Mental Health Bill [Lords]

Wes Streeting Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

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

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

I want to place on record my thanks to Baroness Merron for her leadership of the Bill’s progress in the House of Lords, and to thank Members on both sides of that House for their contribution to scrutiny of it. I particularly thank Baroness May of Maidenhead for the constructive way in which she has engaged the Government, and for commissioning Sir Simon Wessely to undertake the review of mental health that underpins so much of the Bill.

At the general election, Labour stood on a manifesto commitment to modernise the Mental Health Act 1983, and I am proud to say that we are delivering on that promise in the first Session of this Parliament. In doing so, we are providing a once-in-a-generation opportunity to profoundly transform the way in which we view and support people with serious mental illnesses. The measure of a society is how it treats its most vulnerable citizens, and when it comes to the treatment of people with serious mental illnesses, we are falling well short of the humane, compassionate society that we aspire to be. Patients live 15 to 20 years less than the average, and they are often accommodated far away from their families and loved ones. The facilities in which they are housed can be completely unsuitable. During his investigation last year, Lord Darzi found nearly 20 patients in a mental health facility who were forced to share two showers and live among an infestation of rats and cockroaches.

Patients are denied the basic choice and agency that is awarded to NHS patients with physical illnesses. People from ethnic minority communities, especially black African and Caribbean men, are more than three times as likely to be sectioned. Although they are very different conditions, people with a learning disability and autistic people are often lumped in with those who have mental illness, reflecting an outdated lack of medical understanding.

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

The Health Secretary will have been briefed by the Minister for Care about the tragic murder of Christopher Laskaris, the son of my constituent Fiona Laskaris, and the lack of a voice for parents, who know their own children extremely well, in very difficult situations like this. Have the Government considered whether they might table an amendment to make things like Christopher’s tragic murder less likely in the future?

[Wes Streeting]

I am extremely grateful to the right hon. Gentleman for his intervention, and I place on record my thanks to Fiona for her campaigning work in circumstances that are completely unimaginable for those who have not walked in her shoes and experienced the kind of grief that she is experiencing. I know that my hon. Friend the Member for Rother Valley (Jake Richards) has been campaigning assiduously on this issue; similarly, we have had representations from the hon. Member for Dorking and Horley (Chris Coghlan), who is in his place, and the right hon. Gentleman. We are carefully considering the arguments that have been made, and looking at what we can do in this Bill to advance things in the way that Fiona and others like her would like to see. We will continue that engagement throughout the passage of the Bill, and see if there is a workable way in which we can improve it to ensure that others do not have to go through the unimaginable heartbreak that Fiona is living with every day.

[Peter Swallow (Bracknell) (Lab)]

My right hon. Friend is touching on ways to strengthen this Bill even further. He will know that the Joint Committee on Human Rights has just this morning published our report on the Bill. We have praised it for all that it will do to address a number of inequalities, but we have picked out one or two areas where it could go even further. I know that he will not yet have had a chance to look at our report, but will he arrange for a meeting with members of the Committee and the relevant Minister to discuss our findings?

[Wes Streeting]

I wish I could correct my hon. Friend and say that I have already read in detail the feedback from the Joint Committee on Human Rights, but he is right: I have not yet had a chance to do that. However, I can assure him that I and my hon. Friend the Minister for Care will look at the Committee’s report. We would be very happy to meet members of the Committee to discuss in further detail their findings and recommendations.

We want to ensure that the Bill is as strong as it can be, given the length of time that has passed since the Mental Health Act was reformed. Indeed, the Mental Health Act is as old as I am. [Interruption.] Thank you for those interventions. I assure Members heaping compliments across the Chamber that it will not affect investment decisions in their constituencies, but I am none the less very grateful.

There is a serious point here: whereas attitudes to mental health have come on in leaps and bounds in the past four decades, the law has been frozen in time. As a result, the current legislation fails to give patients adequate dignity, voice and agency in their care, despite the fact that patients have consistently told us that being treated humanely, and making decisions about their own care, plays a vital role in their recovery.

When patients are detained and treated without any say over what is happening to them, it can have serious consequences for their ongoing health. To quote one of the many patients who bravely shared their experiences with Sir Simon Wessely’s independent review:

“Being sectioned was one of the most traumatic experiences of my life. Sadly, as a result of being sectioned I developed PTSD”—

post-traumatic stress disorder—

“as the direct result of the way I was treated”.

Sir Simon’s review was published seven years ago. It shone a light on a group of people who had been hidden, ignored and forgotten. In the time that has passed since, the case for change has only snowballed. The Bill now takes forward Sir Simon’s recommendations.

The review stressed that legislation alone would not fix the system; culture and resources matter too. This was echoed in Lord Darzi’s investigation into the NHS, which uncovered some hard truths: a dramatic rise in the use of restrictive interventions on children; and 345,000 patients waiting more than a year for their first appointment with mental health services—more than the entire population of Leicester—of whom 109,000 were under the age of 18. This Bill does not solve every problem in our mental health services, but it marks a vital step in our plans to improve the quality of care, combat long-standing inequalities, and bring about a stronger focus on prevention and early intervention in mental health.

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

Does my right hon. Friend agree that while we are seeing record levels of mental health problems in our young people, investment in community services for people with mental health problems must be a priority?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. As he has heard many times from this Dispatch Box, we want to see a shift in the centre of gravity in the NHS out of hospitals and into the community as one of the three key shifts that will underpin our 10-year plan for health, which we will be publishing in the not-too-distant future.

The Mental Health Act is designed to keep patients and the public safe, but it is clear to anyone who has seen how patients are treated that it does so in an outdated and blunt way that is unfit for the modern age. It is too easy for someone under the Act to lose all sense of agency, rights and respect. It is sometimes necessary to detain and treat patients, but there is no reason why patients experiencing serious mental illness should be denied the choice and agency they would rightly expect in physical care. Not only should the health service treat all its patients with dignity and respect anyway, but giving people a say over their own care means that their treatment is more likely to be successful. In the foreword to his independent review, Sir Simon Wessely said:

“I often heard from those who told me, looking back, that they realise that compulsory treatment was necessary, even life-saving, but then went on to say ‘why did it need to be given in the way it was?’”

Another patient in the 2018 review said:

“I felt a lot of things were done to me rather than with me”.

We need to get this right. We need to give these patients a voice.

[Jim Shannon (Strangford) (DUP)]

I commend the Secretary of State for bringing this Bill before the House. On all occasions when I have inquired of him, he has been keen to share ideas and thoughts on legislation in relation to Northern Ireland. On mental ill health, deprivation and poverty, the figures for Northern Ireland are some of the highest in the United Kingdom, which worries me as the MP with responsibility for my constituents back home in Strangford. I know he will, but will the Secretary of State share all the ideas in the Bill with Mike Nesbitt—the Health Minister back home—so that Northern Ireland can also benefit?

[Wes Streeting]

I am happy to reaffirm that we have a really strong working relationship with Minister Mike Nesbitt and the Northern Ireland Executive, and we are keen to share insight wherever we can.

The hon. Gentleman makes a very important point, which refers back to the remarks I made about the limitations of the legislation. Reform of the statute book is important in terms of how the law treats people. But as well as reforming the model of care, clinical pathways and looking at new treatments, innovations and technologies, we also need to focus on prevention, attacking the social determinants of ill health, including mental ill health, of which poverty is a key driver of stress, anxiety, depression and worse. That is why the Government will keep such a focus not just in our 10-year plan for health, but more broadly across public policy.

The current legislation has left many people with a learning disability and many autistic people in mental health hospitals, when they could receive much better care elsewhere. Around four in 10 people with a learning disability or autism could be cared for in the community. The Bill aims to improve the care and treatment people receive when detained, while keeping patients and the public safe. Through the Bill, we are: strengthening and clarifying the criteria for detention and community treatment orders to better support clinicians in their decision-making; introducing increased scrutiny and oversight for compulsory detention and treatment; and providing patients with a clear road to recovery by introducing statutory care and treatment plans for all patients detained under the Act, except if under a very short-term section.

[Jen Craft (Thurrock) (Lab)]

Does the Secretary of State agree that a proper community treatment plan for those with learning disabilities and autism is not just reliant on the actions of his Department, but a cross-Government effort and an integrated care system at a local level?

[Wes Streeting]

My hon. Friend is absolutely right. I am very glad that my Department is working closely with other Departments across a range of issues, in particular with my right hon. Friend the Secretary of State for Work and Pensions on the link between employment, welfare and health, and with my right hon. Friend the Secretary of State for Education on the reform of special educational needs and disabilities, and the interface between health and education services—I could go on. The point is that a wide range of factors have an impact on people’s health and wellbeing. Indeed, people’s health and wellbeing can have an impact on a wide range of aspects of their lives, which is why we have to work in a mission-driven cross-Government way.

[Alison Bennett (Mid Sussex) (LD)]

I thank the Secretary of State for giving way; he is very kind. I was interested, when he was talking about the impacts of mental health on society at large, whether he has given consideration to the Carers Trust proposal, which would amend the Bill so that when a parent has a mental health crisis, checks and safeguards are put in place to ensure that any young carers in that family are suitably cared for?

[Wes Streeting]

I am grateful to the hon. Member for that intervention and for raising the very serious issue—an issue of increasing prevalence—of the impact of parental mental ill health on children and young people. We are very happy to look at the Carers Trust proposal, and to take representations on that and other issues as the Bill progresses through its Commons stages. We want to ensure that we get not just the legal basis of mental health provision in the right place, but practical care. As we think about children and young people’s mental health and wellbeing, we also need to take into account their parents’ mental health and wellbeing through that lens, too.

Patients’ choices and needs will always be taken into account, thanks to the introduction of a new clinical checklist. It requires clinicians to involve patients and those close to them in decisions affecting their care, while retaining the power to treat individuals compulsorily where absolutely necessary.

[Richard Baker (Glenrothes and Mid Fife) (Lab)]

Does the Secretary of State agree that that should be a case of “only when absolutely necessary”? In my previous role, I provided advocacy for the family of a young man who has been in a state hospital in Scotland for 17 years under a compulsory treatment order. His family live several hours away in north-east Scotland. That is, in my view, a horrendous infringement of his and their human rights. Will he share any learnings from the action the Government are taking, which is so welcome, on how community treatment can be placed effectively for people who are going through such horrific restrictions on their rights to family life?

[Wes Streeting]

My hon. Friend’s question raises two key issues with the provision of mental health services. First, we must ensure that the bar is set in the right place for compulsory treatment. Secondly, we must ensure that both compulsory and voluntary treatment in a hospital setting is within a reasonable distance of family, friends and loved ones. My hon. Friend powerfully describes the impact of such cases, where there is not just a deprivation of liberty, but an impact on an entire family. We need to do much better on both sides of the border when it comes to the appropriate placement of people in mental health settings.

There will always be times when patients hit crisis points and lack the ability to express what they want. To ensure that their voice is not lost and that professionals are working with patients, the Bill introduces duties to encourage people to make an advance choice document while they are well. This document provides a record of their wishes for use by mental health professionals, should the patient later experience a crisis that renders them incapable of making their own decisions.

[Samantha Niblett (South Derbyshire) (Lab)]

I was 11 years old when my mum first tried to take her own life; she was sectioned several times over the coming years, and until I was an adult. How will this new way of treating people and making that part of the community, as well as looking after the children of those impacted, be measured over time so that we know it is successful?

[Wes Streeting]

I am extremely grateful to my hon. Friend for sharing such personal lived experience of the issues we are debating this afternoon. I encourage her to take every opportunity to share those experiences directly with Ministers or through the passage of this Bill, which others in a similar situation will also have had, so that we can provide the best possible support for people experiencing a mental health crisis and for their loved ones, who also experience an enormous amount of pain and anxiety in supporting someone going through acute mental illness.

We are also updating the outdated nearest relative provisions to allow patients to choose someone to be their nominated person, which gives that individual important powers to represent the patient’s interests when they cannot represent themselves. One patient explained:

“My mother used to perform this role, but she now has Alzheimer’s and she lacks capacity. Under the current system, I cannot specify who I wish to serve as my nearest relative. The responsibility would automatically go to my oldest sister—a sister I do not get on with”.

Our reforms will ensure that this statutory role is not chosen for the patient, but is rather the choice of the patient.

Advocacy services are often a lifeline for those who find themselves in the vulnerable position of being detained, giving a voice to those who may otherwise feel voiceless. Patients have reported that an advocate can ensure that

“their voice and opinion is valued and listened to. They came to my meetings, valued my opinion and put my views across to other people. People listened to my advocate.”

We are also extending advocacy services to patients who come to hospital voluntarily and making changes to improve advocacy uptake among those who are detained, as well as working to change the culture of our health and care services so that everyone is listened to and so that patients do not have to rely on an advocacy service to get their voice heard.

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

I am grateful to the youthful Secretary of State for giving way. In the past few months, I have had a number of constituents describe the difficulties they have had in transitioning from care provided by child and adolescent mental health services to adult mental health services—a critical transition. They specifically faced difficulties in accessing the same medication when they turned 18 that they had previously been reliant on as young people. Can the Secretary of State describe to me how either the Bill or the change in culture for which he is advocating will improve the situation for people like my constituents?

[Wes Streeting]

I am grateful for that intervention. The hon. Gentleman raises what is, frankly, the depressingly familiar issue of the transition from youth and adolescent services to adult services, which applies across such a wide range of public services. It is so frustrating that we are still, in this decade of the 21st century, describing a problem that was prevalent in the ’90s and noughties.

None the less, we are working to improve not just the law, but the performance in this space. Many of the changes we will be looking to make under the auspices of our 10-year plan are about better joining up of data, information and patient records, better care planning for patients and designing services around patients so that everyone—whatever their age or stage of treatment—receives joined-up services, with clinicians having a full picture of that patient’s experience. Hopefully, that will also help to deal with some of the cliff edges and bumps in the road that people can often experience when transitioning from one part of the NHS to another, whether that is from youth and adolescent services to adult services or the interface between primary and secondary care.

[Helen Morgan (North Shropshire) (LD)]

I welcome this piece of legislation, which I think is generally in a very good place. I have had a tragic situation in my constituency, where somebody who had been admitted to hospital in a suicidal state discharged themselves, after which, unfortunately, no follow-up care was provided, and they took their own life. It has been devastating for their family. Would the Secretary of State consider looking at how the community supports people experiencing a mental health crisis who might have discharged themselves, and how we can keep them safe in future?

[Wes Streeting]

I am very grateful to the hon. Lady for that intervention. The Bill deals to an extent with cases that would fall under the category she describes, in particular through reforms to community treatment orders. However, it would not necessarily cover the full extent of the sorts of people who might find themselves in that position, which is where I think we can use technology—which is not the answer to every problem in the health service, by the way. However, through better use of data, patient records and analytics, we will be better able in the future to predict risk and prevent tragedies as in the case the hon. Lady describes, which are a tragedy not just for those whose lives are cut needlessly short, but for those who live their lives with that intolerable grief and loss for the many years that follow.

It is a shameful truth about our society that people with a learning disability or autism are detained, sometimes for years, with little or no therapeutic benefit. The Bill will put an end to that injustice, limiting detentions so that people with a learning disability and autistic people are no longer detained beyond 28 days unless they have a co-occurring mental health condition that would benefit from treatment in hospital. This will require the necessary community provision in place to support people with a learning disability or autism, and we are working to set out what strong community services look like and on the resources required to implement them, so that there are robust alternatives to hospital care.

To help to plug the flow of inappropriate admissions to hospital, the Bill places a duty on integrated care boards to improve monitoring and support for people with a learning disability or autism who may be at risk of future detention. The Bill will introduce statutory care, education and treatment reviews to ensure that patients are safe and receiving the right care and treatment when detained, and that a plan to discharge them to the community is being worked up. We will also remove prison and police cells from the definition of “places of safety”. Police cells are for criminals, not patients in desperate need of medical help.

Throughout the development of these reforms, we have maintained the central purpose of the Mental Health Act—to keep individuals and the wider public safe. The vast majority of people with mental illness, including severe mental illness, present no risk to themselves or others, and, for the majority of people, treatment can be provided without compulsion. However, there are some people whose illness, when acute, can make them a risk to themselves, and sometimes to others.

No one knows this better than the families of Ian Coates, Barnaby Webber and Grace O’Malley-Kumar, the victims of Valdo Calocane’s violent rampage in Nottingham, whose campaign for justice and accountability has been truly awe-inspiring, or indeed the family of Valdo Calocane, with whom I have also spent time, listening to their experience of feeling badly let down by health services. As the independent investigation into the murders found, both he and his victims were failed by the health service, and their families have been left to live with the consequences with a level of pain the rest of us can scarcely imagine. I would like to place on the record my thanks to all four families for meeting me as my team and I worked on the Bill.

Thanks to the amendments that we are making to the Mental Health Act, decision makers will have to consider the risk of serious harm when making decisions to detain. That will ensure that any risks to the public and patients are considered as part of the assessment process. We will also introduce a new requirement for the responsible clinician to consult another person when deciding whether to discharge a patient, putting in place robust safeguards against the release of potentially dangerous people.

Finally, as I have said, legislation alone will not fix the wider issues of increasing mental health needs and long waiting times. To do that, the Government are investing in earlier intervention to meet patients’ needs and prevent them from reaching crisis point.

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

Will the Secretary of State give way?

[Wes Streeting]

I am just coming to my conclusion, I am afraid.

In the past 10 months, we have met the mental health investment standard for 2025-26; invested an extra £680 million in mental health services this year, which is a real-terms increase; funded mental health support teams in schools for almost an extra 1 million pupils; invested an extra £26 million to build new mental health crisis centres; funded NHS talking therapies for an additional 380,000 patients; and begun recruiting the 8,500 mental health professionals we promised in our manifesto. That is all part of the additional £26 billion this Labour Government are investing in health and care services—investment that was opposed by every party on the Opposition Benches; investment that is happening only because we have a Labour Government.

Mental health reform is not just about changing laws; it is about changing lives. The action we are taking will provide support and care to people at their most vulnerable, modernise our mental health services to keep us all safe, and create a safety net that any of us might need one day. I commend the Bill to the House.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Secretary of State.

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

I thank the Secretary of State for bringing the Bill before Parliament. The last update to the Mental Health Act, in 2007, took eight years following the Richardson review, and this Bill has been a similarly long time in the making, so I welcome the speed with which he has moved on it since taking office. Although we may tussle on occasion, as I have said since the election, we on the Conservative Benches will not oppose for the sake of opposition. We will be constructive, working to improve legislation and supporting the Government where we believe they are doing the right thing, and I recognise the Secretary of State’s constructive approach to the Bill.

At the outset, let me join the Secretary of State in paying tribute to the families of Calocane’s victims in Nottingham for what they have done subsequently—their campaigning, their dedication and their work, including on this legislation—and for the incredible dignity with which they have conducted themselves in unthinkable circumstances.

As the Secretary of State mentioned, the Mental Health Act 1983—I will not miss the opportunity to allude to his youthfulness—governs the compulsory detention and medical treatment of people with severe mental illness for the safety and protection of themselves and those around them. He also set out that sadly, all too often, those with learning disabilities or autism have been conflated with that group. We must take this opportunity to address that, and the Bill rightly seeks to do so. In the more than 40 years that have followed the 1983 Act, healthcare, treatments and, crucially, our understanding of mental health illnesses have come on in enormous strides. It is not only important but right that our laws are updated to reflect the modern world and the knowledge that we have today.

We are debating measures that impact those with the most severe mental health issues and their families, but as was highlighted in interventions on the Secretary of State, we should not forget the broader context, the challenges posed by mental health issues more broadly, or the importance of continued investment in this space. We should also recognise the many organisations that do amazing work both to educate society about mental ill health and to support people with mental health illnesses.

Let me take this opportunity to pay tribute to my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), who has just left the Chamber, for the work that he did on mental health as Secretary of State. I think it is fair to say that, away from the to and fro of party politics, the current Secretary of State shares my right hon. Friend’s passion and determination to address these issues. As he said, we have done much, but I believe we can and must continue to strive to do better.

Keeping legislation up to date is particularly important for a measure such as the Mental Health Act, which gives the state the power to deprive people of their liberties in order to protect the safety of the individual and those around them and to carry out treatment. Those powers should only ever be used when absolutely necessary, and it is therefore right that they are reviewed and updated to ensure that they remain relevant, proportionate and appropriate.

The most recent update to the Mental Health Act, in 2007 under the last Labour Government, introduced community treatment orders and independent mental health advocates and changed the detention criteria. Since then, as the Secretary of State alluded to, trends have emerged that have raised concerns. The overall number of detentions under the Act has been rising steadily. There were around 52,500 recorded detentions in England in 2023-24, including 963 of children aged 17 and under. That is a 2.5% increase on the previous year and around 14% higher than in 2016-17. In the same year, 2023-24, black people were 3.5 times more likely than white people to be detained under the Act, and seven times more likely to be placed on a community treatment order. The reasons for that are likely to be complex, and I will return to them later.

That is why in 2017, just 10 years after the previous update, the then Prime Minister, Theresa May—now Baroness May—commissioned an independent review of how the Mental Health Act was used and how it could be improved. The review considered not only the trends in detentions, but wider concerns about whether some processes were out of step with what should exist in a modern mental health system, including the balance of safeguards, patient choice and patients’ agency in their own care, and the effectiveness of community treatment orders. Sir Simon Wessely published the report of his review in 2018, and I take this opportunity to put on the record again our thanks for his important work.

[Wes Streeting]

Hear, hear.

[Edward Argar]

The previous Government published a draft Mental Health Bill based on the recommendations in the report, giving others the opportunity to have their say. The draft Bill was subject to pre-legislative scrutiny by a Joint Committee of Parliament, allowing Members of both Houses to thoroughly review it and make recommendations before the final version was introduced.

Given the importance of this area of policy, which can have such a profound impact on people’s lives, I believe it is right that we took the time to get this right. The work to update the Mental Health Act started under the previous Government and we had a commitment in our election manifesto to update the law in this area, and that has been carried on by the new Government. We continue to believe that this is the right thing to do, so I put on the record our in-principle support for the Government on the Bill.

I pay tribute to my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) for his work in this space as a shadow Minister. Not only does he have professional expertise, but he has brought it to the House’s deliberations on this legislation. I suspect that we may hear from him a little later.

There are many areas of the Bill that we welcome, including the strengthening of the patient’s right to express a treatment preference, the expansion of access to independent mental health advocates, and the removal of police and prison cells as places of safety so that patients can be treated in an appropriate setting. That said, of course we will not stand back without scrutinising and seeking constructively to improve the Bill as it passes through the House. Part of our role as the Opposition is to engage constructively in the scrutiny of legislation—to ask questions, to probe further, to seek to prevent unintended consequences, and to identify potential problems and ensure that they are aired in Committee—in order to improve it for everyone’s benefit, and that is what we shall do. I know that my hon. Friend the Member for Hinckley and Bosworth (Dr Evans) will approach the Public Bill Committee in that vein.

We very much welcome efforts to improve patients’ voice and involvement in their own care, including through greater use of advance choice documents. In its current form, the Bill places a duty on NHS England and integrated care boards to make patients aware of their option to have such a document, but this could be as simple as having a poster on a noticeboard, for instance. It does not necessarily require a conversation. Introducing it as a legal right for patients who are being treated or for someone who is at risk of detention would mean that they have to be specifically told about the option, allowing them to make a deliberate decision. I suspect that in Committee we may gently press the Minister to go further in strengthening the patient’s right to have their voice heard. I have been on a number of Bill Committees, and gently hinting to the Minister areas where we might press further may make his and his officials’ lives a little easier when amendments are tabled in Committee.

We were pleased that peers passed an amendment to better protect children who require a nominated person, removing the discretion where a court order regarding parental responsibility is in place. However, we believe there is more we can do to support and protect children, particularly regarding age-appropriate settings for treatment. I hope that when the Minister for Care winds up, or in Committee, he will explore in greater detail the steps the Government are taking to reduce the number of children being treated on adult mental health wards and to ensure that lessons are learned at both national and local service provider level.

Thirdly, we are conscious that a number of elements of the Bill will require additional resources to be put in place. The removal of police and prison cells—sensibly—as places of safety will require sufficient alternative capacity for people to be treated when they are detained. What approach do the Government intend to take in addressing this?

Increasing the frequency with which patients can apply to the mental health tribunal to have their detention reviewed and widening automatic referrals will potentially increase demand and pressure on the system. We know that the legal system is already under pressure, and the impact assessment acknowledges that there will be impacts and costs, so is the Minister confident that the system has the capacity to handle the additional demands? If not, what steps are being taken with the Ministry of Justice to address that?

[Edward Argar]

The hon. Gentleman is right to highlight both the costs and the investment that is needed, but the cost does not detract from the importance of and need for the measures set out in the legislation. He points out that as a proportion of overall health spending, mental health spending has fallen slightly in the latest figures. I hope that the Minister in his wind-up will address how the Government will ensure that this legislation, which enjoys broad support across the House, has the resources behind it to deliver the outcomes we all wish to see in practice?

[Wes Streeting]

Will the right hon. Member give way?

[Edward Argar]

I will regret doing so, but of course I give way to the Secretary of State.

--- Later in debate ---

[Wes Streeting]

I should point out for the record that mental health spending has increased in real terms this year, thanks to the decisions the Government have taken. As a proportion of spend on health services overall, it is true to say that it has decreased by 0.07%, but that does not take into account the fact that as well as investing heavily in our elective backlog and in clearing waiting lists, we are investing in general practice, which will benefit enormously people with mental ill health.

[Edward Argar]

The Secretary of State was kinder than he normally is, and I am grateful to him for acknowledging the reduction in the proportion of mental health spending—it is slight, but it is none the less a reduction. I hear what he says more broadly, but I hope that he and the Minister will reiterate their commitment to ensuring that the legislation succeeds, which we all wish for, and that the pressures it may place on parts of the system will be addressed and not simply be absorbed within the system. I suspect that the Minister will come to that in his concluding remarks.

While it is the right principle to direct more mental health patients away from in-patient hospital settings and to community treatment settings where clinically appropriate—this is key, and goes to the Secretary of State’s point—we must ensure that the NHS has the capacity to provide community treatments when the Bill is on the statute book. The Government accepted that the reforms will take a number of years to implement, given the need to recruit and train more clinical and judicial staff, but what is the plan and how much will it cost? Will it be phased in over a number of years?

The NHS workforce plan will nearly double the number of mental health nurses by 2031-32, but the Secretary of State has said that he intends to update the plan. It would be helpful if, during the Bill’s passage, he or the Minister could tell either the Bill Committee or this Chamber what the changes that he envisages making through this legislation will mean for the workforce.

We recognise the significance of the provisions limiting the detention of patients with a learning disability or autism. Under the Bill, they can be detained for treatment only if they have a co-occurring mental health condition that requires hospital treatment and meet the criteria in the Mental Health Act 1983. Autism alone would no longer justify continued detention under the 1983 Act; in theory, this will ensure that those with autism receive the appropriate support in the right setting, as we would all wish. What steps are being taken to ensure that there are sufficient services, with sufficient capacity, to properly support people with autism and learning disabilities? Can he confirm that under this legislation, there will always be a central role for professional clinical judgments on these matters?

This debate in part follows on from concerns being raised about racial disparities in the application of the Mental Health Act. Can the Secretary of State or the Minister provide more evidence to help the House better understand this issue? What research has been undertaken, or is being planned, to enable us to understand what is behind the statistics?

We welcome this important opportunity to look again at how we treat and protect people with the most severe mental illnesses, and to ensure that our laws remain relevant and proportionate in the modern world, empowering people and treating them humanely. Updating the Mental Health Act is the right thing to do, and we will work constructively with the Government to improve the safety, treatment, agency and, crucially, dignity of mental health patients who are detained, and of the wider public.

Better Care for Veterans: National Training and Education Plan

Wes Streeting Excerpts

Thursday 8th May 2025 Written Statements

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

As the nation marks the 80th anniversary of VE Day, we are announcing a new national training and education plan to transform healthcare for the armed forces community across England.

The Government are proud of the courage and dedication of our armed forces. It is our duty to ensure that those who have been injured or are unwell, whether physically or mentally, receive the very best possible care. However, the NHS is not currently set up to provide the best possible services to the armed forces community. Too many veterans still struggle to navigate civilian healthcare systems and may not self-identify as veterans to NHS staff, putting them at risk of missing out on the additional support and bespoke services that are already available. That is why we are rolling out the national training and education plan—to help guarantee that armed forces veterans and their families benefit from the improved and targeted healthcare that they deserve. The plan will train and educate NHS staff across the country to meet the unique health needs of veterans, serving personnel and their families.

NHS staff across England will receive dedicated training to help them identify and support patients with military backgrounds. GPs, NHS doctors, nurses and managers will work with regional trainers to make sure they embed this support into their services. The three-year training programme, backed by £1.8 million, will be rolled out across England from October 2025.

This announcement sits within wider Government commitments to veterans, including putting the armed forces covenant fully into law, and the newly announced Operation Valour, a £50 million boost in funding to ensure that veterans across the UK have easier access to essential care and support. The national training and education plan will ensure that the NHS is set up to fulfil the armed forces covenant, with the appropriate training and education required to develop a skilled, educated and inclusive NHS primary, community and secondary care workforce, to meet the evolving needs of the armed forces community within the NHS in England. This new training is part of our plan for change to fix the NHS and make sure it works for everyone, including those who have risked everything to serve our country.

[HCWS624]

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 6th May 2025 Commons Chamber

[Jo Platt (Leigh and Atherton) (Lab/Co-op)]

14. What steps he is taking to shift care from hospitals into the community.

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

Despite my best efforts, may I welcome the hon. Member for Runcorn and Helsby (Sarah Pochin) to her place? Being a Member of Parliament is a privilege, and I know how special it is to sit on these Benches having been sent here by constituents. Regardless of our political differences, I wish her well personally.

As part of our 10-year plan for health, we want to deliver a real shift in the centre of gravity in the NHS, so that people get more care closer to home and, indeed, in their home, too. The NHS is as much a neighbourhood health service as a national health service. We have already made progress in shifting care to the community: providing more than £889 million in funding for GPs; agreeing the GP contract for the first time since the pandemic; and recruiting more than 1,500 GPs on to the frontline. Our 10-year plan will set out how we will continue to transform the NHS into a neighbourhood health service.

[Jessica Toale]

I am deeply concerned about the quality of healthcare for people experiencing homelessness in my constituency of Bournemouth West. HealthBus, a local charity, is doing great work in getting out into the community to treat people where they are and to prevent them from having to go into hospital, but it is not getting the funding that it needs and has discovered serious discrepancies in the way that the local integrated care board commissions services, particularly in relation to health inequalities. Can the Secretary of State tell me how this Government are prioritising health outcomes for people experiencing homelessness, and will he meet me and HealthBus to discuss how we can support its important work?

[Wes Streeting]

The founding mission of the NHS was to be there for people whenever they fall ill, so that they never have to worry about the bill. Unfortunately, thanks to the disaster and the failures of 14 years of Conservative Government, too many people in our country today experience the fear that Nye Bevan sought to eradicate. As my hon. Friend would expect, tackling health inequalities for homeless people and other vulnerable groups is central to the values of this Labour Government. Those values will be reflected in our 10-year plan for health. I would be delighted to hear from her further on what we can do to improve services in her area.

[Jo Platt]

I thank the Secretary of State for his announcement this morning regarding GP services. One way that pressure is eased in our GP services is through charities such as Compassion in Action, which provides non-clinical, whole-person care in my constituency. It receives GP referrals from across Leigh and aligns with the Government’s aim to shift care from hospitals to communities. Will the Minister join me in thanking the staff and the founder, Pam Gilligan, and agree to come for a tour of the facilities and to see at first hand the impact that they have?

[Wes Streeting]

I wholeheartedly join my hon. Friend in thanking Pam and everyone at Compassion in Action for the work that they do. At the heart of our approach to health is a recognition that Government action is essential for improving health outcomes in the country, and that Government acting alone will not be sufficient. That is why working with the voluntary sector, employers, trade unions, community groups and all of us as individual citizens is vital for tackling health inequalities and improving care in our country. I would be delighted to ensure that one of the team pays a visit to the charity as soon as possible.

[Mr Speaker]

Stuart Anderson, welcome back.

[Stuart Anderson (South Shropshire) (Con)]

Community hospitals can reduce pressure on major hospitals, especially in rural communities such as mine. Will the Secretary of State lay out his plans to support community hospitals in South Shropshire?

[Wes Streeting]

At the heart of this Government’s approach is investment in, and reform of, the NHS to ensure that we deliver better outcomes for patients. That means the biggest devolution of power in the history of the NHS with more decisions taken closer to patients and to their communities, and more power in the hands of patients, too. Community hospitals have a vital role to play, and thanks to this Government’s decision to deliver £26 billion more into our NHS—opposed by the Conservative party—we will no doubt be able to make further and faster progress.

[Susan Murray (Mid Dunbartonshire) (LD)]

In my constituency there is an ageing population in need of local healthcare services. Will the Secretary of State meet his Scottish counterpart to discuss the need for increased access to community healthcare, and specifically the need for a new health and care centre within my constituency?

[Wes Streeting]

The hon. Member will be delighted to know that only last week I met with my counterparts in Scotland, Wales and Northern Ireland to talk about how we can work together to improve health and care throughout the United Kingdom of Great Britain and Northern Ireland. She will know that health is devolved, but thanks to the decisions taken by this Labour Government, the Scottish Government have just been delivered the biggest financial settlement since devolution began. That might mean that they finally make some progress on their waiting lists in Scotland, where one in six Scots are on a waiting list and the SNP is on its fifth NHS reform plan in four years.

[Alex Ballinger (Halesowen) (Lab)]

3. What steps his Department is taking to support GPs to spend more time with patients.

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[Natasha Irons (Croydon East) (Lab)]

6. What plans he has to reform NHS health and social care services.

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

People deserve the very best health and care. Our plan for change is already bringing waiting lists down. Our 10-year plan for health will set out how we improve access and make the three shifts that I described earlier, so that the NHS is fit for the future. At the same time, we are rebuilding adult social care now and for the future. Baroness Casey’s independent commission has launched, and it will set out through its work how we will create a national care service. All that is made possible thanks to the investment decisions taken by the Chancellor in her Budget. That investment was opposed by the Conservative party, which shows that only Labour can be trusted to invest in and modernise our NHS.

[Natasha Irons]

Last week, the Centre for Young Lives published a report on the state of mental health support for children and young people across England. It outlines that despite an ongoing crisis in mental health among young people,

“There remains a 55% treatment gap”

between adult and children’s mental health, and that

“fewer than 10%...of ICBs have a dedicated strategy”

for supporting children’s mental health. Will the Secretary of State consider strengthening statutory guidance for ICBs to ensure they assess the local need of children and young people, publish treatment gap data on an ongoing basis, and create joined-up, community-based mental health support for our young people?

[Wes Streeting]

Young people’s mental health is a priority for this Government. That is why we set out in our manifesto our commitment to making sure that mental health support is available in every primary and secondary school in the country. We have walk-in mental health services in every community, and we invest in the mental health workforce, so that we can cut waiting times. I am also working closely with the Secretary of State for Education to make sure that our education and health services work together, so that children get the very best start in life, and so that we look after mind, body, soul, aspiration and futures.

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

The Chancellor increased the cost of employing people in social care by raising national insurance contributions for social care employers, and then exempted NHS employers from those increased costs. When will this Government properly support social care and relieve the sector from pressures caused by the Chancellor under this Government?

[Wes Streeting]

Thanks to the decisions taken by this Chancellor, we are putting £26 billion more into health and social care. Thanks to the decisions taken by this Chancellor, the spending power of local authorities has risen. Thanks to the decisions taken by this Chancellor, we have delivered the biggest expansion of carer’s allowance since the 1970s. Thanks to the decisions taken by this Chancellor, we have significantly increased the disabled facilities grant, not just last year but this year. That is the investment delivered by a Labour Government, and opposed by the Conservatives and Reform, and it shows that only Labour can be trusted with our NHS.

[Mr Speaker]

You will have another chance in a minute! I call the shadow Minister.

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

This Government have been in power for 10 months. Two months ago, Labour postponed the cross-party talks on social care. When will they be rescheduled?

[Wes Streeting]

As I have announced to the House, Baroness Casey’s independent commission is up and running. She is making contact with parties across the House as part of the work of her commission, and it is for her to decide the basis on which she engages with parties. I look forward to working with parties at the conclusion of the process.

[Dr Evans]

I thank the Secretary of State for that change, making the process no longer cross-party. The Government have said that the changes will not be implemented fully until 2036. Only this week, the Health and Social Care Committee released its new report on social care and the huge cost of inaction. The report called for new actions that could be taken now, such as the publishing of annual assessments of unmet care needs for adults, and annual estimates of how much delayed discharges cost the NHS. Will the Secretary of State commit to those two today?

[Wes Streeting]

I take the Select Committee seriously, and I will look carefully at its report, but the shadow Minister has some brass neck. He mentions this Government having been in office for 10 months, but the Conservatives had more than 10 years in office, and we are picking up the pieces from the mess they left behind. That is why they were kicked out of government, and why they are being kicked out of opposition. Looking at this lot, I think: this must be how the islanders felt, looking at the dodo.

[Manuela Perteghella (Stratford-on-Avon) (LD)]

7. What recent assessment he has made of the adequacy of access to emergency dentistry.

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

10. What progress he has made on the abolition of NHS England.

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

As the Prime Minister and I announced, NHS England will be brought back into the Department to put an end to the duplication, waste and inefficiency resulting from two organisations doing the same job. That is the final nail in the coffin of the disastrous 2012 reorganisation, which led to the longest waiting times, lowest patient satisfaction and most expensive NHS reorganisation in history. Since the announcement, we have set up a joint board, assessed resources and responsibilities across existing organisations, developed proposals about the role, functions and structure of the new centre, and started detailed operational and legislative planning.

[Gregory Stafford]

The Secretary of State claims to support change, yet delays to NHS reorganisation, including to the promised abolition of NHS England, suggest otherwise. Is it not the truth, as he outlined in his Guardian article, that he is bogging the system down in a slow, top-heavy restructuring, while resorting to tax rises, instead of delivering the decentralised, locally delivered, value-for-money healthcare that our constituents deserve?

[Wes Streeting]

A lot of words and not a lot of sense. We are reforming the NHS and, as a result of these changes, redirecting hundreds of millions of pounds to the frontline. What was the Conservative party’s response to the abolition? The shadow Chancellor of the Duchy of Lancaster, the hon. Member for Brentwood and Ongar (Alex Burghart), said it could be a “great thing”, but it

“could be a total disaster”.

Will they let us know when they have made their mind up?

[Anna Dixon (Shipley) (Lab)]

The Lansley reforms were implemented top down by the Conservatives. The idea that the NHS could ever be truly independent, when it is there to serve us—the taxpayer and the general public! Does the Secretary of State agree that it is absolutely the right decision to move funding away from the centre to the frontline to prioritise patients in the NHS’s work?

[Wes Streeting]

My hon. Friend has huge experience in this area, and she is absolutely right. What we saw under the Conservatives was bloated bureaucracy—layer upon layer of checkers, when we need more doers. That is why frontline staff, patients and provider leaders all welcome the changes that we are making, so that we can invest more into our frontline.

[Mr Speaker]

I call the shadow Secretary of State.

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

The Health Service Journal reports that officials have acknowledged that the first draft of a high-level plan for merging NHS England and DHSC has been delayed. When we ask any written question about the merger, the standard answer seems to be:

“Ministers and senior Department officials will work with the new transformation team at the top of NHS England, led by Sir Jim Mackey, to determine the structure and requirements needed to support the creation of a new centre for health and care.”

Even when we ask a question specifically about the size of the transformation team, the answer is virtually identical. The Government either wilfully decide not to answer, or simply do not know. As with so many things, the Government go for the headline-grabbing announcement and talk the talk on reform, without having done the actual work to deliver it. My question to the Secretary of State is simple: when will that first high-level plan for the merger, with a full assessment of costs and savings, be published?

[Wes Streeting]

Honestly, the right hon. Member had his chance—he was the Minister who took forward the last reform Act, under the Conservative Government. He failed in that task, and now he turns up without a shred of remorse or a shred of humility, attacking this Government for cleaning up the mess that the Conservatives left behind. They are not a party of government—they are not even a party of opposition any more. They are a total irrelevance.

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

11. What steps his Department is taking to implement neighbourhood health centres.

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

Reducing hospital backlogs is a key priority in this Government’s plan for change, as the 18-week standard for elective care has not been met for almost a decade. Our elective reform plan sets out how we will return to that standard by the end of this Parliament, through a combination of investment and reform. Since July, the waiting list has reduced by over 219,000 and we have delivered an extra 3 million appointments, exceeding our manifesto pledge and doing it earlier than planned.

[Adam Jogee]

I am grateful to the Secretary of State for his answer and for the progress made, but there is still more to do. My constituent in Newcastle-under-Lyme has recently been recovering from brain surgery at the Royal Stoke university hospital. However, she has faced multiple setbacks due to failures in the duty of care, including scalding injuries and a severely mishandled admission process. She is now receiving the correct care, but she had to wait many months to be admitted to the correct ward, and has been given limited time for rehabilitative treatment. Does the Secretary of State agree that to tackle backlogs, our hospitals must have the resources they need to provide the right care the first time round, so that patients are given the time and support to fully and effectively recover?

[Wes Streeting]

I am grateful to my hon. Friend for his question, and horrified to hear about his constituent’s experience. This Government will never brush problems under the carpet or pretend that things are better than they are, and I know that for all the progress we have made in the past 10 months, there is still so much more to do. When we publish our 10-year plan for health, we must ensure that quality and safety are at the heart of every patient interaction. My hon. Friend is right about the need for investment. That is why we are investing £26 billion in the NHS and social care, and why it is so disappointing that the Opposition parties voted against it.

[Wera Hobhouse (Bath) (LD)]

On a recent visit to the breast unit of the Royal United hospital in Bath, specialists told me about a red flag system that could help to speed up care. If someone has a red flag symptom, such as a lump or a bleeding nipple, the triage team can book them straight into the breast clinic, rather than waiting to see a GP. Does the Secretary of State support such an approach?

[Wes Streeting]

I thank the hon. Member for her extremely constructive contribution. That is exactly why at the heart of our plans for reform and modernisation, we are placing such an emphasis on digital and technological transformation. We have such rich data about the experiences of our patients, but we are not using it effectively enough. If we use the information more effectively and efficiently, we can spot and identify risk much more proactively, and ensure that people get timely access to urgent care and treatment when they need it.

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

I am grateful to the Secretary of State for the work that he and his team have done to reduce NHS waiting times month on month for the last six months. However, the backlog that grew under the last Conservative Government is still impacting on my constituents. I have listened to countless constituents who have told me about the upsetting impact of long waiting times for an ADHD diagnosis for children. That is having a detrimental knock-on impact on access to support, including child and adolescent mental health services and shared care agreements, and there is a lack of support for adopted children. I welcome the news that waiting lists have gone down, but will the Secretary of State set out how his work will be targeted at bringing down waiting lists for ADHD diagnoses in my constituency, to ensure consistency in diagnosis rates across trusts?

[Wes Streeting]

I am so grateful to my hon. Friend for her question, and I pay tribute to my right hon. Friend the Secretary of State for Education, who is leading cross-Government work in that area. We have a taskforce that is specifically looking at the issues that my hon. Friend raises, and together we are looking to ensure that our education and health services are better joined up to meet the needs of young people. I am working with my hon. Friend the Member for Whitehaven and Workington (Josh MacAlister) and drawing on his experience to look at how we can improve the health and care of care-experienced young people and young adults. I hope we will have lots of progress to report on those issues.

[Lee Anderson (Ashfield) (Reform)]

One way to reduce the backlogs is to reduce or put an end to health tourism in this country, whereby people come to this country, get their treatment, and then nip back to where they come from. Does the Secretary of State think it is a good idea that people entering this country should provide evidence of health insurance or be refused entry?

[Wes Streeting]

When any of us travel abroad, we expect to take out travel insurance and pay for our healthcare needs overseas, and that is the standard that we expect for visitors to our country. We have lots more to do to improve on that front. I deplore the comments made by the hon. Gentleman’s party leader, who said that he does not support a taxpayer-funded NHS for the British people. He might want that debate, and the Leader of the so-called Opposition says that she wants that debate, but as far as Labour is concerned, we are clear about where we stand. Under Labour, the NHS will always be a national health service, publicly funded and free at the point of use.

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

15. What steps he is taking to reduce the reliance of the NHS on private healthcare providers.

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

This Government are taking a hard-headed approach to cutting waiting times. We are investing an extra £26 billion in our NHS, and where the independent sector has spare capacity, we will pay to get NHS patients treated faster and free at the point of use. So far, our approach to investment and reform has cut waiting lists by more than 200,000. Perhaps the hon. Member will tell us how it is going in Scotland.

[Seamus Logan]

The Secretary of State claimed this morning on BBC Radio 4’s “Today” programme—a most excellent programme—that Labour is the only party that can be trusted with the national health service. Can he confirm that no aspect of the NHS whatsoever, whether it is ownership of the estate, the provision of specialist services or any other form of privatisation, will be included in the much-promised trade deal between the UK and the United States? No more excuses, Secretary of State: just give a direct answer to a direct question.

[Wes Streeting]

I have said it before, and I will say it again: the NHS will be privatised over my dead body. This party founded the NHS as a publicly funded public service, free at the point of use. We use the independent sector to cut waiting lists, and guess what? The SNP-led Government in Scotland do the same thing. We have made it clear that the NHS is not up for sale in any trade deal. That is clear and unequivocal. The hon. Gentleman can sling mud as much as he likes, but he cannot run from the SNP’s abysmal record on the NHS over 18 long, poor years.

[Yuan Yang (Earley and Woodley) (Lab)]

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

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

GPs are at the front door to our NHS. Today, I can announce that we are supporting more than 1,000 surgeries across the country to modernise their buildings, backed by more than £102 million—the biggest public investment in GP facilities for five years. Following years of neglect, this vital funding will create additional space to see more patients, boost productivity, improve patient care and enable 8 million more family doctor appointments each year.

[Yuan Yang]

I very much welcome today’s announcement on refurbishing 1,000 GP surgeries across the country, because I have made it my priority to meet with as many GPs as possible in my constituency. Our local GPs have told me that our health centres need more physical space in order to accommodate growing local needs and facilitate the expansion of healthcare into the community. Is the Secretary of State willing to meet me and my local GPs to discuss how we can better improve the physical space needed for care to be brought closer to people’s homes?

[Wes Streeting]

I would be delighted to do so. Since we came into government, we have made this announcement today, put £889 million into general practice and agreed a contract with GPs, including reform for patient access and services. We are fixing the front door to the NHS, but of course that will take time. We recruited 1,500 more GPs by the end of March, but day by day, week by week, month by month and year by year, people should see improvements in their GP services thanks to Labour.

[Mr Speaker]

I call the shadow Minister.

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

Taking medicines on time is important, especially for those with conditions such as diabetes and epilepsy. Dr Acheson, an A&E consultant who has time-critical medicines for his own Parkinson’s disease, understands that well. He has been running a quality improvement programme to ensure that time-critical medicines are given on time in A&E. Will the Secretary of State lend that project his support and commit to reviewing how time-critical medicines are delivered on wards?

[Wes Streeting]

I thank the shadow Minister for her constructive question. I would be delighted to hear more about that initiative. She is absolutely right about timely access to medicines, and through a combination of service reform and the modernisation of technology, we can assist clinicians and patients to help them to manage their medication and ensure that people get timely access to medicines.

[Dr Johnson]

I thank the Secretary of State for that answer, and I would be delighted to meet him to discuss it further.

Unfortunately, when Labour negotiates, Britain loses. The Government capitulated to union demands with nothing in return. It is therefore of no surprise to anyone that within months, they are back in dispute with resident doctors and the British Medical Association has announced a ballot for strike action. What will the Secretary of State do to protect patients and taxpayers?

[Wes Streeting]

I will tell the hon. Lady what we are not going to do: we are not going to see £1.7 billion wasted on strikes by resident doctors or 1.5 million cancelled operations and appointments, which is exactly what happened on the Conservatives’ watch. Within three weeks, we ended the strike by resident doctors and we have cut waiting lists by 200,000 as a result. As I have said to resident doctors, their pay offer will be fair and neither staff nor patients want to go back to the bad old days of strikes under the Tories. They had an unwilling and incalcitrant Government under the Conservatives, who were unwilling to work with resident doctors, but we want to work with them to deliver better care for patients.

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

T3. I pay tribute to my 17-year-old constituent, Arlo Lambie, who tragically died on 13 April following the diagnosis of a grade 4 brain tumour. I knew Arlo—he was a fun and bright lad who will be sadly missed. While Arlo’s parents, Ellie and Alex, wish to put on record their thanks for the “incredible and compassionate care” Arlo received at St Mary’s hospital on the Isle of Wight, they want to know what steps the Secretary of State is taking to improve NHS access to breakthrough treatments to ensure that the commercial interests of pharmaceutical companies do not take precedence, so that children with brain cancer, like Arlo, are given the best possible chance to survive for longer.

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[Helen Morgan (North Shropshire) (LD)]

In his statement to the House just after Christmas, the Secretary of State acknowledged that cross-party consensus is essential to delivering meaningful social care reform. The Liberal Democrats support him in that endeavour, but we still do not have a date for those cross-party meetings, so will he give us one now?

[Wes Streeting]

Dates for meetings with the commission are now a matter for the independent commission.

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

T6.   West Cumbria, like many parts of the UK, is a dental desert. In some communities, urgent dental access centres have proved to be a real success at building up dental services, so will the Minister support my campaign to introduce an urgent dental access centre in west Cumbria?

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

T2. The chief executive of the Royal College of Midwives has said that the axing of the maternity safety ringfenced pot would be a “wrecking ball” to the efforts being made to improve maternity safety. Just a single or a small group of babies being spared lifelong disability would pay for the cost of that ringfenced pot many times over. I know that the Secretary of State cares about this matter deeply, so will he reconsider?

[Wes Streeting]

The funding is still there, but as many people have urged me, including the right hon. Gentleman, we are taking the decision to give more freedom and flexibility to independent care boards, systems and providers to determine how they can best spend NHS resources on services to improve patient care, safety and outcomes. Everyone will know that maternity safety is understandably a priority for this Government. We expect the NHS to deliver on maternity safety standards and will hold it to account on that.

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

T7.   Residents in Theale and across my constituency tell me time and again how hard it is to get a GP appointment, which causes distress and sometimes dangerous delays. Will the Secretary of State outline how his programme of reform and investment will end the 8 am scramble for good and deliver more GP appointments for my constituents?

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[Bob Blackman (Harrow East) (Con)]

T4. One of the great frustrations for medical professionals and patients alike is when patients have appointments but do not turn up. What action will the Secretary of State take to ensure that the system penalises people who miss appointments, so that patients can get the treatment they need when they need it?

[Wes Streeting]

We are absolutely convinced that better use of digital tools will enable us to reduce the number of missed appointments significantly and factor in the likelihood of no-shows, so that we can reduce waste and eliminate inefficiency. I understand the case for penalties that the hon. Gentleman is making, but that is not a route we want to go down until we have made those improvements and judged how effective they have been.

[Jim Dickson (Dartford) (Lab)]

T9. Far too many promises made by the last Government—promises that care would be moved out of hospitals and into the community—turned out to be hollow. From speaking to residents in Dartford, I know that hospital and community services have struggled to keep pace with new housing developments in the constituency. I am pleased to say that later this year in Dartford we will be seeing an expansion of our state-of-the-art community diagnostic centre, taking care closer to where people live. Does the Secretary of State agree that this is the start of Labour getting on with finally delivering that big shift, and will he visit Dartford with me—

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[Blake Stephenson (Mid Bedfordshire) (Con)]

T5. Residents in Mid Bedfordshire are concerned about the standards of maintenance at our two local hospitals. What action are the Government taking to support our hospitals in Luton and Bedford to catch up on maintenance backlogs?

[Wes Streeting]

Thanks to the investment that the Chancellor committed to, we are investing in the NHS estate, which is in a sorry state. I am afraid that that is an investment that the hon. Gentleman did not vote for, and his constituents will be fuming when they find out who was responsible.

[Mr Bayo Alaba (Southend East and Rochford) (Lab)]

I recently heard from Chelsea, a constituent of mine, who raised concerns about her grandmother Anna’s care. After a delayed discharge, she was released with the wrong equipment, which sadly resulted in her falling out of bed and sustaining a further injury. Ensuring that patients are discharged in a safe and timely manner is key to continuing the Department’s significant progress in cutting waiting lists for treatment, so what steps is the Secretary of State taking to promote integrated working between services to support discharge into the community for patients?

[Wes Streeting]

I am extremely sorry to hear about that particular case. It is really important that we support and facilitate better discharge, which is why we are reforming the better care fund and looking to better integrate health and social care services through our 10-year plan. I would be delighted to hear further from my hon. Friend about what we can do to improve in his area.

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

T8. I have a constituent who has broken and rotting teeth. His GP referred him to the local dental hospital, but he has been refused treatment because the hospital said that the surgeon would take a referral only from a dentist, which my constituent and many others in Somerset just do not have. What does the Minister suggest my constituent should do to stop the pain?

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[Ellie Chowns (North Herefordshire) (Green)]

Yesterday’s report from the Health and Social Care Committee is explicit that we cannot build an NHS fit for the future without effectively reforming social care. Back in January, the Secretary of State promised cross-party talks as well as Baroness Casey’s commission. He cannot outsource political leadership to Baroness Casey. Political will is the sticking point with the reform of social care. Will he show that leadership and bring the parties together to find the solutions to unblock this crisis?

[Wes Streeting]

Since we came into government, we have already taken action on social care with the investment we have put in—the biggest expansion of carer’s allowance and the funding for home adaptations through the disabled facilities grant. Now that the commission is up and running, there will be cross-party engagement, but it is an independent commission and for Baroness Casey to decide how to engage.

[Catherine Atkinson (Derby North) (Lab)]

Last week, this Labour Government announced the freezing of prescription charges, putting pounds back in the pockets of people in Derby. I have visited pharmacies, including the Littleover pharmacy, which provide essential care and support for their communities. The Conservatives underfunded pharmacies and more than 750 closed across England between 2021 and 2024. What is the Minister doing to support community pharmacies so that we do not lose these vital local services?

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

I welcome today’s announcement of new money for GPs’ surgeries, but GPs in my constituency tell me that they cannot get capital out of the integrated care board and that the Valuation Office Agency consistently undervalues the cost of rents, making future building impossible. Will the Secretary of State agree to meet me, and GPs from my constituency, in order to understand the problem better?

[Wes Streeting]

Thanks to the investment that we have announced, those practices will be upgraded. I advise the hon. Gentleman to engage with his local ICB. We are happy to receive representations if we can help, but let me gently point out that the investment is only possible thanks to the decisions made by the Chancellor, which he opposed.

[Sonia Kumar (Dudley) (Lab)]

Ladies Walk NHS health centre in Sedgley is a vital hub for my constituents, providing essential services such as phlebotomy and diabetic foot care, but owing to the inaction of the Conservative council this much-needed community asset faces closure in 2026, leaving residents without access to critical care. Will my hon. Friend agree to meet me to discuss urgent steps to safeguard the future of the centre and ensure that Sedgley residents continue to receive the NHS services on which they rely?

--- Later in debate ---

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

Last month I began to receive concerning emails from employees of the NHS trusts in my constituency, saying that the trusts were seeking to create a subsidiary company and move staff into it. They are really worried about their future rights. I know how important it is to the Secretary of State that people have good employment rights. What steps is he taking to ensure that there is full consultation with staff before the creation of subsidiaries, and to prevent the creation of two-tier employment practices in the NHS with no continuity of service?

[Wes Streeting]

While I understand the desirability of such arrangements for NHS trusts, this Government are absolutely clear that staff must be in receipt of good NHS terms and conditions, and must feel part of the NHS workforce and the NHS family. I would be happy to receive further representations from the hon. Lady.

Independent Commission on Adult Social Care: Terms of Reference

Wes Streeting Excerpts

Tuesday 6th May 2025 Written Statements

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

The Independent Commission on Adult Social Care, chaired by Baroness Louise Casey of Blackstock DBE CB, formally launched on 29 April with a meeting with people with first-hand experience of the social care system. Today, I am updating the House that we have published the terms of reference. A copy has been placed in the Libraries of both Houses and on gov.uk at https://www.gov.uk/government/publications/independent-commission-into-adult-social-care-terms-of-reference/independent-commission-into-adult-social-care-terms-of-reference A copy can also be found on the commission’s website at https://caseycommission.co.uk/about/terms-of-reference/

The commission, reporting to the Prime Minister, will work with people drawing on care and support, their families, staff, parliamentarians, local government and the public, private and third sectors to make clear recommendations to define and build the adult social care system that will meet the current and future needs of our population. The commission will consider older people’s care and support for working-age disabled adults separately, recognising that these services meet different needs.

Split over two phases, the commission will set out a vision for adult social care, with recommended measures and a road map for delivery:

The first phase, reporting in 2026, will identify the critical issues facing adult social care and set out recommendations for effective reform and improvement in the medium term. It will recommend tangible, pragmatic solutions that can be implemented in a phased way to lay the foundations for a national care service. The recommendations of this phase will be made within the Government’s spending plans which will be set out at the spending review.

The second phase, reporting by 2028, will make longer-term recommendations for the transformation of adult social care. It will build on the commission’s first phase to deliver a more preventative model of care needed to support our ageing population, and how to best create a fair and affordable adult social care system for all.

The challenges facing adult social care—from inconsistent standards of care to an undervalued and overstretched workforce, and a lack of support for unpaid carers—are complex and deeply rooted. There have been plenty of good ideas in the past 15 years, but we have been missing the broad consensus we need to find a solution around what our country wants from social care so that it stands the test of time.

That is why Baroness Casey has been tasked with starting a national conversation on what people expect from adult social care as well as building cross-party consensus. Given the independent nature of the commission, Baroness Casey and her team will take any future discussions with political parties forward.

While an independent commission is necessary to address the challenges facing the sector, the Government are taking immediate action to improve it. We are making available up to £3.7 billion of additional funding for social care authorities in 2025-26, we have increased the carer’s allowance earnings limit and introduced legislation that is paving the way for the first ever fair pay agreement in adult social care. The Government are also taking forward a range of initiatives for 2025-26 including announcing new measures to professionalise the workforce, uplifting the disabled facilities grant, promoting better use of care technologies, enabling frontline care and health staff to digitally share up-to-date information, and changes to the better care fund.

I am confident that, with Baroness Casey’s leadership and experience chairing this momentous commission, and with help and support from across the House, she will set us on the road to fundamental reform that will build an adult social care system fit for the future.

[HCWS615]

NHS Prescription Charges

Wes Streeting Excerpts

Tuesday 29th April 2025 Written Statements

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

The Prime Minister, my right hon. and learned Friend the Member for Holborn and St Pancras (Keir Starmer), has announced that NHS prescription charges in England will be frozen for the first time in three years. This builds on wider Government action as part of the plan for change to tackle the cost of living crisis, and will save patients around £18 million in 2025-26.

The single charge for prescriptions in England will remain at £9.90. The cost of prescription prepayment certificates will also remain the same, with three-month PPCs staying at £32.05,12-month PPCs at £114.50, and the hormone replacement therapy PPC staying at £19.80.

The charges freeze will also apply to NHS wigs and fabric supports; these prices will remain at current levels:

Surgical brassiere £32.50

Abdominal or spinal support £49.05

Stock modacrylic wig £80.15

Partial human hair wig £212.35

Full bespoke human hair wig £310.55

Around 89% of prescription items in England are already dispensed free of charge to children, over-60s, pregnant women, and those with certain medical conditions. This freeze will not impact current exemptions. All working-age adults who would normally pay for their prescriptions, which is estimated to be around 40% of the population, could benefit from the freeze.

In addition to the freeze on charges, the NHS low income scheme offers help with prescription payments; there are free prescriptions for eligible people in certain groups, such as pensioners, students, and those who receive state benefits or live in care homes.

The prescription charge freeze builds on wider government action to tackle the cost of living, including the roll-out of free breakfast clubs, expanded childcare through 300 new school-based nurseries, lowering the cost of school uniforms, and extending the fuel duty freeze—all aimed at easing financial pressures on families across the country.

This announcement also follows news last month of the Government agreeing funding with Community Pharmacy England worth an extra £617 million over two years. The investment comes alongside reforms to deliver a raft of patient benefits, as part of the Government’s agenda to shift the focus of care from hospitals into the community, so that people can more easily access care and support on their high streets.

Alongside action to rebuild the NHS, the Government’s plan for change is focused on growing the economy to improve living standards across the country. The charges freeze will help contribute to this.

[HCWS611]

2023 Agenda for Change Deal: Non-pay Workstreams

Wes Streeting Excerpts

Wednesday 23rd April 2025 Written Statements

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

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

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

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

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

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

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

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

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

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

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

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

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

Next steps

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

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

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

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

[HCWS597]

Clinical Trials and Health Data Research Service

Wes Streeting Excerpts

Tuesday 8th April 2025 Written Statements

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

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

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

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

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

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

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

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

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

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

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

[HCWS587]

Mental Health: Expected Spend for 2025-26

Wes Streeting Excerpts

Thursday 27th March 2025 Written Statements

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

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

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

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

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

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

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

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

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

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

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 25th March 2025 Commons Chamber

[Lloyd Hatton (South Dorset) (Lab)]

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

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

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

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

[Lloyd Hatton]

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

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

[Wes Streeting]

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

[Sir Oliver Dowden (Hertsmere) (Con)]

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

[Wes Streeting]

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

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

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

[Wes Streeting]

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

[Lisa Smart (Hazel Grove) (LD)]

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

[Wes Streeting]

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

[Andrew Cooper (Mid Cheshire) (Lab)]

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

[Wes Streeting]

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

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

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

[Wes Streeting]

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

[Rosie Wrighting (Kettering) (Lab)]

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

--- Later in debate ---

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

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

[Joani Reid]

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

[Wes Streeting]

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

[Liz Jarvis (Eastleigh) (LD)]

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

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

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

[Wes Streeting]

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

[Dr Johnson]

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

[Wes Streeting]

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

[Max Wilkinson (Cheltenham) (LD)]

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

--- Later in debate ---

[Sojan Joseph (Ashford) (Lab)]

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

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

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

[Sojan Joseph]

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

[Wes Streeting]

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

[Sir Christopher Chope (Christchurch) (Con)]

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

[Wes Streeting]

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

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

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

[Wes Streeting]

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

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

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

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[Anneliese Midgley (Knowsley) (Lab)]

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

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

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

[Anneliese Midgley]

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

[Wes Streeting]

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

[Mr Speaker]

I call the shadow Secretary of State.

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

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

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

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

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

[Wes Streeting]

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

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

[Edward Argar]

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

[Wes Streeting]

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

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

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

[Wes Streeting]

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

[Mr Speaker]

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

[Helen Morgan (North Shropshire) (LD)]

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

[Wes Streeting]

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

[Alistair Strathern (Hitchin) (Lab)]

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

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[Andrew George (St Ives) (LD)]

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

[Wes Streeting]

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

[Patricia Ferguson (Glasgow West) (Lab)]

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

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

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

[Wes Streeting]

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

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

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

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

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

[Wes Streeting]

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

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

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

[Cameron Thomas (Tewkesbury) (LD)]

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

[Wes Streeting]

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

[Euan Stainbank (Falkirk) (Lab)]

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

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

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

[Wes Streeting]

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

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

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

[Daisy Cooper (St Albans) (LD)]

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

[Wes Streeting]

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

[Naz Shah (Bradford West) (Lab)]

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

[Wes Streeting]

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

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

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

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[Charlie Maynard (Witney) (LD)]

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

[Wes Streeting]

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

[Mr Speaker]

That concludes Question Time.

NHS England Update

Wes Streeting Excerpts

Thursday 13th March 2025 Commons Chamber

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

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

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

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

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

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

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

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

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

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

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

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

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

“tensions, wasted time and needless frictional costs”.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Wes Streeting]

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

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

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

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

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

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

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

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

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

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

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

--- Later in debate ---

[Wes Streeting]

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

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

[Madam Deputy Speaker (Caroline Nokes)]

I call the Liberal Democrat spokesperson.

[Alison Bennett (Mid Sussex) (LD)]

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

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

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

[Wes Streeting]

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

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

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

[Dr Simon Opher (Stroud) (Lab)]

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

[Wes Streeting]

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

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

[Madam Deputy Speaker]

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

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

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

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

[Wes Streeting]

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

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

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

[Jen Craft (Thurrock) (Lab)]

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

[Wes Streeting]

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

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

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

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

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

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

[Wes Streeting]

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

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

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

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

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

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

[Wes Streeting]

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

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

[John Glen (Salisbury) (Con)]

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

[Wes Streeting]

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

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

What’s wrong with DCMS?

[Wes Streeting]

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

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

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

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

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

[Wes Streeting]

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

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

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

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

[Wes Streeting]

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

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

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

[Wes Streeting]

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

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

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

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

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

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

[Wes Streeting]

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

[Jim Dickson (Dartford) (Lab)]

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

[Wes Streeting]

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

[Wera Hobhouse (Bath) (LD)]

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

[Wes Streeting]

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

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

[Several hon. Members rose—]

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

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

[Wes Streeting]

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

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

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

--- Later in debate ---

[Wes Streeting]

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

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

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

[Wes Streeting]

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

[Adrian Ramsay (Waveney Valley) (Green)]

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

[Wes Streeting]

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

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

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

--- Later in debate ---

[Wes Streeting]

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

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

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

[Wes Streeting]

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

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

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

[Wes Streeting]

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

[Bob Blackman (Harrow East) (Con)]

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

[Wes Streeting]

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

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

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

[Wes Streeting]

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

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

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

--- Later in debate ---

[Wes Streeting]

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

[Sojan Joseph (Ashford) (Lab)]

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

[Wes Streeting]

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

[Jim Shannon (Strangford) (DUP)]

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

[Wes Streeting]

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

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

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

[Wes Streeting]

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

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

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

[Wes Streeting]

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

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

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

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

[Wes Streeting]

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

[John Slinger (Rugby) (Lab)]

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

[Wes Streeting]

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