Resident Doctors Agreement

Wes Streeting Excerpts

Tuesday 8th October 2024 Written Statements

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

I am pleased to be able to inform the House that on 16 September 2024, the Government and the British Medical Association’s Resident Doctors Committee (BMA RDC), formerly known as the BMA Junior Doctors Committee, agreed a deal on pay for resident doctors—this includes those previously referred to as doctors and dentists in training. This follows BMA RDC agreeing to put the offer to its members.

We will now move to implement the deal, putting an end to strikes which have had a catastrophic impact not just on the country’s economy—with NHS strikes costing the taxpayer almost £1.7 billion in the 2023-24 financial year—but to patients and the nation’s health, with over 1.5 million appointments cancelled.

Resident doctors are a vital part of our NHS and go on to become the consultants and GPs we need tomorrow. This deal is the first step in rebuilding trust between the Government and the profession. This is a Government that cares for those who care for others.

In the deal, resident doctors will receive:

an average investment of 4.05% into 2023-24 pay scales effective from 1 April 2023 with a payment to reflect backpay. This is on top of the average 8.8% uplift they have already received for 2023-24; and

a further consolidated uplift of 6% plus £1,000 in 2024-25, in line with the recommendations of the Review Body on Doctors and Dentists Remuneration (DDRB).

This deal will increase the base salary for a full-time doctor starting foundation training in the NHS to over £36,600 compared to around £32,400 before this deal. A full-time doctor entering specialty training will see their basic pay rise to over £49,900 from around £43,900 before this deal. On average, resident doctors earn around one third additional to their base salary in overtime and out-of-hours payments.

As agreed in the deal, we have now instructed the DDRB to consider, as part of its pay recommendations, the overall reward package and a career progression for resident doctors to ensure that medicine is an attractive and rewarding career choice to deliver our consultants and GPs of the future.

The Government have also committed to improve the current exception reporting process and to work in partnership with the BMA RDC and other health organisations to review the current system of training and rotational placements.

The BMA RDC will withdraw the rate card for doctors and dentists in training in England with immediate effect.

The Government recognise the significant challenges that affect resident doctors. While this deal has agreed to review parts of the training system, we are also committed to addressing challenges, for example through initiatives under NHS England’s Working Lives programme, to improve the working and learning experience of resident doctors in the NHS. We continue to encourage local employers to engage with these policies to address these issues better locally.

This deal marks a significant step forward in fixing the NHS, rebuilding a relationship of trust with doctors and delivering better patient care.

[HCWS113]

NHS Performance: Darzi Investigation

Wes Streeting Excerpts

Monday 7th October 2024 Commons Chamber

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

I beg to move,

That this House has considered Lord Darzi’s independent investigation into NHS performance.

I am pleased to have the opportunity to open this debate on Lord Darzi’s investigation into the national health service, not just so that we can debate the past and what went so badly wrong, but so that the House can also debate the future of our NHS, how it needs to change and the many reasons to be optimistic about what our health service can be.

We have to start with honesty. For too long, Conservative Governments swept problems under the carpet, more interested in scapegoats than solutions. [Interruption.] I know; it is terrible. That is why I asked Lord Darzi to conduct an independent investigation into our national health service. He is an eminent cancer surgeon, with 30 years’ experience in the NHS, yet what he found shocked even him: some 100,000 toddlers and babies were left waiting for six hours in A&E last year; more than one in 10 hospital beds are taken up by patients who do not need to be there; children are less healthy today than they were a decade ago; adults are living longer but getting sicker sooner; conditions such as diabetes and high blood pressure are rising relentlessly; mortality from preventable causes is far higher than in other advanced countries; almost 3 million people are off work sick; and waiting lists are at record highs while patient satisfaction is at a record low.

The fundamental promise of the NHS—that it will be there for us when we need it—has been broken for a decade. Why? Because of four knock-out blows. First, a decade of under-investment means NHS staff are forced to use pagers and fax machines, with fewer cancer scanners than Greece and buildings literally crumbling. That is not to mention the disgrace that the previous Government’s new hospitals programme was written according to fictitious timetables, with the funding running out this coming March.

Secondly, there was Andrew Lansley’s disastrous 2012 top-down reorganisation that nobody voted for, cost billions and took years. It was an enormous waste of time, talent and money that should have been spent on caring for patients.

Thirdly, there was a failure to reform. The reforms made by the last Labour Government, which delivered the shortest waiting times and highest patient satisfaction in history, were ditched—a golden inheritance squandered.

Fourthly, there was coronavirus. Lord Darzi found that the NHS was hit harder than any other comparable healthcare system because of the damage the Tories had already done. It is not just that they did not fix the roof when the sun was shining; they doused the house in petrol, left the gas on and covid just lit the match. That is why millions are stuck on waiting lists, ambulances do not arrive on time and people cannot see their GP. Never forgive, never forget and never let the Tories do it again.

[Munira Wilson (Twickenham) (LD)]

Lord Darzi’s report was utterly damning about the treatment of children in our health system. He said that too many children were being let down, and pointed out that they account for 24% of the population, but only 11% of NHS expenditure, and that over 100,000 children wait for over a year to be assessed for mental health treatment. He said we must do better, so will the Secretary of State commit to putting children front and centre of the 10-year plan, and to making them a priority, because for a decade, the Tories let our children down?

[Wes Streeting]

I strongly agree with the hon. Member. I will talk about the 10-year plan shortly, but I can guarantee that children and paediatric care will be front and centre of that plan. We can do much more to shine a spotlight on paediatric waiting lists, as well as doing much more in practice. She mentioned children and young people’s mental health, on which our parties strongly agree. We will deliver our manifesto commitment to put mental health support in every primary and secondary school in the country, as well as providing walk-in services in every community, so that young people receive the mental health and wellbeing support that they need and do not get to the crisis point reached by far too many of our children.

The hon. Member’s intervention is an example of why I am looking forward to the debate. I hope to listen to contributions and to challenge from all sides of the House. Before I take any interventions from Conservative Members, I advise them that if they want to get a hearing on the NHS ever again, then the first word that should pass their lips is, “Sorry”. Only last week, at the Conservative party conference, we did not see a single shred of remorse or contrition for their appalling record. Indeed, when it comes to the shadow Secretary of State and her party, it seems that sorry is the hardest word.

The NHS is broken. NHS staff do not want to accept that, but it is. According to YouGov, that is what the vast majority of patients say. It is also what staff tell me every time I am on the frontline, but I understand why some people find the word difficult. In the past few weeks, I have met some of the NHS team who happened to be on duty on Monday 29 July. I have listened to paramedics describe the scene they walked into at the community centre in Southport. Children and adults who had been dancing to Taylor Swift were lying bleeding and, in some cases, tragically dying as a result of an unimaginable, senseless, mindless attack. Those paramedics had to make split-second decisions about who to treat and in what order to give the injured the best chance of survival. Security teams cleared busy hospital corridors to shield as many people as possible from the horror. Lab teams mobilised blood supplies. Receptionists fielded calls from panic-stricken patients. Surgical teams across multiple hospitals worked together, fighting to save those young lives. Even now, months later, mental health staff are picking up the pieces for families who are either grieving or going through the unimaginable challenge of supporting their children through what they witnessed.

On that day, those NHS responders—the whole team involved—were the best of humanity confronting the worst. That is who NHS staff are. That is what they do. Let me be clear: the NHS may be broken, but NHS staff did not break it. I want to be clear about this too: what is broken can be fixed. While the NHS may be in the midst of the worst crisis in its history, the biggest asset that we have is the people who work in it. They are up for the challenge, and up for change. The NHS is broken, but it is not beaten. Together with the 1.5 million people working in the health service, this Government will turn our NHS around, get it back on its feet, and make it fit for the future.

[Dr Jeevun Sandher (Loughborough) (Lab)]

Across my constituency, my constituents are struggling to see the GPs they need; indeed, we see that across the whole nation. On Friday, I visited the Park View surgery, where the GPs do not have the necessary resources and cannot move into the premises that they need to be in to treat their patients. Can the Secretary of State assure me that he will follow Lord Darzi’s recommendations and invest in primary care, so that my constituents get the GPs they need and the Park View surgery can move into the premises that it needs, with the capital expenditure that it requires?

[Wes Streeting]

I am grateful to my hon. Friend for his intervention. Of course it is not just in Loughborough that we have a challenge with access to general practice; it is right across the country. I want to be clear, because GPs come in for a lot of criticism: primary care may be broken, and the front door to the NHS may be broken, but GPs did not break it. In fact, there are fewer GPs now than there were in 2015, yet they are providing more appointments. They have worked hard to improve the productivity of general practice, but they are under-resourced. That is why we are committed, as I told the Royal College of GPs just last week, to delivering the shift that we need out of hospitals and into the community—to growing primary care, including general practice, as a proportion of the NHS’s budget, so that we have the GPs needed to treat patients on time.

[Alison Griffiths (Bognor Regis and Littlehampton) (Con)]

Saturday was World Meningitis Day, but in the last year we have seen an almost doubling of meningitis cases in the UK. Does the Secretary of State think that the meningitis vaccination take-up rate is where it should be?

[Wes Streeting]

I am grateful to the hon. Member for her question. No, I do not think that the take-up rate is where it should be. That is why in the short time we have been in office we have put more effort and energy into vaccine take-up, but there is more to do. I welcome her to the House, and will not have a go at her for the record of the people who sat on the Government Benches just before the general election.

[Jess Brown-Fuller (Chichester) (LD)]

At the end of September, a large GP federation serving patients across Sussex suddenly went bust, causing 130 redundancies; patient care was severely affected. The federation reported that the cause was a failure to obtain long-term contracts from any of its major clients, and the erosion of the real-terms value of contracts with both primary care networks and NHS Sussex. Does the Secretary of State agree that protecting continuity of service is key to public confidence in primary care, and will he meet me to discuss this case?

[Wes Streeting]

I am grateful to the hon. Member for her intervention. I wish that this was a challenge only in her constituency; it is a challenge right across the country. As I said to the Royal College of GPs last week, it will take time to rebuild general practice, so that it is back where we want it to be. We would be delighted to hear more from her; I will ensure that my Department makes contact, and that a Minister is in touch about the challenge in her constituency.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for today’s debate. The whole House, and indeed the whole of the United Kingdom of Great Britain and Northern Ireland, wishes him well in bringing forward the changes that we wish to see. An issue that comes to my attention regularly is research and development. We hear in the press every day about new advances in treating diabetes, heart disease, cancer, Alzheimer’s, dementia and rare diseases. When we look at the bigger picture of the NHS, we see the big problems, but sometimes there are smaller issues. Will he reassure us that research and development will be encouraged?

[Wes Streeting]

I strongly agree. Although health is devolved, I look forward to working constructively and closely with Governments right across the United Kingdom of Great Britain and Northern Ireland, because every part of the health system in every part of the UK is going through challenges. We are determined to do that. [Interruption.] I think the hon. Member wants to come in again.

[Jim Shannon]

National Institute for Health and Care Excellence recommendations go from here to Northern Ireland, and then we endorse them; if we do not get them from here to start with, we cannot make people better. That is the point that I was trying to make.

[Wes Streeting]

The hon. Member’s point is taken.

The NHS stands at a fork in the road. There is a choice before us, and the parties represented in the House have different opinions on the best way forward. The first option is for the NHS to continue on its current path—to head down the road to ruin, on a mismanaged decline, with a status quo so poor that patients are forced to raid their savings to go private, and with the worst yet to come, because many Opposition Members believe that all patients should have to put their hands in their pockets when they fall ill. Reform UK has openly stated that it wants to change the funding model and replace it with an insurance-based system, and plenty in the Conservative party want to head in the same direction, chasing Reform UK down the hard-right rabbit hole.

[Victoria Atkins (Louth and Horncastle) (Con)]

That is nonsense.

[Wes Streeting]

The shadow Secretary of State says that it is nonsense. She is very upset about it, so let me point out to her that earlier this year, the Conservative former dentistry Minister, who served in her team, under her leadership, proposed a monthly £10 insurance fee to see a dentist. That is what the Conservatives were planning before the election. [Interruption.] If the hon. Member wants to intervene, I will give way.

[Victoria Atkins]

I will happily intervene. That is simply incorrect. There are a couple of points that the Secretary of State has made that are completely wrong, which I will have to correct in my speech. He is no longer in opposition. He needs to be careful what he says on the record. That is not right.

--- Later in debate ---

[Wes Streeting]

Honestly, Madam Deputy Speaker, “brass neck” springs to mind. Once again, the hon. Member gets to her feet and fails to say the word “sorry”. If she wants to correct the record, how about she stands up and corrects the abysmal record that she and her predecessors lumbered this country with? They took the NHS from being the very best—that is how it was left in 2010—to being the very worst; that is how she inherited it. If she wants to talk about humility, she might like to start demonstrating some before her time in Parliament comes to an end.

If the hon. Member wants to distance herself from her former dentistry Minister, let us turn to the candidate seeking to lead her party who is head and shoulders above the rest with its membership, the right hon. Member for North West Essex (Mrs Badenoch). She wants to go even further. On whether the NHS should be free at the point of use, she told The Times last month:

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

That is what she said about whether the NHS should be free at the point of use. I suspect that she has blamed the journalist for her own words since, but just so that Government Members are clear, that will happen over my dead body. This Labour Government will always defend our NHS as a public service that is free at the point of use, so that whenever someone falls ill, they never have to worry about the bill.

The problem is not, and has never been, the fair, equitable model of funding. It is the same model that we had in 2010, when the last Labour Government delivered the shortest waiting times and highest patient satisfaction in history. A universal, single-payer health service is the fairest, most equitable way to provide healthcare. More than that, in a way that could never have been predicted in 1948 by Attlee and Bevan, it makes the NHS the best placed healthcare system in the world for the revolution taking place in genomics, technology and life sciences. The NHS has the right funding model, but it is not taking advantage of the opportunities in front of it. That is what we need to change.

[Amanda Martin (Portsmouth North) (Lab)]

Under the previous Government, poor investment and a lack of respect for NHS workers, particularly in primary care, resulted in Portsmouth North having over 3,000 patients per GP. That has resulted in over 1,800 people waiting more than a month to see a GP. Despite that, Lord Darzi notes that many of the solutions can be found in parts of the NHS in our constituencies. Will the Secretary of State acknowledge the fantastic initiative and hard work of GPs in Portsmouth North, as they work alongside trainee GPs from King’s College London, and look to push that across the country?

[Wes Streeting]

My hon. Friend is right. In Portsmouth and right across the country, there are people who, against the backdrop of the previous Government, have none the less tried to innovate, do things differently and improve services for patients. Especially given that they sent her to represent them here in Parliament, I am sure they are relieved that they now have a Labour Government on their side.

[Robin Swann (South Antrim) (UUP)]

Chapter 5 of Lord Darzi’s report is about where and how the money should be spent. I know from previous experience that there is a lot of money that can be spent in the national health service, but does the Secretary of State agree that we have to invest to save? We cannot simply move about the money that we currently have in the health service. Investment is needed to allow us to go into the greater detail that Lord Darzi talks about in respect of moving from analogue to digital and from primary care back into the community. That needs investment; it cannot be done simply with the budget that is there.

[Wes Streeting]

I strongly agree with the former Minister. I will take that as a representation for the forthcoming Budget and spending review, and ensure that his comments are sent straight to my right hon. Friends the Chancellor and the Chief Secretary to the Treasury. Without pre-empting future fiscal events, we have been clear for some time that it is investment and reform that deliver results. That is how the last Labour Government delivered the shortest waiting times and the highest patient satisfaction in history. If people are in any doubt about what investment minus reform does, they need only look at what Darzi says about our hospitals: after 2019, lots of resource was poured in, particularly in relation to staffing, but productivity fell. It is investment and reform that deliver results, and this Labour Government will deliver both.

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

One of the moments before the last general election that I will never forget was turning up at Milton Keynes hospital with my 91-year-old grandmother, who we suspected was having a heart attack, only to be told that the average waiting time at that moment was nine and a half hours. Milton Keynes has some of the longest NHS waiting lists in the country, because of the damage done by the last Tory Government. Does my right hon. Friend agree that we all deserve an apology from the Conservatives, not just for the state they left our NHS in, but for going into the election promising a new hospital for Milton Keynes even though they clearly did not have a plan to deliver it?

[Wes Streeting]

I was delighted to visit Milton Keynes hospital with my hon. Friend before the general election. It is doing incredible work in the conditions that he describes; in particular, its innovation in the application of smart, everyday, practical technology to improve patients’ experience is to be commended.

I share my hon. Friend’s anger, his constituents’ anger and the anger of people right across the country in every community—including mine, by the way, where a hospital upgrade was promised. We were told there was a plan and a timetable, and we were told that the programme was fully funded. Then we came into government to find that the timetables were a work of fiction and that the funding runs out in March. That is something else that the shadow Secretary of State should apologise for, and I look forward to hearing her apology. People across the country are owed an apology.

Let me say to every hon. Member who is in the same position that I, my hon. Friend and people across the country are in that we will not play fast and loose with the public’s trust, and we will come forward with a plan for the upgrade of hospitals that is credible, achievable and funded. That is the difference between the way that this Labour Government will behave, in terms of both public trust and public money, and the way that the previous Conservative Government behaved, which was a total disgrace.

[Andrew George (St Ives) (LD)]

On top of coming clean to the public and making a change from the way the previous Government treated the country, will the Secretary of State also assure the House that the Government will establish a proper, effective and honest workforce plan? After the years of Johnsonian bluster, when there was no effective workforce plan, the nurses who are the backbone of the NHS are still being paid £29,000 a year at grade 5. As the Royal College of Nursing says, it is about retention of staff, not just recruitment. They are leaving in droves because they cannot stand the unsafe circumstances in which they are operating.

[Wes Streeting]

The hon. Member is right to raise the issues of recruitment and retention. My message to staff who are thinking of leaving the NHS, or who perhaps have left the NHS in recent years because of working conditions and because there was no light at the end of the tunnel, is to stay—or indeed return—and help us to be the generation that takes the NHS from the worst crisis in its history, gets it back on its feet and ensures that it is fit for the future.

On the workforce plan, let me just say that it was regrettable that it was only at 5 minutes to midnight that the previous Government published such a plan. We were highly flattered by the fact that so much that underpinned that plan was Labour party policy commitments, such as doubling the number of medical school places and increasing the number of nursing and midwifery clinical training places. We are committed to those headline commitments. We will inevitably want to update the workforce plan in the light of the 10-year plan and some of the analysis that underpins Darzi. We are clear that that kind of long-term workforce planning is essential, and we are committed—

[Shockat Adam (Leicester South) (Ind)]

rose—

[Wes Streeting]

I must make some progress; I will try to take more interventions shortly.

The public are clear that they do not want the NHS to be sacrificed. They gave Labour our marching orders at the general election to rescue the NHS and turn it around, and that is what we will do. I appreciate that the shadow Health Secretary must be embarrassed by all this, not just by the state that she and her Conservative predecessors left the NHS in, but by what Conservative Members have been saying. I was going to say, “Members who are sat behind her,” but they are actually not—I think they are hiding in shame. [Interruption.] The shadow Health Secretary says from a sedentary position that we have already had this discussion. The Conservatives would rather we just moved on and forgot their abysmal record. Well, I am afraid that we are not ready to do that just yet. At least some of her Back Benchers now say what they refused to say when they were in office: that the NHS is broken. Some of them even admit that only Labour can fix it.

When the shadow Secretary of State stands up, I wonder whether she can tell us whether she agrees with the hon. Member for Mid Norfolk (George Freeman), who said:

“I applaud Wes Streeting for having the political courage. I think only Labour can really say this. The NHS is sort of their thing…I really hope that we can get behind him”.

It is not just Back Benchers. What about the shadow Foreign Secretary, the right hon. Member for Sutton Coldfield (Mr Mitchell)? He said:

“I’m very supportive of what Wes Streeting is saying… The Conservative government put a lot of money into the NHS, the record is there for all to see… I’m not one of those who is seeking to attack…the Labour Party on the NHS.”

He is going for my vote, but sadly—or gladly—I am not qualified to vote in that particular election. Perhaps the shadow Health Secretary can tell us what the shadow Foreign Secretary meant when he said we were not—[Interruption.] She is clearly enjoying this. Was the shadow Foreign Secretary speaking for the shadow Cabinet? [Interruption.] No, he was not.

Let me move to my favourite comments on the NHS from a Tory MP. This right hon. Member said:

“We were not obsessed with how we can ensure that it actually delivers the experience that patients actually deserve…Out of fear of our opponents mischaracterising our efforts, we shirked the difficult decisions…If Wes Streeting comes forward with genuine reforms I think we should back him.”

Those are the words of the candidate that the shadow Health Secretary is backing to lead her party, so does she agree with the right hon. Member for Newark (Robert Jenrick)? Will she finally apologise for her part in the Tories’ abysmal record and have the humility to admit that when it came to NHS reform their cupboard was bare, and that actually they quite agree with our efforts to clean up the mess that they left behind?

For all the agreement with our diagnosis and praise of our plans, the problem is that there is no apology. Of the four leadership candidates and eight former Health Secretaries, not a single one has apologised for the state they left the NHS in. Would the shadow Health Secretary like to correct that record today and finally say sorry? I expect that we might have to wait a long time. While the Conservatives continue the longest leadership election in history, we are getting on with the job of cleaning up their mess.

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

The reform that we desperately need includes the so-called “left shift” out of hospitals and into primary care. Yet under the previous Government, the amount of money spent on hospitals went from 47% to 58% of the NHS budget. According to Age UK, every day 2,000 people are admitted to hospital who could be treated elsewhere and earlier. Does my right hon. Friend agree that the only way to fix the NHS is to get more and better care in the community?

[Wes Streeting]

My hon. Friend is absolutely right, and that brings me to our reform agenda.

To deliver the Government’s reform agenda, we will have to take on both left and right-wing orthodoxies—for simplicity’s sake, we will call them The Guardian and the Daily Mail. The Daily Mail agrees on the need for health service reform, but attacks proposals for public health reform as “nanny state”. The Guardian loves prevention, but all this talk about health service reform makes it very nervous. The truth is that the Daily Mail and The Guardian are half right and half wrong. We all need to face up to the challenges of today. Our society is getting older and living longer but becoming sicker sooner. Those rising tides of demands and costs are combining to form a perfect storm that threatens to shipwreck the NHS.

[Shockat Adam]

Will the Secretary of State give way?

[Wes Streeting]

I must make progress.

The right must accept that without reform on public health, we will pay a heavy price, with higher taxes and poorer quality of life—exactly the sort of dependency culture that the right rails against. The left must accept that investment without reform of the health service would be killing the NHS with kindness, with more cash and poor results until the public give up altogether.

[Several hon. Members rose—]

[Wes Streeting]

I must make more progress.

That is the choice: public health reform or higher taxes; NHS reform or no NHS. The Tories did neither; Labour will do both. It really is reform or die, and we choose reform. That is why this month we will begin formal engagement with NHS staff and patients, who will help to write the 10-year plan for our NHS—a plan that will deliver the change and modernisation that our health service is crying out for—with three big shifts in its focus.

First, a shift from hospital to community will turn the NHS into a neighbourhood health service as much as a national health service, so that patients get more of their tests, scans and healthcare on high streets and in town centres in their own community, and from the comfort of their own home. It will ensure that patients can easily book appointments to see the GP they want to see in the manner that they choose, and it will bring back the family doctor, rebuild NHS dentistry and build a national care service.

[Shockat Adam]

Will the Secretary of State give way?

[Wes Streeting]

I must make progress. There are lots of speakers and little time.

Secondly, there will be a shift from sickness to prevention. It will mean that we take action to give our children a healthier and happier life, flattening the curve of rising pressures that threaten to overwhelm the NHS by building a healthier society, which will help to build a healthier economy.

Thirdly, there will be a shift from analogue to digital. Upgrading the NHS app will give patients real choice and control over their own healthcare, creating a single patient record owned by the patient and shared across the system so that every part of the NHS has a full picture of the patient that they are treating. Getting the NHS working hand in glove with our country’s leading scientists will put modern technology and equipment in the hands of NHS staff, and patients at the front of the queue for the latest treatments.

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

rose—

--- Later in debate ---

[Wes Streeting]

I must begin to conclude my remarks, Madam Deputy Speaker, but I see that the Chair of the Select Committee on Health and Social Care is seeking my eye. Given that I will be before her Committee soon and know where my bread is buttered, I give way.

[Layla Moran]

The Secretary of State is very kind indeed. I can take no credit for what I am about to say, which comes from reports on prevention and digital transformation published by the previous Select Committee, which he would do very well to look at. What those reports say is very much echoed in Lord Darzi’s report—particularly that the place-based narratives about embedding the NHS into our communities are key, as is reform of Government as a whole, and embedding health in every Department. Will he say a bit more about reform in Government, and not just reform in the NHS?

[Wes Streeting]

I strongly agree with the Chair of the Select Committee and commend the work of the previous Committee, to which she refers. She has certainly given me some revision for the first meeting that I will attend. To answer her question, she is absolutely right that digital transformation and place-based healthcare planning are key. This Government will have a much sharper focus on health inequalities than the previous Government did. In fact, if we consider the NHS over the past 30 or 40 years, even when it has performed well overall, and patients in every part of the country have received access to timely care, some health systems have still been more challenged than others. We need to be honest about the structural challenges in those areas. Secondly, she is absolutely right that, if we are serious about health and prevention, we need a serious cross-Government approach. That is why I am delighted that the Prime Minister’s mission-driven approach has already seen Departments coming together with a focus on prevention. That will deliver fruit.

This is the major surgery that our national health service needs over the next decade to make it fit for the future. There is no time to waste, so we have hit the ground running. We inherited a Care Quality Commission that is not fit for purpose. I was genuinely stunned to learn that one in five health and care providers has never been inspected; some hospitals have been left uninspected for a decade; and inspectors were sent to care homes when they had never met someone with dementia. The Conservatives did not think that patients would like the answers, so they stopped asking the questions. This Labour Government are different: we will be honest about the problems facing the health service, and serious about solving them. Our policy is radical candour.

Today I am delighted to announce that Sir Julian Hartley has been appointed the new chief executive of the CQC. He is a proven reformer with a track record of turning around large organisations, and I am confident that he will provide the leadership that staff in the CQC need to address this crisis, improve patient safety and restore confidence in the regulator. Sunlight is the best disinfectant, so this Government are taking action to turn the regulator around. That is the difference a Labour Government make.

We inherited the farce of newly qualified GPs facing unemployment. Patients could not get a GP appointment, while GPs could not get a job, so we cut red tape, found the funding and are recruiting an extra 1,000 GPs. That is the difference a Labour Government make. We have tabled a motion to ban junk food ads targeted at children —our first step towards making our country’s children the healthiest generation that has ever lived. That is the difference a Labour Government make. Just this week, the Secretary of State for Science and Technology and I announced funding to produce new cutting-edge cancer treatments: a new blood test that can detect 12 different cancers. We are backing Britain’s scientists to save lives. That is the difference a Labour Government make.

Of course, strikes in the NHS have cost taxpayers billions. Patients saw 1.5 million operations and appointments cancelled. The Conservatives saw strikes as an opportunity to scapegoat NHS staff, so they let the strikes rage on. In fact, the shadow Health Secretary had not even bothered to meet the junior doctors since March. This Government do not exploit problems; we solve them. I called the junior doctors on day one and met them in week one, and in just three weeks, we had negotiated a deal to end the strikes. That is the difference a Labour Government make.

Those are just our first steps. Rebuilding the NHS will not be easy and it will take time, but we have done it before and we will do it again. Along with the millions of dedicated staff in health and social care across our country, this can be the generation that takes the NHS from the worst crisis in its history to build an NHS fit for the future—an NHS that is there for us when we need it, with world-class care for the many, not just the few. That is the change that Britain voted for; that is the change we will deliver together; and that change has already begun.

[Madam Deputy Speaker (Judith Cummins)]

Before I bring in the Opposition Front Benchers, the House should be aware that over 50 Members wish to speak in the debate, so I ask you to help each other. On this occasion, I will impose a three-minute limit on Back-Bench speeches, with the exception of maiden speeches and that of the Chair of the Health and Social Care Committee. I call the shadow Secretary of State.

--- Later in debate ---

[Victoria Atkins]

I will help the hon. Gentleman, because I appreciate that he is new to this place. If he had been listening carefully to me, he would have heard that I am and have always been—in fairness, I hope the Health Secretary would acknowledge this as well—very open about the fact that the NHS needs reform. In fact, I said as Secretary of State that I wanted to reform our NHS to make it faster, simpler and fairer.

By the way, I speak with personal experience. I know there are some Members on the Back Benches who are new to this place and perhaps have not quite moved on from the natural competitiveness of a general election campaign, but I was diagnosed with type 1 diabetes at the age of three. I have seen the very best of the NHS, but I have also seen some of its darkest corners. The NHS is genuinely one of the reasons why I came into politics, and one of the most damaging things about political discourse and the healthcare system in this country is when people seek to attribute to others a lack of care or commitment to our healthcare system, just because we have different ways of tackling these challenges and different solutions.

This is why—I will say this again, because I am not sure that the right hon. Gentleman is listening—I will work constructively with him to improve the health service, but we have to do this on the facts. Some of the suggestions he made in the debate today and in his discourse during the general election campaign and so on are not accurate, and this is where I will pull him up. For example, he has not mentioned the introduction of Pharmacy First or the 160 community diagnostic centres. Just to help him, those were backed by the largest central cash investment in MRI and CT scanning capacity in the history of the NHS. Those, as well as the new surgical hubs that we introduced, are not only putting healthcare into the community but, critically, helping to improve the numbers of chest checks and scans going through the system, which means speedier diagnosis.

[Wes Streeting]

The right hon. Lady mentions Pharmacy First. How many pharmacies went bust on her watch?

[Victoria Atkins]

As the right hon. Gentleman knows, because I imagine he will have got exactly the same briefing I used to get when I was in his shoes and being advised by exactly the same civil servants—and I am having to let this flow back into my memory here—the average person in England is within walking distance of their pharmacy. He will know that in many high streets in our market towns, as well as in London and other urban areas, there is a density of pharmacies. We want to support those pharmacies to ensure they are able to provide the services that they can provide, and in fairness, to enable pharmacists to work at the top of their licences. He supported Pharmacy First when I introduced it, so I am a little surprised that he appears to be casting doubt on it, but I am grateful for his intervention.

The next point is that our women’s health strategy—it does not have the attention from his ministerial team that it should have at the moment, and I hope that will improve over the coming months—is seeing the roll-out of women’s health hubs across England into every integrated care board area by the end of this year, ensuring that women’s health issues receive the attention they deserve.

Of course, there are parts of the NHS that need to change and do much better. The NHS needs to reform for the future of healthcare, and our focus must be on improving outcomes for patients, not protecting structures, bureaucracy and vested interests in the NHS. As I have said repeatedly, we will scrutinise constructively and support any meaningful efforts to reform the NHS to improve outcomes and experiences for patients, because we all want the NHS to thrive.

However, after nearly 100 days, there has not been anything yet for us to scrutinise or indeed support from this Government. [Interruption.] The Secretary of State says he has just given me a list. Interestingly, I am pretty sure that three out of those four were started under my Government. [Interruption.] I am pretty sure that I was the Secretary of State who ordered the review of the Care Quality Commission, precisely because I was so concerned. He will be able to build on that report, and quite rightly so, but he should please be careful of his facts. Disappointingly, it is the right hon. Gentleman’s fondness for parties and concerts that has made the news recently, rather than his health policies. This Government need to sober up and start taking responsibility for their choices.

--- Later in debate ---

[Victoria Atkins]

I am going to make some progress.

One of the choices facing the Health Secretary is whether he will fight for the investment required from the Treasury to implement the productivity plan. At spring Budget, the Conservatives announced more than £3.4 billion of investment to upgrade IT systems, expand services on the NHS app and make better use of artificial intelligence, in order to reduce bureaucracy for staff and free up clinical time for doctors and nurses. Alongside the long-term workforce plan—the first ever in the history of the NHS—this plan will see productivity grow by 2% a year by the end of the decade and unlock £35 billion of savings, yet the productivity plan is not mentioned anywhere in this 163-page report.

This plan was made in partnership with NHS England and funded by the Conservative Government. While the right hon. Gentleman has talked a good game on productivity, we are still waiting for him to confirm his commitment to deliver the plan that was drawn up with NHS England to help improve productivity. I asked him three weeks ago whether he was cancelling this plan, and he failed to answer. I am very happy to give way now if he wants to commit to it. The whole NHS would like to know.

[Wes Streeting]

I am delighted that the shadow Secretary of State has so generously given way. I am not going to pre-empt the Chancellor’s announcements at the Budget and the spending review, but I say to her that the reason why so many of the things she said at this Dispatch Box as Secretary of State were a pile of nonsense is that they were plans built on a pillar of sand—a £22 billion black hole for which she and her party are yet to apologise. Will she do that now?

[Victoria Atkins]

As the right hon. Gentleman knows, calculations were made in the Treasury for this economic inheritance, but the Treasury cannot even explain how it has arrived at those calculations. If I were him, I would be a little bit careful of relying on that figure, because I fear it may trip up his Chancellor in due course. Perhaps the reason why he cannot answer the question about whether he is in fact committed to the productivity plan is that his friend the former Health Secretary, who has been walking in and out of the Department for Health with all of his private healthcare businesses, has not told him whether he plans to accept it, but we will find that out in due course.

The Secretary of State’s silence continues with new medicines, technology and trials. These will be at the forefront of the reforms needed in health services across the world, let alone the NHS, yet the Darzi report mentioned NICE only once in 163 pages. Even worse, I am hearing from the life sciences sector that he and his team are refusing to meet these businesses, putting at risk the hundreds of millions of pounds of investment that the Conservative Government secured, as well as the highly skilled jobs they provide and the life-enhancing treatments they promise our constituents. It is his responsibility to persuade the Chancellor to continue supporting and investing in this innovation for the future, because patients will not thank Labour if it refuses to engage in the medical revolution with these businesses.

Another choice that the right hon. Gentleman must make—we perhaps have a precursor of what he is going to say—concerns the workforce. We know that NHS staff are at the heart of our healthcare services, and that training, retaining and developing our workforce is critical to the future of the NHS. The Conservative Government created the first ever long-term workforce plan for the NHS—again, a plan that was asked for and welcomed by the whole NHS, and developed hand in hand with NHS England to train the doctors, nurses, midwives and other healthcare staff that we need now and in the future. The plan was described by NHS England’s chief executive as

“one of the most seminal moments in our 75-year history.”

Crikey, even the right hon. Gentleman supported it. Yet this supposedly independent investigation failed to mention the plan once. Will the right hon. Gentleman confirm that this Government stand by this plan and will fund it as the Conservatives would do? [Interruption.] He says that he talked about it, but he did not give an answer, because his job is to ask the Chancellor for this funding—has he done so?

[Wes Streeting]

I did.

[Victoria Atkins]

Right, okay. We have that on the record now and we will wait to see what happens at the Budget.

It is also striking that the report mentions pay and wages only twice in 163 pages, despite the fact that staff costs account for 65% of provider operating costs a year. If the report and the Secretary of State do not acknowledge the single biggest cost pressure for providers, how can they claim to have the answers on reform? He claims to have sorted out industrial action in the NHS, and I must again correct him on something. He keeps referencing when I last had a conversation with the junior doctors committee, as it then was. What he neglects to tell us is that we entered mediation with junior doctors in May—he never thinks to mention that when he is holding forth at the Dispatch Box.

[Wes Streeting]

How did it go?

Points of Order

Wes Streeting Excerpts

Thursday 12th September 2024 Commons Chamber

[Mims Davies (East Grinstead and Uckfield) (Con)]

On a point of order, Madam Deputy Speaker. We are all passionate about our hospices, our hospitals, our GP practices and the other health services that our constituents get. Coming to this place is not for the faint-hearted, but is it appropriate for the Secretary of State for Health and Social Care to adopt the tone that he brought to the Chamber earlier? As I say, we are all passionate, but perhaps his tone—his bedside manner, may I say—needs a new approach on occasion. I noted his more collegial tone later in the statement, but to tell Opposition hon. Members—we are all hon. Members in this place—to sit down and listen, or to liken some previous holders of his role to arsonists and similar paraphernalia, is not befitting of this Chamber.

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

Further to that point of order, Madam Deputy Speaker. I like the hon. Lady very much, and I will just say two things in response: first, she has been around in this Chamber a long time. Conservative Members cannot sit and heckle, then get cross when Ministers respond robustly. Secondly, I think that was a perfectly legitimate analogy; indeed, I might say that the arsonists should not complain about the fire brigade.

[Madam Deputy Speaker (Judith Cummins)]

I remind all hon. Members that good temper and moderation are the characteristics of a good debate.

NHS: Independent Investigation

Wes Streeting Excerpts

Thursday 12th September 2024 Commons Chamber

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

With permission, I would like to make a statement on Lord Darzi’s investigation into the NHS.

Unlike the last holders of this office, this Government will be honest about the problems the NHS faces and serious about fixing them. That is why I asked Lord Darzi, an eminent cancer surgeon who served both Labour and Conservative-led Governments with distinction, to conduct an independent investigation into the state of our national health service. I am sure the whole House will want to join me in thanking him for producing this expert, comprehensive report, a copy of which I have placed in the Libraries of both Houses.

I told Lord Darzi that we wanted hard truths, warts and all. His findings are raw, honest and breathtaking. He says:

“Although I have worked in the NHS for more than 30 years, I have been shocked by what I have found”.

He has uncovered an enormous charge sheet, too long to list in this statement, so these are just a few: the NHS has not been able to meet its promises to treat patients on time for almost a decade; patients have never been more dissatisfied with the service they receive; waiting lists for mental health and community services have surged; 50 years of progress on cardiovascular disease is going into reverse; and cancer is more likely to be a death sentence for NHS patients than for patients in other countries. It is not just the sickness in the NHS that concerns Lord Darzi, but sickness in society. Children are sicker today than a decade ago and adults are falling into ill health earlier in life. That is piling pressure on to the NHS and holding back our economy.

Those are some of the symptoms; the report is equally damning on the causes. First, a decade of under-investment left the NHS 15 years behind the private sector on technology, with fewer diagnostic scanners per patient than almost every comparable country, including Belgium, Italy and Greece, and in 2024 mental health patients are treated in Victorian buildings with cockroach and mouse infestations, where 17 men are forced to share two showers.

Secondly, there was the disastrous 2012 top-down reorganisation overseen by Lord Lansley. Lord Darzi’s assessment is damning:

“A calamity without international precedent…it took a ‘scorched earth’ approach to health reform”.

“By 2015…ministers were…putting in place ‘workarounds and sticking plasters’ to bypass the legislation”.

“Rather than liberating the NHS, as promised, the Health and Social Care Act 2012 imprisoned more than a million NHS staff in a broken system for the best part of a decade”.

“the effects…are still felt to this day.”

Just imagine if all the time, effort and billions of pounds wasted on dissolving and reconstituting management structures had instead been invested in services for patients—clearly, the NHS would not be in the mess it finds itself in today.

Thirdly, there was coronavirus. Everyone can see the lasting damage caused by the pandemic, but until now we did not know that the pandemic hit the NHS harder than any other comparable healthcare system in the world.

The NHS cancelled far more operations and routine care than anywhere else. As Lord Darzi writes:

“The pandemic’s impact was magnified because the NHS had been seriously weakened in the decade preceding its onset.”

In other words, it is not just that the Conservatives did not fix the roof while the sun was shining; they doused the house in petrol and left the gas on, and covid just lit the match. That is why waiting lists have ballooned to 7.6 million today. [Interruption.] If I were an Opposition Member, I would not complain about the diagnosis. I would take responsibility.

Fourthly—this sits firmly at Opposition Members’ door, so they should sit and listen—there was the failure to reform. From 2019 onwards, the previous Government oversaw a 17% increase in the number of staff working in hospitals. Did it lead to better outcomes for patients? No. At great expense to the taxpayer, the NHS has instead seen a huge fall in productivity. We paid more, but got less—a deplorable waste of resources when so many parts of our health and care services were crying out for investment. As Lord Darzi has put it:

“British Airways wouldn’t train more pilots without buying more planes.”

Doctors and nurses are wasting their time trying to find beds for their patients and dealing with outdated IT when they ought to be treating patients.

Too many people end up in hospital because they cannot get the help that they need from a pharmacy, a GP or social care. The effective reforms of the last Labour Government, which drove better performance and better care for patients, have mostly been undone, and that is why patients cannot get a GP appointment, an operation or even an ambulance when they need one today. That is what the Conservatives did to take the NHS from the shortest waiting times and highest patient satisfaction in history to the broken NHS that we see today.

Lord Darzi has given his diagnosis. Now it is over to us to write the prescription, and we have three choices. The first is to continue the Conservatives’ neglect, and allow the NHS to collapse. That is the path on which they set the NHS, and the path that it is on today. Or we could—as some of my critics on the left demand—pour ever-increasing amounts of money in without reform, wasting money that is not there and that working people cannot afford to pay. That would be wasteful and irresponsible, so we will not take that path. This Government are making a different choice: we choose recovery and reform. We are taking action today to deal with the immediate crisis by hiring 1,000 GPs whom the Conservatives had left without a job while patients were going without an appointment, and agreeing an offer to end the strikes that they allowed to cripple our health service.

At the same time, we will introduce the fundamental reforms needed to secure the future of our NHS. Earlier today, my right hon. Friend the Prime Minister confirmed that the Government would publish a 10-year plan for change and modernisation, on the foundation of Lord Darzi’s report. Our plan will deliver the three big shifts needed to make our NHS fit for the future. The first is from analogue to digital, giving patients proper choice and control over their own healthcare, and finally realising the untapped potential of the NHS app. There will be fully digital patient records so that your surgeon can see the notes that your GP writes. By marrying our country’s leading scientific minds with the care of more than 1.5 million NHS staff, we will put NHS patients at the front of the queue for cutting-edge medicines and treatments that we can only imagine today.

Secondly, there is the shift from hospital to community, turning our NHS into a neighbourhood as much as a national health service so that patients can get their tests and scans on their high streets and be cared for from the comfort of their own homes. That means bringing back the family doctor and building a national care service that can be there for us when we need it, able to meet the challenges of this century.

Thirdly, there is the shift from sickness to prevention, which means taking the decisions that the Conservatives ducked to give our children a healthy, happy start in life. It means stopping the targeting of junk food ads at children, banning energy drinks for under-16s, reforming the NHS to catch illness earlier—starting by offering health checks in workplaces and on smartphones—and delivering the Tobacco and Vapes Bill that the Conservatives failed to pass, to tackle one of society’s biggest killers.

Lord Darzi’s diagnosis is that the NHS is in a “critical condition”—unless we perform major surgery, the patient will die—but he also finds that

“its vital signs are strong”:

an extraordinary depth of clinical talent, and a shared determination to improve care for patients. This is a public service, free at the point of use, so that whenever we fall ill we never have to worry about the bill. The NHS is broken, but it is not beaten. Every person I have met in the NHS during my first two months as Health and Social Care Secretary is up for the challenge. It will take time, but this party—the party that created the NHS—has turned the NHS around before, and we will do it again. I commend this statement to the House.

[Mims Davies (East Grinstead and Uckfield) (Con)]

On a point of order, Mr Speaker.

[Victoria Atkins (Louth and Horncastle) (Con)]

Thank you, Mr Speaker. I thank the Secretary of State for advance notice of his statement.

The NHS belongs to us all, and we all care about it, so let us stop the political posturing and talk constructively about its future. We all know that our healthcare system faces significant pressures, as do all health systems around the world. We are living longer, and with multiple and complex conditions. We have wider societal pressures, such as the impact of social media on the development of some young minds, as well as the cost pressures of miracle drugs developed by our world-class life sciences sector for their treatment benefits, and the shock of the pandemic has had catastrophic impacts on the NHS and its productivity.

I believe there is much to be proud of in the NHS. Its dedicated staff look after 1.6 million people a day— 25% more people than in 2010. It has more doctors, more nurses and more investment that at any point in its history. It is delivering tens of millions more out-patient appointments, diagnostic tests and procedures for patients than in 2010, and we delivered the fastest roll-out of vaccinations for covid in the world, freeing our society more quickly than other countries. We have more healthcare in the community, with the opening of 160 community diagnostic centres—the largest central cash investment in MRI and CT scanning capacity in the history of the NHS—and 15 new surgical hubs; and the launch of Pharmacy First, helping to free up 10 million GP appointments for those living with more complex conditions. [Interruption.] I say to the Secretary of State that I paid him the courtesy of listening to him in silence, so I hope he will do the same for me.

[Wes Streeting]

I didn’t say anything!

[Victoria Atkins]

The right hon. Gentleman was chuntering from a sedentary position. We on the—[Interruption.]

--- Later in debate ---

[Mr Speaker]

Order. I am sorry; I meant that you were to conclude now, not to continue with the rest of the speech. I call the Secretary of State.

[Wes Streeting]

The first word that the shadow Secretary of State for Health and Social Care should have said was “sorry”. She says that she never pretended everything was fixed, and that is true, but it is about time that she admitted that it was her party that broke the NHS in the first place.

In fact, it has been a feature of debate in the House since the general election that the Opposition have taken absolutely no responsibility for the mess they left our country in, including a £22 billion black hole and the new hospitals programme that the right hon. Lady referred to, in which the timetables were a work of fiction and the money ran out in March. She knew that when she went to the country to claim that the programme was fully funded. She talks about the decisions made by NICE; that was a new Labour reform and modernisation—one that thankfully survived the last 14 years.

The right hon. Lady has endorsed the right hon. Member for Newark (Robert Jenrick) in the Conservative party leadership election. I wonder what she makes of his admission that the Conservatives failed to make the tough reforms that the NHS needed because they were afraid of what Labour might say. Is that not the most derisory excuse for 14 years of neglect?

My predecessor does not bear responsibility for everything in the Darzi report—this crisis was more than a decade in the making—but I wonder when the right hon. Lady will show some humility on behalf of her party and apologise for the mess that her Government made of our national health service. Otherwise, why should anyone trust what the Conservatives have to say ever again?

This Government were given a mandate for change, and nowhere is that more needed than in our NHS. The report must mark the beginning of the long, hard work of change. It is the platform from which we will launch a decade of reform that will make sure that the NHS can be there for us when we need it—for us, our children and our grandchildren. It must draw a line in the sand, so that we never go back to the pain, fear and misery that the Conservative party inflicted on millions of patients.

[Several hon. Members rose—]

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

Thank you, Mr Speaker. I will rise to the challenge.

I welcome the Secretary of State’s statement. In 2008, the previous Labour Government commissioned a report from Sir Michael Marmot on the state of society and health, and he found that there was health inequality, particularly in deprived areas. Ten years on, his second report found that health inequality had become even worse against the backdrop of an underfunded NHS. Does that not demonstrate the urgency of the need to invest in those communities under this Government? What can my right hon. Friend do to direct resources into the most deprived communities in order to turn around those health inequalities?

[Wes Streeting]

My hon. Friend is absolutely right that our country has stark health inequalities. It is not right that people who live in different parts of the country have such different chances of living well. A girl born in Blackpool can expect to live healthily until she is 54, whereas a girl born in Winchester can expect to live healthily until she is 66. That is why, with the Prime Minister’s mission-driven approach, we will not just get our NHS back on its feet and make sure it is fit for the future; we will also reduce the cost and burden of demand on our national health service by attacking the social determinants of ill health.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Daisy Cooper (St Albans) (LD)]

Much of the content of Lord Darzi’s report has been known for some years. None the less, today’s report is a scathing summary of the complete devastation that the Conservatives have wrought on our health services and on the health of our communities. We Liberal Democrats have long argued that we need to shift healthcare from hospitals to high streets, and from treatment to prevention, because doing so improves health outcomes and saves taxpayers’ money. It is a win-win.

But the report is long on diagnosis and short on prescription, so may I invite Ministers to read our fully costed manifesto to fix public health and primary care by recruiting 8,000 GPs, ending dental deserts, boosting public health grants by £1 million, implementing our five-year plan to boost cancer survival rates, and putting a mental health expert in every school?

Does the Secretary of State accept that there is an elephant in the room: social care? Will he meet me to discuss the Liberal Democrat plans for social care, starting with free personal care? This bold idea would prevent many people from going into hospital in the first place, as well as enabling them to be discharged from hospital faster. Does he accept that it is a truth universally acknowledged that we cannot fix the NHS if we do not fix social care too?

As for the dire state of our hospitals and primary care estate, well, the Conservatives have left it to fester like a wound. Will the Secretary of State give the green light to hospitals that are ready to rebuild, such as mine in west Hertfordshire? Will Ministers look to reform outdated Treasury rules that are preventing our integrated care boards and hospital trusts from spending and investing their funds in the GP practices and hospitals that we need? This Government say that they want growth. Well, health and wealth are two sides of the same coin, which is something the Conservatives do not understand. If Labour wants economic growth, fixing our health and social care must be its top priority. And it must be a priority without delay.

[Wes Streeting]

How refreshing to have constructive opposition in the Chamber. It was clear throughout the election campaign that my party and the Liberal Democrats have much in common, both in the commitments we made, which in some cases were identical, and in our shared areas of emphasis: the link between health and wealth, the importance of prevention and the importance of social care.

As the Prime Minister reiterated again this morning, we are absolutely determined to address both the short-term crisis and the long-term needs of the century in our social care system. We want to work on a cross-party basis wherever possible, so I would be delighted to meet the Liberal Democrat spokesperson.

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

Hundreds of thousands of operations, including dozens of my own lists, were cancelled because of the strikes in the NHS over the past two years. Does the Secretary of State agree that the Conservatives’ refusal to negotiate with the doctors contributed to the terrible state of the health service, and that ending the strikes is the first step towards fixing the NHS?

[Wes Streeting]

It sticks in the craw to hear the carping and criticism from the Conservatives, and their obvious bitter resentment that we were able to do in three weeks what they failed to do in over a year. All the while they complain about the costs of solving the strikes, they say nothing about the costs they racked up—the direct financial costs of covering the strikes, as well as the untold costs of misery to patients whose operations, procedures and appointments were cancelled, even as the shadow Secretary of State for Health and Social Care and her Ministers had not even bothered to meet the junior doctors since March this year. The Conservatives have no grounds to complain.

[Mims Davies (East Grinstead and Uckfield) (Con)]

I thank those who daily work in NHS services across our country. If the Secretary of State is truly serious about assisting and supporting the whole of our NHS in England, across all our constituencies, “warts and all”, as he says, will he explain thoroughly why the health outcomes and experiences of families across Wales, over the last 25 years, do not merit this attention equally? Is it perhaps because Wales is Labour-run?

[Wes Streeting]

I have never denied, nor have the Welsh Government, that our health and social care systems are in crisis across the United Kingdom, and that waiting times and patient outcomes are not where they should be. [Interruption.] The Conservatives do not wish to acknowledge the truth, and even now, without a shred of humility or acceptance of the responsibility of their record in government, they carp from the sidelines. They will not admit or accept that different parts of the United Kingdom have different strengths and weaknesses.

Regardless of the fact that there is a Scottish National party Government in Scotland or a unique arrangement in Northern Ireland, as well my friends in the Welsh Government, I am proud that in my first weekend as Secretary of State for Health and Social Care, I made it my business to phone my counterparts in Scotland, Wales and Northern Ireland. I made it clear that we will always work constructively, whatever our parties and however hard we will fight each other at the ballot box. Rather than pointing fingers at other parts of the United Kingdom, as the Conservatives did when they were in government, this Government are determined, just as the last Labour Government were, to create a rising tide that lifts all ships. I look forward to working with every devolved Administration to improve health and care outcomes across the whole of our United Kingdom.

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

The Secretary of State is right that the future of our NHS lies in reform, and not waiting until people get sick before we intervene to keep them well, but we cannot do that without money. He says we cannot waste money that is not there, but we are wasting money that is there on the contracts we have with the private sector. He knows I feel strongly about this issue. Millions of pounds are being paid to private equity-backed funds to run sexual health centres in the NHS—the iCare clinics. Billions of pounds are being lost to the legal loan sharks of our NHS—the private finance initiative companies—and some trusts are spending more on PFI payments than on drugs. As part of the process, will he commit to an urgent review of the way in which the NHS has worked with the private sector, because reform must also include restructuring our debt?

[Wes Streeting]

My hon. Friend has done a lot of work in this area and I would be delighted to meet her. Let me give the Conservative party a lesson in humility. However proud I am of the last Labour Government—and I am incredibly proud of what they did to our health estate, the investment they brought in, through a range of different types of private financing, and the impact that had; I can see the benefits in my own constituency— I have never shied away from what we did not get right. At the same time as celebrating what we got right in government, we must reflect on what we did not get right and genuinely learn those lessons, which is what we did in opposition. It took us too long to get back into government—we will learn from that for the future—but it has been really interesting to listen to Conservative Members over the past nine weeks. They have not learned anything, they have not got the message and they are not going to change.

[Dr Kieran Mullan (Bexhill and Battle) (Con)]

As Labour embarks on a reform programme, may I ask whether the Secretary of State has read the report of the Mid Staffordshire public inquiry, which looked at the shocking patient neglect last time Labour was in charge? Reading it might temper the hubris that he is showing in the Chamber today, in the face of the challenges that his colleagues in Wales have certainly not managed to overcome.

[Wes Streeting]

I gently point the hon. Gentleman to the bold claims made by the now shadow Chancellor, the right hon. Member for Godalming and Ash (Jeremy Hunt), about patient safety. He might like to reflect on every subsequent patient safety scandal. In fact, he might want to walk into maternity services across the country and ask himself whether the Conservatives bothered to learn lessons on patient safety.

[Nick Smith (Blaenau Gwent and Rhymney) (Lab)]

Pharmaceutical producers Auden Mckenzie and Actavis UK charged excessive and unfair prices for hydrocortisone tablets. NHS spending on those products rocketed because producers gamed the system. How will my right hon. Friend ensure that future procurement processes deter the rigging of drug prices?

[Wes Streeting]

My hon. Friend makes a great point, and he has given great service to the Public Accounts Committee of this House by drilling into waste, inefficiency and exploitation of the public purse. I want to work with the great life sciences sector and pharmaceutical industry in this country and globally, but in a spirit of genuine partnership. A really good working relationship requires social responsibility; it certainly involves not ripping off the taxpayer.

[Andrew George (St Ives) (LD)]

I welcome the report. The previous Government left this Government with NHS and care services in the worst crisis in their history. The Secretary of State led by emphasising the decade of underinvestment; that needs to be coupled with pointing out the very weak workforce planning. When he meets the Liberal Democrats, will he review our costed plan to raise the investment necessary to address the issues highlighted in the report and to strengthen workforce planning in order to deliver services?

[Wes Streeting]

Fiscal policy is a matter for the Chancellor. I know on which side my bread is buttered, so I will not write her Budget or spending review now, but let me reassure the hon. Gentleman that, notwithstanding the £22 billion black hole that the Conservatives left in the public finances this year and the weak foundations of our economy that we have inherited, the Chancellor knows as well as I do that it is investment and reform that will deliver results. It will take time—we cannot reverse more than a decade of underinvestment in a single Budget or even a single spending review—but at least we have a Government able to face up to the hard choices and capable of making them.

[Jo White (Bassetlaw) (Lab)]

I very much welcome Lord Darzi’s report, which exposes how our country was let down by the previous Government. In my Bassetlaw constituency, I will be asked when people who need a GP appointment will get one, and when the 2,000-person dental waiting list will come to an end. I am listening to my GPs and my dentists so that I can work with them to tackle this crisis. I will be meeting them shortly. What is the Secretary of State’s message to them all?

[Wes Streeting]

My hon. Friend, who I am delighted to see representing Bassetlaw, is already showing herself to be an outstanding champion for her community. She raises a really good challenge that we all face as constituency MPs: the public recognise that change takes time and that we cannot fix more than a decade of problems in the immediate future, but they want to know that at least we are hitting the ground running and getting the job done.

I can reassure my hon. Friend’s constituents in Bassetlaw that within our first couple of months, this Government employed 1,000 more GPs on the frontline who had been left unemployed by the previous Conservative Government. We did that pretty much immediately. We have settled—I hope; we await the outcome of the ballot—the junior doctors’ dispute, so we can remove the cost of disruption and industrial action and start work on getting the waiting lists down. We will be working at pace to deliver 40,000 more appointments every week so that we can cut waiting lists, and 700,000 urgent emergency dentistry appointments so that we can ensure that people get the care they need. Every single promise in our manifesto, notwithstanding the challenges in the public finances, was a fully costed, fully funded promise that we will keep and that the country can afford.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

May I urge the Secretary of State to learn from what is working well in the NHS, as well as from what has gone wrong? In reference to the Health and Care Act 2022, paragraph 14 on page 121 of the report states:

“The result is that the basic structure of a headquarters, regions, and integrated care boards (ICBs) is fit for purpose.”

I draw the Secretary of State’s attention to the Suffolk and North East Essex ICB, which is one of the most successful in the country. Can we learn from that success, and build it into other areas?

[Wes Streeting]

I thank the hon. Gentleman for his constructive approach. The tragedy of the Health and Care Act 2022 was that a large part of its focus was on trying to correct the enormous damage done by Lord Lansley through a top-down reorganisation that nobody wanted and that the country could not afford. That is why I have said very clearly that we will not repeat the mistakes of top-down reorganisation. With the architecture of the system, we will take an approach of evolution rather than counter-revolution.

On the hon. Gentleman’s point about learning from what is working well in the NHS, what gives me great hope for the future of our national health service is that every day there are amazing people providing great-quality care, reforming, innovating and showing us what the future looks like. It is the responsibility of this Government to take the best of the NHS to the rest of the NHS. That is exactly what we will do.

[Olivia Blake (Sheffield Hallam) (Lab)]

Lord Darzi’s report makes grim reading and lays bare the failure of the last Government. NHS staff up and down the country will recognise everything in it. Does the Secretary of State agree that much more needs to be done on retaining, recruiting and compensating the NHS workforce and making sure that we have a workforce fit for the future?

[Wes Streeting]

For all the innovations that modern technology will bring—the revolution in big data AI, machine learning and medical advances that we will see very soon but can scarcely imagine today—health and social care will always be fundamentally a people-based service. If you do not value your people, you lose them and end up in the appalling situation that we are in today. We have invested so much money and time in training people who imagined a long future for themselves in the NHS but who, because of the reality to which they were subjected by the previous Government, are now packing up and moving into different careers—or to other continents. We are determined not just to recruit the great staff we need, but to value and retain the brilliant staff we already have.

[Dame Caroline Dinenage (Gosport) (Con)]

The Secretary of State will know that cancer is the biggest cause of death by illness for children under 14 in the UK, and that this is Childhood Cancer Awareness Month. He will not know that it is also the third anniversary of the death of my constituent Sophie Fairall, who was 10 years old. With Sophie’s mum Charlotte, I have been campaigning for the past three years for the children and young people cancer taskforce to be set up. The taskforce was set up at the beginning of this year with the stated aim of meaningfully changing detection, treatment and care for children with cancer. I have listened carefully to the Secretary of State and have heard him passionately set out that he wants to focus on prevention and early intervention, yet this month we learned that he is pausing the taskforce. Parents of children with cancer are deeply disturbed by that announcement, as am I. Can the Secretary of State set out why it was made?

[Wes Streeting]

Absolutely. I thank the hon. Member for the way she put her question. I send my deepest condolences to Sophie’s family on what will inevitably be a difficult day—I suspect just the latest of many difficult days—on the imaginable pain, grief and loss that they have suffered. I thank the hon. Member for her work over many years campaigning on children’s cancer in this House on behalf of her constituents and so many other families affected by young cancer.

The pause is because we are looking at the breadth of the work of the Department to make sure that we have the right vehicles to deliver the outcomes that we want. That is why we have paused rather than cancelled, slammed or criticised the work that she was doing. I would be delighted to meet her to talk about the genesis of the taskforce and how we can take forward the outcomes that she wants to see. What we are trying to avoid is a plethora of taskforces, and the risk that there has sometimes been—this is not a party political point, because this spans successive Governments—of taskforces being an alternative for action. I know that she wants action, so let us meet and see what we can do together.

[Jacob Collier (Burton and Uttoxeter) (Lab)]

When I grew up in Stretton under the last Labour Government, I could get an appointment with my family doctor the next day. After 14 years of the Conservatives, Stretton residents now often have to travel more than six miles to a GP surgery in another village just to get an appointment for which they have already waited weeks. Does the Secretary of State share my view that this is unacceptable, and that it falls to this Government to fix the Conservatives’ mess?

[Wes Streeting]

My hon. Friend is absolutely right. We need to make sure that we have the right staff in the right place and an equitable distribution of access to NHS services right across the country. We also want to shift from the hospital-centred NHS that we see today to a neighbourhood-centred service. That is why we have acted immediately to put 1,000 more GPs on the frontline before the end of this year. I am looking forward to working with GPs to expand access to primary care right across the country, especially in communities that are particularly under-served.

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

This review highlights the need for capital investment in the NHS. The question that NHS staff and patients in North West Norfolk have is urgent: are the Government committed to replacing their hospital, which is affected by reinforced autoclaved aerated concrete, with a new Queen Elizabeth hospital in King’s Lynn by 2030—yes or no?

[Wes Streeting]

I can absolutely reassure the hon. Member that RAAC-impacted hospitals are a priority. We are putting safety first, and it is just a shame that when his residents had a Prime Minister in their backyard, the Conservative Government did not fix the problem.

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

For the sake of openness and transparency, I will just mention that I am a former chair of an NHS trust and a public health academic. I recognise the real issues that are raised in the findings of the Darzi rapid review. I am grateful to Lord Darzi for referring in particular to the inequalities that we have experienced, and how those inequalities were laid bare during covid. Will the Health and Social Care Secretary expand on the cross-departmental work that he is doing? I agree with my hon. Friends the Members for Walthamstow (Ms Creasy) and for Eltham and Chislehurst (Clive Efford) that people’s socioeconomic circumstances drive their health status. We do not want a situation where, for every 1% increase in child poverty, six additional babies per 100,000 live births do not reach their first birthday.

[Wes Streeting]

I thank my hon. Friend for her question and congratulate her warmly on her election to the Chair of the Work and Pensions Committee. I am looking forward to sharing, through the Secretary of State for Work and Pensions, the work that our Departments are doing together, particularly on the link between mental health and unemployment and on integrating pathways. She is right about the social determinants of ill health. That is why I am genuinely excited that, through the mission-driven approach that the Prime Minister has set out, we are already bringing together Whitehall Departments, traditionally siloed, to work together on attacking those social determinants. The real game changer is genuine cross-departmental working, alongside business, civil society and all of us as active citizens, to mobilise the whole country in pursuit of that national mission, in which we will be tough on ill health, and tough on the causes of ill health, as someone might have said.

[Madam Deputy Speaker (Judith Cummins)]

I call the Father of the House.

[Sir Edward Leigh (Gainsborough) (Con)]

I greatly respect the Secretary of State, and, as an older person who relies on the NHS, I support his radical zeal. I repeat what he said in his statement: cancer is more likely to be a death sentence for NHS patients than for patients in other countries. We have had this conversation previously, but can he at least look at the health systems in other countries, particularly those in the Netherlands, Australia, France and Germany? Those countries, which have wonderful health systems protecting the vulnerable, use a mixture of social insurance and public and private funds to maximise inputs into their health services.

[Wes Streeting]

Every time the right hon. Gentleman praises my zeal for NHS reform, Labour Members get very nervous. Let me reassure him that I have looked at other countries, and I will definitely continue to do that. I genuinely do not think that it is the model of funding that is the issue—the publicly funded, public service element. I hope that he knows me well enough to understand that if I did think so, I would be more than happy making, and would quite enjoy taking on, the argument, but I think that the equitable principle that underpins our NHS is one that we should cherish and protect. The single-payer model has enormous potential for the century of big data, AI, and machine learning. There is huge potential there that we must unlock, but that does not mean that we cannot learn from the way that other countries organise care, particularly in the community and particularly social care. This week, I met virtually with my friend the Health Minister in Singapore. I will continue to work with my international counterparts to learn from other countries whose health outcomes are far better than ours.

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

In my constituency of North Warwickshire and Bedworth, patients wait far too long for GP appointments. The Conservative party has presided over sticking-plaster solutions, papering over the cracks in our health service rather than making it fit for the future. Does the Secretary of State agree that today’s report is a chance to get the right diagnosis of the problems, so that this new Labour Government can come up with the right prescription, and my constituents can once again get the treatment that they so desperately need?

[Wes Streeting]

I am delighted to see my hon. Friend in her place. She is absolutely right. We will take Lord Darzi’s diagnosis to write the prescription and ensure that our reform agenda benefits every part of the country—not just big cities and the wealthiest communities—so that every person, wherever they are from, grow up and live, has access to the very best health and care services.

[Ayoub Khan (Birmingham Perry Barr) (Ind)]

A key finding in the Darzi report is that NHS staff morale is low. The Medical Defence Union of medical practitioners stated recently that more than 44% of NHS staff will reduce the number of hours that they work, because of low morale. Will the Secretary of State meet representatives of the union to explore those issues and work out ways of improving staff morale?

[Wes Streeting]

Of course we seek to work constructively with all trade unions representing staff across our health and care services, and also with the royal colleges. We want to work in a spirit of partnership, and we are only able to do so because people sent Labour MPs to Parliament to replace the Conservatives.

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

I agree with my right hon. Friend: this is the most devastating analysis that I have read of the NHS in over 30 years. It just shows the challenges that lie before him. Talking of challenges, will he challenge the integrated care boards to focus on moving resources into primary care? In particular, will he look at what is happening in York, where Nimbuscare has been able to pull out services from the acute sector and deliver work in the community?

[Wes Streeting]

I am really grateful to my hon. Friend for her question. She has a huge amount of expertise in health and care, and she is absolutely right about the need for that shift. I have made it very clear to ICB leaders and to trusts across the country that I want more focus on secondary prevention, which means much more activity in the neighbourhood. I know that she will keep on championing these causes. She is a good critical friend, and I know that she will hold my feet to the fire to ensure that I deliver.

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

I declare my interest as the husband of an NHS doctor; I also served as a non-executive director of my local NHS trust. The last time that Lord Darzi was brought into service was by a Labour Government, shortly before they appointed him to the House of Lords. Will the Secretary of State take steps to ensure the widest possible input from senior clinicians? It is clear that some, including Professor Sir John Bell, do not share Lord Darzi’s prescription for the improvement of the NHS. Will he also apologise to my constituents for the doubt that he has cast over the future of the new Hillingdon hospital, on which work had already started under the previous Government?

--- Later in debate ---

[Wes Streeting]

I am not sure that is a fair characterisation of Sir John Bell’s position. I have a huge amount of respect for him. I am grateful to Lord Darzi for writing the diagnosis. Given that the Conservative party was in government for 14 years, repeatedly promised to rebuild Hillingdon hospital and left my Department in a position where the money for the new hospitals programme ran out in March, the hon. Member has some brass neck to point the finger at us while he is in opposition.

[Sean Woodcock (Banbury) (Lab)]

In 2016, the Horton hospital in my constituency lost its consultant-led maternity unit—a temporary downgrade that ended up being made permanent three years later. Is it not about time that someone from the Conservative party apologised for the damage done to Banbury’s hospital, as well as to the NHS as a whole?

[Wes Streeting]

I am delighted to see my hon. Friend here. His constituents can already see that he is not backwards in coming forwards. He will stand up and champion their interests in this House as a great constituency MP. When it comes to the Conservative party, sorry seems to be the hardest word.

[Alison Bennett (Mid Sussex) (LD)]

I welcome the announcement of the Secretary of State about the shift from hospital to community care. My fellow Liberal Democrats and I fully believe that fixing social care is part of the solution in getting the NHS back on its feet, so I also welcome the announcement of a national care service. Part of care in the community is of course the hospice sector. I recently met the chief executive of St Catherine’s hospice, which is in the constituency of the hon. Member for East Grinstead and Uckfield (Mims Davies). He highlighted to me that, although the hospice has 24 beds, it is currently using only 12 of them. What assurance can the Secretary of State give me, and people right across the country, that fixing the hospice sector will be part of the solution as we take the NHS forward?

[Wes Streeting]

I am so grateful for that question, not least because it gives me the chance as a constituency MP to say a huge thank you to St Francis hospice and Haven House children’s hospice for the care they provide to constituents, like so many other hospices around the country. I know that the sector is under real pressure. We look forward to working with the sector throughout the period of the spending review and the 10-year plan, not only to support our hospices but to improve end-of-life care, which is pertinent to debates that I know this House and the other place will have about how we ensure a good death for everyone, in every part of the country.

[Tahir Ali (Birmingham Hall Green and Moseley) (Lab)]

On Tuesday, I was at the Birmingham children’s hospital. Will the Secretary of State join me in congratulating the excellent staff on their work and their commitment to each individual patient who goes through the door? That evening, I was also with a local GP at Sparkbrook health centre whose frustration was with the outdated computer system. If he could get one message across to the Secretary of State, it would be that he has to reboot his computer numerous times a day. Will the Secretary of State put resources in to ensure that the IT is up to date?

--- Later in debate ---

[Wes Streeting]

First, my hon. Friend is right that we should celebrate and thank staff who are doing an outstanding job against a very difficult set of circumstances. On his second point, we have to ensure that, on the tech side, we unlock productivity in the system. Having literally sat looking over the shoulder of GPs at their IT systems, I well understand those frustrations. For the benefit of all observers, there is sometimes a perception that I am up against NHS staff when it comes to reform. Actually, it is staff who are crying out for change.

[Bob Blackman (Harrow East) (Con)]

One aim of the Lansley reforms was to transfer from Ministers to clinicians decisions on the day-to-day running of the health service. It is not clear from his statement whether the Secretary of State intends to change that process, but let me give him a constructive proposal that he might take on board, which is to streamline the business planning side of the NHS. Staff have to go through multiple bids and preparations of business plans before decisions are made. That means that more money is spent on employing business consultants than consultants in hospitals. I have campaigned for this change for many years. Will he take that on board? [Interruption.]

[Wes Streeting]

The Minister for Secondary Care was whispering in my ear that it was her frustration with exactly the bureaucratic processes that the hon. Gentleman describes that led to her seeking election as a Member of Parliament to sort them out, so I defer to her on this one.

On a serious note, he is right that wherever we find waste and inefficiency designed in, we must deal with it. I want to see an NHS that is more clinically led, free from political interference. We must also be honest: as it is such an enormous part of the public sector, which the public pay an enormous price for and value so much, there will always need to be an accountability relationship. What I have tried to build with NHS England in the last couple of months, with real joy in the process, is a real team between the Department of Health and Social Care and NHS England, as well as the team across the country. I look forward to continuing to galvanise that team as we embark on the 10-year plan process.

[Dr Marie Tidball (Penistone and Stocksbridge) (Lab)]

In my constituency, a staggering 28% of patients said that it was “not easy at all” to get through to someone at their GP practice. Worse, the figure for patients who said that doing this was “generally easy” was far below the national average. Does the Secretary of State agree that the Conservatives have pushed the NHS to breaking point, and only this Government can get the NHS fit for the future?

[Wes Streeting]

I am delighted to see my hon. Friend in her place, standing up for her communities in Penistone and Stocksbridge. In opposition, it was very frustrating watching successive Ministers promise better hold music for people trying to get through to their GP, rather than solving the problems of access. Fixing general practice, and building general practice so that it can meet the needs of this century, will be a vital part of our 10-year plan process.

[Mr Mark Francois (Rayleigh and Wickford) (Con)]

May I make the Secretary of State a little more nervous? The Darzi report makes seven high-level recommendations, the fourth of which is to drive productivity in hospitals. From 2017, in south Essex we saw a merger of Basildon, Chelmsford and Southend hospitals to create the Mid and South Essex NHS Hospital Trust. It has not been an unmitigated success. As local MPs, we were promised significant back office savings that could be channelled into patient care. In fact, the reverse has been true, and there has been such a turnover of senior managers in that trust in recent years it has been like a game of musical chairs. The trust is now trying to appoint three permanent managers and directors for each hospital to provide stability, which makes sense, but is offering a salary of £200,000 for each post, which is more than the Prime Minister earns to run the country. Now that this is on his watch, will the Secretary of State take a personal interest? We should pay a good rate for that job, but £200,000 sends the wrong signals to all the other very hard-working people in the trust.

[Wes Streeting]

I thank the right hon. Gentleman for that question. He is not too far away from me geographically, but he is miles away from me politically, and I always get nervous when he stands up to praise me. We have to keep a sharp eye on value for money. The Darzi report presents some politically challenging messages about NHS management. I could be wildly popular with the country if I stood up and said, “I’m going to take the axe to management across the country and sack loads of managers.” What we need is better management and a sharp eye on value for money. The NHS would not work without good leadership. We have to ensure that we have the right people in the right place, delivering against the public’s expectations, so it is a more nuanced position, but I am sure that what he says will have been heard by his local trust. I will certainly keep an eye on value for money across the country.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

The Darzi report rightly says that prevention is better than cure, and that public health interventions that protect health are far less costly than tackling the consequences of illness and ill health. Does my right hon. Friend agree that the recklessness and incompetence of the 14 years of Conservative government, stripping millions of pounds from local authorities, which deliver the public health work, has contributed to children being sicker than they were 10 years ago, and adults getting iller sooner?

[Wes Streeting]

My hon. Friend is right, and at some point the Conservatives will have to take responsibility for it. We learned through bitter experience that if we did not change as a party, the country would not choose to change the Government. Long may the Conservatives continue, therefore, with their head in the sand, and long may we continue to get on with the job of clearing up their mess and building an NHS that is fit for the future.

The relationship between the NHS and local government, and between my Department and local government, is of particular importance in relation to social care, which is why I was especially delighted that the Prime Minister chose this week to appoint Tom Riordan, the chief executive of Leeds city council, as second permanent secretary. He is an outstanding public servant with a demonstrable record on health and care integration, public health and prevention. I look forward to having that local government perspective, and local community delivery perspective, at the heart of our Department.

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

I think the whole House agrees with what the Secretary of State said in his statement: the NHS needs reform. In reality, when I speak to people in the NHS, almost all of them say that this is not about a shortage of money, but about the legendary levels of waste, bureaucracy and mismanagement. Indeed, the report refers specifically to the huge number of regulators, accountants and bureaucrats from the top down. Is there recognition among the NHS senior leadership that management reform is a critical part of improving healthcare in the United Kingdom?

[Wes Streeting]

I welcome the hon. Member to his place and thank him for that question. I am always cynical about huge volumes of regulation. We reassure ourselves as legislators and regulators that putting regulations in place means that we have dealt with the issue. But the problem is that if we fail to deliver, we put another regulation in place, then another, and then more, and before we know it, we have drowned the people responsible for delivery in so much regulation that they cannot sort the wheat from the chaff or see the wood for the trees, compromising standards and patient safety. That is why I welcome the work that Penny Dash has done in relation to the Care Quality Commission, and we will continue to work with her to reduce the burden of regulation, focus on the things that really matter and free NHS staff from red tape. I hope that he finds that reassuring. I plead with him not to send his party leader to agree with me as well, or I really will be in trouble.

[Ms Julie Minns (Carlisle) (Lab)]

I declare an interest as the mother of an NHS nurse. It is important that we remember what is at the centre of this issue: people. Three individuals came to my Carlisle surgery last week because they were at the end of their tether about the care that their loved ones had received, or not received, at our local hospital. One is the husband of a woman who has profound physical disabilities and cannot leave the House unaccompanied. She now has no trust in her local hospital because, among other things, her recent care involved her being fed food that she was known to be allergic to.

I also saw the parents of a young woman who has epilepsy, a physical disability and profound anxiety. The failure to put in place a care plan to account for all that means that she is now self-harming. The other case was that of an elderly woman whose husband was discharged from the hospital without her consent. He is now in a care home 20 miles away, and she cannot visit him. Will the Secretary of State assure those people that this Government will not only fix our NHS, but restore their broken trust in it?

[Wes Streeting]

I am so grateful to my hon. Friend. I enjoyed visiting her Carlisle constituency ahead of the general election campaign, and I look forward to working with her to improve health services there and across the north-west, especially in the rural and coastal communities that rely on the hospital in Carlisle, as well as on more local neighbourhood services. I must warn new Members that one of the most depressing things about the last nine years has been constituency advice surgeries, where people would come to see us about the consequences of the failure of Government and the failure of this place. We owe it to them to do better—better integration of health and care services, better access and outcomes, and better joined-up care. As she has painfully described, if we do not tackle the problems early, they become multiple, higher-cost and personal tragedies. We have seen enough of that.

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

Famously, the House has not seen an impact assessment of the withdrawal of the winter fuel allowance from frail 85 and 90-year-olds on low incomes. Has Lord Darzi or the Secretary of State seen an assessment of the impact of that decision on NHS bed capacity over the coming winter?

[Wes Streeting]

The hon. Member is an experienced Member of this House, as both a former Chair of the Treasury Committee and a former Treasury Minister, so she knows how impact assessments are done at the Treasury. She knows that impact assessments of all the Chancellor’s fiscal decisions at the Budget and the spending review will be published at that time. She also knows, I suspect, that despite the withdrawal of the winter fuel allowance from some pensioners—it will be targeted at those most in need—they will still be better off because the Government have committed to maintaining the triple lock and to extending the warm home discount scheme and the available hardship support, so that pensioners are not left behind as we clean up the £22 billion mess that the Conservatives left behind.

[Uma Kumaran (Stratford and Bow) (Lab)]

Lord Darzi’s report lays bare the scale of the challenges that our NHS faces. Does the Secretary of State share my deep concern that because of the Conservative party’s dismal record, the progress made by the previous Labour Government on heart disease and stroke—of which I have had recent personal experience—is now in reverse? The number of people in England dying from cardiovascular disease before the age of 75 has risen to its highest level in 14 years.

[Wes Streeting]

I am delighted to see my hon. Friend in the House representing my old east end stomping ground. I wish her and her husband well in his recovery, and for their recovery, as a family, from his experience. Let me reassure her that, when it comes to the future of health and social care, we will clean up the mess that the Conservatives made. That will take time. The reverse in the progress made on cardiovascular disease, and the early warning signs of an uptick in smoking, are why we must put public health and prevention at the forefront. That is not just about what is good for the individual, their health and their chances; look at what the Office for Budget Responsibility says today about the long-term cost to the Exchequer. We have no choice but to act.

[Nigel Huddleston (Droitwich and Evesham) (Con)]

A key conclusion of the report is the absolute necessity of focusing on productivity and not just throwing money at the NHS; I think we all agree on that. Ministers are constantly telling us that government is about making difficult decisions—something that that we already knew. Why, then, on one of his first opportunities, did the Secretary of State do the absolute opposite of that? In solving the doctors dispute, he took the easy option of throwing money at it, and did not require productivity enhancements and changes. Will he reassure me that in future he will practise what he preaches?

[Wes Streeting]

I like the hon. Gentleman very much, but what audacity to criticise this Government for cleaning up the Conservatives’ mess. He fails to acknowledge the cost to the Exchequer and to patients in delayed and cancelled operations, appointments and procedures. More than £1 billion has been lost and more than 1 million appointments cancelled because of the Conservatives’ gross incompetence and failure to understand the difference—they are penny-wise and pound-foolish. That is why they have been sent into opposition and Labour has been trusted to clean up their mess.

[Natasha Irons (Croydon East) (Lab)]

There can be no greater example of the previous Government’s failure than the shocking outcomes for our children and young people, as Lord Darzi’s report highlights. Our children now have some of the worst health outcomes in Europe, with higher rates of obesity, diabetes and asthma, and poor oral and mental health. From head to toe, they have been failed. Will the Secretary of State ensure that the Government’s long-term plan for our NHS will give young people’s health the priority that it deserves?

[Wes Streeting]

I am delighted to see my hon. Friend in her place. She might be from the wrong side of the river, but she is absolutely right about the importance of prioritising children’s health. As the Prime Minister said this morning, it is shocking that the No. 1 cause of hospital admission among children aged between six and 10 is tooth decay. I was criticised by the shadow Secretary of State, who said that I called our children “short and fat”; she is more outraged by my calling out the scourge of childhood obesity that her Government fuelled than she is by the scourge of child obesity itself. That is why we will act and why the Conservatives failed.

[Richard Foord (Honiton and Sidmouth) (LD)]

I welcome the fact that the Health Secretary talks about a shift from hospital to community care; that builds on Lord Darzi’s finding that 13% of beds are occupied by people who are waiting for care in more appropriate settings. Caring for patients in community hospitals is much more cost-effective than caring for patients in big acute hospitals like the Royal Devon and Exeter hospital where I live. What thought has the Secretary of State given to the use of community hospitals that have lost beds in the last decade, such as Seaton, Axminster, Honiton and Ottery St Mary?

[Wes Streeting]

The hon. Gentleman is absolutely right about the value of community hospitals, step-down accommodation and care close to people’s homes—or, better still, wherever possible, in their homes, so long as it is clinically safe and the right support and care is available. The shift from hospital to community will be at the heart of our 10-year plan for reform and modernisation. Like lots of his colleagues on the Liberal Democrat Benches and lots of those on the Government Benches behind me, the hon. Gentleman has already done a good job of putting his local lobbying of Ministers on the record in the House.

[Several hon. Members rose—]

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

A recent survey of staff at East Kent Hospitals University NHS foundation trust showed that less than half of employees would be happy for their loved ones to be treated at an east Kent hospital. That is a devastating verdict from staff, showing the impact on their morale and on confidence in the community for the care that people need. Does the Secretary of State agree, however, that a broken NHS is not the fault of staff like them, but down to the previous Government’s decade of austerity and top-down reorganisation of the NHS?

[Wes Streeting]

I am delighted to see my hon. Friend in her place. She is absolutely right. I feel really sorry for NHS staff for what they have been put through over more than a decade of mismanagement and political incompetence, and we will work with them to clean up the mess. She establishes exactly the right test, which is whether we would want our loved ones to be treated in our local health and care services, and whether we would have confidence that, in every case, on every occasion and in every interaction, they would have access to the best-quality care. The truth is that we do not have that certainty, and too often it feels like chance. That is why we will always put the patient voice, the patient interest and the patient experience at the heart of our reform and modernisation programme.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for the honesty in his statement, and for his contact with the regional Minister responsible at the Northern Ireland Assembly. Those are the first actions of a Secretary of State who, I suggest, does not run away from issues but takes them head on. I congratulate him on that.

I appreciate the terminology used in the report, which outlines the seriousness of conditions in the NHS but also highlights the fact that the vital signs are still strong. Will the Secretary of State outline how he intends to address the fact that the NHS in devolved regions is in an arguably worse condition? Will he confirm that the review will incorporate Northern Ireland and will he ensure that the findings, new practices and standards will be in place for Northern Ireland, along with increased funding in a new funding formula?

[Wes Streeting]

I thank the hon. Gentleman for what he said; coming from him, that means a great deal to me. I reassure him that I am committed to working with Ministers in all devolved Administrations to improve health outcomes for everyone in every part of our United Kingdom. I know that the system is particularly pressed in Northern Ireland and I will do whatever I can, working with Ministers in Northern Ireland, to help that situation and create the rising tide that lifts all ships right across the UK.

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

I truly learned to appreciate the NHS when I became a parent and saw the care given to my family and children. It therefore horrified me, having sat in A&E with an ill child, to see in Lord Darzi’s report that 100,000 infants waited for over six hours in A&E last year. Does the Secretary of State agree that that is a shocking state in which to leave the NHS? Will he commit to bringing the numbers down and making sure that parents do not have to endure that terrible wait?

[Wes Streeting]

I am delighted to see my hon. Friend representing Calder Valley. He has captured the fear and anxiety about the length of the wait experienced by far too many parents when they access A&E departments. It is a terrifying experience, particularly for parents with small children, to be in that situation. Frankly, the lack of focus on paediatric waiting lists and waiting times, whether in A&E or for electives, really is shameful. We have got to put children first and that is exactly what this Government will do.

[Jessica Toale (Bournemouth West) (Lab)]

My constituents in Bournemouth West have faced rising NHS waiting times; we have GP surgeries closing despite rising populations and health burdens; there are no dentists accepting any NHS adult patients and residents are being told to go to Southampton; and the junior doctors and nurses I meet are devastated that they cannot deliver the quality of service that they want to. Does the Secretary of State agree that although the road ahead is long, Lord Darzi’s frank and raw assessment is the first step to recovery under a Labour Government?

[Wes Streeting]

I am delighted to see my hon. Friend in her place representing the people of Bournemouth. The great thing about where we are at this moment is that, for the first time in a long time, there is a feeling of hope and optimism about what the future could be. We are determined to build on that and give staff and patients the confidence of knowing that the best days for the NHS lie ahead.

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

Lord Darzi’s report highlights the use of capital expenditure to cover in-year spending by successive Tory Governments. Money intended for long-term investment has been redirected over and over, and that has exacerbated the extremely serious and urgent problems that the Secretary of State so rightly raises today. Does he agree that that has stopped us making progress on capital projects that would enable big productivity improvements and improve access to care for all, particularly those in my constituency of Leyton and Wanstead?

[Wes Streeting]

I am delighted to see my parliamentary neighbour in his place; he has big shoes to fill and he will certainly do that. The Chancellor and I are determined to break the vicious cycle in which ballooning costs and overspends in day-to-day spending see raids on capital and tech budgets to fund the shortfall. The £22 billion black hole that we have inherited is a direct example of exactly where Conservative short-termism leads. That is why, in respect of the spending review, I assure my hon. Friend that productivity, tech and capital will be my focus in my representations to the Chancellor and in the work we will do together to fix the mess that the Conservatives left behind.

--- Later in debate ---

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

To return to a subject close to the Secretary of State’s heart, does he agree that people’s actual experience is how we will measure whether the NHS has been improved? One of my children’s grandparents, who was diagnosed under a Labour Government, had 12 great years of cutting-edge treatments and 12 years with their grandchildren. Their grandfather, who was diagnosed under a Conservative Government, had 12 weeks.

[Wes Streeting]

I am grateful to my hon. Friend for the work she does championing Milton Keynes. Therein lies the challenge: it cannot be right that delays in diagnosis lead to the difference between life and death. I am very lucky that my cancer was caught early. It was diagnosed quickly and treated quickly. Not everyone is fortunate, and I am so sorry that my hon. Friend’s family is bearing the consequences of what happens when things go wrong.

[Sonia Kumar (Dudley) (Lab)]

Despite the damning analysis of the state in which the Conservatives left the NHS, Lord Darzi says that its vital signs remain strong. Does the Secretary of State agree with the case for the health service being taxpayer funded, free at the point of use, and based on need and not the ability to pay?

[Wes Streeting]

I am delighted to see my hon. Friend from Dudley. I agree wholeheartedly, 100%, unequivocally.

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

In a recent conversation, a nurse in Brunswick Village in my constituency shared her damning experience of the increasing number of black alerts in her hospital. Does the Secretary of State agree that, although her experience is no surprise to many who have used the NHS recently, the Tories have pushed our NHS to the brink and it is up to Labour to fix it and make it fit for the future?

[Wes Streeting]

Absolutely.

[Darren Paffey (Southampton Itchen) (Lab)]

The amazing NHS staff in my constituency work tirelessly, day in and day out, in our local hospitals and surgeries. Will my right hon. Friend join me in thanking them, and will he be clear that Lord Darzi’s shocking findings are not on them, but on the appalling legacy of the Conservatives, who still have not apologised?

[Wes Streeting]

NHS staff did not break the NHS—the Conservatives did—and this Labour Government will mobilise them to help fix it.

[Anna Dixon (Shipley) (Lab)]

It was great to see the Prime Minister speaking this morning at the King’s Fund, where I worked as director of policy for a number of years. In my constituency, I met a man who had been told he needed urgent surgery on his leg, but was still waiting 18 months later and had had to give up work. It is clear from today’s report that too many people have been stuck on NHS waiting lists and locked out of work. Does the Secretary of State share my view that a healthy nation is critical to a healthy economy, and will he work with his colleagues in the Department for Work and Pensions to deliver that?

[Wes Streeting]

My hon. Friend is absolutely right: the health of the nation and the health of the economy are inextricably linked. Under this Government, the Department of Health and Social Care is a Department for growth as well as a Department for health and care, and the Chancellor understands those linkages too. I can say to my hon. Friend and all of her friends at the King’s Fund—we were delighted to see them host the Prime Minister this morning—that unlike our predecessors, this Government cannot get enough of experts.

[Madam Deputy Speaker (Judith Cummins)]

That concludes the statement. We have had more than 45 contributions from Back Benchers, so I thank you for your patience.

Government Policy on Health

Wes Streeting Excerpts

Monday 9th September 2024 Commons Chamber

[Victoria Atkins]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the involvement of people with no formal appointment in the development of Government policy on health.

I apologise to the House, Madam Deputy Speaker. I am more used to answering, but believe you me, I am looking forward to the questions.

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

And I am committed to making sure that the right hon. Lady is there, asking the questions, for a very, very long time.

Unlike our predecessors, this Government cannot get enough of experts. We work with a wide range of stakeholders in developing policy, because that goes to the heart of our approach to mission-driven government. But I think the shadow Secretary of State was referring specifically to the right honourable Alan Milburn, so let me address him specifically. I walked into the Department of Health and Social Care on 5 July to be confronted with the worst crisis in the history of the national health service: waiting lists at 7.6 million, more than a million patients a month waiting four weeks for a GP appointment —if they could get one at all—the junior doctors still in dispute and on strike, and dental deserts across huge parts of our country, where people cannot get an NHS dentist for love nor money.

This Government are honest about the scale of the crisis and serious about fixing it, which means that we need the best available advice—it is all hands on deck to fix the mess that the previous Government left. If a single patient waited longer for treatment than they needed because I had failed to ask for the most expert advice around, I would consider that a betrayal of patients’ interests. I decide whom I hear from in meetings, I decide whose advice I seek, and I decide what to share with them. I also welcome challenge, alternative perspectives and experience.

The right honourable Alan Milburn is a former Member of this House, a member of the Privy Council and a former Health Secretary. He does not have a pass to the Department and, at every departmental meeting he has attended, he has been present at the request of Ministers. During Alan’s time in office, he gave patients the choice over where they are treated and who treats them, as well as making sure that the NHS was properly transparent, so that all patients were able to make an informed choice—a basic right that we expect in all other walks of life, but which only the wealthy and well connected were able to exercise in healthcare until Alan changed it. He gave patients access to the fastest, most effective treatment available on NHS terms, so that faster treatment was no longer just for those who could afford private healthcare. He made the tough reforms that drove better performance across the NHS and, along with every other Labour Health Secretary, delivered the shortest waiting times and the highest patient satisfaction in the history of the NHS. That is his record and Labour’s record, and it is the kind of experience that I want around the table as we write the reform agenda that will lift the NHS out of the worst crisis in its history, get it back on its feet, and make it fit for the future once again.

[Victoria Atkins]

I fear that the right hon. Gentleman is betraying his inexperience. It is a shame that he needs all that help and experience; the rest of us have just got on with the job.

The Department of Health and Social Care manages incredibly sensitive information, ranging from the development of healthcare policy to the handling of market-sensitive information concerning vaccines and medication, and the rules regarding patient confidentiality. It has emerged that Mr Milburn, a former Labour politician, has received more than £8 million from his personal consultancy firm since 2016. He advises one of the largest providers of residential care for older people, and is apparently a senior adviser on health for a major consultancy firm. [Interruption.] A Member sitting opposite says, “So what?” Given the risk of conflicts of interest—that, rather than the right hon. Gentleman’s inexperience, is the point of this UQ—has Mr Milburn declared his business interests to the Department? Can the right hon. Gentleman reassure the House on how such conflicts are being managed, so that we can get a sense of the scale of this open-door policy and Mr Milburn’s access?

Could the right hon. Gentleman tell us how many meetings Mr Milburn has attended? How many were with NHS England? How many were conducted without ministerial presence? What sensitive information has Mr Milburn been given access to? Does it include information concerning the sale of patient information to pharmaceutical companies? Has Mr Milburn seen internal DHSC or NHSE documents regarding the pricing of medicines and vaccinations, and other market-sensitive information? This is all information that comes across the right hon. Gentleman’s desk, and there is no formal record for understanding what Mr Milburn has seen.

If the right hon. Gentleman uses, as he has done just now, the excuse that this is all okay because Mr Milburn is a former Secretary of State and a Privy Counsellor, could the right hon. Gentleman set out where in the ministerial code or the civil service code such an exemption exists for unrecorded access to information by members of the public? I hope the Secretary of State will also confirm his lists of other advisers, their commercial interests and any other members of the public attending meetings that are of a deeply sensitive nature, so that we get a sense of just how far this goes.

This is just more evidence of cronyism at the heart of this new Labour Government. Following recent press reports that a Labour party worker had been parachuted into a civil service role in the Department through a closed recruitment process, will the Secretary of State finally come clean to the House and be transparent about who is running his Department and shaping policy for him?

[Wes Streeting]

The right hon. Lady wants to compare experience. It took me three weeks to agree a deal with junior doctors—she had not even met them since March—and in the two and a half years that I was the shadow Secretary of State for Health and Social Care, she was the fifth and among the worst. Does it not just tell us everything we need to know about the Conservatives’ priorities? She does not ask me what we are doing to cut waiting lists. She does not ask about the action we took to end strikes. She does not ask about the action that has been taken to hire a thousand GPs, who she left to graduate into unemployment. She has not asked me about the news on the front page of The Daily Telegraph that, on their watch, 50 years of health progress is in decline. And funnily enough, there was nothing on the news from The Observer this weekend that the NHS was hit harder than any other health service by the pandemic because it was uniquely exposed by a decade of Conservative neglect. Having broken the NHS, all they are interested in now is trying to tie this Government’s hands behand our back to stop us cleaning up their mess.

What the right hon. Lady is implying in this question is that, as Health Secretary, she never sought the advice of people who did not work in her Department, which would explain quite a lot actually. I feel sorry for her, because when I need advice, I can call on any number of Labour Health Secretaries who helped deliver the shortest waiting times and the highest patient satisfaction in history. But she never had that luxury, because every single one of her Conservative predecessors left NHS waiting lists higher than where they found them—except, of course, for Thérèse Coffey, who was outlasted by a lettuce.

In fact, it says a lot about the modern Conservative party’s anti-reform instincts that the right hon. Lady is so opposed to Alan Milburn. They used to hug him close when they were cosplaying as new Labour. Andrew Lansley even asked whether Alan Milburn would chair the new clinical commissioning board that his top-down reorganisation created, although Alan sensibly turned him down and labelled the reorganisation “the biggest car crash” in the history of the NHS, which just goes to prove that Alan Milburn has sound judgment and is worth listening to.

But if the right hon. Lady wants to lead with her chin and talk cronyism, let us talk cronyism. Why do we not talk about Owen Paterson lobbying Health Ministers on behalf of Randox? The Conservatives care so much about cronyism that they welcomed Lord Cameron back with open arms following his paid lobbying for Greensill. For reasons of ongoing court cases, let us not even get into Baroness Mone and the £200 million contract for personal protective equipment. Where was the right hon. Lady during those sorry episodes? Cheering on that Government and presiding over a record of abysmal failure that has put them on the other side of the Chamber.

This Government are having to rebuild not only the public services that the Conservatives broke and the public finances they raided, but the trust in politics that they destroyed. We will put politics back into the service of working people and rebuild all three. Clearly, we will have to do it without the support of the Conservative party’s one- nation tradition, who are not even running and have abandoned their flag. It is clear that the Conservatives have not learned a thing from the defeat they were subjected to on 4 July, and we will get on with the business of clearing up their mess.

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

On a point of order, Madam Deputy Speaker. The Secretary of State has obviously decided that attack is the best form of defence, but the operation of the House will collapse if he declines to answer any questions about a very serious matter of public concern. Can we seek your guidance, Madam Deputy Speaker, on whether he is conducting himself appropriately in the House? We are seeking transparency on a matter of probity, and he has a duty to answer the House, not least under the ministerial code.

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

The sheer brass neck of the Conservatives to turn up on the very day that Transparency International UK published its report showing that £15 billion of contracts were red-flagged during the covid epidemic—[Interruption.] I am not reading. Those contracts have been red-flagged and are worthy of further investigation, and £500 million of them were given to companies that had not even lasted 100 days. Should the Conservatives not have taken that into consideration before coming here with this urgent question?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. Frankly, every single contribution from the Opposition Dispatch Box should begin with a grovelling apology for the way they conducted themselves in government, but they will not apologise: they have learnt nothing and they show no humility. To my hon. Friend’s point, when it comes to covid corruption and crony contracts, the message from the Chancellor is clear. We want our money back and the covid commissioner is coming to get it.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat Front-Bench spokesperson, Sarah Olney.

[Sarah Olney (Richmond Park) (LD)]

The Liberal Democrats find it deeply ironic that the shadow Health Secretary has raised this question on the involvement of people with no formal appointment in the development of Government policy. Are they forgetting their record in government? Perhaps we should remind everyone that, under the Conservatives, it was their friends that benefited from large contracts to supply the Government during the covid pandemic. The result is that, just today, as the hon. Member for Eltham and Chislehurst (Clive Efford) has already highlighted, Transparency International UK has revealed multiple red flags in more than 130 covid contracts totalling over £15.3 billion. With the Conservatives out of power, we have the opportunity to clean up our politics, so will the Secretary of State update the House on whether the Prime Minister plans to appoint his own ethics adviser or whether Sir Laurie Magnus will remain in the post? Will the ethics adviser be empowered to initiate their own investigations and publish their own reports?

[Wes Streeting]

I am grateful to the hon. Member for her serious contribution. She is right to say that transparency matters. That is why meetings in my Department, and their attendees, will be published in the right and proper way on a quarterly basis.

It is also right to draw a distinction between those areas of business and meetings in the Department that are about generating ideas and policy discussion, and those that are about taking Government decisions. It is right that people from outside government come into the Department for Health and Social Care, or any Department, to lend their expertise and share their views, and it is right that Ministers make decisions absent of those outsiders. That is the distinction I would draw. The hon. Member raises a specific point about the Prime Minister’s ethics adviser. This is a Prime Minister who does take ethics seriously and will not behave in the way that his Conservative predecessors did. As for individuals, that is a decision for the Prime Minister, but I will ensure that the hon. Member gets a more fulsome reply.

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

I have been a surgeon for 28 years. In the first 14 years, we had a Labour Government and we saw the waiting lists more or less disappear, such that by 2010, a patient coming to see me in the clinic would be offered an operation. In the second 14 years, we have seen record waiting lists. I welcome the advice of Mr Alan Milburn, one of the most successful Secretaries of State and one of the architects of the fall in the waiting lists, and I support the Secretary of State in this.

[Wes Streeting]

I am grateful to my hon. Friend and I am delighted to see him here, bringing his experience to the House, sharing it with the nation, standing up for his constituents and being part of the team that will do what the last Labour Government did, which was to ensure that our NHS is back on its feet and fit for the future.

[Kit Malthouse]

Notwithstanding the Secretary of State’s bluster, he must appreciate that, given Mr Milburn’s involvement in the private healthcare sector, his direct access to the Secretary of State may have conferred a competitive advantage. What does the Secretary of State say to those companies who compete with Mr Milburn’s companies about the access that he has had to the Secretary of State? How can we in the House be reassured about the kind of information that Mr Milburn has been able to access and what, if any, advantage that might have conferred upon him?

[Wes Streeting]

With the way that Conservative Members are carrying on, and with the smears and innuendo they are applying, I am surprised that Alan Milburn is not paying them a marketing commission. The right hon. Gentleman makes out that Alan Milburn has come into the Department and is making all the decisions. If he were up to what they are suggesting, I could not think of better word-of-mouth publicity.

There is a clear distinction between inviting people with a wide range of experience and perspectives into the Department to have policy debates and to generate ideas, and having meetings that are about transacting Government business. I can assure the right hon. Gentleman and the House that nothing commercially sensitive has been shared with Alan Milburn, and I am genuinely astonished that Conservative Members think it is inappropriate for a Secretary of State for Health and Social Care to seek views, input and advice from their predecessors. In fact, I wonder how one of my Conservative predecessors, who is coming in to see me soon, will feel about their objections.

[Mr Jonathan Brash (Hartlepool) (Lab)]

In October 2023, when I phoned my NHS dentist to get an appointment for my children, the next available appointment was in June 2024. [Interruption.] When June 2024 rolled around, they cancelled the appointment. The next available appointment is April 2025. Given my right hon. Friend’s disgraceful inheritance, does he think the Conservative party should spend a little more time reflecting on its record and a little less time asking pointless questions?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. Let the record reflect that, when he was raising the crisis that is leaving people in Hartlepool without access to NHS dentistry, Conservative Members were shouting, “What about Alan Milburn?” That says everything about their priorities, everything about their lack of remorse and contrition, and everything about why they should stay in opposition for a very long time while we sort out the state of NHS dentistry in Hartlepool and across the country.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

How legitimate is it for the House of Commons to ask about external people coming into Departments and potential conflicts of interest? In cases like Alan Milburn’s, or that of a former Conservative Secretary of State, how does the Department identify and manage conflicts of interest?

[Wes Streeting]

It is entirely legitimate to ask questions, and it is also entirely legitimate for Government Departments to invite people with a wide range of experience and insight to advise on policy debates and discussions. That happens all the time. Where do we draw the line? Do we have to send compliance forms to Cancer Research UK before it comes in to talk about how we tackle cancer? Do we have to send declaration of interest forms to patients who want to discuss awful cases they have experienced?

Frankly, I find this pantomime astonishing. I am surprised that the shadow Secretary of State thinks this is such a priority that she should raise it on the Floor of the House rather than NHS waiting lists, ambulance response times, GP access or the state of social care. It is clear that the Conservatives have not learned why they are in opposition.

[Anna Dixon (Shipley) (Lab)]

I congratulate my right hon. Friend on taking advice from his predecessors. As someone who worked as a senior civil servant in the Department under Alan Milburn, I would like to echo my right hon. Friend’s comments about what a fantastic Secretary of State he was and speak to his record in that position. I also worked as a civil servant under the coalition Government.

Will the Secretary of State also be seeking advice from Andy Burnham who, as Secretary of State when Labour last left office, left record low waiting times and high public satisfaction?

[Wes Streeting]

My hon. Friend is absolutely right. How fortunate we are to be able to turn to every living former Labour Health Secretary, from Alan Milburn to Andy Burnham, and in every single one of those cases be able to draw on people whose record of delivery led to the shortest waiting times and the highest patient satisfaction in history. I can confirm to my hon. Friend that, both in opposition and in government, I have been talking to the Mayor of Greater Manchester. He is doing some brilliant work on prevention. I am really looking forward to working with all our metro mayors to tackle health inequalities across the country and to improve the integration of health and care services across the land.

[Paul Holmes (Hamble Valley) (Con)]

I know it will be a novelty for the Secretary of State actually to answer a question during this urgent question, but maybe he will do the House a favour by answering this very simple question with a yes or no. He said that no pass was given to Alan Milburn, so will he guarantee that no confidential documents that could have been used for commercial purposes were accessed or left his Department? Will he take responsibility if any documents or data discussed at ministerial meetings with Alan Milburn leave the Department—yes or no?

[Wes Streeting]

Yes.

[Shaun Davies (Telford) (Lab)]

Fixing and getting our NHS back on its feet should be a national mission, and everybody should be able to play their part in that. Will the Secretary of State confirm whether any former Conservative Ministers have put themselves forward to try to fix the mess that the party now in opposition created over the last 14 years?

[Wes Streeting]

This is the extraordinary thing: notwithstanding the public job application of a former Conservative Secretary of State, which did not meet the bar, I have been approached by former Ministers in the Department of Health and Social Care who served in the Conservative Government who, in a spirit of public service, have wanted either to do work for the Labour Government on issues that they care about, or have sought to share their experiences—the highs or, indeed, the many lows—of being in government. That is a totally legitimate thing to do. I suspect that, if I rang round all my Labour predecessors, I would find that the Conservative Government tried desperately hard to get them to work for them, because, as I say, the challenge for Conservative Health Secretaries was that they did not have any successful Conservative predecessors to turn to.

[Mr Paul Kohler (Wimbledon) (LD)]

I share the Secretary of State’s frustration and understanding of the brass neck of the Tories on this point and I do not doubt the expertise of Alan Milburn, but legitimate questions have been asked about conflicts of interest. What safeguards are being imposed or considered to address the appearance of conflicts of interest?

--- Later in debate ---

[Wes Streeting]

It is absolutely right that people appointed to roles in public life declare their conflicts of interest so that they can be assessed when taking decisions or exercising powers to ensure that they are doing so in a way that manages those conflicts of interest and no conflict arises. Alan Milburn does not, at this stage, have a role in the Department of Health and Social Care. Many people have come into the Department for meetings in the past eight weeks. We do not ask them all to declare their interests. I know there is more red tape now in health and social care than when we left office, but this Government want to reduce that not increase it.

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

The Conservative party appointed a party donor, Wol Kolade, who wants to change how the NHS is funded, to the board of NHS England. In January, the right hon. Member for Louth and Horncastle (Victoria Atkins) held a meeting with his private equity firm, Livingbridge, less than one month after he gave her party £50,000, so is it not the shadow Health Secretary who ought to be answering questions about cronyism?

[Wes Streeting]

It is not for me, thankfully, to answer for the shadow Secretary of State for Health and Social Care; it is just my responsibility to clean up her mess.

[Mims Davies (East Grinstead and Uckfield) (Con)]

Will the Secretary of State please illuminate the House about any conflict of interest concerning the gentleman in question? Did he head into the ministerial floor or access the Department? Many of us want our constituents to access health services and GP appointments. Did the right honourable gentleman, who is the Secretary of State’s friend from the old days and with whom he has worked with previously, have a day pass or a departmental pass? Beyond the bluster, can the Secretary of State assure hon. Members that there is no conflict of interest?

[Wes Streeting]

My right honourable friend, Alan Milburn, does not have a role in the Department. He does not have a pass to the Department. I am asked whether he has accessed the ministerial floor. I do not know where the Conservatives held their meetings, but I tend to hold them in my office on the ministerial floor.

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

Across Cramlington and Killingworth, I have heard countless stories—heartbreaking stories—of residents’ experiences of the NHS. They talk about the staggering length of waiting lists, access to GPs and access to dentists. Does the Secretary of State agree that, rather than focusing on who he might have once had a conversation with, the Conservatives would do better supporting the Labour Government in cleaning up the mess they left behind, which my residents live with every single day?

[Wes Streeting]

My hon. Friend is absolutely right. It is because of the way that she champions her constituency and her community that she was sent to this place to stand up for their interests. It will not be lost on her constituents or anyone else in the country that, with our national health service in the state that it is in and with the appalling headlines that we have been reading in recent days, the Opposition have absolutely nothing to say about the responsibility that they bear for the crisis or what they would do to fix it. They have the wrong priorities, but, fortunately, the country has the right Government.

[Nick Timothy (West Suffolk) (Con)]

How many meetings has Alan Milburn had in the Department? Will the Secretary of State place a list of all those meetings in the House of Commons Library? Knowing that the former Secretary of State has extensive financial interests in healthcare, did the Secretary of State ask him to declare those interests and publish them?

[Wes Streeting]

First, my right honourable friend, Alan Milburn, does not have a role in the Department. Secondly, of course we will publish, in the routine way that we do, details of meetings held in the Department and who attended them. I gently suggest that if the hon. Member has not made his way there already, there are plenty more interesting things to read in the House of Commons Library.

[Sam Rushworth (Bishop Auckland) (Lab)]

I think Opposition Members may be making the mistake of judging this Government by their own standards. I wish to ask the Secretary of State this: after my constituents and many others have suffered from the economic disaster that was caused in part by dodgy covid contracts and VIP fast lanes, what will this Government do differently?

[Wes Streeting]

I am delighted to see my hon. Friend here representing Bishop Auckland. The people of his constituency will be struck by the fact that this afternoon the Conservative party has chosen to create a mountain out of a molehill about a former Health Secretary coming in to lend his advice and experience to a Labour Government. On covid corruption, my hon. Friend is absolutely right to be angry, as indeed the country is, too. That is why my right hon. Friend the Chancellor of the Exchequer has been very clear that, when it comes to cronyism and corruption in covid contracts, we want our money back and the covid corruption commissioner is coming to get it.

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

There is just one standard and it applies to whichever party is in power, and that should be respected. All this whataboutery relating to what may have gone on under a Conservative Government! Anyone who has done something wrong should be pursued. Anyone in authority should be accountable. It is the failure of accountability, a failure of recognition, by the right hon. Gentleman that lets down the House today. Can he confirm to the House that Alan Milburn did not have access to official sensitive papers? Anyone who visits a Minister—they come in all the time—sits on one side of the table and the official sensitive documents are on the other side. Can he confirm that Alan Milburn did not have access that no other visitor would have?

[Wes Streeting]

In the meetings that I asked my right honourable friend to attend—I need to make sure that I get this absolutely right—I tend to think that I saw him on the other side of the table in the corner. I cannot guarantee that he sat at that point in every single one of the meetings, but he certainly was not sitting next to me. With regard to the papers for the meetings that he attended, they were discussion papers about the challenges facing health and social care. They were not Government decision papers or recommendations for Ministers. There is a distinction between those two things. I decide who attends meetings in the Department, and, when it comes to wide-ranging policy discussions, I decide what reading material people receive.

[Andrew Lewin (Welwyn Hatfield) (Lab)]

The Conservative party famously said that they had “had enough of experts”, and look at where that got us—the longest NHS waiting list in history. I am pleased that my right hon. Friend rejects that approach emphatically. In the spirit of listening to professionals who are trying to make a difference, I ask him and his team to consider visiting Hertfordshire, where the community trust is working on a hospital at home scheme. The scheme is making a huge difference to patients at the end of their life, who need to be supported, cared for and monitored. This is an important part of easing the burden on our NHS with which we have been left.

[Wes Streeting]

I would be delighted for either myself or one of my ministerial colleagues to take my hon. Friend up on that offer. What a refreshing change from so many of the contributions that we have had this afternoon from the Opposition. Of course we want to learn from people with experience and expertise in getting it right on the NHS and social care. Many of those people are outside Government. Many of them have valuable experience in other parts of the public sector, in our public services, in the voluntary sector and in the private sector—or indeed experience as patients, users or carers in our health and social care service. Our message as a Government is clear: when it comes to fixing the crisis in health and social care created by the Conservatives, we cannot get enough of experts, and we are looking forward to mobilising the country in pursuit of our mission, so that we can deliver an NHS that our country can once again be proud of.

[Gregory Stafford (Farnham and Bordon) (Con)]

Given the potential for commercial advantage to Alan Milburn, will the Secretary of State publish all the papers that Alan Milburn was able to read? If the Secretary of State gave them on Privy Council terms, as he seems to be saying, will he at least give them to any Privy Counsellor who wants them?

[Wes Streeting]

Given the state of the Opposition, I bet they would love to see what policy discussion papers we are putting forward in the Department of Health and Social Care. The hon. Gentleman is right: papers have been shared with my right honourable friend on Privy Council terms. The Opposition will, in time, be able to judge the fruits of the labour, in terms of my decisions and the decisions of this Government when it comes to fixing the mess that they created.

[Matt Turmaine (Watford) (Lab)]

I welcome the decision of the Secretary of State to seek wisdom from experts across the health and care system in order to build a better NHS. Is he aware of the virtual hospital system that has been used at West Hertfordshire Teaching Hospitals NHS Trust Watford site, developed during covid in order to treat more people in a better setting?

--- Later in debate ---

[Wes Streeting]

I am grateful to my hon. Friend for his question. We know that the NHS is broken, and is going through the worst crisis in history. We will shortly hear from the noble Lord Darzi about the outcome of his investigation into the true state of our national health service, but against that bleak backdrop of political failure are stories across the country of triumph against the odds, and of some outstanding public servants doing extraordinary things, showing what the future of our health and care services could look like with a Government on their side. I am pleased that such a Government is here—this Labour Government—and I would be delighted to hear more about my hon. Friend’s constituency.

[Jim Shannon (Strangford) (DUP)]

I wish the Secretary of State all the best in his new role, and in the task that he has taken on. With great respect to my Conservative colleagues, the downfall of the Tory Government was due in part to the fact that people did not trust the background politics behind closed doors. I want the Government to succeed, as do most people in this House. Stability and direction are much needed, but that can happen only with openness, transparency and a desire to put nation before party. How can the Secretary of State assure us that this Government will do things differently, and that policy will be proposed by those with know-how, and passed with scrutiny in this place, not simply due to pressure from lobby groups?

[Wes Streeting]

I strongly agree with the hon. Member. In the short time that I have been in post, I have been delighted to have had virtual meetings with the current Northern Ireland Minister of Health, as well as with his predecessor, the hon. Member for South Antrim (Robin Swann), who now sits over there on the Opposition Benches—I am delighted to see him in his place.

Ministerial meetings attended by third parties are declared in our quarterly transparency publication. People will want to lobby and influence Government, and Members of Parliament, all the time. Members of Parliament regularly receive correspondence—let alone the deluge of advice that we receive in government. The important thing is that Ministers take decisions on the basis of the best possible advice available, that they weigh up carefully the evidence and arguments in a fair and proper way, and that advisers may advise but Ministers ultimately decide.

This Government are aware of the deep crisis in trust in our politics. That is why, on his very first day, the Prime Minister talked outside Downing Street about restoring Government to service. It is why it should be no surprise whatsoever that many people who have given outstanding public service to this country, such as my right honourable friend Alan Milburn—and the same is true of Patricia Hewitt, Alan Johnson, my noble Friend Lord Reed, the Mayor of Greater Manchester and many more—want to roll up their sleeves and help the Government. They can see the state that the Conservative party left our country in, and are willing once again to roll their sleeves up to get our country back on its feet, turn the situation around and ensure that everyone in our country can look forward to the future with optimism and hope after 14 years of abysmal failure.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

That is the end of the urgent question. I thank all Members who participated. In reference to the Secretary of State earlier, the privilege of choosing UQs is down to the Chair and is based on merit and the urgency of the point being raised.

Gender Identity Services: Children and Young People

Wes Streeting Excerpts

Wednesday 4th September 2024 Written Statements

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

I am writing to update the House about the Government and NHS England’s work to improve gender identity services, as well as implement the recommendations of the independent review into gender identity services for children and young people by Dr Hilary Cass.

During summer recess the Government and NHS England made progress toward these recommendations. The aim of this work is to ensure that children and young people who are experiencing gender incongruence or dysphoria receive a high standard of care that meets their needs and is safe, holistic and effective.

Puberty blockers

The Cass review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender dysphoria and incongruence to know whether they are safe or beneficial.

The review recommended that puberty suppressing hormones should only be prescribed in the context of a clinical trial or under the guidance of the national multidisciplinary team. The report also recommended defining the dispensing responsibilities of pharmacists of private prescriptions of puberty blockers and considering other statutory solutions that would prevent inappropriate overseas prescribing.

The NHS has subsequently ceased the routine use of puberty blockers to treat gender incongruence in children. The former Secretary of State also issued an emergency order to extend restrictions to the private sector.

That emergency order came into force from 3 June 2024 in Great Britain and was due to expire on 2 September 2024. On 22 August, this Government renewed the order jointly with the Minister of Health in Northern Ireland. It commenced in Northern Ireland on 27 August 2024.

The Government recognise that the introduction of this order may cause concern to individuals and families who are impacted. If a young person has already taken these medicines or has been prescribed these medicines in the 6 months prior to 3 June 2024 (in Great Britain) or 27 August 2024 (in Northern Ireland), they can continue to do so, providing their prescription is now issued by a UK registered prescriber. They are strongly advised to meet with their prescribing clinician to fully understand the safety risks. For those patients accessing prescriptions from an EEA-registered prescriber, they can seek help from a UK private provider or see their GP.

The new order extends to Northern Ireland. The First Minister and Deputy First Minister gave their approval for the Minister of Health to co-sign the order. This will remain in place until the end of 26 November 2024 while we gather responses to a targeted consultation on a permanent banning order issued last month to representative organisations of those likely to be impacted by a permanent order. The proposed permanent order would continue the same restrictions and apply to the same medicines impacted by the emergency order, on a permanent basis. This would apply to private and overseas prescribing.

We do not yet know enough about the impacts of using puberty suppressing hormones at this critical stage in young people’s lives. In partnership with the National Institute for Health and Care Research, NHS England is launching a clinical trial to assess the potential benefits and harms of puberty suppressing hormones.

Within this trial, the effects of puberty blockers can be safely monitored, and the research will give Government and the NHS the evidence we need to decide whether they can be used as a safe and effective treatment. The trial aims to begin recruiting participants early in the new year.

New children’s services

In April, NHS England opened two new children and young person gender services in the north-west and London that offer a different clinical model, embedding multidisciplinary teams in specialist children’s hospitals. This includes a nominated paediatrician or psychiatrist with overall clinical responsibility for patient safety in these services. A third new service will open in the south-west in the autumn, and a fourth in the east of England in spring of next year. NHS England is advancing towards meeting its commitment for there to be a specialist children’s gender service in every region by 2026.

Referral service specification

NHS England has published a new service specification for the national referral support service for specialist services for children and young people with gender incongruence. A referral can only be made by an NHS-commissioned, secondary care-level paediatric service or a children and young person mental health service. This will ensure that healthcare professionals with the relevant expertise conduct the assessment and help determine any co-existing mental health or other health needs of these children and their onward care.

Adult services review

Dr Cass also recommended a review of the adult service specification for gender services, given the changing demographic presenting to children and young people’s services is reflected in a change of presentations to adult services. In response, NHS England has taken the decision to conduct a review of the operation and delivery of adult gender dysphoria clinics. The review will examine the model of care and operating procedures of each service, with the aim of producing an updated service specification for adult gender services. This will be led by Dr David Levy, medical director of Lancashire and South Cumbria integrated care board, and previously NHS England’s north-west regional medical director. Dr Levy will act as the independent chair of the review, which will include an expert panel of professionals and patients.

Conclusion

The trans community is disproportionately affected by issues of mental ill health, suicide and self-harm. We have a duty to them to lower the temperature and look for common ground away from the toxicity of the current debate.

The Government will not lose sight of the fundamental point that anyone accessing a gender identity service deserves the highest quality of care and support, and to be treated with dignity and respect, just as we would expect from any other service. This Government are determined that the public discourse about these issues does not lead to harm.

That is why this Government are absolutely committed to making sure every trans person feels fully part of our society. I believe the Cass review will deliver material improvements in the wellbeing, safety, and dignity of trans people of all ages and gender identities.

There is much to do in overhauling children’s gender identity services, and I can assure the House that I will be working closely with NHS England to implement further changes as soon as possible to ensure that every child receives the best possible care.

We will proceed with caution at every step, always putting the evidence first, and putting people above politics.

[HCWS70]

Care Quality Commission Section 48 Review of Nottinghamshire Healthcare NHS Foundation Trust

Wes Streeting Excerpts

Tuesday 3rd September 2024 Written Statements

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

On 30 January 2024, my predecessor as Secretary of State asked the Care Quality Commission to conduct a special review of mental health services in Nottinghamshire in response to the horrendous killings of Ian Coates, Grace O’Malley-Kumar and Barnaby Webber.

I am grateful to the CQC for the detailed work it has undertaken on this report. My thoughts are with the families and friends of Barnaby, Grace and Ian. This report makes for distressing reading, especially for those living with this unimaginable loss in the knowledge that this tragedy could have been prevented.

The review was composed of three strands. The reports for strands 2 and 3, relating to the safety and quality of services provided by Nottinghamshire healthcare NHS foundation trust and the services provided at Rampton hospital, were published on 26 March 2024.

On 13 August, the CQC published the remaining report for strand 1 of the review into the care and treatment provided to Valdo Calocane by NHFT in the period leading up to the horrific events of June 2023. As part of this review, the CQC was also asked to determine whether its review of Valdo Calocane’s care and that of 10 other benchmarking cases indicated wider patient safety concerns or systemic issues with the provision of mental health services in Nottinghamshire.

This report identified serious failings in the care and treatment provided to Valdo Calocane by NHFT that may have contributed to these tragic killings after he was discharged from the trust’s mental health services. These failings are consistent with the CQC’s findings from strands 2 and 3 of the review, published in March, which identified issues with the safety of services and quality of care at NHFT as a whole.

While there was no single point of failure for Valdo Calocane’s care identified in the report, the strand 1 review identified serious shortcomings relating to four areas: risk assessment and record keeping, care planning and engagement, medicines management, and discharge planning.

I have met with NHS England, which has provided me with assurance that it and NHFT are taking action to address the serious failures identified in the report. I have made it clear to NHS England that I expect regular updates on progress against all the recommendations across the three strands of the review.

In advance of the publication of this report, NHFT has taken action to implement the CQC’s recommendations, specifically relating to managing patients who may be at risk of harming themselves or others. These actions include:

Changing “did not attend” policies to make sure patients are not discharged for not attending appointments.

Implementing systems to make sure staff more robustly consider risks to patients and the public.

Reviewing the approach to managing beds—there are early positive signs of a reduction in patients being placed in incorrect care settings as a result.

Putting into place a new crisis telephone system so that patients can access crisis services 24/7 without delay.

Reviewing patients waiting to access community support—the waiting list has reduced from 1,500 to 1,092.

Providing increased oversight for patients who are waiting to access care and checking medications for everyone in the community on antipsychotic medication.

I have made it clear that I also expect regular progress reports from NHFT.

I also expect these findings and recommendations to be considered and applied throughout the country. NHS England has accepted all of the CQC’s recommendations and has initiated a series of actions to ensure nationwide improvements are made.

As part of this work, NHS England has tasked every provider in England to review the policies and practices in place to ensure patients who are very unwell and who need help to engage with services do not fall through the cracks. I expect regular updates from NHS England on the progress of this review.

Other measures the NHS has already undertaken include:

Issuing guidance to trusts reiterating instructions not to discharge patients with serious mental health issues if they do not attend appointments.

Commissioning an independent investigation into the incident, which will be published by the end of 2024.

Continuing to improve data on community mental health services including developing metrics around access to psychological therapies for severe mental health problems and outcomes for people accessing community mental health services.

Establishing an expert advisory group to oversee the development of core standards for safe care in community mental health services.

[HCWS66]

Doctors and Dentists in Training: Pay Offer

Wes Streeting Excerpts

Monday 29th July 2024 Written Statements

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

I am pleased to be able to inform the House that today I have made a formal offer on pay for the 2023-24 and 2024-25 financial years to the British Medical Association’s Junior Doctors Committee for doctors and dentists in training in England. The BMA, which represents these staff and other unions in negotiations, will recommend the offer to their members.

I am pleased to have been able to make this offer fewer than four weeks after becoming the Secretary of State for Health and Social Care. I said during the general election campaign that I would get around the table with unions and find a way to resolve industrial action. This is a promise made, and a promise kept.

Under the offer, doctors and dentists in foundation and specialty training will receive:

an average investment of 4.05% into 2023-24 pay scales effective from 1 April 2023, with a payment to reflect backpay; and

a further consolidated uplift of 6% + £1,000 in 2024-25, in line with the recommendations of the Review Body on Doctors and Dentists Remuneration (DDRB).

If accepted this will mean an average pay uplift of 22.3% in basic pay for doctors and dentists in training over the past two years.

The Government will instruct the DDRB to change the approach they take when considering pay for doctors and dentists in training from 2025-26.

The Government have also committed to improving the current exception reporting process and to working in partnership with the BMA and other health organisations to reform the current system of training and rotational placements.

This offer would increase the base salary for a full-time doctor starting foundation training in the NHS to over £36,600 compared to around £32,400 before this offer was made. A full-time doctor entering specialty training would see their basic pay rise to over £49,900 from around £43,900 before this offer was made.

If this offer is accepted, the BMA will withdraw the rate card for doctors and dentists in training in England with immediate effect, and the current trade dispute with doctors and dentists in training will end.

The BMA will now begin the process of consulting their members on the offer. The BMA JDC and its officers will recommend that members accept this deal, and I strongly encourage members to do so. I will update the House on this matter in due course.

From September, I will refer to this group of doctors as resident doctors. This is the preferred nomenclature of the BMA, and an important sign of a new collaborative relationship between the medical profession and the Government based on a firm foundation of mutual respect.

Separately, I want to inform the House that this Government will also honour the offer made by the previous Government to the BMA Specialists, Associate Specialists, and Specialty Committee for SAS doctors. The BMA’s SAS members voted to accept the offer during the pre-election period.

These commitments come alongside the publication of the pay review body reports, on which I have updated the House separately.

[HCWS41]

NHS Pay Review Recommendations: England

Wes Streeting Excerpts

Monday 29th July 2024 Written Statements

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

Today I am accepting the recommendations of the NHS Pay Review Body, the Review Body on Doctors’ and Dentists’ Remuneration and the Senior Salaries Review Body. This means that 1.5 million NHS staff in England will receive a significant pay rise backdated to 1 April 2024. For staff directly employed by NHS providers, this will be funded by NHS England through system allocations.

I am grateful to all the chairs and members of the NHSPRB, the DDRB and the SSRB for their reports that recognise the vital contribution that NHS staff and leadership make to our country. I am accepting their pay recommendations in full, re-committing to financial prudence and fair uplifts for public servants.

The NHSPRB recommended a 5.5% increase to all Agenda for Change staff, alongside other recommendations for a funded envelope for structural reform. In accepting these recommendations, we have committed to:

Uplifting all pay points for AfC staff (c.1.3m staff) by 5.5% on a consolidated basis, taking effect from 1 April 2024.

Adding intermediate pay points at AfC Bands 8a and above.

Working with the NHS Staff Council to take forward the PRB's recommendations on AfC pay structures.

Recognising the role of the NHS Staff Council, we are accepting the second recommendation regarding the addition of intermediate pay points to bands 8a and above in principle but are asking the NHS Staff Council to ratify it before it is implemented. We want to work with the NHS Staff Council on issues with the AfC pay structure, so we will work with stakeholders on the third recommendation.

The DDRB recommended a 6% increase to salary scales, pay ranges and the pay elements of contracts from 1 April 2024. It also recommended that an extra £1,000 be added to the pay points for doctors and dentists in training. In accepting these recommendations, we have committed to:

uplifting pay points for doctors and dentists in training (c. 73,000 doctors) by 6% plus £1,000 on a consolidated basis (an average of around 8.2% increase in pay);

uplifting the salaries of consultants (c.61,000 doctors) by 6% on a consolidated basis;

uplifting the pay range for salaried General Medical Practitioners (c.15,000 doctors) by 6% and uplifting the pay element of the GP contract by 6% on a consolidated basis (an increase of 4% on top of the 2% interim uplift in April);

uplifting the pay element of the General Dental Practitioners contract (c.24,000 dentists) and the minimum and maximum pay scale for salaried dentists by 6% on a consolidated basis;

uplifting the pay scales of specialist and associate specialist (SAS) doctors on all contracts by 6% on a consolidated basis.

The SSRB recommended an increase of 5% for all executive and senior managers and all very senior managers in the NHS in England from 1 April 2024, which we have accepted. The Government are still considering its approach to the recommendation to have a four-week turnaround on pay cases for VSMs and ESMs and so cannot confirm acceptance at this time.

These recommended uplifts are broadly in line with private sector earnings growth.

The previous Government neglected public sector pay for 14 years, and now we are resetting our relationship with public sector workforces. We will take further steps to restore confidence in the pay-setting process. We are accepting those recommendations, and will reform those public services, to deliver our missions.

The reports of the DDRB, the NHSPRB and the SSRB will be presented to Parliament and published on gov.uk.

[HCWS40]

Care Quality Commission

Wes Streeting Excerpts

Friday 26th July 2024 Written Statements

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

Today I wish to update the House on the publication of the interim findings of the review into the operational effectiveness of the Care Quality Commission that is being conducted by Dr Penny Dash. I have asked Dr Dash to publish these interim findings, as I wish to share with the House and the public the serious failings they expose.

Getting regulation right is critical to ensuring that health and social care is not only safe but also high quality. If the way we regulate is not fit for purpose, it means that people are not properly supported in their choices about health and care, and there is a lost opportunity to deliver improvements. Dr Dash’s interim findings demonstrate that the CQC, as the regulator of health and social care in England, is exactly that: not fit for purpose.

Dr Dash’s report has given people across the health and social care system, including from within the CQC, the opportunity to speak up about what I believe are systemic and cultural problems. I commend the report for creating an environment in which people have been able to speak up; to fix the NHS we must create a culture that values and listens to the voices of those who can see where the problems are.

Dr Dash has heard major concerns from significant groups of stakeholders. There are failings in the way that the CQC assesses organisations relating to the single assessment framework, which means that we cannot be confident that inspections are looking at all the things the public should rightly expect. There are also concerns about how ratings, which both the public and service providers depend on, are calculated. These failings are compounded by a further finding that the CQC does not have appropriate sector-level expertise throughout the organisation. Dr Dash is clear that all of these concerns mean that the CQC has lost credibility.

As recommended by Dr Dash, the Department of Health and Social Care will work with the board of the CQC to address the issues raised. The board will have my full support in ensuring the right leadership is in place to drive through the changes that are needed.

While this is an interim report, I would like to highlight four immediate steps that I will be taking with the CQC.

First, the CQC have asked Professor Sir Mike Richards to review the single assessment framework. This is an important step in addressing the concerns Dr Dash raises about how the safety and quality of hospitals is assessed. Sir Mike is an eminent and highly regarded clinician who was the CQC’s first chief inspector of hospitals. The fact that the CQC has asked someone with Sir Mike’s significant experience to give detailed and thorough consideration to improving the framework shows that the CQC is now taking seriously the concerns raised in the report and is acting swiftly to address them.

Second, I have asked the CQC to urgently improve the transparency of its ratings. This will include being clearer about what evidence has been considered in reaching the ratings, as well as setting out clearly the dates of the inspections that a rating is based on. This is to address the report’s finding about the historical practice of combining inspections over several years to produce a rating. This is important so that members of the public can have confidence that they know what a rating actually means. The action I am taking is a first step to bring in greater transparency, but more work will be required as the CQC looks in more detail at its assessment framework.

Third, the Department of Health and Social Care will increase the level of oversight of the CQC, including the frequency and seniority of that oversight. Over the summer, I will be looking at what is needed to ensure that the recommendations in the interim review are acted upon. This arrangement will continue once the final report is published. Ultimately, the Department’s objective must be to ensure that improvements in the delivery of CQC’s core functions are achieved for service users and service providers across health and social care. I have requested firm assurance from the chair that effective and credible appointments are made for a permanent chief executive and chief inspectorate of healthcare.

Fourth, the CQC sits within a complex landscape of bodies with responsibility for safety. Pending completion of her final report in autumn 2024, I am asking Dr Dash to undertake further work and make recommendations on how we can maximise the effectiveness of key bodies, individually and collectively, within that landscape. Terms of reference will be determined in due course.

Only by ensuring that we have a health and social care system that works as a whole will we be able to restore the public’s confidence in the safety and quality of care and, most importantly, put the voice and experience of patients and service users back at the heart of our regulation and oversight of the whole health and social care system.

The interim findings of the review have been published on gov.uk. I will provide a further update to the House once Dr Dash’s final report has been published.

[HCWS27]