New Hospitals

Wes Streeting Excerpts

Thursday 25th May 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

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

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

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

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

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

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

[Steve Barclay]

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

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

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

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

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

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

Recovering Access to Primary Care

Wes Streeting Excerpts

Tuesday 9th May 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

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

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

[Steve Barclay]

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

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

The Boots chief executive says that this is

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

The Company Chemists Association says that it is a

“real vote of confidence for the future profession”.

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

“a real game-changer for patients”,

and that is what our focus has been.

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

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

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

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

Oral Answers

Wes Streeting Excerpts

Tuesday 25th April 2023 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

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

[Will Quince]

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

--- Later in debate ---

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

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

[Steve Barclay]

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

[Wes Streeting]

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

[Steve Barclay]

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

NHS Strikes

Wes Streeting Excerpts

Monday 17th April 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

[Wes Streeting]

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

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

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

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

[Steve Barclay]

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

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

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

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

Junior Doctors’ Strikes

Wes Streeting Excerpts

Thursday 30th March 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

[Wes Streeting]

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

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

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

[Steve Barclay]

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

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

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

NHS Workforce Expansion

Wes Streeting Excerpts

Tuesday 28th February 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I beg to move,

That this House condemns the Government’s failure to train enough staff to tackle the worst workforce crisis in the history of the National Health Service with a current shortage of 9,000 hospital doctors and 47,000 nurses; notes reports that the draft NHS England workforce plan calls for a doubling of medical school places to address this crisis; calls on the Chancellor of the Exchequer to use the upcoming Spring Budget to end the 200-year-old non-domiciled tax status regime; and further calls on the Government to use revenue generated by ending that regime to adopt Labour’s plan to expand the NHS workforce by doubling the number of medical training places, delivering 10,000 more nursing and midwifery clinical placements, training twice the number of district nurses each year and delivering 5,000 more health visitors.

To anyone who has needed medical care in recent months, it is blindingly obvious that the NHS is desperately in need of more staff. Doctors and nurses are overworked, hospitals are understaffed and the staff are burnt out. Patients are waiting longer than ever before, and 13 years of the Conservatives’ failure to train enough staff has broken the NHS, leaving patients to pay the price. In the words of the right hon. Member for Gainsborough (Sir Edward Leigh), Labour has a plan; where is the Government’s?

[Sir Edward Leigh (Gainsborough) (Con)]

The point I have been trying to make in recent months is that we should try to learn from the experience of Europe, where they have very effective social insurance systems and much more effective outcomes, so when the hon. Gentleman says he has a plan, I think we would all like to know what the plan is. Is it radical reform, or is it just more and more taxpayers’ money thrown into the NHS?

[Wes Streeting]

I am grateful beyond words for that intervention. I will outline Labour’s plans immediately and return to the right hon. Gentleman’s challenge—proposing a social insurance system—a little later in my remarks.

The point of this debate is that there is a serious shortage of staff. Labour has a plan to address that shortage, whether that is measures for retention of the staff we have or our plan for the biggest expansion of the NHS’s staff in history. The Conservatives have no plan, so let me outline what Labour’s plan is. We will double the number of medical school places so that we train 15,000 doctors a year. We will train 10,000 new nurses and midwives every year. We will double the number of district nurses qualifying each year and train 5,000 more health visitors. In a formula that will become familiar in the run-up to the next general election, we are clear about how we would pay for it, too. We will pay for it by abolishing the non-dom tax status, because patients need doctors and nurses more than a wealthy few need a tax loophole.

[Catherine West (Hornsey and Wood Green) (Lab)]

Does the shadow Secretary of State agree that it is not just about cash; it is also about the huge recruitment issues? For example, the North Middlesex University Hospital has 800 patients a day into accident and emergency, and it is suffering because even if there is the budget, there simply are not the staff to employ to put on the frontline?

[Wes Streeting]

My hon. Friend is absolutely right, and it is why current staff in the NHS are right to say that retention is urgent and that we need measures from the Government immediately to deal with retention. By definition, if we have a shortage of staff, retention is not enough, and that is why Labour has put forward a fully costed, fully funded plan for the biggest expansion of NHS staff in history.

[Yasmin Qureshi (Bolton South East) (Lab)]

Does my hon. Friend agree that the £1.3 billion that the NHS spent on agency staff last year could have been used to recruit proper, full-time NHS staff?

[Wes Streeting]

I wholeheartedly agree. It is why we are in the worst of all situations: the shortage of staff means not only that patients are receiving poorer care, but that we are paying over the odds as taxpayers for the Conservatives’ failure to recruit and retain the staff we need.

We are not alone in thinking that the biggest expansion of NHS staff in history and doubling the number of medical school places is the right solution. Amanda Pritchard, the chief executive of NHS England, has rightly said that we need greater investment in training to stop excellent British students being turned away. The Royal College of Physicians has called for medical school places to be doubled, and now the NHS is formally asking the Government to fund it. Why are the Government refusing to fund a doubling of medical school places, which the NHS and the Royal College of Physicians say is necessary, and which patients can see through experience is desperately necessary?

[Dr Luke Evans (Bosworth) (Con)]

rose—

[Wes Streeting]

Perhaps the hon. Member can tell us.

[Dr Evans]

I am grateful to the shadow Secretary of State for bringing me in on this point. Training is really important. As someone who has been a medical student, I know that one of the most important things to look at is how many people will be on one’s firms. We do not want 12, 15 or 20 people all coming into a cubicle to see a patient. Although I welcome the idea of expansion, can he talk me through what the ratio will be on ward rounds for medical students being trained?

[Wes Streeting]

I am glad that finally Government Members have noticed that Labour has got a plan and are asking how it will work; I wish that Government Ministers would join in. The proposal we set forward to double the number of medical school places is based on modelling put forward by the Royal College of Physicians, which understands perfectly well the points the hon. Member makes. I have had excellent meetings with university vice-chancellors, who are keen to roll up their sleeves and help. The reason we set out a plan this far from a general election was for two reasons. First, we want to give medical schools and NHS employers time to prepare for the expansion. Secondly, we hope that the Government adopt this plan to give the next Labour Government a head start. I very much hope, as this motion says, that the Chancellor will take our plan and incorporate it into his Budget, and I will cheer him if he does so.

I will tell the House how ludicrous the situation is today. There are medical schools in England today that are exclusively training international students, many of whom will leave upon graduating, while at the same time we are turning away thousands of straight-A students from our own country who want to help the NHS. Brunel University is training 100 new doctors, with not a single UK student. Chester University has deferred the launch of its medical degree by a year because the Treasury will not give it a penny. Local NHS trusts and charities have chipped in to fund 20 UK medical student places at Three Counties Medical School at Worcester University, because the Government are refusing to fund a single domestic student. Despite pleas from the NHS, the Minister for Skills, Apprenticeships and Higher Education, the right hon. Member for Harlow (Robert Halfon), has threatened to fine medical schools if they increase their offers to applicants next term.

[Mr Peter Bone (Wellingborough) (Con)]

rose—

[Wes Streeting]

I am almost certain that the hon. Member for Wellingborough (Mr Bone) will not agree with his universities Minister.

[Mr Bone]

The hon. Member is making an interesting speech. On the point about retaining people from overseas going into medical training, who he said will then qualify and leave, does he think there is an argument for having an arrangement of the sort they have in the airline industry, whereby someone who is trained here then has to work here for a certain number of years, or otherwise repay the cost? Does he think that would help the situation?

[Wes Streeting]

There are a couple of challenges with that approach. First—I want to be clear about this—having international students come to study at UK universities is a wonderful thing. It is wonderful for British students who mix with cohorts drawn from across the world, and it is wonderful because they contribute to the cultural and intellectual life of our universities, and of the towns and cities in which they live while studying here. It is a wonderful thing because they often return to their countries with fond memories of Britain, which is an extension of our soft power and diplomatic influence. Those are all great reasons why we should cherish, embrace and welcome international students, and it is why I hope the Home Secretary does not win the argument inside Government to restrict further access to international students. Finally, I should say that international students also pay an enormous amount to come and study here in the UK, and they subsidise home students.

I want to be clear about how much I welcome international students, but it is an absurdity that people are coming to this country to study in medical schools that have no British students. It is an absurdity, when we have a chronic shortage of doctors, nurses, midwives and allied health professionals, that we see straight-A students from our own country being turned away, while university medical schools are being told they can only recruit international students. That is the depths of stupidity that this Government are plumbing.

[Jim Shannon (Strangford) (DUP)]

I commend the shadow Minister for his thoughts. The poaching of junior doctors by Australia, for example, for better pay and working conditions, as opposed to fractured shift patterns here, is a major issue. It is not just about expanding the workforce, to which he has referred; it is also about having a careful and concerted campaign to retain staff here. Does he agree that has to be part of the thrust of this debate?

[Wes Streeting]

I wholeheartedly agree with the hon. Member. I will talk about this later in my speech, but it is why the Government have to resolve this pay dispute with existing NHS staff. The danger is not that they walk out for another day of strike action, but that they walk out of the NHS altogether for countries that treat them better. What an absurd position to be in. It is also absurd, by the way, that we still have doctors retiring early for no other reason than that the pensions rules create an active financial disincentive to work up to normal retirement age, as many of them would like to do. It is completely absurd.

[Dr Evans]

Will the shadow Secretary of State give way?

[Wes Streeting]

I am happy to give way to the hon. Member again, but may I gently suggest that he would be better off lobbying current rather than future Ministers?

[Dr Evans]

As the hon. Gentleman sees himself as a future Minister, what is his solution for the pensions position for consultants?

[Wes Streeting]

I am delighted that the hon. Member asks. I had a good meeting with the British Medical Association pensions committee recently. There are a number of ways in which this matter could be resolved, one of which might be a tax-unregistered scheme, which we have seen used successfully in the judiciary. [Interruption.] I am perfectly fine with having a tax-unregistered scheme. I think the difference between the Opposition and the Government is that the Government have an army of civil servants to do the modelling. That is what I would like the Government to do. I say to the hon. Member again that it is no use lobbying the next Government—lobby the current Government.

Turning again to the international picture, the NHS is having to recruit from countries on the World Health Organisation’s red list—countries that desperately need the few doctors and nurses they have—because our Government cannot be bothered to train their own. I think that is unethical, immoral, a disgrace and a kick in the teeth for the UK students who desperately want to be the doctors, nurses, midwives and allied health professionals that our country needs.

The Chancellor is refusing to budge, I believe, on cost grounds, but Labour’s plan before the House today would cost £1.6 billion a year. We have shown how we would pay for it: scrapping non-doms would raise more than £3 billion. If the Chancellor needs any tips about the non-doms system, or if perhaps he is worried that non-doms might flee the country, he need only knock on his next-door neighbour’s door to see a case in point. He will find out how the system works, and that when people are asked politely to pay their taxes here, they do not flee the country.

Inaction also has costs. The NHS spent an eye-watering £3 billion on agency staff last year. One hospital was so desperate that it paid £5,200 for a doctor to work a single shift. Does that not sum up the approach of this Government: penny wise and pound foolish?

[Alex Sobel (Leeds North West) (Lab/Co-op)]

My hon. Friend is making a remarkable speech. My constituent Marjorie Dunn spent seven weeks and a day in Harrogate Hospital last year, and in that time she saw NHS nurses leave the service and she was treated predominantly by agency staff—mistreated, I have to say, by agency staff. It is a disgrace. When she was eventually moved to a recovery hub run by Leeds City Council, she got excellent treatment there. She had broken her pelvis and been told she would never walk again, but it was the council physiotherapist who got her up and walking again. Is it not right that we should be supporting local authorities such as Labour-run Leeds to get such facilities as well as the NHS?

[Wes Streeting]

My hon. Friend is absolutely right. I very much enjoyed my visit to Leeds with the shadow Chancellor to look at the work the acute trust is doing with Leeds City Council to speed up delayed discharges. He is absolutely right about the impact of the churn of staff on a ward—because they are not regular staff on a contract of employment at a particular hospital or medical facility—and it can be quite distressing for patients to see the faces and names change every day and to constantly be explaining once again what their experience in the hospital has been, if indeed the staff have time to stop and talk.

I am really struck by the fact that one of the biggest issues that staff raise with me is the moral injury. The fact is that they are busting a gut and working their socks off, and they go home at the end of the day deeply demoralised, distressed and depressed because they know that, despite their very best efforts, they are not providing the quality of care that patients deserve, through no fault of their own. That is why, even above the issues of pay and of terms and conditions, which I think many of us would understand in and of themselves, I think the straw that is breaking the camel’s back is the moral injury. Unless we address that, we are going to lose the brilliant staff we have, before we even start to think about recruiting the staff we need.

[Grahame Morris (Easington) (Lab)]

I am very grateful to my hon. Friend for giving way before my knee does. Clearly, he is a man with a plan. Is it not incredible that we do not have a plan for dealing with cancer—the Government have dropped the 10-year cancer plan—particularly at a time when 50,000 patients a month are having to wait more than two weeks between diagnosis and seeing a specialist? We need a plan that incorporates workforce recruitment and retention.

[Wes Streeting]

I apologise for keeping my hon. Friend bobbing—the last thing the NHS needs is another patient, so I hope the exercise has been good for his joints rather than the straw that breaks that camel’s back.

My hon. Friend is absolutely right. I think cancer treatment is in many respects the canary in the coalmine, because it is an area where speed really does matter and where early detection can make a huge difference to the success of the outcomes. It is why, when we were in government, we had a cancer guarantee. By pursuing that cancer guarantee and making sure that patients received timely access to both diagnosis and treatment, the rising tide for cancer patients lifted all ships, and we saw a general improvement in the NHS, so that by the time we left government we had the lowest waiting times in history.

I am deeply anxious that within those waiting lists, which stand at a record in excess of 7 million now, will be a huge amount of undiagnosed cancer. As I know from personal experience of going to accident and emergency with something else, it is often in A&E departments that cancer is detected. I worry how many cancer patients like me will arrive at A&E, see the waiting times and walk away with a cancer undiagnosed. It certainly keeps me awake at night, and it should keep Ministers awake at night too.

[Bambos Charalambous (Enfield, Southgate) (Lab)]

I congratulate my hon. Friend on an excellent speech. Is he aware that Macmillan Cancer Support has today published research showing that 2022 was the year in which all national cancer targets were missed in at least one month? That is truly shocking, and it is why we need an NHS workforce plan urgently. Does he agree that it is about time the Government came forward and produced such a plan?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. Unless the NHS has the staff it needs, patients will not get the timely care they deserve. It really is as simple as that. We have a plan; the Government do not, and they are very welcome to take ours.

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

The shadow Secretary of State is making a very good speech. On the issue of cancer, around half of cancer patients need radiotherapy, but barely a quarter get it. One reason is that the workforce in radiotherapy is small— 6,400 people. At the moment, the number of posts vacant in radiotherapy centres is 30% higher than the number of new graduates leaving college and coming into the professions that make up that workforce. We also found in the Radiotherapy UK survey that 80% of the workforce in radiotherapy centres reported that either they or a colleague had considered leaving. Does he think that the cancer workforce is essential to a cancer plan that will actually save lives?

[Wes Streeting]

The hon. Gentleman is absolutely right, and I have been following his work and that of the all-party parliamentary group on radiotherapy in this area, because he raises issues that ought to be taken very seriously. I was very grateful to my hon. Friend the Member for Easington (Grahame Morris) for coming to meet me about these challenges in particular. Of course, this has to be at the heart of a serious plan to improve cancer outcomes.

There is no doubt but that Labour’s workforce plan—supported by the NHS, supported by the professions, supported by so many members of the public—would make a difference. In fact, our inboxes have been filling with people welcoming the plan. It was a particular surprise to me to see one piece of fan mail that said:

“Despite my obvious political allegiances it would be remiss of me not mention the fact that Labour has pledged to double the number of medical school places and recruit additional health visitors and district nurses.”

It goes on to say that it

“is something I very much hope the government also adopts on the basis that smart governments always nick the best ideas of their opponents.”

Well, what luck that this particular fan of Labour’s policy joined the Government just two weeks after he sent the email. It is, of course, the Chancellor of the Exchequer, who I must say I thought was an excellent Chair of the Health Committee. It is almost as if he had learned from all his mistakes when he was the Secretary of State for Health.

This is Lent, a period for atonement and a time for forgiveness, so I make this pledge today: if the Chancellor realises the errors of his ways and comes to this House to double the number of medical school places in the Budget and adopt Labour’s NHS expansion to deliver the biggest expansion of the NHS workforce in history, I will cheer him on from the Opposition Front Bench during the Budget. I will cheer him on—

[Dr Luke Evans]

Come across!

[Wes Streeting]

Well, I need the help of the hon. Gentleman and Conservative Members, because my pleas seem to be falling on deaf ears. That is why I have taken the trouble to circulate this email to every Conservative Member, so that they can collar the Chancellor in the voting Lobby this evening—no doubt when he is voting with us, because he agrees with us—and I look forward to their assistance in helping him to see the error of his ways. In all seriousness, it is time that the Chancellor put his money where his mouth is, abolished non-doms and used the proceeds to train the doctors and nurses that the NHS needs.

We know the consequences of the current NHS crisis. Earlier this month, I met Samina and Minnie Rahman, who lost their loving husband and father on Christmas eve after calling for an ambulance three times. The family were initially told a nurse or paramedic would call them back, as it was deemed Iqbal did not require an ambulance. Forty minutes later, when his condition worsened and his family were unable to lift him into their car to drive him to hospital, they phoned 999 again. This time an ambulance was sent, but was then diverted to a higher-priority call. When Iqbal stopped breathing an hour after the first call, his family called 999 a third time, and an ambulance eventually arrived 24 minutes later. The paramedics spent 90 minutes attempting to revive Iqbal in front of his family, but they were unable to. That story is tragic and awful for the family who lost a husband, a father, and a grandfather. Perhaps most depressing is that this case is no longer surprising. The hour and a half that Iqbal waited for an ambulance was the average amount of time that patients with conditions such as heart attacks and strokes waited in December.

The West Midlands Ambulance Service has apologised to Mr Rahman’s family, but they want the Government to take action. They are calling for change to ensure that no other family must endure what they have been through, and they have three asks. First, they want an independent review to establish the number of deaths and serious harms caused by ambulance delays. The Government have rejected figures from the Royal College of Emergency Medicine that claimed that up to 500 people a week were losing their lives this winter due to long waits for emergency care. They also rejected figures from the Office for National Statistics on the number of excess deaths suffered in the past year. Well, Mr Deputy Speaker, “ignorance is bliss” is not a responsible approach to the crisis in emergency care. Sunlight is the best disinfectant, so I hope the Minister will commit to establishing the true scale of the harm caused by the crisis in the NHS.

Secondly, Minnie and Samina ask the Government to instigate Cobra-style meetings to deal with the public health emergency of ambulance delays. That is already happening to deal with the fallout from industrial action, but we need the same level of action for non-strike days. Thirdly, Minnie and Samina have asked to meet the Health and Social Care Secretary, so that he can hear at first hand about their experience, and see the trauma it has caused. The Secretary of State is not able to be here this afternoon, but I hope the Minister will convey that request to him. I gently remind her that I passed on Zaheer Ahmed’s request to meet the Secretary of State after his five-year-old nephew passed away following multiple failings by the health service, but that meeting is yet to be arranged. I think the least we can do as public servants is listen to those we serve, especially those who have suffered in the most unimaginable way. I hope the Secretary of State will meet those families, and that they are able to spur the Government into taking the action we need.

One promise of the NHS is that it is there for us when we need it. That has been completely fundamental in this country for as long as many in the Chamber can remember, but that promise is now broken. People are frightened that the NHS will not be there for them in an emergency. It is not hard to understand why. Look at the news today that more than 1.5 million patients waited for more than 12 hours in A&E last year, which is estimated by the Royal College of Emergency Medicine to have seen 23,000 people lose their lives.

This is not just about emergency care. Patients in need of an operation or even a GP appointment do not know whether the NHS will be there for them when they need it. That is why so many people are voting with their feet, and with their wallets, and going private. Of course most people in this country cannot afford to pay, so they have no choice but to wait and worry. Restoring that promise of an NHS that is there for us when we need it should be a basic task for any Government, but this Government do not even have the ambition, let alone a plan to get there. Instead, the Health and Social Care Secretary said last month that a world where patients are seen within four hours at A&E is “too ambitious” and “not achievable”. But it was achieved until 2015. It was certainly achieved under the last Labour Government.

The target for ambulances reaching patients with strokes or heart attacks has almost doubled to half an hour. If someone wants to see a GP, there is an “expectation”, not a guarantee, that they will be able to do that in two weeks. Two weeks! I remember Tony Blair being attacked because people were forced to see a GP within two days—what people wouldn’t give to be in that position now. Millions wait longer than a month. The Government missed the goal so they moved the goalposts. They have accepted that the NHS will not be there for all of us when we need it. That is what managed decline looks like. That is what brings about the end of the NHS. It is not calls for a different model from the right hon. Member for Gainsborough and others; it is this: slow, irreversible decline. That is what the end of the NHS will look like, and that is why we desperately need a change in Government.

[Catherine West]

Does my hon. Friend remember when the NHS had an 80% approval rate among UK citizens back in 2008? Now look at it—approval is under 50%, perhaps 38%.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. We delivered the highest levels of patient satisfaction in the history of the national health service. Now patient satisfaction is at its lowest level since at least 1997. There is a second basic promise of the NHS which, if it is not broken, is under attack today like it has not been for years. When I went through my treatment for kidney cancer I had lots to think and worry about—every cancer patient does—but the one thing I never had to worry about was the bill. That is the thing that people love most about the national health service, but those who have never believed that healthcare should be provided to all, regardless of their means, are using this crisis to attack that principle. The right hon. Member for Gainsborough called the NHS the

“the last example of collective planning and socialist central control”—[Official Report, 22 September 2022; Vol. 719, c. 840.]

and even today called on the Health and Social Care Secretary to look at insurance based systems instead.

The hon. Member for Christchurch (Sir Christopher Chope) has a Bill before the House this week that would extend user charging. The Prime Minister himself pledged last summer to charge patients who miss GP appointments, although he has since ditched that pledge—indeed, he has ditched an awful lot since he became Prime Minister. Two former Health Secretaries have joined in. The right hon. Member for West Suffolk (Matt Hancock) has proposed charging for missed GP appointments. The right hon. Member for Bromsgrove (Sajid Javid) went further and suggested charging patients to see a GP, or even to attend A&E. If he were here, I would happily give way to hear an explanation as to how that would work. The most deeply cynical thing about this, is that the right hon. Members for West Suffolk and for Bromsgrove are the people who bear much of the responsibility for the mess we are in today. They ran down the NHS. They refused to train the staff needed to treat patients on time. Now they say that timely care, free at the point of use, as we enjoyed 13 years ago, and as we have enjoyed for much of the past 75 years, is no longer possible—that we cannot afford it any more, that it is not achievable. That regressive, miserabilist argument cannot be allowed to win. Not only is it unjust, but it is wrong, so let us take it on in its own terms.

Why do patients who are ill enough to need to see a doctor miss appointments? Very often it is because the appointment clashes with work, they are unable to travel, they did not receive the letter, or it arrived too late. The answer is to change the archaic and maddening way that patients are forced to book appointments, and build a new system around patient convenience. If patients could choose whether to have an appointment face-to-face or over the phone, if they did not have to wait on hold at 8 am to book an appointment, then wait for a call back that can come at any time of the day, fewer appointments would be missed. Why is it that those who attack NHS managers as being wasteful bureaucrats want to install far more of them? Because that is what an insurance-based system would mean. One-third of US healthcare costs go to insurance company overheads and providers billing patients. Is that really what the proponents of an insurance system want—more administration, more bureaucracy, and less money spent on delivering healthcare?

What would happen if we charged patients to see a GP? People would stay away. In some cases, yes, that would mean people who did not need to see a GP would not take up an appointment. But it would also mean that many people who needed to see a GP but could not afford the price stayed away. More conditions would go undiagnosed, and left to become more serious until the patient had to go to hospital instead. It would mean worse outcomes for patients, a less healthy society, and greater cost to the taxpayer. While we might save £39 on a GP appointment, it costs far more for patients to go to A&E, which costs £359 on average. Not only are those proposals unfair, but they would mean more bureaucracy, more late diagnosis, more expensive and less effective hospital treatment—exactly the opposite of what the NHS needs. Such proposals are wrong on fairness, wrong on efficiency, and wrong on health outcomes. Those in government have no plan for the NHS, and there are even worse ideas sitting on their Back Benches.

[Chi Onwurah (Newcastle upon Tyne Central) (Lab)]

My hon. Friend is making an excellent speech. Does he agree that the lack of support for a workforce plan, and the deliberate running down of the NHS, will prevent it from being able to take on and take up changes in technology, innovation, processes and treatment that could ensure better healthcare with less cost, enabling the NHS of the future to provide the support and treatment that the British people deserve?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. This really is the crux of it after 13 years of Conservative Government: either the NHS is in the mess it is in today through deliberate policy choice, deliberately running down the NHS because they do not believe in it, or the NHS is in this state through negligence and incompetence. [Interruption.] Perhaps the Minister would like to tell us whether it is negligence and incompetence, or deliberate policy choice. [Interruption.] Apparently, it is the pandemic. I wondered how long it would be before we ticked that box on the health debate bingo card.

If the NHS was in its worst crisis in history and we had the longest waiting times in the history of the NHS because of the pandemic, why were NHS waiting lists at their longest historic level before the pandemic? Why were there 100,000 staff shortages before the pandemic? Why were there 112,000 vacancies in social care before the pandemic? I will tell you why, Mr Deputy Speaker. For the entire time they have been in government, whether pre-pandemic or post-pandemic, the Tories have not had the first clue what to do with the NHS. They took a golden inheritance of the shortest waiting times and the highest patient satisfaction in history, and they have squandered it over the last 13 years to the extent that people dial 999 and an ambulance does not come, people ask to see a GP and there are not enough appointments, and cancer outcomes and cancer waiting time targets are not met—not a single one. That is their record. It is the consequence of their choices and it is one of many reasons why this country needs a change and a Labour Government.

The right hon. Member for Gainsborough asked what reform under a Labour Government looks like. I say to him that it is not the model of funding that is broken, but the model of care. The NHS diagnoses too late, by which stage treatment is less effective and more expensive. We focus too much of our spending on hospital care and not enough on primary care, social care and prevention. The reform our health service needs is shifting that focus out of the hospital and into the community, because if we can reach people sooner we can catch illness earlier and even prevent it in the first place—better for patients and better value for money for the taxpayer. That is what a real reform argument looks like.

Of course, we need to retain the necessary NHS staff. There are 133,000 vacant posts in the NHS today. The number of fully qualified GPs is falling, with an extra 140 patients per doctor compared with five years ago, and midwives are leaving faster than they can be recruited. There is no NHS without the people to staff it, so that is the great gamble the Government have taken on the industrial action in the NHS. It is not just that staff walk out for a day on strike; it is that they walk out of the health service altogether. By ignoring the nurses and the ambulance workers for months, the Government have allowed 140,000 appointments and operations to be cancelled, and risk putting off thousands of staff from continuing their careers in the health service.

Have the Government learnt their lesson? Of course they have not. In two weeks’ time, junior doctors are set to walk out on strike for 72 hours. It will mean huge disruption to patient care, yet there has not been a single meeting or minute of negotiation between Ministers and junior doctors. Why on earth are they not trying to stop yet more disruption to NHS care? Instead of ignoring staff, the Government ought to be doing everything they can to retain them in the health service. That means getting around the negotiation table and resolving the dispute on pay; it means getting around the table and fixing the pensions dispute; and it means listening to staff about their everyday experiences and making sure that, finally, they can see some light at the end of this miserable tunnel.

[Afzal Khan (Manchester, Gorton) (Lab)]

My hon. Friend is making an excellent speech. On the lack of workforce, does he agree that another area is the mental health service, which is getting worse across the board? Individuals and families are suffering, but there also is a knock-on effect on the police. A fifth of their time is spent helping people with mental illness. The economy loses £100 billion every year through mental illness.

--- Later in debate ---

[Wes Streeting]

I am really grateful to my hon. Friend. He is absolutely right to talk about the mental health workforce. Labour is committed to an extra 8,500 mental health workers, which would mean dedicated mental health support in every school, and community mental health hubs that would reduce pressure on GPs and ensure people get seen sooner. It would ensure support for young people in school before they reach crises in mental health. We would pay for it by abolishing the carried profits loophole, a tax loophole that benefits private equity fund managers. It is not on the Order Paper this afternoon, Mr Deputy Speaker, but if the Government want to adopt that plan in the Budget too, they are very welcome to do so.

Whether it is more mental health staff, more doctors, more nurses, more midwives or more health professionals, the NHS is in crisis and only Labour has a plan to fix it. The Chancellor knows it is the right thing to do—he said so himself. The NHS backs it. Medical schools have the capacity to train more doctors. Thousands of straight-A students want to help the NHS and the NHS needs their help more than ever. The only thing standing in their way is this Government. I challenge them today: double the number of medical schools places, so that we train 15,000 doctors a year; train 10,000 new nurses and midwives every year; double the number of district nurses qualifying every year; train 5,000 more health visitors; and pay for it by abolishing the non-dom tax status, because patients need doctors and nurses more than a wealthy few need a tax loophole. That is the choice the Conservatives face in the Budget. We have a plan; they do not. They are welcome to nick it. Patients across the country would thank them and us if they do.

--- Later in debate ---

[Helen Whately]

A responsible Government take a responsible approach to funding our public services, including the NHS. Later I will come to exactly the point about the Opposition’s proposals to use that funding pot again and again for the health service.

Coming to social care and international recruitment, we have put care workers on the shortage occupation list. As a result, social care employers have already been able to offer care worker visas to more than 34,000 people. I welcome international nurses joining our nursing and midwifery register, and I make no apology for continuing to encourage bright and talented international doctors to come and work in the NHS. In fact, that is the very idea of the points-based immigration system that we have so successfully implemented.

As well as recruiting the best and the brightest, it is vital that we retain them. Ultimately, our goal is to make sure that the NHS is one of the very best places to work in the world; both my parents were NHS doctors and, believe me, I have had plenty of conversations about why sometimes it is not. What is most frustrating is when the system prevents them from giving people the very best care.

It is not simply all about pay, as Opposition Members might have us believe. The hon. Member for Ilford North talked about nursing pay, but he will understand that we are currently in talks and now is not the moment to play politics with this issue. We are pleased that the Royal College of Nursing has paused strike action. We have no doubt that both sides are committed to finding a fair and reasonable settlement—one that recognises the vital role that nurses and nursing play in the health service, the wider economic pressure facing the United Kingdom and the Prime Minister’s priority to halve inflation.

[Wes Streeting]

Will the Minister give way?

[Helen Whately]

I will not, as the hon. Gentleman had a long time at the Dispatch Box.

Our talks are focused on pay, terms and conditions and enhancing productivity. We are hopeful that we will find a pragmatic way forward. We also know that pensions and the interaction between pension, pay and taxes matter. In general practice, we are consulting on changes to the pension scheme so that clinicians who want to stay in the NHS will not have to worry that they might lose out financially. Going beyond pay, from my conversations with staff I know the importance of their day-to-day experience at work, and of having the resources and the support that they need. We will continue to press ahead with supporting the mental health and wellbeing of NHS staff.

As we work to support our workforce, we must move beyond discussion just about numbers and pay. In the NHS we have one of the largest workforces in the world, with many hundreds of organisations within it. It is an entire ecosystem. We have an incredible opportunity to do things differently at real scale, with bold new ways of working. Take our surgical hubs, which are getting hundreds of thousands more patients quicker access to procedures. Community diagnostics centres are bringing diagnostic care nearer to home without the need even to visit acute hospital sites.

We are empowering our community pharmacists to do more. We have already introduced a range of new clinical services in community pharmacy, including blood pressure checks and minor illness referrals from GPs and NHS 111. This year we will introduce more services, including a pharmacy contraception service. Just as these innovations are good for patients, they are good for the workforce too, freeing up more time for colleagues to do what they do best.

On training, the Opposition motion calls for an expansion of medical school places. I will not pre-empt the upcoming NHS workforce plan, but I can say that it will set a clear direction for our workforce, making sure that we have the right people with the right skills in the right places over the next 15 years. It was this Government—through the Chancellor when he was Health Secretary—that expanded medical school places from around 6,000 each year to more than 7,500—a 25% increase in just three years. In fact, that was such a substantial expansion that it saw the creation of five new medical schools in England, one of which in east Kent I visited earlier this month. There, they are not only training more future doctors but innovating in how they do so, preparing medical students to work in the NHS of the future.

Equally, it is not for me to tell the House what will be in the spring Budget. In the current fiscal environment there are far fewer public spending elements that can be traded off against health and care spending compared with previous decades. Yet even when faced with tough choices in the autumn, including very real pressure on public finances, this Government made a deliberate choice to prioritise health and social care, including investment of an additional £14 billion over the next two years.

When it comes to the spring budget, I can guarantee to the House that our sums will add up, unlike those of the hon. Member for Ilford North, who seems to be banking on what he believes will be an inexhaustible pot of non-dom taxation, including for his uncosted and unfunded reorganisation of primary care. He did not mention that much earlier—a policy so roundly mocked by the sector that we woke up to it on the “Today” programme and found it had been put to bed by “Newsnight”.

Since the business investment relief scheme, introduced in 2012, non-doms have invested more than £6 billion in the UK. They play their part in supporting the vital public services that we all depend on. Even a former Labour shadow Chancellor has said that scrapping non-doms would probably end up costing Britain money—to be fair, that seems to be the Labour party’s main objective, with £90 billion of unfunded spending commitments to date, and counting.

--- Later in debate ---

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

May I start by expressing my thanks to all health and care staff across the UK? I pay tribute to them for the work they do year in, year out—especially during the pandemic, when they literally risked their lives to care for us and our loved ones. Sadly, some of them paid the ultimate price. Others who are suffering with long covid face losing their pay or their job, and we should be ashamed of that.

The covid pandemic had a massive impact on all four health services across the UK. The two biggest challenges are the backlog and the workforce we need to deal with it. However, there were underlying problems before covid. We had 10 years of Tory austerity: up to 2010, the annual average uplift in NHS funding was usually between 3.5% and 4%, but for most of the 2010s it was less than half that.

Scotland spends more than 6% more per head on health than England. That money covers things like free prescriptions. The shadow Health Secretary, the hon. Member for Ilford North (Wes Streeting), talked about not charging for GP appointments. Free prescriptions, in the same way, ensure that people take their medication, so that we do not let diseases get out of control and they do not end up costing more in hospital later.

We also spend a massive extra 43% on social care. That allowed us to provide free personal care, valued at £86,000, when we heard about the potential care cap in England. Providing free personal care, which in Scotland includes people younger than 65 if they have a need for it, allows people to live independent, high-quality lives in their own home for as long as possible. I am sure that there is not a person in this Chamber who will not want that when their turn comes.

Scotland has the highest number of nurses, care staff, GPs and consultants per head of population in any of the UK nations, but all the national health services are facing staff shortages in both NHS care and social care. Even where staff numbers appear to have increased, the problem is that demand is growing quicker. That is because we are an ageing population—and, sadly, we are not ageing well. From the age of about 50, we start collecting diseases. The NHS gets us through and helps us to manage, but many people, particularly in deprived communities, can spend 20 years or more in ill health. The NHS is struggling to cope. We need to invest in a wellbeing approach to every person who lives in the UK—every child born—so that they do not end up a bunch of old crocks like many of us in this Chamber.

Safe staffing is vital. It is not hospitals or machines, but people, who deliver treatment and care when we are ill. The staffing issues have multiple causes. The decade of austerity meant many public sector pay freezes and caps, which made jobs seem unattractive. Caps on public pay and benefits take money out of local economies—many of us know of dead high streets. It is a pointless approach, because less tax goes back to the Government and it strangles the economy. Giving people enough to live on, with decent benefits and decent public sector pay, injects money into local economies and stimulates growth, which we keep hearing is the big thing that this Government believe in.

Another cause is Brexit. There was a 90% fall in EU nurses coming to the UK after the vote in 2016—not even the loss of freedom of movement in 2021, but the vote. Since the formal loss of freedom of movement, care providers have suddenly had to deal with the Home Office. Many MPs in this Chamber will know just how difficult that is, with the cost of visas, the administrative burden and the general shortage of workers because of Brexit. Health and social care is having to compete with almost every other sector in the economy, so paying people badly simply will not wash.

Of course, there was also the pandemic. I was back in the NHS in the first wave in 2020, and I know that staff were incredible. They felt empowered. We were able to sit around a table, whether it was physical or virtual, work out what needed to be done, make a decision and move on in a way that staff on the frontline are rarely empowered to do. The problem is that this has gone on for three years now. Staff are suffering from exhaustion and burnout, but instead of having people clap for them, they get negative media complaining about staff and GPs and suggesting that GP practices are shut or that a phone appointment does not count.

I became quite ill and ended up in the hospital across the road in autumn 2021. When I finally got back to where I live, I had three GP consultations, two specialist consultations and just one day in a hospital, going through tests, before my medication was organised. Frankly, with my lifestyle, that suited me down to the ground. I did not need to hang around in a clinic, risking infection with covid. The job got done. Let us stop denigrating phone appointments. GPs are not stupid. If they speak to a patient on the phone and need to examine them, they will arrange that.

We have to realise that it is not just about the media; as politicians we have a duty, too. I have to gently point out to the shadow Health Secretary—particularly as my own husband was a GP—that GPs are not just gatekeepers for the NHS. They provide long-term continuity of care, they examine the patient, they are advocates and they guide the patient to the right service. Imagine someone with back pain. Were they digging the garden? Do they need to see a physio? Do they have a slipped disc, do they have a kidney stone, do they have a leaking aneurysm—or do they have metastatic cancer? How is a patient meant to disentangle that without a GP?

[Wes Streeting]

Let us be clear about this: I have never disputed GPs’ expertise or the important role that they play in diagnosis. But if the hon. Member thinks GPs are so fantastic, why are there so many fewer now under the SNP in Scotland?

[Dr Whitford]

That is not true—and 99% of our trainee posts last year have already been filled. Perhaps the hon. Gentleman should look at the statistics. We have more GPs per head of population than any of the other nations in the UK, including Wales, which his party runs.

So what do we need to do about this? Clearly we need to train more staff, but we must also not only increase the number of both nursing and medical student places, but look at the cost of studying and the student debt that those people will be left with. We do not have tuition fees in Scotland and our nurses receive a bursary of £10,000 a year, which means that we are investing £20,000 in every student nurse in Scotland.

[Dr Whitford]

I think I have spent the last eight years demonstrating the different approaches that Scotland takes. The Minister talked about community pharmacies, which have been providing minor ailment care in Scotland since 2005. Our optometrists are allowed to refer people with cataracts directly to hospital, whereas in England, they are often made to go through a GP. So I am sharing and have shared ideas in that way. However, there has been a 5.8% increase in the uptake of nursing jobs in Scotland, so we also have more nurses per head of population.

[Wes Streeting]

rose—

[Dr Whitford]

I should like to make some progress. The hon. Gentleman had a very long time at the Dispatch Box and I think there should be more than just the three of us.

It is important to recognise the impact of the loss of the nursing bursary in 2016. The number of nursing student applications fell in England after the bursary was cut, so perhaps this is one of the ideas that I am sharing. The numbers recovered to some extent in 2019, when the bursary was brought back, but it is only £5,000, and tuition fees are more than £9,000 a year. Nurses in England are graduating with debt of about £50,000, and they need to begin paying it back immediately, which means that the money is coming out of their salaries. Perhaps that could be looked into.

If the number of medical students is increased, it is necessary not only to ensure that there are places on the ward where they can learn—this was mentioned by the hon. Member for Bosworth (Dr Evans), who is no longer in the Chamber—but to expand and fund the training places in hospital they will occupy after they graduate. There was a real problem last year when the extra medical students who were graduating could not find foundation jobs until the last minute. If graduates do not go through the foundation scheme, they cannot practise as doctors. We also need to invest in middle-grade specialist training in order to create consultants.

We need to recruit more from overseas, because progressing from student to consultant or GP takes nine or 10 years, while progressing from student to consultant surgeon takes about 15 or 16 years. Adding more student places will not solve the problem in the short term. We must, however, avoid recruiting from low and middle- income countries on the World Health Organisation red list. That is simply unethical, and is being reported as direct recruitment from trusts in England. We should be ruling that out. It should not be allowed and I think the Government could tackle the matter.

We have, unfortunately, lost freedom of movement, and it is clear from what Labour is saying that it will not return. That is a challenge for us in Scotland, because we need people: we are facing a huge demographic challenge. The Government should put all health and social care roles on the shortage occupation list, and reduce visa costs and hassle. Forty-nine per cent. of overseas GP trainees in the UK report these issues, and 17% of those say that they may leave. The obstructive process of dealing with the Home Office is driving doctors away. The Government should perhaps also waive the NHS charge for staff who work in health and social care.

However, I agree with all the Opposition Members who have said that what is most important is retaining staff, because otherwise we will lose experience. Some decent pay would be a start, and after the pay freezes and after covid, those staff certainly deserve it. The Government are keen to rave about the independent pay review body when it suits them, but to ignore it when it does not. Nurses in Scotland were already being paid between £1,300 and £2,500 more than those in the rest of the UK, and to catch up with what is being paid to Agenda for Change staff in Scotland, the UK Government will need to provide a 14% pay rise for the coming year. If they did give a decent pay rise to the incredible staff who work in the NHS, devolved nations would also be able to fund a decent pay rise for their staff. Both Scotland and Wales are limited by having no real borrowing powers.

We need a review of the pay, terms and conditions and support for junior doctors, of how their rotas are managed and of their quality of life, because we need to understand why they are leaving the UK—part of that is wanting the adventure and experience of working overseas, so perhaps we should consider building that into our training schemes, giving junior doctors a flexible year in which to do research, work as a volunteer or work in another country—and, of course, we need reform of the mess that is the NHS pension. The lifetime and annual tax allowance system is penalising senior staff who do extra work. Many are refusing extra roles such as that of clinical director or educational supervisor. They are turning down the overtime that is critical to clearing the backlog, going part time, or even retiring earlier.

The Scottish Government and, I am sure, the Welsh Government are offering pension recycling and “retire and return”, but that is all the devolved Governments can do. The problem lies in the Treasury. This system was introduced in 2015, supposedly to deal with tax evasion and avoidance. It is nonsensical to apply it to a public sector defined benefit scheme. Pensions cannot be played with that way. The problem is that increases in the pension pot are being counted as income. Staff have no way to predict that, and end up being faced with vast bills simply for being able to work some extra weekends.

We also need to maintain the wellbeing projects that were started during the pandemic. All NHS staff are still facing a huge amount of stress this winter, which is made worse by the staff shortages and the increased demand resulting from covid, influenza and other respiratory infections. The covid data from 2022 shows that there was no respite. Unlike in 2020 and 2021, hospital admissions stayed relatively high, even between the peaks, which means that staff have literally been running non-stop for nearly a year and a half. As has been said, staff are willing to work hard—they have always worked hard—but the problem is that when they go home at night feeling they did not do a good job and when they feel that their ward is not safe, that undermines both their commitment and their ability to do the job. The General Medical Council reports that burnout and dissatisfaction are the two main factors driving senior staff out of the NHS.

However, we must not forget social care staff. I was surprised that they were not mentioned in Labour’s motion. The standard measure of NHS performance in all four health services is the four-hour A&E target because it assesses the flow through a hospital from admission to discharge. It started to deteriorate in England in 2013, following the changes introduced in the Health and Social Care Act 2012, but it fell in all four health services in the later phases of the pandemic as hospitals tried to restart elective work. NHS Scotland is also struggling after covid, but let me gently point out, notwithstanding the snide comments from Tory and Labour Members, that Scotland is still the best-performing of the four nations in this regard.

Struggling A&E performance is driven not by A&E issues but by the back-pressure of patients who are waiting for beds—in other words, by delayed discharges. The lack of care workers to deliver home care is what is actually driving the A&E issue, and this should be the thermometer to test the temperature of the entire acute system. There are currently more than 160,000 vacancies for social care in the UK. We cannot fix the NHS without fixing social care, so we need a workforce plan for NHS and social care. As in Scotland, we need to respect care staff: pay them a minimum of the real living wage, not the pretendy living wage; pay sleepovers when they carry them out; and pay travel time. To have them doing all these things unpaid is undermining their take-home pay.

In Scotland, care staff are now registered and getting access to professional training and development. This is part of our plan for a national care system, but care staff need decent pay. They also need recognition and respect for the very tough job of looking after our loved ones. I cannot imagine anyone in this Chamber who could do the job. They need a career path so that good staff who enjoy delivering care can remain in the care sector and not just use it as a stopgap until they can get a better paid job on the till in a supermarket.

NHS Strikes

Wes Streeting Excerpts

Monday 6th February 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the NHS strikes.

[The Minister for Health and Secondary Care (Will Quince)]

I am grateful to the hon. Member for his question, which I am taking on behalf of the Department as the Secretary of State is attending a COBRA meeting focused on minimising the disruption experienced by patients because of today’s walkouts.

In preparation for today’s industrial action, we have again drawn on extra support from a range of places, including military service personnel, volunteers and the private sector. People should continue to use NHS 111 if they need medical help and to dial 999 in the event of an emergency. Yet even such strong contingencies, including more people trained to drive ambulances and doctors redeployed to other parts of the system, are no replacement for having the right people doing the right jobs.

Any strike inevitably means that some patients will have their treatment delayed, and I know that people are being contacted if their appointments need to be changed. About 88,000 procedures or outpatient appointments have been postponed as a result of industrial action over the last eight weeks, so I am disappointed and concerned that patients are facing disruption once again, especially because strikes by Royal College of Nursing members have now come together with action by GMB and Unite members in eight ambulance trusts.

I recognise that there have been efforts on behalf of unions to ensure that derogations are in place to keep people safe, and I acknowledge that some aspects of that can indeed be challenging, but it is essential that all unions adhere to a set of derogations at a national level so that we can plan and act with certainty. I have also been heartened to hear that on previous strike days, some devoted ambulance workers and nurses who received calls while on the picket line returned to work where derogations were not going to be met. That is a real tribute to the care and dedication we see on the frontline day in, day out.

Ultimately, both staff and the public should no longer be in this situation, because we all know that industrial action is in nobody’s best interests, especially given the collective challenges we face to help the NHS recover from the pandemic. Despite what the hon. Member for Ilford North (Wes Streeting) might imply, there is much common ground, not least our shared desire to improve the NHS and deliver better care. Last week we announced our plan to recover urgent and emergency care—the second of three plans to cut waiting times in the NHS, including our elective recovery plan and our primary care recovery plan, which will be published in the next few weeks. With such important missions ahead of us, and fewer than two months left of this financial year, it is time to move forward, to look ahead and to come together in the interests of the patients we all serve.

[Wes Streeting]

This week will see the biggest strike in the history of the NHS, with nurses, ambulance workers and physiotherapists all driven to walk out. Some 88,000 appointments, including 10,000 operations, have already been cancelled, with much more disruption to patients expected this week, yet Government Ministers still speak as if they are mere observers or commentators, not leaders key to solving this dispute. This is the cost of the Prime Minister’s failure to sit down and negotiate with nurses, paramedics and other NHS staff.

Let us be clear about this fact: there has not been a single minute of negotiation on pay. NHS leaders are asking the Government to negotiate. Chief nurses are desperate for the Government to negotiate. The unions have offered to call off the strikes if the Government are willing to negotiate. The public cannot understand why, even now, they will not get around the table to sort this out. What on earth are they playing at?

Developments in Wales show that there is a deal to be done. The general secretary of the Royal College of Nursing has written to the Prime Minister, but she has not heard anything from the Government for weeks. It looks to the country like the Prime Minister and the Health Secretary are the ones on strike. Where is the Prime Minister? Where is the Health Secretary? In the week of the biggest strikes in the history of the NHS, during the biggest crisis the NHS has ever faced, the Health Secretary was not available for interviews this morning and he is not available to MPs today. Are we meant to believe that at 4 o’clock in the afternoon he is talking about how to avert disruption that has been taking place all day? Don’t make me laugh. Perhaps the Health Secretary is busy briefing against the Chancellor, just as the Chancellor is busy briefing against him. All the while, the Prime Minister is too weak to do anything about it.

The power to stop these strikes is in the Government’s hands. Patients have suffered enough disruption as it is. Is it not time for the Prime Minister to swallow his pride, sit down with NHS staff and negotiate an end to these strikes by paying NHS staff fairly?

[Will Quince]

I am not going to engage in the playing of party politics on this. The hon. Gentleman already knows that the Secretary of State is due to attend a Cobra meeting, which he and I rotate, and the hon. Gentleman may have missed it, but this morning the Secretary of State did do a media clip, and Members will have seen that across multiple outlets.

Where I do agree with the hon. Gentleman is that he is right to talk about the amazing job that our NHS colleagues do on the frontline. I know he does that, and I thank him for that, but that is even more reason why we must find a fair resolution, and NHS colleagues certainly will not get one from those on the Opposition Benches. The Opposition say that they back the independent pay review process, while disagreeing with the body’s decision when it does not suit them. They say they would not increase public spending, while failing to set out any plans for how they might pay for unaffordable pay increases. They say they believe in public safety, too, while criticising the common-sense steps we are taking to ensure safe minimum staffing levels, just as they do in many other European countries. We have got a plan—they do not.

More than 1 million NHS staff have been given at least a £1,400 increase in their pay, representing a 9.3% rise for those on the lowest salaries. NHS staff also received a 3% pay rise last year—even when pay was frozen across the rest of the public sector. We have done this because we know how hard NHS colleagues work and we recognise that there are cost of living pressures on NHS staff.

Our goal has always been a resolution that is fair for colleagues and for the country: to find a way forward that ensures we are spending money where it is needed most, and helping the NHS to recover from the pandemic, but not on pay hikes that would stoke inflation and ultimately make us all poorer. I met GMB members last week, and—together with my ministerial colleagues—I remain fully committed to working together with the unions, the NHS and others to find a responsible and fair way forward.

--- Later in debate ---

[Will Quince]

I have met employers, and I believe in open and honest dialogue. What the hon. Gentleman has not accepted—and I appreciate that being in opposition is the easiest job in the world—is that, as I have pointed out, every 1% is £700 million. I have a budget this year of £153 billion and, yes, that is rising, but I have some huge challenges. We have huge challenges to tackle within our NHS. The hon. Gentleman the shadow Secretary of State just says, “Negotiate, negotiate”—

[Wes Streeting]

Yes, yes!

[Will Quince]

Yes, yes—but where exactly is the funding coming from? The hon. Gentleman rightly pushes me on the elective backlog and he rightly pushes me on urgent and emergency care, but every 1% is £700 million that I would have to find from our NHS budget. That is exactly why we have to ensure that the pay review body makes the recommendation from April that is affordable to the NHS and recognises and rewards NHS staff, taking account of recruitment and retention and some of the challenges that we face, but that is fair to taxpayers too. That is why I would encourage the unions to get involved and take part in that pay review body process, so we can get it right.

--- Later in debate ---

[Will Quince]

The hon. Lady says the cavalry is coming; how many more unfunded pledges—[Interruption.] Labour Members say they are fully funded: absolute tosh. I have heard the Opposition spend that non-dom money more times—

[Wes Streeting]

Once.

[Will Quince]

Once? The shadow Home Secretary, the right hon. Member for Normanton, Pontefract and Castleford (Yvette Cooper), has spent it twice over already. And that is if indeed it would raise any money; I know I look very young, Mr Speaker, but I am old enough to remember a former Chancellor, one Ed Balls, say he did not believe taxing non-doms would raise any money whatsoever.

Urgent and Emergency Care Recovery Plan

Wes Streeting Excerpts

Monday 30th January 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

After 13 years of Conservative mismanagement, patients are waiting longer than ever before. Heart attack and stroke victims are waiting more than an hour and a half for an ambulance. Mr Speaker, “24 Hours in A&E” is not just a TV programme; it is the grim reality for far too many patients. Some 7.2 million people are waiting for NHS treatment. Why? The front door is broken—people are finding it impossible to get a GP appointment—so they end up in A&E. At the same time, the exit door is broken because care in the community is not available. Patients are trapped in hospitals, sometimes for months. Between the two is a workforce who are overstretched, burnt out, ignored by Government Ministers and forced out on strike.

Does this plan even attempt to get patients a GP appointment sooner? No. Does this plan restore district nursing so that patients can be cared for in the comfort of their own home? No. Does this plan see Ministers swallowing their pride and entering negotiations with nurses and paramedics? No. And does this plan expand the number of doctors and nurses needed to treat patients on time again? No.

The Health Secretary said a lot of things, but he did not say when patients can expect to see a return to safe waiting times. His colleague the Minister for Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately), rather let the cat out of the bag this morning. She was asked, “Is there any plan at all for when we will get back to 95% of patients in A&E being seen within four hours?” Her answer—and I am not joking—was, “I can’t tell you that.” How can the Secretary of State claim that his plan is ambitious and credible? What kind of emergency care plan does not even attempt to return waiting times to safe levels? It is a plan that is setting the NHS up to fail right from the start—a plan for managed decline.

These targets are not plucked out of thin air; patients waiting more than five hours in A&E are more likely to lose their lives, and so are heart attack and stroke victims waiting more than 18 minutes for an ambulance. Sadly, that is exactly what has happened this winter, it is what happened this summer and it has been going on since before the pandemic began. The four-hour A&E waiting time target has not been met since 2015. The only time the Conservatives have met the 18-minute target for ambulance response times was during lockdown. What is the Secretary of State’s ambition now? It is 30 minutes —30 minutes waiting for a heart attack or stroke victim to receive an ambulance, when every second counts. Is not the truth that the Government missed the targets, so they are moving the goalposts? They are fiddling the figures, rather than fixing the crisis.

The Secretary of State boasts that he is pouring more money in—£14 billion, which is almost as much as his Department has wasted on dodgy, unusable personal protective equipment—yet standards are being watered down. So can he explain why patients are paying more in tax but waiting longer for care? Why is it that under the Conservatives we are always paying more but getting less? So what is their answer? It is:

“There are so many people in hospital who wouldn’t need to be there if we could provide quality care at home… medical science and technology…offers a world of possibility for the NHS to transform patient care… Virtual wards allow people to receive hospital care at home.”

Those are not his words—that is my party conference speech! He did not have a plan for the NHS so he is nicking Labour’s.

I am happy for the Secretary of State to adopt Labour’s plans, but here is what he missed: you cannot provide good care in the community, in people’s homes or in hospital without the staff to care for people. That is the supermassive blackhole in his plan published today: people. Virtual wards without any staff is not hospital at home; it is home alone. So where is his plan to restore care in the community? Labour will double the number of district nurses qualifying every year, so can he hurry up and nick that plan too?

Of course, good care in the community is not a substitute for good care in hospital—we need both, now. So why, in the middle of the biggest crisis in the history of the NHS, with hospitals so obviously short of staff, is the universities Minister writing to medical schools to tell them not to train any more doctors? This is ludicrous. Labour will double the number of medical school places and create 10,000 new nursing and midwifery clinical placements, all paid for by abolishing the non-dom tax status. I know that the Prime Minister might not like that last bit—[Interruption.] Government Members are all complaining, but they did not complain when they put up income tax. The Prime Minister does not like it, but perhaps this would be a good time for the Conservatives to act tough on tax dodgers. So when is the Secretary of State going to nick that plan?

And when is the Secretary of State finally going to get his act together and end the strikes in the NHS? Perhaps I am speaking to the monkey when the Chancellor is the organ grinder. If that is the case, when will we get a chance to question the real Health Secretary on the strikes that this one is causing in the NHS? Labour will create more front doors to the NHS and we will tackle the crisis in social care. The Secretary of State offers sticking plasters and by now it is very clear: only Labour can offer patients the fresh start the NHS needs.

[Steve Barclay]

The hon. Gentleman started by thanking me for advance sight of the statement, and then he made a series of remarks that simply ignored what was in it. Even his last point shows how riddled with contradictions the Opposition’s approach is. He says in interviews that he supports the pay review body process—that is the official position, or at least it was—but then he says, “No, we should be negotiating individually with the trade unions and disregarding the pay review process.” There is no consistency on that at all.

The shadow Secretary of State talks about operational performance—[Interruption.] He has just had his go; he should listen to the answers. He says that it is about operational performance, but in my remarks I tried to be fair and said that these are challenges that are shared across the United Kingdom and globally. He seems to think that they are unique to England alone. We need only look at Wales to see that more than 50,000 people—notwithstanding the fact that Wales has a smaller population—are waiting more than two years for their operations, when we cleared that figure in the summer in England, leaving fewer than 2,000 in that cohort.

The shadow Secretary of State talks about the workforce. Obviously, he did not bother to read or listen to what was said in the statement. We are on track to deliver our manifesto commitment of more than 50,000 nurses. We have more than 30,000 so far. We have 10,500 more nurses in the NHS this year compared with last year. The grown-up position is to recognise—[Interruption.] Well, in the first five years we were dealing with what that letter said, which was that there was no money left. [Interruption.] Labour Members just do not like the response, but the facts speak for themselves. We have 10,500 more nurses this year than last year. The grown-up position, as I was saying, is to recognise that we have an older population with more complex needs, and that the consequences of the pandemic are severe—they are severe not only in England, but across the United Kingdom, in Wales and Scotland, and indeed in countries around the globe.

The shadow Secretary of State says that the statement did not cover the plan for GPs. Well, again, I was clear that this was one of three plans. We had the elective plan in the summer, which hit its first milestone. We have the second component today on urgent and emergency care, and we will set out in the coming weeks our approach to primary care. That is the approach that we are taking. [Interruption.] The shadow Secretary of State keeps chuntering. We did not have the pandemic 13 years ago. [Interruption.] I can only surmise that he did not get his remarks quite right the first time, which is why he feels the need to keep chuntering now and having a second, third and fourth go—perhaps next time.

On ambition, the shadow Secretary of State ignores the fact that we need to balance being ambitious with being realistic. These metrics, in the view of NHS England, show the fastest sustained improvement in NHS history. Clearly, his remarks are at odds with NHS England.

On funding, we are putting an extra £14.1 billion of funding into health and social care over the next two years, which reflects the fact that the Chancellor, notwithstanding the many competing pressures he faced at the autumn statement, put health and social care, alongside education, as the key areas to be prioritised.

On virtual wards, I had not quite realised that the shadow Secretary of State was the clinician who had invented virtual wards. I think that the credit for virtual wards actually goes to the staff, such as those I met at Watford, who are driving forward that innovation. It is slightly strange that he sometimes wants to claim ownership of something that has been clinically led by those working on the frontline. We have recognised the value of virtual wards, which is why, at North Tees this morning, at Watford last month, or on various other visits, I have been discussing how to scale up those plans.

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 24th January 2023 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

Labour founded the NHS to be free at the point of use, and we want to keep it that way. Given that the Prime Minister has advocated charging for GP appointments, and one of the Secretary of State’s predecessors has urged him to charge for A&E visits, will he take this opportunity to rule out any extension to user charging in the NHS?

[Steve Barclay]

I can see from your reaction, Mr Speaker, and the reaction of colleagues in the House, that that is a misrepresentation of the Prime Minister’s position. For the majority of its existence, the NHS has been run by Conservative Governments. We remain committed to treatment free at the point of use. That is the Prime Minister’s position and the Government’s position.

[Wes Streeting]

I note that the Secretary of State did not rule out any future extension of user charging, and I am sure that patients will have noticed too. Given that the chief executive of NHS England has said that the NHS needs to expand training; that many of the Secretary of State’s own Back Benchers are echoing Labour’s calls to double the number of medical school places; and that he has no plan whatsoever to expand NHS medical school training places, nursing and midwifery clinical training places, to double the number of district nurses qualifying, or to provide 5,000 more health visitors, is it not time for the Conservatives to swallow their pride, admit that they have no plan and adopt Labour’s workforce plan instead?

[Steve Barclay]

I am not surprised that the hon. Gentleman wants to misrepresent the Government’s plan, not least because his own plan is disintegrating before his own Front Bench. The hon. Member for York Central (Rachael Maskell), who spoke earlier, contradicted his point. Not only have the hon. Gentleman’s Front-Bench colleagues contradicted it; even the deputy chair of the British Medical Association has said that Labour’s plan would create higher demand and longer waiting times. I am not surprised that the hon. Gentleman does not want to talk about his own plans anymore; that is why he has taken to distorting ours.

NHS: Long-term Strategy

Wes Streeting Excerpts

Wednesday 11th January 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I beg to move,

That this House condemns the Government for failing to recognise the current crisis in the National Health Service; regrets that, as a result of Government mismanagement, hundreds of lives may be being lost every week due to the collapse of emergency care while patients are finding it impossible to get a GP appointment, ambulance or operation when they need one; calls on the Prime Minister to acknowledge the crisis and act with the necessary urgency to mitigate the impact on patients; and further calls on the Secretary of State for Health and Social Care to ensure the NHS is never in this situation again by bringing forward a long-term strategy which will end delayed hospital discharges, provide the NHS with the necessary staff to treat every patient in good time, and reform primary and community care to reduce the number of people needing hospital treatment.

I rise to support the national health service, which is going through the biggest crisis in its history, and most importantly, to defend the patients who are suffering as a direct result of 13 years of Conservative mismanagement of the NHS. This winter has shown just how high a price patients are paying: NHS staff are walking out on strike—in the case of nurses, for the first time in their history—patients are waiting entire days for an ambulance to arrive, and then days on end in A&E before they are admitted; there were 50,000 needless, preventable deaths last year, which experts have blamed on unacceptably long waiting times; and there have been hundreds of avoidable deaths every week this winter, because emergency care has collapsed.

The Secretary of State for Health and Social Care says that he disputes those figures from the Royal College of Emergency Medicine and the Office for National Statistics, but I invite him to listen to some of the stories behind the numbers. An 89-year-old fell in the bathroom and waited nine hours for an ambulance. The sepsis that caused him to fall killed him. His consultant said:

“Had I seen him within a couple of hours it could have been avoided. Maybe.”

Teresa Simpson, a 54-year-old woman from Hull, suffered a cardiac arrest and lost oxygen supply to the brain. She waited 16 hours for an ambulance, which arrived only when her husband phoned 999 a second time, after she had become lifeless. She passed away. A consultant in the north of England described a scene in a hospital waiting room this winter when a patient collapsed:

“They get CPR on the floor. I am forced to declare his time of death in front of frightened, horrified members of the public and his wife. On the floor of the waiting room. He was elderly and frail and hadn’t wanted to bother us. We had run out of trolleys and beds. In the whole hospital. This was by 10am.”

The Prime Minister refuses to describe this as a crisis.

Our motion before the House calls for a long-term plan to end delayed discharges, give the NHS the staff it needs to treat patients on time, and reform primary and community care, so that fewer people end up in hospital.

[Alun Cairns (Vale of Glamorgan) (Con)]

Will the hon. Member give way?

--- Later in debate ---

[Wes Streeting]

The Government do not have a plan, but perhaps the right hon. Gentleman will surprise me by telling me, against all hope and expectation, that they do.

[Alun Cairns]

Clearly, some of the statistics and cases that the hon. Member highlights are distressing and no doubt need to be investigated. The Prime Minister has rightly prioritised waiting times as one of his key commitments this year. How does the hon. Member account for the performance in Wales, which is worse than in England on all the statistics that we highlight, in spite of the Labour party having been in charge of the NHS there for more than 20 years?

[Wes Streeting]

I am grateful for the right hon. Gentleman’s intervention, because it brings me directly to the Government’s amendment to the motion, which is not a plan but a litany of excuses for the situation across the United Kingdom, including in Wales. I will run through them. By way of excuse, they say that the situation is challenging across the United Kingdom, and they are right: in Wales, the NHS is struggling; in Scotland, the NHS is struggling; and in Northern Ireland, the NHS is struggling. What do all parts of the United Kingdom have in common? Thirteen years of Conservative underfunding.

I will tell the right hon. Gentleman that, as he knows perfectly well as a Welsh Member, the reason why the Welsh NHS struggles more than England overall is the age profile of the population, the number of disabled people in Wales and the level of deprivation. The same disparities between Wales and England overall also explain the enormous health inequalities within England, which is why health outcomes in my city—in London—are so much better than in so many parts of the north or south-west of England. And you know the way to deal with that? It is genuine levelling up. But if people want a Government who tackle health inequalities so that every person in every part of the United Kingdom gets good-quality healthcare, they need to elect a Labour Government here in Westminster. That is the truth that the right hon. Gentleman does not want to admit.

I know that SNP Members will not be here today, because we are talking about England, but here is another truth that Nicola Sturgeon does not want to admit either: people in Scotland will be better off under a Labour Government too. She knows that just as well as anyone else.

When Conservative Members are not talking about other parts of the United Kingdom, they say that health pressures exist right across the world, but international pressures do not explain why the average wait for an ambulance is 14 minutes in France, while heart attack victims and stroke victims routinely wait an hour for an ambulance here in England. International pressures do not explain why it is that, over the past year, one in six UK adults had a pressing need for medical examination or treatment but could not get access. They do not explain why this is the highest figure out of 36 European countries and almost triple the EU average. Their excuses about international pressures do not explain why cancer outcomes in England are behind other comparable countries. None of that explains why the state of the NHS is as bad as it is today, but perhaps the hon. Member for Bosworth (Dr Evans), who was trying to intervene, wants to stand up and justify why it is that, after 13 years of Conservative Government, his constituents are waiting an average of an hour for a heart attack or stroke case.

[Dr Luke Evans (Bosworth) (Con)]

I am grateful to the hon. Member for giving way, and there are two points that I would like to pick up, seeing as he has come back to me on the second one. The first one, about comparable data, is really important. Does Labour have a position on sharing data between Wales, for example, and England, because the data is not comparable, which makes it very difficult to work out what is going on? Secondly, a plan was brought forward by the Government. It is called the NHS White Paper, which was brought forward by the NHS to transform the NHS with the integrated care boards, which are now in place. The people on those boards—42 of them—are the best people to make that change.

[Wes Streeting]

I find it astonishing. The hon. Gentleman’s position seems to be this: the Government have a plan, after 13 years, and apparently that plan is in progress. So why is it that so many Conservative Members just this week have stood up to talk about the fact that their constituents cannot see a GP, they cannot get an ambulance when they dial 999, and they are waiting hours on end in A&E departments? I know they like three-word slogans, but is the latest Conservative slogan on the NHS really “Crisis, what crisis?”?

[Lee Anderson (Ashfield) (Con)]

I have received several emails from Labour party members in Ashfield asking me to back the Labour party’s fully costed NHS plan. Could the hon. Member please send me a copy?

[Wes Streeting]

I would be delighted. I can barely believe it. Honestly, I can barely believe it. This is the second time this week that Conservative MPs have said, “We need to see Labour’s plan, because we haven’t got one.” I would be absolutely delighted. The hon. Member can even sign it and put it in one of his party’s fundraisers—God knows he is going to need it at the next general election. I will tell him what the plan is: it is a fully funded, fully costed plan to deliver the biggest expansion of NHS staff in history—doubling the number of medical school places; 10,000 more nursing and midwifery clinical training places; 5,000 more health visitors; and doubling the number of district nurses. That is my plan. Where is their plan?

The Government amendment refers to funding and states that they are putting in an extra £14.1 billion. I wonder how much of that will be swallowed up by the inflation caused by their catastrophic mismanagement of the economy. People are not just paying the Truss and Kwarteng premium; this is the price of 13 years of low growth, low productivity, high taxes and stagnation. Every penny will be swallowed up by higher inflation. That is the truth. Why do people talk about 13 years of underfunding? It is because they know it did not need to be like this, and because they saw what the last Labour Government did. With Labour, per capita spending on health increased by 5% each year, and we were able to do that because we grew the economy. Under the Conservatives, spending per capita fell during the coalition years, fell in the following two Parliaments, and even the increases that the Government promise today will not match the investment that Labour put in. That is the price of Tory economic failure.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

My hon. Friend is making an outstanding opening speech. My constituent told me last week about his relative who has multiple myeloma and had a stem cell transplant last year. She had a bad viral infection for three weeks, which is a serious issue after chemotherapy and a transplant. My constituent was asked by her consultant to take his relative to another hospital, because no beds were available at the hospital where she was being treated. She was treated in the corridor and waited 24 hours for a bed. Does my hon. Friend agree with my constituent that that hospital and its staff were not to blame and that, with underfunding and no strategy for the NHS now or in the future, the fault lies squarely with this Government?

[Wes Streeting]

I wholeheartedly agree. We hear this time and again. When patients are struggling to get access, and experiencing appalling delays in accident and emergency, they do not blame the staff. They know that the staff of the NHS are busting a gut, but those staff are suffering in the same way as patients because of 13 years of Conservative mismanagement. The only part of the Government’s amendment that I agree with is the part that praises NHS staff. Why is the Secretary of State’s Prime Minister bringing in his “sack the nurses” Bill next week? How many nurses will he sack? How many paramedics or junior doctors will he sack? The only people who need the sack are this Government—[Interruption.] Perhaps the hon. Member for East Worthing and Shoreham (Tim Loughton) agrees.

[Tim Loughton (East Worthing and Shoreham) (Con)]

When the last Labour Government left power, they were spending 8% of GDP on the NHS. Last year that figure was 10.6%, which is average for the EU nations. Why did the last Labour Government so chronically underfund the NHS?

[Wes Streeting]

The hon. Gentleman has got some brass neck. I have already given him figures showing that per capita funding increased by 5% under the last Labour Government—[Interruption.] And as for GDP, perhaps he should look at growth figures and ask why the economy is so much smaller than it would have been if we had had a Labour Government managing the economy well. That is the truth; it is a simple fact. If not, perhaps he wants to explain how his Government will put more money into the NHS, but I did not hear that commitment.

[Mr Toby Perkins (Chesterfield) (Lab)]

I thank my hon. Friend for his excellent speech. I do not quite know why I have intervened, because I am very much enjoying watching him flay the bowling to the boundary when he gets questions from Conservative Members. He is absolutely on to something in relation to the money that has been wasted in our NHS by the failure to plan for NHS staffing. Is not the reality that far too much money is being spent on agency workers because there is no long-term strategic plan for NHS staffing?

[Wes Streeting]

My hon. Friend is absolutely right. We are spending £3 billion on agency costs that would surely be better spent on ensuring that we have a serious workforce plan, and on hospital departments that are staffed by regulars who get to know their shift, get to know their colleagues, and get to know their patients and communities.

Let me turn to what the Secretary of State for Department for Business, Energy and Industrial Strategy said about ambulance staff, because I think he irresponsibly suggested that ambulance staff have not committed to minimum service levels for category 2 calls today, which is just not true. I think he ought to apologise to ambulance workers.

[Dr Luke Evans]

rose—

[Dame Angela Eagle (Wallasey) (Lab)]

rose—

[Wes Streeting]

I will give way to my hon. Friend the Member for Wallasey (Dame Angela Eagle), who has been waiting.

[Dame Angela Eagle]

On minimum service guarantees, does my hon. Friend think that the Conservative party has a brass neck to try to enforce minimum service guarantees, which are always made by agreement on any strike anyway, but says nothing at all about the catastrophic loss of service guarantees because of their mismanagement and underfunding on every other day?

[Wes Streeting]

My hon. Friend brings me neatly to the argument that I want to make about minimum service levels. Let me tell the Health Secretary who they are talking about when the Government attack ambulance crews. Donna Wilkins called an ambulance when she became concerned that her disabled son James may have been having a stroke, which is a listed side-effect of the medication that he takes. She and James waited in an ambulance for nine hours outside the Royal Bournemouth Hospital because there were no beds. Paramedics waited with them for the full nine hours. They chatted with James, loaded his favourite TV shows on their phone for him to watch and ran into the hospital to bring tea for Donna and soft food for James, who has problems with swallowing, which they spoon fed him. This is who NHS staff are. This is who ambulance crews are. These are the very staff the Government would have sacked with the legislation that they are bringing forward next week. As my hon. Friend said, what brass neck from this Government to talk about minimum standards on strike days when they cannot deliver basic minimum standards on any other day of the year.

The two-month target from GP referral to cancer treatment has not been met since 2015. Four in 10 people are waiting more than four hours in A&E. The four-hour target for A&E waits has not been met since 2015. The 18-week treatment target for elective care has not been met since 2016. One in seven people cannot get a GP appointment when they try. More than 1.3 million waited more than a month to get a GP appointment in November. How much more evidence do the Government want that they are incapable of delivering the minimum basic standards that patients deserve every single day of the year?

This has to be seen to be believed: the Government are planning an advertising campaign to urge patients to stay away from the NHS with the tagline “Help us help you.” Do they not see the risk in patients not coming forward for help when they need it? Can they not understand that people are fed up with being told that they have to protect the NHS, rather than the other way round? Instead of asking the public to help the NHS, the public want the Government to help the NHS to help them.

[Andy McDonald (Middlesbrough) (Lab)]

I do not know whether my hon. Friend is as horrified as I am by the juvenile and facile comments from the Conservative Benches, or whether he heard today on Radio 4 about the 600,000 people who every single month are waiting for four hours or more to get into A&E and be treated. As a direct result, horrifyingly, each and every month, hundreds and hundreds of people are dying needlessly in our country. That is on this Government’s watch. Should they not be hanging their heads in shame?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend—avoidable and preventable. The Chancellor wrote an entire book about getting the number of preventable deaths down to zero, because that is where the figure should be, so to have 50,000 preventable, avoidable deaths reported is a badge of shame for the Government.

Worst of all, the height of the Prime Minister’s ambition is to stop making things worse. If we have 7.1 million people waiting for treatment, rather than 7.2 million people, apparently that is a job well done in the Prime Minister’s book. Our NHS needs to be rebuilt and renewed, but all he offers is managed decline. His five pledges have the bar set so low that even his predecessor could meet those promises.

If hon. Members want to know what real ambition and action look like, it is this: 89,000 more nurses; 44,000 more doctors; waiting times cut from 18 months to 18 weeks; 3 million more operations carried out each year; banning smoking in pubs; the largest hospital building programme in history promised and delivered; 100 new walk-in centres; GP appointments guaranteed within two days; free prescriptions for cancer patients; appointments with a cancer specialist within two weeks of referral; waiting lists cut to their lowest point in history; and patient satisfaction at its highest levels in history. That is the difference that a Labour Government make.

[Mrs Natalie Elphicke (Dover) (Con)]

On delivery by Labour, over the many years of a Labour Government, Dover and Deal saw its health service absolutely decimated, service by service. What has happened under a Conservative Government? There has been a new hospital built for Dover, the first dementia village in the country, built for Dover and Deal, one of the first 40 diagnostic covid hubs, delivered for Dover and Deal, and a new GP training centre, delivered for east Kent. Of course, there is more to do on health, but we have the plan—

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Interventions must be brief by definition.

[Wes Streeting]

I cannot believe that the Member for Dover and Deal seems to be standing up and telling her constituents that when it comes to the NHS they have never had it so good. I know she is desperate and scraping the barrel because Prime Minister after Prime Minister have broken their promises on immigration and the Prime Minister is not dealing with small boat crossings, but I am afraid that pretending the NHS is working will not save her at the next general election.

To govern is to choose and the last Labour Government showed that investment plus reform equals better standards for patients. You do not need to do A-level maths to get to that equation. The right hon. Member for Gainsborough (Sir Edward Leigh) asked his Health Secretary:

“What is our long-term plan? We cannot leave the Labour party to have a long-term plan while we do not. How are we going to reform this centrally controlled construct?...What is the Secretary of State’s plan?”—[Official Report, 9 January 2023; Vol. 725, c. 297.]

What indeed is the Secretary of State’s plan? He has been in power for 13 years. His Government have presided over this record and still, after 13 years, they have no plan. Conservative Members asked what my plan was and I outlined it: a fully costed, fully funded plan to deliver the biggest expansion of NHS staffing—[Interruption.] They are saying, “Where is it?” I will repeat it for them again: double the number of medical school places; 10,000 more nursing and midwifery clinical training places; 5,000 more health visitors; and doubling the number of district nurses qualifying, paid for by abolishing non-dom tax status, because we believe that people who make Britain their home should pay their taxes here, too.

I understand that, in their partisan fury, because they cannot bear the fact that Labour has a plan and they do not, Conservative Members cannot swallow humble pie enough to take our plan and run with it. If they do not believe me, they should at least believe their own Chancellor, because this is what he said about Labour’s plan:

“I very much hope the government adopts this on the basis that smart governments always nick the best ideas of their opponents.”

If we were in any doubt already, this is not a smart Government and it will take a Labour Government to deliver Labour’s plan. That is why we end up with these sticking plasters, as we saw on Monday, to deal with this crisis.

Why did the Government choose to leave 230,000 patients languishing on NHS waiting lists when the spare capacity was there for them to be treated in the private sector? We know what our priority is: get patients treated as quickly as possible, pull every lever available to make it happen and make sure that patients do not have to pay a penny. The Government could act on doctors’ pensions to stop doctors retiring early for no reason other than that there is a financial disincentive to stay, but they still have not done it. They could bring strikes to an end by negotiating with the unions instead of threatening to sack the staff, but they still have not done it.

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

I want to give the hon. Member an idea to nick. He mentioned earlier the chronic situation with cancer waiting times, with 40%-plus of people diagnosed with cancer waiting two months to be seen. I wonder if he is aware of the work of the all-party parliamentary group on radiotherapy; I chair the group and his hon. Friend, the hon. Member for Easington (Grahame Morris), is a vice-chair. Fifty per cent. of people with cancer need radiotherapy. We spend 5% of the cancer budget on it. The average across developed nations is about 9%. Will he agree to give a bit of time to come to the group’s inquiry on 18 January? In looking at Labour’s plan, will he consider how we can fund radiotherapy, so we can treat people and do not have so many avoidable deaths?

[Wes Streeting]

Unlike the Government, we are happy to look at good ideas wherever they come from. I do not know whether I can make 18 January, but I am certainly happy to meet the hon. Gentleman so that we can ensure that Labour’s plan tackles the appalling waits that we are seeing for cancer treatment.

[Vicky Ford (Chelmsford) (Con)]

Will the hon. Gentleman give way?

[Wes Streeting]

I have to make progress. I know that Conservative MPs were not interested in speaking in this debate, but many Labour Members were.

We cannot continue pouring money into 20th-century healthcare that is not fit for the future. We do not focus nearly enough on prevention, early intervention and care in the community. Because people cannot see a GP, they end up in A&E, which is worse for them and more expensive for the taxpayer. Because people cannot get the mental health support they need, they reach a crisis point, which is worse for them and more expensive for the taxpayer. Because people cannot get the social care they need, they are left stuck in hospital, which is worse for them and more expensive for the taxpayer. That is why the next Labour Government will agree a 10-year plan with the NHS to shift the focus of healthcare out of the hospital, into the community and closer to patients, which is where it should be.

[Marsha De Cordova (Battersea) (Lab)]

My hon. Friend makes an excellent case, showing that Labour is the only party with a plan to deliver for the NHS. He will know that prevention and early intervention are key for people who are losing their sight. More than 650,000 people are currently on waiting lists. We know that 50% of all sight loss is avoidable, but many people are completely losing their sight because they are not getting early intervention and appointments. Does he agree that the Government need to get on with having a plan to tackle the eye health crisis in our NHS?

[Wes Streeting]

My hon. Friend has campaigned so determinedly on the issue, and she is absolutely right. When I spoke about self-referral in an interview with The Times, it was partly with ophthalmology in mind. In the vast majority of cases and for the vast majority of conditions, self-referral will not be appropriate and it is right that people see a GP before being referred to specialist services. But when people go and see someone who is trained and qualified to investigate their eyes, and that person makes a clinical judgment that they need to see a specialist, how can it be that, rather than being referred straight to the specialist, they are sent off to a GP first? That is absolutely crazy. It is wasting valuable doctors’ appointments and is lengthening waiting times for patients.

Labour is willing to look with an open mind at how we improve the patient journey. It is that fresh thinking that the NHS needs and is so badly missing from this Government. That touches on what I have been saying about the need to fix the front door to the NHS in primary care, with more care in the community. Our plan to recruit more doctors will deliver better access to GPs and ease pressure on accident and emergency departments.

We have to take a look at the GP partnership model, which under this Government is withering on the vine. By 2026, a majority of GPs will be salaried. There are three routes: let it wither on the vine, as the Conservatives are doing; accept that it is in decline and have something better to follow as it phases out over time, which is how we would approach it; or accept that GP partnership is valuable, in which case we should rebuild it. I am open-minded about whether we phase out GP partnerships or whether we rebuild general practice, but what we cannot do is what the Conservatives are doing, which is allowing general practice to wither on the vine. That is exactly what they have done.

Do you know what I found most remarkable today, Mr Deputy Speaker? In advance of this debate, I received a letter from the Minister, no less—the hon. Member for Harborough (Neil O’Brien), who is unfortunately not in his place—telling me that the current system of general practice is working. Bad news for you guys sat opposite, who are facing the patients and the voters at the next general election: your Ministers think that general practice is working. Your Ministers are therefore not looking at plans to fix it. Your Ministers are leaving you hanging out to dry at the next general election, because patients can see that only Labour is thinking about how to fix the front door to the NHS and rebuild general practice.

Our plan to recruit 8,500 mental health workers and provide community mental health clubs in every community—a plan championed by my hon. Friend the Member for Tooting (Dr Allin-Khan)—will deliver faster treatment, supporting schools and easing pressure on hospitals, as well as general practice.

Then there is the exit door of the hospitals to social care. Labour’s commitment to deliver better pay and better terms and conditions for care workers will reduce the 400,000 delayed discharges every month and provide a better quality of care for not just older people but working-age disabled people. There are so many people in hospital who would not need to be there if we could provide quality care in their homes, which is why our commitment to double the number of district nurses qualifying every year is central to our policy. We will also give every child a healthy start to life, with 5,000 more health visitors. [Interruption.]

The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield) has just said, from a sedentary position, “We need more GPs.” I know we need more GPs. Patients know we need more GPs. So why have the Government cut more than 5,000 GPs in the last decade?

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

We have seen 13 years of failure in social care, with promises made and nothing ever delivered. There are now 165,000 social care vacancies, which is why the NHS is logjammed. Does my hon. Friend agree that it is time to pay our social workers a fair wage? Agenda for Change is a framework already built; let us give social workers a decent wage for the excellent work that they do.

[Wes Streeting]

My hon. Friend has consistently made the powerful case that pay and terms and conditions are directly linked to retention. No wonder we are losing so many people, not just from the NHS but from social care, to other employers in sectors such as retail. Earlier today, in this Chamber, I heard the Prime Minister say that as the minimum wage increased care workers would benefit, which tells us that care professionals are on the minimum wage while doing a really difficult job. No wonder they are going off to other jobs that cause less stress and anxiety and are better paid. This is not the way to run a social care system. We understand that, but the Government do not.

[Vicky Ford (Chelmsford) (Con)]

Will the hon. Gentleman give way?

[Wes Streeting]

No, because I must conclude my speech now. So many other Members want to speak that it would be unfair to take up more of their time.

This year marks the 75th anniversary of the NHS. For 75 years it has been there for us when we need it, founded by Labour but built by the British people, a public service, publicly funded, free at the point of need. Those are the values that are written into the DNA of the NHS. They are British values, they are Labour values, and it now falls to us, the party that created the NHS, to make sure that it is fit for the future.

I know, and the Opposition know, that the biggest obstacle to that change is no longer a busted, discredited Conservative Government on their way out, but the belief among too many people in our country that voting does not change anything, that politics does not matter, and that things cannot get better. I urge people throughout the country to ask themselves this simple question: are you better off than you were 13 years ago? Are your NHS services better off than they were 13 years ago? Are your public services better off than they were 13 years ago?

Labour has a plan; the Conservatives do not. Labour has a proud record of 13 years in government; the Conservatives do not. Only Labour can offer Britain the fresh start that it needs.

[Several hon. Members rose—]