab)]

Bassetlaw has an increasingly older population, with 22% now over the age of 65. As the needs of my constituents change, I welcome the additional £198,000 in funding for local disabled facilities grants. Does the Secretary of State agree that it is vital to shift care out of our hospitals and into our community?

--- Later in debate ---

[Wes Streeting]

I am so grateful to my hon. Friend for her question and for championing that issue since she arrived in the House six months ago. The disabled facilities grant is not just about new handrails, new ramps, new accessible kitchens and bathrooms and home adaptations; it is about freedom, independence, dignity and happiness. It is really good investment in preventing demand on other health and care services by giving people back their own independence and happiness.

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

My constituents will welcome the opportunity to get more services delivered through their GP surgeries, of which there are many excellent examples in West Worcestershire, and through community hospitals. However, I hear from those very same GP surgeries their concerns over the national insurance rises, and how that is leading them to think about reducing services. When will the Secretary of State be able to square that circle?

[Wes Streeting]

Before Christmas—I appreciate that it was just before, but I wanted to get out the certainty to general practitioners before we all went off for Christmas—we announced the biggest uplift in funding for general practice in a considerable number of years, and we will now negotiate the contract in the usual way. That should give general practitioners the stability and certainty to know that this Government are determined to fix the front door to the NHS.

The other thing I would say to the Opposition is that they cannot continue to welcome the investment while opposing the means of raising it, unless they spell out which services they would cut or which other taxes they would increase. They do not have an answer; they do not have a leg to stand on.

[Matt Rodda (Reading Central) (Lab)]

I warmly welcome the Secretary of State’s statement, and his emphasis on investment and reform. Will he say a little more about the important role of training for staff and investment in new technologies such as AI to speed up diagnostics?

[Wes Streeting]

Of the many great possibilities and opportunities facing this country are our strengths in life sciences and medical technology. If we can combine the strength of our scientific and technological base with the ingenuity and care of our NHS staff and our ability to deliver at scale with the model that was designed in 1948, which is well served to take us well into the 21st century, the sky is the limit for what we can achieve. We will have to support staff through that revolution. I appreciate that for many staff working in the NHS today they would be grateful if the machine simply turned on when they turned up for work.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

I am concerned about the lengthy timescale set out in the social care review, with the second phase not due to report until 2028. The care system is broken and it particularly affects rural areas such as Glastonbury and Somerton. For example, a resident in Castle Cary, a 105-year-old D-day veteran, is facing moving care homes due to high care costs. This will have a negative impact on his health, wellbeing and quality of life. What actions will the Secretary of State take in the near term to reform the social care sector and provide older people with the dignity they deserve?

--- Later in debate ---

[Wes Streeting]

I am very grateful for that question for two reasons. First, it gives me the chance once again to say that the first part of the Casey commission will be reporting next year, so we can set out a whole range of further actions that will be needed throughout this Parliament. We have taken a great number of actions already in the first six months and I dare say there will be more to follow in the next 12 months. I must say it is very encouraging that one thing we are hearing from across the House on the Casey commission overall is to go faster. I think that shows genuine cross-party appetite on this issue and that is a really good place to start.

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

I welcome the Secretary of State’s commitment to tackling the backlog of appointments—all our constituents would benefit from that—and his honest recognition that there is a risk, because there are not two separate workforces. Unless we have sensible safeguards, we could end up paying the same NHS doctors more to do operations in the private sector. The Secretary of State for Education set a cap on the profits that can be made in the children’s care sector. Is the Secretary of State considering a similar cap to protect the NHS and ensure value for money in his work with the independent sector in the NHS?

[Wes Streeting]

I am grateful for that question. I am not sure that the level of exploitation in either independent healthcare or adult social care mirrors what we have seen, disgracefully, in children’s social care, but we keep a sharp eye on that. I remind my hon. Friend of the commitments we made in opposition around tackling the excesses and the worst kind of behaviour of some private equity-owned care homes that are leeching money out of the system. We will not tolerate that. We will act to regulate further. I hope that provides Members across the House with the assurance that we are taking both a principled and a pragmatic approach to the constructive and positive relationship we want to build with the independent sector, as we rebuild our national health service and build a national care service we can be proud of.

[John Glen (Salisbury) (Con)]

I would love to see a consensus evolve on social care. I welcome the Secretary of State’s appointment of Louise Casey and the talk about the balance between the individual family and the state. However, in every fiscal event that I was part of in the Treasury, more money was put into the NHS, so I respectfully ask the Secretary of State this: what does he say about wide variance in performance across the NHS? Secondly, what does he say about consumption patterns? I understand his emphasis on the Deliveroo concept, but we have to come to terms with the fact that most GPs would say that they have excessive demand from people who do not really need to see their GP. That is a delicate and difficult subject to grasp, but one that we really must grasp, collectively, in this place.

[Wes Streeting]

I am grateful for that thoughtful question. Let me say two things to the right hon. Gentleman. The first relates to the wider fiscal pressures on the Chancellor. I find it difficult enough to manage the different choices and trade-offs to be made between different parts of health and social care and the competing challenges that I hear from Members in all parts of the House, so I am always thankful that I am not the Chancellor of the Exchequer, who has to balance demands from the NHS alongside the demands of education, a rising welfare bill, rising child poverty and the threats to our nation. These are enormous challenges, which is why I am determined to ensure that every penny that goes into the health service is well spent.

My second responsibility, in addition to ensuring that patients are treated at the right time, in the right place and in the right way, is ensuring that we have a sustainable healthcare system in which there is reduced demand. That means doing more on the prevention side, so that we can keep people out of hospital and not needing to knock on the door of their GP surgery, so that they do not achieve the frequent flier status in the NHS that so many people do achieve—the one frequent flier status to which they do not aspire. We can deal with this only through both health service reform and public health reform, and I want very much to build cross-party consensus on the latter.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. That was a very lengthy answer.

[Nesil Caliskan (Barking) (Lab)]

Just before Christmas, I met care workers in my constituency, who told me about the day-to-day work that they do supporting the most vulnerable people in our community. Does the Secretary of State agree that just as access to GPs helps to relieve pressure on hospitals and A&E departments, an adequate number of adult social care workers will help to relieve the pressure on our GP services, which also have to deal with huge demand?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend, who has done much to bang the drum on this issue during the six months in which she has been a Member of this House. That is why we are taking a systematic approach to health and social care reform.

[Seamus Logan (Aberdeenshire North and Moray East) (SNP)]

I thank the Secretary of State for advance sight of his statement, and for writing to the leader of my party. I am sure that the Scottish Government will co-operate and engage fully with Baroness Casey as she does her work. The Secretary of State spoke of failure. One such failure—the elephant in the room, in fact—is the labour shortages that the NHS and social care are experiencing as a result of Brexit. I ask him not to pass the buck, but to tell me what steps he will take, after consultation with Cabinet colleagues, to address those shortages by making it easier for migrant workers to come to this country and fill the vacancies.

[Wes Streeting]

We had a referendum and two subsequent general elections on the issue of Brexit, and I can tell the hon. Gentleman that none of those three democratic events went the way that I wanted. As we said to people at the time, the country chose a path that would have consequences and implications. However, we have a constructive working relationship with our friends and allies in the European Union, and while we cannot change the past, we can build a new partnership and a brighter future for our country.

[Derek Twigg (Widnes and Halewood) (Lab)]

As my right hon. Friend will know, a large number of elderly people are admitted to hospital, through A&E, with respiratory conditions. What plans does he have to strengthen the community respiratory teams, who do a great deal of good work but could do more work, if they had the resources, to prevent admission, and certainly readmission?

[Wes Streeting]

My hon. Friend is right, and that is why the vaccination campaign has been so important this winter. He is also right about the importance of community-based teams. One of the Darzi conclusions was that since 2019, we have significantly increased staffing in our hospitals, but because we had the wrong people in the wrong place, we ended up with falling productivity in hospitals. We need a shift out of hospital into the community, which is what our 10-year plan will deliver.

[Jeremy Corbyn (Islington North) (Ind)]

Most residential social care in England is delivered by the private sector. Is the Secretary of State able to give local authorities the resources necessary to allow them to reopen residential care facilities, or to open the new facilities that are so desperately needed? Will he assure me that in the review that Baroness Casey is undertaking, the primary objective will be the delivery of a public sector national care service, not a privatised service?

[Wes Streeting]

Thanks to the decisions taken by the Chancellor in the Budget, we are boosting the spending power of local authorities significantly, and £880 million has been ringfenced specifically for social care. I appreciate that a single Budget cannot undo 14 years of Conservative failure, but this is an important start, and of course we want year-on-year improvement in the delivery of social care. Baroness Casey will consider all these issues, and also how we can improve ease of access and care quality across the public and private sectors.

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

I strongly welcome the Government’s action to help my constituents in Leyton and Wanstead get the care that they need faster. Our local hospital, Whipps Cross, continues to struggle, despite the hard work of its staff and leaders, NHS workers and carers, who continued to provide services to our community over Christmas. In November, 36% of patients at Whipps waited more than four hours for emergency care. In recent weeks, 16% have waited longer than 12 hours. Does my right hon. Friend agree that this welcome package of long-term reforms will address both elective care and emergency care for our constituents by moving the effort from hospital to the community?

[Wes Streeting]

My hon. Friend is absolutely right about that. If we improve the service at Whipps Cross hospital for his constituents, it will have the added benefit of improving the service at Whipps Cross Hospital for my constituents, too.

[Rebecca Smith (South West Devon) (Con)]

What is missing from today’s announcement is any sort of update on the new hospitals programme review, which is vital in my constituency of South West Devon, because Derriford hospital needs its urgent and emergency care centre to bring down ambulance waiting times before it can even start to tackle its general waiting list issues. When will Derriford hospital hear whether it has been successful in the new hospitals programme review?

--- Later in debate ---

[Wes Streeting]

I was grateful to staff at Derriford hospital for showing me at first hand the emergency department pressures when I visited just before Christmas. I have also visited Derriford at the height of summer, when it experiences high pressures. There are year-round difficulties at Derriford, and I thank the staff and leadership of the hospital for what they are doing in difficult circumstances. We will come forward shortly with the timetable for the new hospitals programme. I expect that it will be published sooner than the Conservatives apologise for their appalling record.

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

I welcome my right hon. Friend’s statement, but can he expand a bit more on the new agreement with the private sector? For example, he mentioned that the surgical hubs will be delivered solely by the private sector, but what arrangements will there be for emergency care, when the occasion arises?

[Wes Streeting]

Some of the new capacity announced in today’s elective reform plan will come through the independent sector, and some of that new capacity will be in the NHS. It is our ambition to rebuild the NHS so that it is available for everyone where and when they need it, and we will work with the independent sector. We are publishing full details of our independent sector agreement, so that people can see the deal that we have reached, and the sensible and effective partnership, including safeguards and protections, that we have come to. I look forward to working with the sector to make sure that everyone, whatever their income and background, can get faster access to care.

[Sir Gavin Williamson (Stone, Great Wyrley and Penkridge) (Con)]

When the Casey review reports, if its recommendations are implemented, it will have a significant impact on local government. As the Secretary of State will be aware, large parts of the country are going through local government reorganisation, and the outcomes of the Casey review will determine the right reorganisation for those areas. In the best interests of joined-up government, to use an old Blairite phrase, is there any way to bring forward the review, so that the best choices for local government reorganisation can be made?

[Wes Streeting]

I can definitely reassure the right hon. Gentleman that the Deputy Prime Minister and I are working very closely on this issue, which is close to her heart; she has a huge amount of experience in this area. We will follow her progress as she embarks on her local government reforms. Baroness Casey will take those reforms into account when she considers what the long-term future for social care will look like. Once again, I note the exhortation to go faster.

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

When I raise concerns about GP appointments, GPs tell me that they have difficulty recruiting to posts in their practices. Too few newly qualified doctors choose general practice as their profession. What can we do to get those doctors in place, so that we can make diagnostics in the community work?

[Wes Streeting]

That is an excellent question. Having put in place funding to ensure that there are 1,000 more GPs on the frontline before April, and having announced just before Christmas a significant uplift for general practice, I hope that in the first six months of this Government, we have sent the strong message to people who aspire to long careers in medicine that general practice has a huge role to play in the NHS in the 21st century. It is an exciting place to be, but I recognise that we have to fix the front door to the NHS to make it more attractive. The situation is even worse than my hon. Friend has described, because when the Conservatives left government, there were qualified GPs unable to find jobs, at a time when patients were unable to find GPs. We got to work on that issue within weeks of taking office, and we will do more over the next 12 months.

[Jim Shannon (Strangford) (DUP)]

It is good to hear the latest announcements on overhauling the increasingly costly care for older and disabled people, and I very much welcome what the Secretary of State has said. I understand that this will happen through a three-year review, and that we will be clearer on the plan to introduce this in 2028. Health is devolved to Northern Ireland, but thousands of care packages in Northern Ireland are not fulfilled. What can he do to assist Northern Ireland in achieving its goals? Goals that are set here for England and the United Kingdom need to be in place in Northern Ireland as well.

[Wes Streeting]

The ministerial team and I have enjoyed working with counterparts in the devolved Governments over the last six months, and we will continue to do that. Thanks to the decisions that the Chancellor took in the Budget, we see significant investment in health and care services here in England, and the Barnett consequentials will create a rising tide that will lift all ships across England, Wales and Scotland. I might even say that all roads lead to Westminster. I say this to Scottish National party colleagues: down the road to Westminster lie the resources for the SNP Government, so they do not have an excuse not to act.

[Several hon. Members rose—]

Hospices

Wes Streeting Excerpts

Thursday 19th December 2024 Written Statements

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

This Government want a society where every person receives high-quality, compassionate care from diagnosis through to the end of life.

Palliative care services are included in the list of services an integrated care board must commission. This promotes a more consistent national approach and supports commissioners in prioritising palliative and end of life care.

Whilst the majority of palliative and end of life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life and their loved ones.

This Government are determined to shift more healthcare out of hospitals and into the community, to ensure patients and their families receive personalised care in the most appropriate setting and palliative and end of life care services, including hospices, will have a big role to play in that shift.

This Government recognise the range of cost pressures the hospice sector has been facing over a number of years. In recognition of this, I am delighted to update the House that £100 million in additional capital funding is being provided to support the hospice sector. We believe that this capital investment will help with physical and operational pressures that hospices are facing. This package will allow hospices to create an improved physical environment and allow them to focus on providing the best quality care to patients.

The £100 million in additional capital funding will be spent across the remainder of this financial year (2024-25) and next (2025-26).

The principal requirements for the £100 million capital funding would be for hospices to deliver improvements that directly benefit patients, have a tangible impact on the physical environment and provide value for money.

I am also delighted to announce that children and young people’s hospices will receive a further £26 million revenue funding for 2025-26. This is a continuation of the funding which until recently was known as the children and young people’s hospice grant.

These two funding streams will help both adult and children’s hospices in England to continue delivering the best end of life care possible for patients, their families, and loved ones.

The allocation and distribution method for both strands of this additional funding will be set out in early 2025.

[HCWS348]

Puberty-suppressing Hormones

Wes Streeting Excerpts

Wednesday 11th December 2024 Commons Chamber

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

With permission, Madam Deputy Speaker, I shall make a statement on puberty blockers.

At the outset, I wish to make clear the principles that drive the Government’s approach to this issue. First, children’s healthcare must always be led by evidence. Medicines prescribed to young people should always be proven to be safe and effective. Secondly, evidence-led, effective and safe healthcare must be provided to all who need it, when they need it. Thirdly, this Government believe in the dignity, worth and equality of every citizen, and recognise that trans people too often feel unsafe, unrecognised and unheard, and that must change. None of these simple ambitions has been achieved in recent years. Medicine has been provided with insufficient evidence, and young people have been left to go without the support and care that they need. This Government are determined to change that.

The Cass review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender incongruence to know whether they are safe or beneficial. That evidence should have been established before they were ever prescribed for that purpose. It is a scandal that medicine was given to vulnerable young children, without proof that it was safe or effective, or that it had gone through the rigorous safeguards of a clinical trial.

Following the Cass review, the NHS ceased the routine use of puberty blockers to treat gender incongruence in children. In May, the previous Government issued an emergency order to extend these restrictions to the private sector. In Opposition, my party and I, as shadow Health and Social Care Secretary, supported those decisions. Since coming into office, I have renewed this order twice, continuing restrictions until the end of this year. That was done jointly with the Health Minister in Northern Ireland, and I updated the House via a written statement.

While the temporary ban was in place, I asked the Commission on Human Medicines to look at the current environment for prescribing puberty blockers, and we launched a targeted consultation. The commission is an independent body, made up of leading clinicians and epidemiologists, that advises on medicine safety. It took evidence directly from clinical experts, consultant paediatric endocrinologists and patient representatives, including representatives of trans people, young people and their families. After thoroughly examining all the available evidence, it has concluded that prescribing puberty blockers to children for the purposes of treating gender dysphoria, in the current prescribing environment, represents “an unacceptable safety risk”. Of particular concern to the commission was whether these children and their families were provided with enough time and information to give their full and informed consent. The commission found that children had received prescriptions after filling out online questionnaires and having one brief Zoom call with prescribers from outside the UK.

Consequently, the commission has recommended that the Government extend the banning order indefinitely, until a safe prescribing environment can be established for these medicines. On the basis of those findings, I am acting on the commission’s advice and putting in place an indefinite order to restrict the sale or supply of puberty blockers to under-18s through a prescription issued by either a private UK prescriber, or a prescriber registered outside the UK. This is on the advice of expert clinicians, the independent Commission on Human Medicines—advice based on the best available evidence—and follows the cautionary and careful approach recommended by Dr Cass. The legislation will be updated today, and will be reviewed in 2027, when there will be an updated assessment of the safety of the prescribing environment for these medicines.

We are working to grow a thorough evidence base for puberty blockers. The National Institute for Health and Care Research is working closely with NHS England to establish a clinical trial on puberty-supressing hormones. The NIHR is now contracting the team that will deliver the study and is working tirelessly towards recruiting the first patients by spring. The trial is the first of its kind the world over. It will help us better understand the effects of puberty-suppressing hormones on young people, providing the robust evidence required.

The Cass review also made clear recommendations to the Government and NHS England on improving healthcare services for children with gender dysphoria. I will now provide an update on the progress made. NHS England has published its implementation plan, which will transform its services. It has also published a new services specification, to ensure that children and young people experiencing gender incongruence have an appointment with a paediatrician or mental health professional before being referred to specialist services. Dr Cass was clear on the need for the model of care to change and take account of children and young people’s holistic needs.

Since April, NHS England has opened three new gender identity services—in the north-west, in London and in Bristol—with a fourth expected in the east of England by the spring. That puts us on track to open services in every region by 2026. These services offer a fundamentally different clinical model. They bring together clinical experts in paediatrics, neurodiversity and mental health, so that care can be tailored to patients’ needs. At first, the new services were prioritising patients registered with the old Gender Identity Development Service, but I am delighted to report that the north-west and Bristol services are now taking patients off the general waiting list.

On the waiting list, Dr Cass’s review painted a picture of a service unable to cope with demand. Children and young people face unacceptably long waits for care, with some children passing into adulthood before their first appointment, leaving them facing a dangerous cliff edge. I am pleased to tell the House that NHS England is working with potential partner organisations to explore establishing a much-needed follow through service for 17 to 25-year-olds, as Dr Cass recommended. Young people’s distress or needs do not vanish when they turn 18, and neither should their healthcare.

We do not yet know the risks of stopping pubertal hormones at this critical life stage. That is the basis on which I am making decisions. I am treading cautiously in this area because the safety of children must come first. There are some who have called on the Government not to go ahead with the clinical trial recommended by Dr Cass. Others on the opposite side of the debate want the Government to ignore the recommendations of the independent expert Commission on Human Medicines. We are taking a different approach. The decisions that we take will always be based on the evidence and the advice of clinicians, not on politics or political pressure.

Finally, there are many young people in this country who are desperately worried and frightened by the toxicity of this debate. This has not been helped by some highly irresponsible public statements, which threatened to put vulnerable young people at risk. In the past few months, I have met young trans people, who either have been, may be, or will be affected by the decisions that I and my predecessor have taken. I have listened to their concerns, fears and anxieties, and I want to talk directly to them. I know it is not easy being a trans kid in our country today. The trans community is at the wrong end of all the statistics for mental ill health, self-harm and suicide. I cannot pretend to know what that is like, but I do know what it is like to feel that you have to bury a secret about yourself, to be afraid of who you are, to be bullied for it, and then to have the liberating experience of coming out. I know it will not feel like it, based on the decisions that I am taking today, but I really do care about this, and so does this Government.

I am determined to improve the quality of care and access to healthcare for all trans people. I am convinced that the full implementation of the Cass review will deliver material improvements in the wellbeing, safety and dignity of trans people of all ages, and the Government will work with them to help them live freely, equally and with the dignity that everyone in our country deserves. 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 thank the Secretary of State for advance sight of his statement, and for his courtesy in coming to the House to make an oral statement, which gives hon. Members the opportunity to ask him questions.

When the Secretary of State is wrong, we will challenge him robustly and hold him to account, but when he is right, we will support him. That is responsible opposition. In what he sets out today, he is right, and he has my support for what he is doing. Protecting children is one of the most important priorities that a Health Secretary can have. My predecessor, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), worked tirelessly to do just that. She set out that it was her priority to protect children and young people from risks to their safety from the prescription of puberty blockers, given the lack of an evidence base. I welcome the Secretary of State’s continuing the work started under the previous Government, and I welcome his support at the time and all that he has done since, including in his statement on 4 September. I associate myself with the three principles that he enunciated when he opened his statement.

With increasing numbers of young people questioning their gender identity, NHS England, with the support of previous Conservative Health Secretaries Matt Hancock and Sir Sajid Javid, commissioned Dr Hilary Cass to examine the state of services for children questioning their gender. That historic review cut through the noise and ideology to lay bare the clear facts, so that we as policymakers can seek to make decisions based on evidence, safety and biological reality, and create a service that better serves the needs of children, as the Secretary of State set out. In the review, Dr Cass made it clear that not enough is known about the lifelong impacts of using puberty blockers on young minds and bodies to be sure that they are safe, and that the robust evidence base was simply not there. In March, NHS England made the landmark decision to end the routine prescription to children of puberty blockers for gender dysphoria. With the support of the then Government, it announced that it was stopping children under 18 from being seen by adult gender services with immediate effect.

As one of the final acts of the previous Government, my right hon. Friend the Member for Louth and Horncastle used emergency powers under section 62 of the Medicines Act 1968 to extend the ban to private clinics selling puberty blockers to young people questioning their gender. It was the right thing to do, and I agree with and pay tribute to her, as I do to the Secretary of State for what he has subsequently done. The safety and wellbeing of children and young people must come above any other concern. I welcome the fact that the Secretary of State renewed the order; his saying that he will make the ban indefinite, given the absence at present of an evidence base; and his seeking to better understand and build that evidence base.

I have a few questions that I hope the Secretary of State can offer clarifications on in a constructive spirit. I hope—I think he alluded to this—that he will confirm that he intends to implement the Cass review’s recommendations in full. Of course, support must be available to children and young people who are questioning their gender identity, and that support must be holistic, multidisciplinary and evidence-led. The Tavistock clinic closed earlier this year, and as he set out, three new regional NHS children and young people’s gender services have opened to provide better, tailored gender services for children and young people—again, that is based on recommendations in the Cass review. Can the Secretary of State provide more detail on the delivery of the remaining regional centres, and say what order they are due to open in, so that children and families can see what is happening in their region? Again, that is about putting the best interests of young people first.

Can the Secretary of State reassure the House that these measures will be UK-wide and that he is working in tandem with the devolved Administrations? Will he advise on what progress has been made thus far—I appreciate that it is early days—on further research into patient care and increasing that evidence base? Can he update the House on the steps taken to continue the work of his predecessor, my right hon. Friend the Member for Louth and Horncastle, when she announced to the House in May the decision to work to close any online loopholes to the regulations put in place? Finally, will he commit—I suspect I know the answer to this one—to keeping the House updated in the months and years ahead on developments in this space?

Our children and young people deserve healthcare that is compassionate, caring, careful and led by the evidence. I associate myself with the Secretary of State’s concluding remarks on the need for the debate to be conducted in a respectful and sensitive way, with the needs of children and young people at its heart. We will support measures that protect children, and support him in bringing forward such measures; we want to work constructively with the Government to give the next generation access to the right healthcare to meet their needs. I look forward to working with him in the months ahead.

[Wes Streeting]

I thank the shadow Secretary of State for the constructive way in which he has responded to the statement, and for the tone with which he has approached the issue. It is worth everyone bearing in mind that every word of statements in this House, and indeed online, are often hung upon by a particularly vulnerable group of children and young people. Many of them feel afraid about the environment in which they are growing up, as do their families. Establishing an environment in which we can discuss issues with their welfare and wellbeing at its heart is therefore the right way to approach these issues. As I have said many times before—and I am sure the shadow Secretary of State agrees—we need less heat and more light, and we can show leadership together in trying to provide that climate.

I am absolutely committed to the full implementation of the Cass review. The shadow Secretary of State asked about the implementation of new children and young people’s services on gender incongruence. As I said, the north-west London and Bristol services are now open. A fourth service is planned in the east of England for spring next year. We want a specialist gender service in every region by 2026, and of course I will keep him and the House updated on that.

I am working closely with my counterparts in the devolved Governments. I particularly welcome the engagement I have had with my counterpart in Northern Ireland and his predecessor, the hon. Member for South Antrim (Robin Swann), who is within my line of sight. I appreciate the way we have been able to work together on this and many other issues. The shadow Secretary of State asked about loopholes. I will keep the matter under close observation and review.

With regard to sanctions, penalties and enforcement, it is worth pointing out that breach of the order is a criminal offence under the Medicines Act 1968. It is a criminal offence to supply these medicines outside the terms of the order. That means pharmacists who dispense medicines against prescriptions that are not valid may be liable to criminal prosecution. It is a criminal offence to possess the medicines where the individual had responsible cause to know the medicine had been sold or supplied in breach of the terms of the order. There are fines and penalties associated with that, including case-by-case and regulatory enforcement by the General Pharmaceutical Council.

We have approached the matter in an evidence-based and considered way, and with the welfare and interests of children and young people at the heart of our decision making. I urge everyone else involved in the provision of health and care to do the same.

[Tonia Antoniazzi (Gower) (Lab)]

I thank the Health Secretary for his statement and for the manner in which he continues to handle this important issue. I welcome the fact that the Government are following clinical evidence, particularly in relation to children and young people, whose wellbeing and protection are paramount—that is the right approach. Given that the Cass review found insufficient evidence on whether puberty blockers are safe, and highlighted their potential harms, there are understandably concerns about the risks of trialling them. Can the Secretary of State reassure me that the upcoming trial will have robust safeguards, and will he continue to be led by the wellbeing and safety of children?

[Wes Streeting]

I can certainly give my hon. Friend that assurance. Better-quality evidence is critical if the NHS is to provide reliable and transparent information and advice to support children and young people, and their parents and carers, in making potentially life-changing decisions. That is why we support the setting up of the study into the potential benefits and harms of puberty-supressing hormones as a treatment option. The study team’s application for funding is going through all the usual review and approval stages ahead of set-up—including peer review, consideration by the National Institute for Health and Care Research funding committee, and ethical approval processes. We want the trial to begin recruiting participants in spring 2025. I am confident in the robust, appropriate and ethical way in which the trial is being established.

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I thank the Secretary of State not only for the content of his statement, but for its tone and his recognition of the importance of such a tone in this place. For too long, children and young people who are struggling with their gender identity have been badly let down by low standards of care, exceptionally long waiting lists and an increasingly toxic public debate.

Before GIDS closed, more than 5,000 young people were stuck on the list for an appointment and waited, on average, almost three years for their first appointment. For teenagers going through what is often an incredibly difficult experience, three years must feel like an eternity, so change is desperately needed.

The Liberal Democrats have long pushed to ensure that children and young people can access the high-quality healthcare that they deserve. We welcome the NHS move to create multiple new regional centres, but those centres must get up and running as quickly as possible. Will the Secretary of State outline what steps the Government are taking to ensure that happens in every region, and will he give a timetable for that work? Tackling waiting lists and improving access to care must be priorities.

I understand why today’s news is causing fear and anxiety for some young trans people and their families, who have been badly let down for so many years—not least those I have met in my constituency, who have highlighted the catastrophic mental health impacts of the situation. It is crucial that these sorts of decisions are made by expert clinicians based on the best possible evidence. Will the Secretary of State publish all the evidence behind his decision, including the results of the consultation, to give those families confidence that this is the right move for them?

We welcome the announcement of a clinical trial. We need the NHS to build up the evidence base as quickly as possible, and the Government to provide certainty that they will follow evidence and expert advice on behalf of those children.

[Wes Streeting]

I thank the Liberal Democrat spokesperson for her approach to this matter. I can certainly respond to her questions. We want all those regional centres to be up and running by 2026, and we are working with NHS England to achieve that outcome.

The hon. Lady mentioned the waiting lists. To give people a sense of the challenge, the latest figures show that 6,237 children and young people are on waiting lists for gender services, so we have seen growth in the waiting list in the time that she mentioned. As with all NHS waiting lists, I want to see those numbers fall. It is particularly important to note, in the context of children and young people’s services—be they gender identity or other paediatric services—that a wait of many years can represent a school lifetime. I know that for that group of children and young people, time really does feel of the essence, so we owe it to them to get the waiting lists down faster.

We are also working to implement the recommendation on the follow-through service for 17 to 25-year-olds. I know that there is some anxiety about that issue—some people have interpreted it as an extension of children’s services up to the age of 25, but that is not what we intend. It is about a transitional service from children’s to adult services, which I think will lead to better care.

Finally, in the context of a statement that focuses on puberty-suppressing hormones, it is worth pointing out that they are not the only treatment for children and young people in this area. I think there is a danger that the focus on that treatment—because of an inevitable but necessary political process—means that it is held up as the gold standard, so some children and young people and their families feel that if they miss out on it, they are missing out on all treatment. That is not the case. Indeed, for many trans people of all ages in our country, puberty blockers have never been considered an appropriate intervention. We must see all the treatment options in the round, which is why I support the holistic approach to supporting children and young people with gender incongruence, as Dr Cass outlined in her excellent report.

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

I thank the Secretary of State for addressing the points in my letter to him, particularly on the holistic approach to the health of trans young people. In his statement, he said that the order would

“restrict the sale or supply of puberty blockers”

to under-18s through private prescriptions. Can he assure me that that will apply to all under-18s, not just those with gender dysphoria? Otherwise, it will be used as an attack on trans young people, as he well knows. Is the order universal rather than targeting trans young people in particular?

[Wes Streeting]

The order relates to the use of puberty blockers by that particular group of patients for that particular purpose, where the evidence base is not sound and for which the Commission on Human Medicines has described the current prescribing environment as representing an “unacceptable safety risk.” Puberty blockers are safe and proven for use among children and young people for other conditions, including precocious puberty. Where we lack a sound evidence base and a safe prescribing environment, and where that medicine represents an unacceptable safety risk, is in relation to its use for that particular purpose for that particular group of patients.

[Rebecca Paul (Reigate) (Con)]

I welcome the statement and commend the Secretary of State for putting the safety and wellbeing of children first. The use of puberty blockers to treat gender dysphoria is—I will not mince my words—nothing short of a medical scandal, in my view, so I very much welcome his approach. He said that it is important that young people receive the right care from paediatricians and mental health professionals. Does he agree that no child should ever be told by a health professional that they were born in the wrong body?

[Wes Streeting]

It is important, particularly with this group of children and young people, that clinicians ask a range of questions to identify the nature of a child’s needs, and respond appropriately by providing holistic and evidence-based healthcare. That is the best way of turning around the horrendous statistics on the effects of gender dysphoria on children and young people, and it is how we will achieve better, healthier and happier outcomes for that cohort of patients.

[Kate Osborne (Jarrow and Gateshead East) (Lab)]

I wrote to the Secretary of State this morning, before his statement was announced, to highlight that a Council of Europe report notes that gender-affirming hormone therapy for trans minors in the UK is almost impossible to access, and that the total withdrawal of access to healthcare outside of a research trial may breach the

“fundamental ethical principles governing research”.

The restrictions on puberty blockers remove the clinical expertise from medical decision making, which significantly impacts on young trans people and their families, and I am hugely disappointed by the content of the statement. Will he read that Council of Europe report, and will he agree to meet me, as a UK delegate, to discuss it?

[Wes Streeting]

I am certainly happy to continue meeting my hon. Friend on this issue. With great respect to the Council of Europe and the authors of the report that she mentions, I have to take decisions about the welfare, wellbeing and safety of children in this country based on clinical evidence. When our own Commission on Human Medicines says that there is an “unacceptable safety risk” and an unsafe prescribing environment, I have to take that seriously. When one of our country’s leading paediatricians says that there is insufficient evidence about the long-term effects of the use of this particular drug for this particular purpose for this particular cohort of children and young people, I have to take that seriously.

I know there are people who will be deeply disappointed by this decision, including many trans people and their families. Thinking about some of the young people I have met in recent weeks and months, I have taken to heart what they have said, and I know this will be deeply upsetting to them. I do not take that lightly, but to anyone challenging me to do something else, I ask them quite sincerely whether if they were standing in my shoes as the Secretary of State for Health and Social Care, looking at recommendations from clinicians in our country—including the Commission on Human Medicines—saying that there is insufficient evidence for the use of medication in children and young people for this purpose and an unacceptable safety risk arising from the current prescribing environment, they would really take a different position.

[Siân Berry (Brighton Pavilion) (Green)]

I am extremely worried and fearful about this decision to continue the blanket ban, and I want to ask the Secretary of State about his reliance in the terms of reference and reasons for this decision on the purpose for which these drugs are being prescribed—that is, being trans—when they are safely used by young people for other conditions, as he acknowledges. Does he understand that this is, at heart, discriminatory?

[Wes Streeting]

I do not agree with the hon. Member’s characterisation. A whole range of medicines are prescribed for a whole range of uses among a whole range of patient cohorts that may well be unsafe, inappropriate or ineffective for use by other patients with other conditions. That is a basic fact of medicine and, if I may say so, the hon. Member’s intervention is why we should listen to clinicians, not politicians.

[Nadia Whittome (Nottingham East) (Lab)]

I share the deep disappointment that many young trans people and their families will feel about the Health Secretary’s decision today. I know that many will be devastated by this news, and I know that they have communicated to the Health Secretary and his Department the huge concerns that they have about their wellbeing in the face of these restrictions. Too many young trans people are already in, or at high risk of, mental health crisis. What consideration has he given to the impact of this decision on their mental health?

[Wes Streeting]

Very heavy consideration—of all the considerations, it is the one that has weighed most heavily. As I said in my statement, trans people too often find themselves at the wrong end of the statistics on mental ill health, self-harm and suicide. I take those issues very seriously indeed.

What I would say to my hon. Friend, Members of this House, and campaigners—particularly online actors—is that a number of claims have been made about the data that are not borne out by the facts. In fact, I asked Professor Louis Appleby, the Government’s suicide prevention adviser, to examine the evidence for some of the claims made that there has been a large rise in suicide. His paper, published on 19 July, concluded as follows:

“The data do not support the claim that there has been a large rise in suicide in young gender dysphoria patients at the Tavistock.

The way that this issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide.

The claims that have been placed in the public domain do not meet basic standards for statistical evidence.

There is a need to move away from the perception that puberty-blocking drugs are the main marker of non-judgemental acceptance in this area of health care.

We need to ensure high quality data in which everyone has confidence, as the basis of improved safety”.

I would add that it is important that we make sure that these children and young people have access to good-quality mental health support, and I am working with NHS England to make sure that this is the case. This area is one in which all Members should tread carefully when engaging in debate.

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

I do not think anyone who has listened to the Secretary of State today could be in the slightest doubt about the responsibility that he has borne and the personal empathy that he has injected into his handling of this very difficult question. I personally thank him for it.

I was told a long time ago that one should never ask a question in the House to which one does not already know the answer, but I think I will break the rule this time. What about surgical procedures? One hears about irrevocable steps such as so-called top surgery—the removal of healthy breast tissue from young females. Where does the law stand on that issue at the current time?

[Wes Streeting]

The only thing worse than a Member not knowing the answer to their own question is the Minister not knowing the answer. Happily, in this case, I can say that surgical intervention for trans people does not apply to children and young people.

[Peter Swallow (Bracknell) (Lab)]

I welcome the spirit in which the Health Secretary has made today’s statement and his commitment to improving healthcare for all trans people, but I want to press him a bit on continuity of care. This summer, I had a real struggle working with parents of young trans kids who were supporting their children in their journey and had accessed puberty blockers through overseas prescribers. They had done so after much heartfelt indecision, because they thought they were supporting what was best for their children and, frankly, because better healthcare options were not available to them under the previous Government. I welcome the moves taken to speed up the trial, but can my right hon. Friend assure me that while we wait for that trial to be set up, nobody currently receiving treatment with puberty blockers—however they may have accessed them in the past—will face a discontinuity in their care?

[Wes Streeting]

Any young person in Great Britain and Northern Ireland who had a valid prescription for these medicines in the six months prior to 3 June and 27 August respectively can seek continuation of their prescription from a UK-registered clinician. Guidance has been issued to general practitioners setting out prescribing scenarios. It remains the case that continuation of puberty-supressing hormones can be considered where the GP feels competent to do so, and where confirmation in the form of documentary evidence that treatment had been under way is available. The guidance also makes clear that GPs should consider what further support should be offered, including assessing whether referral to the children and young people’s gender service or, indeed, for mental health support is required.

[Christine Jardine (Edinburgh West) (LD)]

I, too, thank the Secretary of State for the empathetic and reassuring approach he has taken today, because this has been a very toxic and, in many ways, very damaging debate for everyone involved. Further to the question about continued care, what reassurances can he give to people who have embarked on a course of treatment that they might now fear will be halted, and to the very many young people and their families in this country who are going through a very difficult time? Desperate situations make people do desperate things. What steps is the Secretary of State taking to ensure that the availability of these drugs is not driven underground—that they are not made available through means that none of us would like to see?

[Wes Streeting]

As I say, any young person in Great Britain and Northern Ireland who had a valid prescription for these medicines in the six months prior to 3 June and 27 August respectively can seek continuation of their prescription from a UK-registered clinician. More broadly, it is my intention to ensure we start bringing down those waiting lists, to make sure that children and young people and their families receive access to the wide range of support, information, advice and guidance that they need in order to navigate their pathway and to make sure they feel safe, respected and included in discussions about their own healthcare.

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

The Health Secretary is right when he says that young trans men and young trans women in this country need us all to do better on their behalf, particularly in the debate and how we move forward—there must be more light, not heat. He is also right when he says that time is of the essence. I think we all share his concern that all medicines must be regulated properly and that we should all understand, for every patient group, the risks and benefits of any medication. However, can he give us more clarity, and give those who will be listening to this statement in fear a sense of where this is going? He has talked about an indefinite ban until 2027—not a rolling ban, but an indefinite ban—and he has talked about recruiting participants to a study that might begin its recruitment in 2025, but he has not said when the review will begin or when we will get the data that he feels is missing and that Dr Cass identified as needing to be provided so that we can move the debate forward. If time is of the essence and puberty is the matter, we need to give these young people a route map forward.

[Wes Streeting]

I am grateful to my hon. Friend for her question. We are trying to proceed at pace with the clinical trial. I share the urgency that she brings to her question. I have had to temper my own urgency with the need to make sure that the clinical trial that is established is as robust and ethically sound as, if not more robust and ethically sound than, any other clinical trial. The worst thing I could do at this stage, especially when the NIHR and NHS England are working at pace to establish a trial, would be to interfere politically in what must be an independent approach.

The planned pathway study, which includes the clinical trial component to build the evidence of the relative benefits and harms of puberty-suppressing hormones, is in the final stages of the commissioning process, subject to a robust ethical approval process. The study remains on track to commence recruitment in the spring, and I will issue further updates in early 2025 to keep my hon. Friend, the House, and young people and their families informed.

[Carla Lockhart (Upper Bann) (DUP)]

I am sure the Secretary of State will welcome the Northern Ireland ban as well, making this a UK-wide ban.

Going through puberty is a biological and natural way for a boy or girl to develop. Anything that interferes with this process in such an extreme way is going against the natural process. Therefore, I agree with the sentiments about its being a scandal that medicine was being given to vulnerable young people without proof of its being safe or effective. Will the Secretary of State therefore outline what support is available for children and young people who have taken these drugs and bear the scars of these drugs? On the clinical trial, we once again see the NHS being used totally contrary to what it was designed for, which is to protect and preserve life.

[Wes Streeting]

I thank the hon. Member for her question. On the cases of young people who have been on a gender identity pathway and later regret those interventions, whatever those interventions may have been, they are small in number, but they are addressed in the Cass review. It is important that we do not lose sight of those young adults and older adults who may well need the support of health services if they feel they were inappropriately placed on a gender identity pathway or undertook medical interventions that they have later come to regret. We will keep that and other evidence under close review.

[Jonathan Davies (Mid Derbyshire) (Lab)]

I thank the Secretary of State for his statement and the sensitive way in which he has approached this issue, because nothing is more important than our children and young people’s health. A lack of an evidence-based approach may have taken us into a space where some children and young people have received puberty blockers as an appropriate intervention, but others have received that medication when it was not right for them, so can I ask him or his officials to look at how we got ourselves into that space? There may be lessons for us to learn not just about this issue, but about healthcare more generally. Sometimes when we have rushed into things in the past, we have found what appears to be a panacea for an issue, but it has turned out not to be the right thing at all.

[Wes Streeting]

I am grateful to my hon. Friend for his question. This lies at the heart of the dilemma that has plagued clinical leaders and political leaders, particularly since the scandal at the Tavistock clinic was brought into the public eye. There are many people in our country—young people, and young and older adults—who will say, and some have certainly told me in my office, that having access to puberty-suppressing hormones has been completely life-changing and affirming, and has led to a positive outcome for them. Yet we know that the prescription of that medication to this particular group of patients for this particular medical need has not been supported by underpinning evidence in the way that the use of other drugs has been underpinned by effective trials and an evidence base.

That has been the challenge: people with a lived experience saying that this has been positive, while none the less—at the Tavistock clinic, in particular—not only puberty blockers but a whole range of medical interventions were delivered with the best of intentions, but in ways that were inappropriate and clinically unsound. That was the genesis of the Cass review, and it is why I think it is so important that we proceed in an evidence-based way. To do the contrary risks real harm to people and also a lack of trust in the medical profession that will be damaging for our entire country, and particularly for this group of patients.

[Joy Morrissey (Beaconsfield) (Con)]

May I thank the Secretary of State for a very nuanced, well thought out and genuinely moving statement? He will very rarely hear me praise those on the Labour Front Bench, so he should enjoy it. I thank him for taking what is a very difficult stance. What I saw is that the Secretary of State has put young people first and has protected young people today. I am very grateful for that, and I would like to offer him my thanks. I also thank him for his nuanced approach in helping trans people in their transition in adulthood, because this is complicated and it needs a nuanced approach. I thank him for understanding that, and for his boldness today.

[Wes Streeting]

I thank the hon. Member for her question. In case she worries that she is going soft on the Government—or, worse still, in case I worry that I agree with her—we should just remind each other that even a stopped clock is right twice a day. For those watching our proceedings this afternoon, it is true to say that politics in our country has been quite divided on a wide range of issues, certainly in the nine and a half years that I have been in this House. However, that is not to say that, on a wide range issues, we do not have consensus or work together to build it. I actually think that is a good thing in our politics. There are plenty of things we can disagree about in this House and contest elections on, but especially in an area such as this that involves vulnerable children and young people, the more we can try to build consensus and create an environment in our country where these children and young people and their families feel safe, the more we will be doing a really good job.

Far and away the hardest part in this process for me personally has been spending time with these children and young people and their parents, many of whom have spoken in genuinely heartfelt terms about the fear they feel living in our country. Some are looking to live in other countries, and doing so quite sincerely. It breaks my heart, actually, because I want this country to be one where everyone, whatever their background, feels safe, included and respected, and there is much we can do across this House to build that kind of country.

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

I thank the Secretary of State for his recognition of how difficult it will be for many young trans people and their families to hear the news today, and for his comments about the wider environment in which the trans community is threatened every day in the UK.

My significant concern about the announcement is that it will lead to more people getting drugs from unknown sources online without prescription, and God knows what is actually in some of those drugs. I also have significant concerns about access for both young and older trans people to the services they need. We know that there is currently a six-year waiting list, and it is estimated that those joining the list today, if things are not improved, will have to wait 15 to 20 years before actually accessing any specialist services or starting any treatments. Can the Secretary of State reassure trans people across this country, both young and older, that we are committed to making sure they get the health services they need as quickly as possible?

[Wes Streeting]

I can certainly give my hon. Friend that assurance. We want all trans people, in fact all people in our country, to receive timely access to safe and effective healthcare. We want to improve services for trans people specifically, because we recognise the extent to which they have been let down. I emphasise that young people who have been in receipt of puberty blockers with a valid prescription for the six months prior to 3 June and 27 August respectively can seek continuation of their prescriptions. There are risks that would be associated with an interruption of those prescriptions, which is why we have taken that approach. I know that I speak for the Government as a whole in saying that whether it is access to healthcare as in my case, access to a wide range of public services, or indeed safety on our streets, this Government are committed to improving the lives of trans people so that they can live with the freedom, dignity and respect that any of us in our country would expect for ourselves.

[Jim Shannon (Strangford) (DUP)]

I very much welcome the Secretary of State’s statement. It is never easy to deliver a policy decision that has so much effect on people, and I admire him for his diligence and his courage. He will be aware of the findings of the Cass report, which found that the change in practice from psychological and social support to drugs was based on no good evidence. In the light of medical professionals highlighting that puberty blockers by definition disrupt a crucial natural phase of human development, does the Secretary of State believe that we must extend the ban from temporary to permanent, not only to protect our children, but to prioritise mental health and the support that they so desperately need?

[Wes Streeting]

I am grateful to the hon. Gentleman for what he said. These issues weigh heavily on my conscience. On what he says about the safety and efficacy of puberty blockers, the simple fact is that we just do not know enough. That is why building the evidence base and research is important. I want to ensure that young people with gender incongruence and dysphoria are receiving the best quality healthcare to improve their safety, welfare and wellbeing as children, and that they live long, healthy and happy lives as adults. That is the basis on which we are taking decisions, and we are approaching the issue with care and sensitivity, as I know my counterpart in Northern Ireland also does.

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

Today will be a difficult day for trans young people, not because of the Secretary of State’s statement, but because of how our media might choose to portray what has been announced in the House. I welcome the remarks of the shadow Secretary of State, and I hope that we can take things forward together.

I know that one of my constituents will be upset, but will reflect on this with his mum, who has been supporting him. He was referred by his GP for gender dysphoria when he was in year 8. He has still not been seen by a specialist, and he is now in his first year doing his A-levels. He has had to endure going through periods, and suffering at school with the embarrassment of that. He decided to stop eating and was diagnosed with anorexia because that was the only way that he felt he could stop his periods and stop his breasts growing. Those are the kinds of things that trans young people go through day in, day out. Three and a half years later, it is not good enough that he has still not been seen by a medical professional. He is in the west midlands, which is one of the areas where we are not yet announcing that specialist services will be extended.

I welcome the gravity with which the Secretary of State has dealt with this matter. In particular, he responded to me when I asked him to meet trans young people, which he has done. I hope that we can move forward together and improve the mental health of all our young people. We must take this issue seriously and work together, rather than make this into a culture war.

[Wes Streeting]

My hon. Friend demonstrates powerfully why waits of the length that she describes in that case are simply unacceptable and unjustifiable. She also details the real pain that is being experienced by young people who are not being seen by the NHS, and not receiving the care and support they need. That is why I am determined to improve waiting times and quality of care. It is also why those of us in positions of influence or power, or those who have access to the microphone or the pulpit, need to think very carefully about the way that we talk about this group of children and young people, and trans people more generally. It is why headline writers and editors in our media have a responsibility to think carefully about how they exercise their freedoms in the media responsibly—freedoms I strongly support—and create a culture where we are not adding to the harms of that group of children and young people. That is for the exact reasons that my hon. Friend describes with that utterly heartbreaking case.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I associate myself with the remarks of my hon. Friend the Member for Beaconsfield (Joy Morrissey) about both the tone and content of the Secretary of State’s remarks. I first raised my concerns about the Tavistock clinic back in 2019, when a number of professionals resigned because they were so concerned about what was happening with regard to prescribing. He will know that anyone who raised those issues—I think of Kathleen Stock, for example—has been treated very poorly, and with spite, by some of the militant activists in that field. Although I entirely recognise the tone that the Secretary of State adopts—he is a thoughtful and sensitive man—I must ask him this. He has been clear that the prescribing practice was inappropriate, that people were not given time to give their full and informed consent, and that it was an unacceptable safety risk. Who oversaw that? When were those decisions made? Who made them, and how will they be held to account? Many young lives have been severely damaged.

[Wes Streeting]

As the report into the failures of the Tavistock clinic shows, a whole range of individuals and organisations did not discharge their duty of care appropriately to an extremely vulnerable group of children and young people. I pay tribute to the whistleblowers of the Tavistock and Portman who laid their careers on the line. They were subjected to the worst kinds of attempts to silence whistleblowers, and in some cases to bully them out of the organisation or vilify them. That was not only a disgraceful way to treat good colleagues who were raising legitimate concerns in the right way, but ironically—I have no doubt that many of the people behaving in that way did so with the best of intentions towards that vulnerable group of children and young people—they set back the national conversation about that group of children and young people and undermined confidence in gender identity services. That cannot be a good thing.

I also pay tribute to those journalists who were willing to report on this issue. I pay particular tribute to Hannah Barnes, whose “Newsnight” investigation took some of these issues to a wider audience, and whose journalism on broadcast media and in print showed how we can expose failure, and expose the risks to a wide range of children, young people and adults, in a thoughtful, evidence-based way.

Finally, the right hon. Gentleman talked about the treatment of other people who have raised concerns in a wide range of contexts in this debate. He mentions Kathleen Stock, and there are others, too. I do not think that has been helpful; in fact, I think it has been actively harmful to having the kind of national conversation we should have more broadly about gender identity and how some women fear their sex-based rights are at risk. If we were able to navigate those issues in a much more thoughtful, considered way, listening to different perspectives and experiences, I feel confident that, despite all the challenges, as a society we could find a way through that not everyone loves, but everyone can live with. We have done that before on same-sex marriage, on sexual orientation and religious freedoms, for example. It is possible, if we are willing to listen, to engage in good faith and to not shout down people raising heartfelt concerns. Perhaps if we engaged in the conversation in a much better way, we would find a better way through as a country.

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

While I am deeply disappointed, on behalf of our trans children, by the Secretary of State’s statement, I thank him for speaking directly to those children. I know that they will appreciate his sentiments. Trans young people in Mid Dorset and North Poole already rely increasingly heavily on their GPs, their schools and CAMHS, with many leaving education entirely, doing serious harm to themselves and losing their lives while on the waiting list.

The former director of Tavistock told me that no data was collected on incidents of assisted suicide and deaths of children who were on the waiting list. Data was collected only of children and young people who had already started treatment. As a result, we have no information about the harms that young people and their families are going through in those years leading up to treatment.

What assurance can the Secretary of State give me that those already under the care of CAMHS and paediatricians will be treated urgently? Can he update me on progress on how long those already on the list might expect to wait? Will he commit to collecting data from families on the waiting list, so that we can truly understand their experiences?

--- Later in debate ---

[Wes Streeting]

The hon. Member points back to the waiting list, which currently has 6,237 people on it. I do not think it is too much to expect the NHS to have a relationship with each of those young people and to make sure that they are receiving some support and care while they are waiting. I have been given assurances that support is offered to young people on the waiting list, and I continue to monitor that like a hawk. I am grateful for representations I receive from across the House from right hon. and hon. Members’ casework, and I am happy to pick up individual cases.

As for the most catastrophic failures of children and young people, I reassure all right hon. and hon. Members that all child deaths, whatever the circumstances—suicide has been mentioned—undergo a multi-agency review by a child death overview panel, and that information is reported to the national child mortality database. There is a monthly exercise by NHS officials to check the waiting list against NHS records, so we do monitor the situation closely, and the mental health and wellbeing of this particular cohort of children and young people is both very close to my heart and very close to my gaze.

[Jim Allister (North Antrim) (TUV)]

I certainly welcome the Secretary of State’s extension of the ban on the prescription of puberty blockers. I want to ask him whether he has more information for us on the criteria that will apply for entry into the clinical trials. Will there, for example, be a minimum age? Will parental consent be required? Both those things seem to be important, so may I have assurance on those two points?

[Wes Streeting]

The details of the trial are still being worked through. They will be and are subject to a robust ethical approvals process. Only once final ethical approval is granted is the final study design set in stone. As such, I cannot comment on the finer details at this time, but I just reassure the hon. and learned Member that the issues he raises are very much under consideration in the design of the trial.

[Carla Denyer (Bristol Central) (Green)]

I share the concerns expressed by experts at the Council of Europe that removing access to puberty blockers except through clinical trials may breach the fundamental ethical principles governing research, amounting to coercion and therefore a breach of young people’s human rights. Exactly how harmful that decision is, however, hinges on how easy or hard it is to get on the clinical trial. How many places will there be on the trial? If he cannot at this stage, can he please reassure me that he will take careful consideration of the fact that if the trial is limited in size, that will cause harm to more trans and gender-questioning young people.

[Wes Streeting]

The trial will be uncapped, and I reassure the hon. Member and the House that all NIHR-commissioned research must go through robust scientific and ethical approval processes, both of which can influence final study design. In terms of the design of this trial, ethics is an integral part of the trial’s approval.

[Robin Swann (South Antrim) (UUP)]

I thank the Secretary of State for his statement, which I welcome, both in its tone and the approach taken. I welcome that this indefinite ban will include Northern Ireland. I thank the Secretary of State and his predecessor for the collaborative approach they have taken with the Minister of Health in Northern Ireland. It is important for the House to note that the ban in Northern Ireland was supported by all the Northern Ireland Executive parties. In his statement, the Secretary of State talks about being able

“to restrict the sale or supply of puberty blockers…through a prescription issued by…a prescriber registered outside the United Kingdom.”

What steps will he take to close all those loopholes and avenues that would allow these drugs to be prescribed, recommended or supplied by online suppliers for under-18s?

[Wes Streeting]

The challenge that the hon. Member mentions relates not just to these drugs, but goes more generally, too, and it is something we are looking at closely. More broadly, I want to acknowledge the first part of his question. I am grateful, not just to my counterpart Mike Nesbitt in the Northern Ireland Executive, but to the First Minister, the Deputy First Minister and all parties involved in the Northern Ireland Executive for the collaborative way and the spirit in which they have engaged in discussion about this issue for Northern Ireland, and also for their willingness to work in partnership with the UK Government. That is to their credit and to the benefit of all citizens across every part of the United Kingdom.

Tobacco and Vapes Bill

Wes Streeting Excerpts

2nd reading
Tuesday 26th November 2024 Commons Chamber

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

I beg to move, That the Bill be now read a Second time.

Today, across the UK, 350 young people aged 25 and under will take up smoking. It is a decision that the vast majority will later regret. They will try to quit again and again, but most will not be able to break their addiction. They will suffer strokes, diabetes, heart disease, cancer, stillbirth, dementia or asthma as a direct result of smoking. For two in three of those young people, the habit they are beginning today will eventually kill them.

Smoking takes 80,000 lives a year and causes one in four deaths from cancer in England, a hospital admission almost every minute and 100 GP appointments an hour. It is the leading cause of sickness, disability and death in our country. And today, Members of this House can consign it to the history books.

The Bill before the House will raise the legal age of the purchase of tobacco by one year every year, creating the first smokefree generation and, eventually, a smokefree nation. The Bill will enable the Government to extend the current indoor smoking ban to certain outdoor settings, and we will consult on banning smoking outside schools and hospitals and in playgrounds, protecting children and vulnerable people from the harms of second-hand smoke.

The Bill will come down on the vaping industry like a ton of bricks, to prevent a new generation of children and young people from getting hooked on nicotine. Taken together, these measures add up to the most significant public health intervention in a generation. They are a giant leap in this Government’s mission to build a healthy society and, in doing so, they will help to build a more healthy economy too.

[Sir Desmond Swayne (New Forest West) (Con)]

Can the Secretary of State imagine the plight of a shop assistant, some decades hence, when a middle-aged or elderly person presents themselves seeking to buy a packet of cigarettes? Is that shop assistant really expected to demand their bone fides?

[Wes Streeting]

I can not only imagine it, but I recently experienced a similar situation. There I was in Barkingside Sainsbury’s one evening, only weeks ago, buying a bottle of wine to have with dinner and, to my surprise, I was asked for my ID. I am afraid it is just a burden that those of us with youthful vim and vigour in our early 40s have to bear, and it is a price I am willing to pay—for good moisturiser. However, there is a serious point. Along with many others that I am sure we will encounter during the passage of the Bill, this is one of the cynical arguments being deployed by the mendacious smoking lobby, which would have us believe that, decades hence, there will be people who are at the margins—one aged 41 and one aged 40, for example—being asked for ID on the sale of cigarettes. The point is that the Bill will create a smokefree generation. Young people growing up in our country today will not be smokers, because we will have stopped the start. We will do everything we can to support adults who are currently smoking, because the vast majority want to break the habit but struggle to do so.

[Simon Hoare (North Dorset) (Con)]

If only proof of age was still asked of me.

The Secretary of State knows that I support the Bill and will vote for it this evening, but he will know that rural pubs are increasingly marginal in their operations. He has referred to further powers, post consultation, that may stop smoking outside in particular places once the Bill is on the statute book. Will he put the minds of rural MPs, from across the House, at rest by saying that he does not envisage at any point, either now or post-Royal Assent, the inclusion of a ban on smoking outside rural pubs? That would be a further nail in their business model at a time when we need them.

[Wes Streeting]

I was going to address that point later in my speech, but let me address it now. It is not often that a Government comment on leaks or welcome the events following a leak; I do not want to encourage future leaks, either. However, it is well known and a matter of accurate reporting, in this case, that we were considering an extension of the ban on outdoor smoking to include outdoor hospitality, including pubs, as the hon. Gentleman mentioned. Because of that leak, representations were heard from Members from across the House, including the hon. Gentleman, my hon. Friend the Member for Great Grimsby and Cleethorpes (Melanie Onn) and others. We took those representations very seriously because we know the hospitality industry has been through a torrid time, and not just in rural communities. I accept that rural pubs face a big challenge, but even high street pubs in towns and cities are struggling.

Our approach to public health always has to weigh up the upside benefits to public health against the downside consequences elsewhere. It is not in the national interest to see our high streets further suffer, so I reassure the hon. Member for North Dorset (Simon Hoare) and the hospitality industry—although I think it feels reassured on this already—that we will not be consulting on extending the powers to outdoor hospitality spaces. I hope that reassures people, as we embark on consultation on the measures that I am outlining today, that the Government listen, engage and consult seriously. Consultation is genuine with this Government.

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

I will not comment on how young I look, but I still get asked for ID when buying non-alcoholic wine.

It is 10 years since the smoking ban came into operation and there are 1.9 million fewer smokers in the UK. Does that show the Secretary of State the difference that a Government that take the matter seriously can make?

[Wes Streeting]

My hon. Friend is absolutely right. I am really proud of the impact that the last Labour Government made in reducing smoking harms and the prevalence of smoking in our country.

That brings me on to the next point that I wanted to make. President Truman famously said that it is amazing what you can accomplish

“if you do not care who gets the credit.”

When I first sat down with Rachel Sylvester of The Times in January 2023 and flew a kite to start a debate that a Labour Government might introduce a ban on children and young people today ever buying cigarettes, of the type introduced by our sister party in New Zealand, I was not necessarily convinced my own side would buy it, but I thought it was a debate worth having. I never imagined, in a million years, that I would tune into a Conservative party conference speech by a Conservative Prime Minister announcing his intention to legislate for such a ban. I will do something I do not often do with Conservative party conference speeches and quote extensively—and approvingly—what the then Prime Minister said.

“As Prime Minister I have an obligation to do what I think is the right thing for our country in the long term. And as Conservatives, we have never shirked that responsibility.”

I say that bit through gritted teeth.

“We have always been at the front of society, leading it—”

Who wrote this?

“And when we have the tools at our disposal…to do for our children what we all, in our heart of hearts, know is right, we must act, we must lead…we must put the next generation first.”

In that spirit, I pay tribute to the former Prime Minister, the right hon. Member for Richmond and Northallerton (Rishi Sunak), for picking up the proposal and running with it despite opposition from his own party. That took courage. While we have taken steps to improve this Bill compared with the one put forward by the previous Government, I hope that hon. and right hon. Members on the Conservative Benches will follow his lead, showing that the one nation tradition still has a constituency in the modern Conservative party, and vote for this Bill in the national interest.

The Darzi investigation into the NHS set out the twin challenges facing me, my Department and this Government. The national health service is broken; it is going through the worst crisis in its history. At the point we came into office, waiting lists stood at 7.6 million. We had worse cancer survival rates than most comparable countries, ambulances not arriving on time, the number of GPs falling and dentistry deserts across the country.

Some of the most shocking findings in Lord Darzi’s report, however, were about not the sickness in our NHS, but the sickness in our nation. Children are less healthy today than they were a decade ago. Life expectancy was extended by three and a half years over the course of the last Labour Government, but in the past 14 years, it has grown by just four months. Brits now live shorter lives than people in any other country in western Europe, and we spend fewer years living in good health, becoming sicker sooner. Those are huge costs, borne by all of us as individuals. It means less time in which we are able to live our lives to the full, to do all the things we love and to spend time with the people we love. Sickness is forcing many of us out of work long before retirement age, leaving us dependent on welfare, ridding us of the purpose and belonging that work provides, and for everyone else, it means higher costs to us as taxpayers. Our sick society is holding back our economy, and that is why we should act.

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

Will the Secretary of State give way?

--- Later in debate ---

[Wes Streeting]

I give way to the Chair of the Health and Social Care Committee.

[Layla Moran]

In the spirit of cross-party working, I want to congratulate Members on the Conservative Benches for deciding, when the former Prime Minister put this policy forward, that it was a priority. It shows how important it is that No. 10 gets behind this kind of thing, and I hope we learn that lesson for the Government’s missions.

I gently say, however, that it is not just the evil tobacco lobby that has concerns about the age escalator. I completely agree with everything that the Secretary of State says, but if smoking is that much of an issue, why are we not just banning it for those under an age of, say, 25? That would have been another way to go. What is the thinking behind an age escalator, as opposed to a ban for those under a particular age so that people do not need new ID every time?

[Wes Streeting]

I recognise that there are people who have the freedom and the liberty to smoke today, the vast majority of whom, by the way, want to stop and struggle to do so. That is why we are announcing support to enable people to do that, with £70 million of investment in smoking cessation services. That is important, but for a future where people are no longer able to smoke, a phased approach is the right thing to do. It is also essential for the health of the individual, the nation and our economy.

Since 2018, our productivity has dropped by £25 billion due to worsening health alone. Some 900,000 more people are off work than would have been on pre-pandemic trends. That is more people than are employed by Tesco, Sainsbury’s and Asda put together. Smoking alone accounts for more than £18 billion in lost productivity. The rising tide of ill health, coupled with our ageing society, presents an existential challenge to our health service. If we do not act now, ever-increasing demands for healthcare threaten to overwhelm and bankrupt the NHS. That is the choice that we face.

[Andrew Rosindell (Romford) (Con)]

Surely the Secretary of State realises that banning things rarely works. When tobacco was banned in South Africa during the covid pandemic, 95% of the trade went underground. Surely we should be promoting the concept of freedom with responsibility and allowing people to make choices about their own lives. I am glad that he goes shopping in Barkingside—he should go and speak to the shopkeepers in Collier Row, where local retailers will lose a lot of potential business if the ban comes in.

[Wes Streeting]

I am grateful for the intervention, because I anticipate that there will be similar arguments made from the Opposition Benches, particularly from a right-wing libertarian perspective. I want to engage seriously with those arguments.

[Jonathan Davies (Mid Derbyshire) (Lab)]

Will my right hon. Friend give way?

[Wes Streeting]

I will just respond to the point made by the hon. Member for Romford (Andrew Rosindell).

There is no liberty in addiction; there is no freedom in addiction. The logical extension of the libertarian argument the hon. Gentleman puts forward would be the end of the ban on indoor smoking. If we should take a live and let live approach, why not legalise cannabis? Why not legalise cocaine? We prescribe certain harmful substances, and there is, I think, an unanswerable case on tobacco because it is uniquely addictive and uniquely harmful. That is why we will take a tougher approach with this harmful substance than we would with something such as alcohol, or other harms such as gambling.

[Jonathan Davies]

The Secretary of State stole my line when he said that there is no freedom in addiction. I just want to thank him for his pragmatic approach to the hospitality industry, which has made representations to me on this matter. May I also impress on him that vapes are a valuable quitting aid for many adults, but many young people are now taking to vaping when they have never actually smoked at all? Can he say a little bit more about how we will address that?

[Wes Streeting]

I will certainly come on to the action that we are taking on vaping, and the case for it. I welcome the contribution that my hon. Friend has made in his first few months as a Member of this House. He brings enormous expertise and experience, particularly on health, which we very much value here in the Chamber.

One choice would be to continue paying an ever heavier price for failure. That is the road that we were heading down, under the previous Government. Our NHS already takes £4 for every £10 spent by the Government day to day. We are on course to go from being a nation with a national health service to a health service with a nation attached to it. It is projected that by the end of this Parliament, 4.3 million people will be on sickness benefit if we fail to act. Smoking could cause 300,000 patients to be diagnosed with cancer over the next five years, including 3,000 for whom that is the result of exposure to second-hand smoke. That is what happens if we only ever treat the symptoms of ill health. We end up spending more on the NHS than ever before, but with worse care for patients, a ballooning welfare bill due to more and more people being out of work, stagnant economic growth, and the heaviest tax burden in 70 years. In short, we will be paying more, but getting less.

Britain is like a ship with a hole. We are constantly battling to chuck enough water overboard to keep us afloat, as more and more floods in. We must break out of this cycle. Britain can break out of this cycle, but only if we are serious about tackling the causes of ill health, and shift our focus from treating the symptoms to preventing them. Plugging the hole in the ship is how we get back to growth, how we reduce the burden of taxation, and how we ensure that this Government can intrude more lightly on people’s lives.

[Sir Christopher Chope (Christchurch) (Con)]

The argument that the Secretary of State puts forward is essentially one for banning smoking altogether. What he said earlier was misleading; he suggested that people of a particular age group will not be able to smoke. They will not be able to buy cigarettes, but they can still smoke. They can cadge cigarettes off other people. Is this not a half-baked measure?

[Wes Streeting]

I am sure that the hon. Gentleman was not accusing me of misleading the House. The argument that he puts forward is used against all sorts of laws and prohibitions. Most people in this country are law-abiding citizens who follow the law. In my constituency today, there will be people dumping fridges and mattresses on street corners—fly-tipping—because they are irresponsible and not law-abiding citizens. We will not always catch them, either through closed-circuit television or local authority enforcement, but that does not mean that we should not tackle them when they do those things.

By phasing in a generational smoking ban, we are taking a measured and reasonable way of creating a smokefree country. That is the right way to proceed, and it is sensible. I know that he does not agree, but he must accept the trade-off—the choices that he is making for the Opposition. First, he is accepting that people will pay a higher price for their healthcare, either through taxes, if he still believes in the national health service, or through the cost to the individual of their healthcare. Secondly, he must concede that, through the harm caused by smoking, he is fuelling welfare dependency. My right hon. Friend the Secretary of State for Work and Pensions had a point when she said earlier that Labour is the party of work, and the Conservatives are the party of welfare. That is the logical conclusion of the hon. Gentleman’s opposition.

[Anna Dixon (Shipley) (Lab)]

I congratulate my right hon. Friend on introducing this once-in-a generation public health measure. As he acknowledges, too many people are dying young from the effects of smoking. They are losing out on being grandparents and on the opportunity to live a long and healthy life. Smoking is a leading cause of health inequality, so does he agree that the proposals will help close the shocking gap in life expectancy between the rich and poor?

[Wes Streeting]

My hon. Friend is absolutely right. I am afraid that one of my first experiences of death was watching my grandmother die a very long, slow, painful death from lung cancer as a result of a life of chain smoking. That is the consequence of this cruel addiction. People who start smoking come to regret it. They struggle to stop, and I am afraid that the stolen years that they could have spent with children and grandchildren are only part of the cost. Part of my argument today, particularly to some Opposition Members, is about better use of public money and reducing the taxation burden. Other arguments, too, may have some currency with Members who might be opposed to these measures for libertarian reasons. We should not forget for a moment the impact of this cruel addiction and the harms caused by smoking on people’s quality of life, family life, and memories.

[Wera Hobhouse (Bath) (LD)]

rose—

[Wes Streeting]

I must make progress, otherwise we will not hear from anyone else in this debate—and I think that it will be a debate.

Taking action requires a reforming Government who are unafraid to take on the orthodoxies of both the right and the left. As I said, my right hon. Friend the Work and Pensions Secretary is today proposing radical reforms to the welfare system. Earlier this month, I set out a package of reforms to drive better productivity in the NHS. Today, we are proposing the biggest public health reform in a generation: phasing out smoking for the next generation by raising the legal age at which tobacco can be sold by one year every year, so that anyone aged 15 and under today will never legally be sold cigarettes. That will phase out smoking altogether.

Almost 20 years ago, the last Labour Government introduced the ban on smoking indoors in public places, as my hon. Friend the Member for Harlow (Chris Vince) said. We heard many of the same arguments, frankly, from opponents of that measure as we hear from opponents of the Bill today. They are free to correct me if I am wrong, but I do not think that Opposition Members who oppose the Bill are also proposing scrapping the indoor smoking ban. We have political consensus on the issue because of its success. The year after the ban came into force in 2007, hospital admissions for heart attacks dropped by 1,200. Admissions for children with asthma had been rising by 5% a year before the ban. After it was introduced, admissions fell by 18% in just three years. Since 2007, smoking rates have been cut by over a third, and as our understanding of second-hand smoke grew, the ban sparked a cultural change. People no longer thought it acceptable to smoke in front of their children, and many stepped outside, even in their own homes. It is time to build on that success.

No smoker intends to cause harm to others, but that is unintentionally what they do through second-hand smoke. The harms from second-hand smoke are less than from actively smoking, but the evidence shows they are still substantial. If people can smell smoke, they are inhaling it. Smoke near schools and playgrounds exposes children to smoke. Hospitals, by definition, have high numbers of medically vulnerable people on their grounds. The Bill will allow Government to extend the ban on indoor smoking to certain outdoor settings, and we will consult on banning smoking outside schools, playgrounds and hospitals to protect children and the most vulnerable.

As we act to prevent harms from smoking, we must also tackle the rising problem of youth vaping. It has more than doubled in the last five years, and one in four 11 to 15-year-olds tried vaping last year. A new generation of children is getting hooked on nicotine, and there should be no doubt about the cause, and no illusion that this has happened by accident. On any high street in the country, we can see shop windows filled with brightly coloured packaging for vapes, with flavours like blue razz lemonade and tongue twisters sour apple. Those products are designed, made, packaged, marketed and sold deliberately to children. This industry has cynically targeted its harmful products to kids.

Action is long overdue. We promised to stamp out youth vaping in our manifesto, and the Bill delivers the change that we promised. It will close loopholes that allow vapes to be sold or given away to children, provide powers to regulate the flavours, packaging and display of vapes, and introduce on-the-spot fines of £200 for under-age sales. Just as we took action on the advertising and sponsorship of tobacco products, we will bring the law into line for vaping products, too.

[Wera Hobhouse]

I do not know whether the Secretary of State will still be in the Chamber when I talk about Spice-spiked vapes. I see a gap in the Bill: it does not talk about refills. The harmful practice of spiking vapes with Spice comes from the refills. I hope that the Government will listen to my concerns and be flexible, as they have already shown themselves to be in other places. Perhaps, during the passage of the Bill, we can include something about refills. Would he agree to that?

[Wes Streeting]

We want to work in a genuinely collaborative and cross-party way, and I know that is true right across the House. As I look at the Opposition Benches, including Conservative Benches, I see long-standing campaigners for action on smoking and vaping. We want to listen and engage.

I feel strongly about the matter, as does the Prime Minister. In our manifesto, we set out Labour’s mission to improve the health of the nation. We will be far better served as a country if this is a truly national mission, and if we come together in common cause for action on public health.

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

rose—

[Wes Streeting]

In that spirit, I will give way to the hon. Gentleman—and then to some of my hon. Friends.

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

Can the Secretary of State tell us if there is any place for vapes as a step-down, in the context of the addictive aspects of tobacco? I seem to remember that when vaping first came along, it was heralded as a way to help wean people from their tobacco addictions. Sadly, it has turned into something else, as he describes, and starts children on the road towards nicotine addiction, but does it have a role as a step-down?

[Wes Streeting]

The right hon. Member is right to make that distinction. As a stop-smoking tool, vaping has a part to play. For smokers, vaping is a better alternative—a route away from smoking. We do not want to throw the baby out with the bathwater. What we are interested in tackling is the scourge of youth vaping and the extent to which young people have been cynically addicted. It is important to say that we do not yet know the full extent of the harms caused by vaping, but we do know two things: first, it is better to vape than to smoke—that is why we are striking the balance in this legislation—and secondly, vapes are harmful. Ask any teacher in the country; they will talk about the signs of nicotine addiction that they see in their pupils, and about having to monitor school toilets to stop children congregating to vape. It is urgent and necessary to act today to protect this generation of kids from a new addiction, and that is exactly what we will do.

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

As an ear, nose and throat surgeon, I can attest to the absolutely desperate trouble that cigarettes have caused over many generations. Implementing this measure is one of the best things that this Parliament could possibly do, and I expect that the measure will be widely supported all over the House. I am grateful to my right hon. Friend for introducing it.

[Wes Streeting]

I am grateful to my hon. Friend for that intervention, not least because of the expertise that he brings to the House as a clinician. We are well served by his expertise in debates on the health of the nation.

Opposite me sit many opponents of the Bill and of the Government’s prevention agenda. I acknowledge that their opposition is based on genuine, sincere beliefs about the limits of government and the size of the state, but I appeal to them by saying that the Bill is in the national interest and, ironically, in their ideological interest.

[Robin Swann (South Antrim) (UUP)]

I thank the Secretary of State for making a number of times the point that this is a truly national Bill that applies across the United Kingdom. I thank him for including Northern Ireland, Scotland and Wales in the measures. When we in this place consider measures to promote health, we should do so equally for the entirety of the United Kingdom.

[Wes Streeting]

That is a very helpful intervention because it gives me the opportunity to say thank you to my counterparts in Wales, Scotland and Northern Ireland. This is a genuinely four-nations Bill, and through it, we have an opportunity to create a smokefree generation in every corner of our country.

I say to people who have an ideological objection to the Bill that if they believe in lower taxes, as they say they do, and in maintaining a national health service, as they say they do, they cannot duck this simple equation: an ageing population plus a sicker society equals more spending on the NHS, paid through higher taxes. The Bill is just one measure, but it will make a significant difference to the health of our society, and to the balance of that equation.

The question that opponents of the Bill must answer is this: if they want our health and care services to continue having to spend £3 billion every year on the symptoms of smoking, are they willing to accept that that means higher taxes or higher healthcare charges for their constituents? Are they happy for their constituents to shoulder the welfare bill for smokers falling out of the workforce? Those are the consequences of what we are voting on today. Higher taxes and higher welfare are not the Labour way.

There are arguments about liberty from those who oppose based on libertarian belief. They say that the state should not deny individuals the choice to smoke if they want to, but three quarters of smokers want to stop and wish they had never started. It takes a smoker an average of 30 attempts to quit before they manage it. By definition, an addict is not free; there is no choice, no liberty and no freedom in addiction. Nor is choice afforded to anyone inhaling second-hand smoke. Tobacco is not only highly addictive but uniquely harmful. Yes, some smokers can quit, but most who want to cannot. Those who have help to quit are three times more likely to succeed. That is why the Government are, as I said, investing £70 million in smoking cessation services—an investment that will pay for itself several times over—but prevention is better than cure, and that is why we are taking action, through the Bill, to stop the start.

In conclusion, this Bill marks the start of a decade in which we will shift the focus of healthcare from treatment to prevention; take serious action on not just smoking, but obesity; reform the NHS, so that it catches problems earlier and gives patients the tools that they need to stay out of hospital; harness the revolution taking place in life sciences; and fundamentally transform the NHS, so that it predicts illness and prevents it from ever taking hold. That is the future available to us, and it is the future we must realise if we are going to put our welfare system, health service and public finances on a sustainable footing. It starts with this Bill. Smokers are more likely to need NHS services, be admitted to hospital, drop out of the workforce and on to welfare, and need social care years earlier than if they did not smoke. By taking the measures set out in the Bill, we are putting the UK on the road to becoming smokefree, building a healthier, wealthier nation with a health service fit for the future and leading the world as we do so. I commend this Bill to the House.

[Madam Deputy Speaker (Caroline Nokes)]

I call the shadow Secretary of State.

Regulation of NHS Managers: Consultation

Wes Streeting Excerpts

Tuesday 26th November 2024 Written Statements

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

Ensuring strong and accountable NHS leadership will be critical to fixing a broken NHS and delivering our health mission. We know the important role that high-quality leadership plays in fostering a positive, compassionate, and transparent culture within the NHS while ensuring that local organisations are anchors of growth and opportunity in the areas that they serve.

Currently, NHS managers and leaders are not a regulated profession. Today, I am announcing that the Department of Health and Social Care is launching a 12-week consultation on options for the regulation of NHS managers, as part of a programme of work to meet the Government’s manifesto commitment to introduce professional standards for, and regulation of, NHS managers. This issue, and the related question of the duty of candour, has been variously highlighted by the Kark review (2019), the infected blood inquiry (2024) and the ongoing Thirlwall inquiry into events at the Countess of Chester hospital.

It is essential that managers are also supported with the skills they need to deliver transformation and increase productivity in the NHS, which is why today’s consultation forms part of a wider programme of leadership and management development work to equip the NHS with the leaders needed to deliver our 10-year plan. This includes establishing a college of executive and clinical leadership to champion and enhance the support available to NHS leaders, and asking Sir Gordon Messenger, through the 10-year plan process, to look at how we can accelerate efforts to develop more systematic talent management in the NHS.

This consultation seeks views from all partners, including health and care organisations, regulators, professional bodies, health and care managers and senior leaders, the public, patients, and other health and care staff, on the most effective way to strengthen oversight and accountability of NHS managers.We are seeking views on:

the type of regulation that may be most appropriate for managers

which managers should be in scope for any future regulatory system

what kind of body should exercise such a regulatory function

what types of standards managers should be required to demonstrate as part of a future system of regulation

the sequencing of the introduction of a regulatory regime for NHS managers, alongside work that is already being undertaken by NHS England to support their development

a new professional duty of candour to cover NHS managers, and making managers accountable for responding to concerns about patient safety.

We are today also publishing a separate report on the findings of the Department’s call for evidence—launched in April 2024—on the existing statutory duty of candour on providers, which is a key step to fulfilling a recommendation from the infected blood inquiry. We will use the findings of our consultation on manager regulation, and the call for evidence, to help inform the final response to the Department’s review of the statutory duty of candour.

Views from partners will be critical in informing further policy decisions during the next phase of this work to support and improve NHS leadership. We will publish our findings and set out next steps following the closure of the consultation.

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