NHS Workforce

Wes Streeting Excerpts

Tuesday 6th December 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I beg to move,

That this House recognises that the National Health Service is facing the worst workforce crisis in its history with a shortage of 9,000 hospital doctors and 50,000 nurses; condemns the Government’s failure to train enough NHS staff to tackle this crisis; regrets that, as a result, patients are finding it impossible to get a GP appointment, ambulance or operation when they need one; calls on the Government to end the 200-year-old non-domiciled tax status regime which currently costs taxpayers £3.2 billion a year; and further calls on the Government to use part of the funds raised to invest in the NHS workforce by doubling the number of medical training places, delivering 10,000 more nursing and midwifery clinical placements, training twice the number of district nurses per year and delivering 5,000 more health visitors to guarantee that the NHS has the staff to ensure every patient can access the care they need.

The NHS is facing the worst crisis in its history. Seven million people are waiting for NHS treatment, and they are waiting longer than ever before; 400,000 patients have been waiting for more than a year. Heart attack and stroke patients are waiting an hour for an ambulance, on average, when every minute matters. “24 Hours in A&E” is not just a TV programme; it is the grim reality facing patients in an emergency. Behind those statistics are people being held back from living their lives: people forced to give up work because they cannot stand the pain; young people, still bearing the scars of lockdown, unable to get the mental health support they need to step into adulthood; families losing loved ones for no other reason than that the NHS was unable to treat them in time.

My friend and colleague the shadow Leader of the House shared with me an email from one of her constituents. A patient with suspected cancer was urgently referred by his GP, which ought to mean being seen by a specialist within a fortnight. Four weeks later he had heard nothing. He phoned the hospital and was told, “two weeks currently means six weeks” and that he would be contacted, not seen, within the next two weeks. He has now had his appointment, during which the doctor identified cancerous cells. He has been told that he will wait up to eight months to have that cancer removed. He said that until waiting lists are down,

“more people will die unnecessarily from cancer. I hope not to be one of them.”

That is not uncommon. That is where we are. That is why Labour is today putting forward our plan to solve this crisis, make the NHS fit for the future, and get patients treated on time again.

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

Yesterday I spoke to a paramedic who had been with a patient with sepsis, waiting for two and a half hours to be taken in. There were 98 calls at that same Yorkshire hospital waiting to go in. Are we now post-crisis and in complete breakdown, and do we need Labour’s plans to come in now, and not have to wait?

[Wes Streeting]

I strongly agree with my hon. Friend. As the Leader of the Opposition has said, the NHS is not on its knees; it is on the floor. How many times were we told during the pandemic that restrictions were needed to stop the NHS falling over? It has now fallen over, and for the first time in its history people no longer feel certain that, when they phone 999 or arrive at A&E, they will be seen in time. It is the first time in our country’s history that people have not felt confident that emergency medicine will be there for them when they need it.

The Conservatives blame the crisis in the NHS on everything from the weather to the pandemic, and even NHS staff. Of course there is no doubt that the pandemic has made things worse, but the Government—the Conservative party—sent the NHS into the pandemic with 100,000 staff shortages. They spent a decade disarming the NHS, before sending it into the biggest fight it has ever faced. They cannot pretend that the NHS was well prepared. The problem for the Conservative party is that people are not stupid. Their memories are not that short. They know that the NHS was struggling to treat them on time before the pandemic, and they know who is to blame.

[Dr Luke Evans (Bosworth) (Con)]

Is not the point that health is devolved across four different nations, which are each led by a different party? Does this mean that the pandemic has hit all health services, including across the western world? This is a rising tide of the problem of the pandemic and dealing with an ageing population. This is not party political at all, and it is remiss of the hon. Gentleman to try to make it that. What does he say to that?

[Wes Streeting]

I would say two things. As I have already said, I accept that the pandemic made the challenge right across the United Kingdom worse. I also accept that, in every part of the United Kingdom, the NHS is under severe pressure. I would say two things in response. First, even if some of our friends on the SNP Benches do not want to acknowledge it, there is no doubt that every part of the United Kingdom would be better off with a Labour Government and every part of the NHS in every part of the United Kingdom would be better off if there were a Labour Government, because the investment that we are proposing in NHS staff today would benefit countries right across the United Kingdom. [Interruption.] In response to the outgoing hon. Member for Peterborough (Paul Bristow), do not say that politics does not make a difference. Do not expect the people to believe that somehow there was an inevitable sense of decline in the NHS. I am sure people remember that, when Labour was last in government, we delivered the shortest waiting times and the highest patient satisfaction in history.

[Paul Bristow (Peterborough) (Con)]

rose—

[Wes Streeting]

Is the hon. Member planning to cross the Floor? I look forward to hearing from him.

[Paul Bristow]

Certainly not. The hon. Member’s plan seems to be simply vote Labour—there is no detail to it and nothing else to it. I suggest that he looks at the good people of Wales, who suffer under a socialist healthcare system. They are certainly not very happy, are they?

[Wes Streeting]

I do not pretend that our plan is not vote Labour, but of course those are the means by which we get to better ends. What we propose today is the biggest expansion of the NHS workforce in history. I will explain how that will benefit patients across the country and how we will pay for it. I think that people in Peterborough, 2,788 of whom are waiting more than a month to see a GP, will welcome Labour’s plan for investment. That is why, after the next general election, Peterborough will have a Labour MP.

[Emma Hardy (Kingston upon Hull West and Hessle) (Lab)]

I want to raise the case of my constituent, Mr Simpson, whose wife died last Tuesday after waiting 16 hours for an ambulance. On 29 November, his wife was confused. At 3 pm, he first called for an ambulance and was told that one might be sent and that he might hear from the service. At 6 pm, he rang the ambulance again. The person wanted to speak to his wife, but she was very confused and unable. He tried to give her a drink at 2.30 am; there was still no ambulance. His wife went to sleep, but she was still moving a bit. He fell asleep. He woke at 7.30 am and found that his wife was not moving; she had passed away. All the while they were still waiting for the ambulance to arrive. I do not believe for one moment that that happened because the ambulance service does not care. Does my hon. Friend agree that the service is desperately understaffed, desperately short of resources and in desperate need of adequate funding?

[Wes Streeting]

I thank my hon. Friend for raising that heartbreaking case. It is every family’s worst nightmare. All of us now know someone who is waiting for treatment. Many of us know someone who has called for an ambulance and waited for hours and hours—and, in some cases, given up on it and gone to hospital. I have spoken to ambulance service staff who, like many other staff across the NHS, feel a real sense of deep personal moral injury because they know that, despite their best efforts and busting a gut at work every single day, their best simply is not good enough because the system has collapsed. Ambulance turnaround times are not fast enough because A&E waiting times are too high. That is because people cannot see a doctor and the social care is not available, so the beds are full of people who are well enough to go home and would be better off at home. This is the problem in the NHS: the whole system is broken. I am afraid to say that political decisions made in this place by the Conservative party have led us to this tragic situation.

[Andy McDonald (Middlesbrough) (Lab)]

My hon. Friend is making an excellent case. At the James Cook University Hospital in Middlesbrough, the number of people still in hospital who could be discharged into social care amounts to three full wards. That is the situation that we have got to. It is a perfect storm, with ambulances queueing outside and people turning up at A&E because they cannot get to a GP. That will only ever be addressed if we also address staffing in our GP services to ensure that they can attract people who are offered Agenda for Change terms and conditions to alleviate the backlog. Does he agree that we need to invest in all the elements along that supply chain?

[Wes Streeting]

My hon. Friend is absolutely right. This is the tragedy of where we have got to on social care in particular. The Government have allocated half a billion pounds to alleviate pressure this winter, but not a penny of it has reached social care providers. Not a penny of it is currently being worked in action to try to deal with delayed discharges. I have no doubt whatsoever that one reason why it has taken so long from that commitment to getting money to the frontline is the constant churn of Ministers that we saw over the summer. The absolute circus that we saw in the Conservative party has had a direct impact on the competence of effective Government in this country. We now have ineffective Government, so even when the Government seek to do the right thing and allocate the resources, they cannot get the money out the door far enough because Ministers seem to change week in and week out.

[Jim Shannon (Strangford) (DUP)]

I commend the shadow Secretary of State for what he is saying. When it comes to staffing issues, one thing should clearly be done. Does he agree that part of the reason why we rely so heavily on agency staff is because our NHS staff have migrated to agency working, where there is less pressure, so the Government should spend less money on agency workers and give our NHS staff greater support and appropriate pay so that they can stay in the NHS?

[Wes Streeting]

I strongly agree with the hon. Gentleman. I will come shortly to talk about industrial action, but this should be at the heart of the Secretary of State’s thinking. The demands from staff trade unions, whether on pay, terms and conditions or the wider pay machinery, should be seen not just as a negotiation with staff unions but as a retention issue. We are losing staff faster than we can recruit them in some places—especially in areas such as midwifery—and if we lose the staff that we have, even Labour’s plans to undertake the biggest recruitment in the NHS’s history would not be as effective as they would be if we kept staff in the service today. That is why I urge the Secretary of State to treat those NHS staff with respect, get their representatives around the table, and negotiate a solution.

I am aware that the situation in the NHS in Northern Ireland is the worst that we see throughout the United Kingdom. The shadow Secretary of State for Northern Ireland, my hon. Friend the Member for Hove (Peter Kyle), visited NHS services in Northern Ireland only recently. I have no doubt that we need to get effective governance back up and running again in Northern Ireland as well. I urge the Government to discharge their responsibilities in that area, too. Certainly, when Labour was last in government, I do not remember Labour Prime Ministers taking such a complacent, lackadaisical or indeed absent approach to the governance of Northern Ireland. I hope that we can see a breakthrough of the deadlock so that the people of Northern Ireland get the Government they deserve in Stormont, as well as the United Kingdom getting the Government it deserves here in Westminster.

Waiting lists were already at a record 4.5 million before the pandemic. Ambulances were taking longer than is safe to reach patients in an emergency before the pandemic. Patients were waiting longer than four hours in A&E before the pandemic. The 18-week guarantee for elective treatment had not been met for four years before the pandemic, and more patients have waited longer than two months to start their cancer treatment every year since 2010. From the moment the Conservatives entered power, things began to deteriorate. It is not just that the Conservatives did not fix the roof while the sun was shining; they blew off the roof and ripped up the floorboards, and then they wonder why the storm did so much damage.

[Charlotte Nichols (Warrington North) (Lab)]

My hon. Friend mentioned cancer diagnosis rates. I believe he will be aware that one in four people diagnosed with pancreatic cancer dies within a month of their diagnosis, with 70% receiving no treatment at all because they die before they could be treated. Does he agree that cancer diagnosis rates are a disgrace and that early intervention, early diagnosis and early treatment are vital for people with all forms of cancer, particularly the most aggressive types such as pancreatic cancer, to have any chance of survival?

[Wes Streeting]

My hon. Friend is absolutely right. One reason why this country has much poorer cancer outcomes than many comparable economies is precisely because of late diagnosis. I know from my own experience how vital early diagnosis can be for good cancer outcomes. I am terrified by the fact that, within those 7 million patients waiting in the elective backlog, there will undoubtedly be cases of undiagnosed cancer and other conditions. If the NHS had eyes on the patients, they would be detected faster, patients would receive treatment much more quickly and the outcomes would be better. One of the tragedies for the NHS is that, because we do late diagnosis, we get more expensive and less effective treatment. If we could diagnose faster, patients would get better outcomes and taxpayers better value for money. That is the kind of reform to the model of care that Labour would like to see.

[Wera Hobhouse (Bath) (LD)]

On diagnosis, access to GPs is also a vital part of the puzzle. Is it not terrible that the Government are not listening to GPs, who say they need a different visa system? They cannot recruit enough GPs into the system because the Government are so stuck with these immigration rules, and the Home Office does not want to change certain parts of the visa system?

[Wes Streeting]

I am grateful for that intervention. We are in the worst of all worlds on immigration and the NHS. The Government try to have it both ways. They talk tough on rhetoric, so we end up with a very bureaucratic, ineffective and costly system, but because they fail to invest in our own homegrown talent, they are over-reliant on immigration from other countries, including those who desperately need their own doctors and nurses. I do not think it is good enough, after 12 years of Conservative Government, that we are turning away bright potential doctors, nurses and allied health professionals because the Government cannot be bothered to pull their finger out and train our own homegrown talent. We need to see improvement, so we that can draw the best international talent and make the system smooth, efficient and effective, but it is also crucial that we train our own homegrown talent.

Turning to more of the Conservatives’ excuses—we have heard the excuses of the pandemic—let us now look at the excuse they are planning to deploy this winter. There is no denying that this winter could be the most challenging the NHS has ever faced. The Royal College of Nursing, for the first time in its more than 100-year history, is planning to undertake strike action. Just this lunchtime we got strike dates from Unison, the GMB union and Unite the Union. That raises the question: why are the Government not even trying to stop the strikes in the NHS from going ahead? Surely, when the NHS already lacks the staff it needs to treat patients on time, the Government ought to be pulling out all the stops, getting around the table and negotiating to stop industrial action? So why aren’t they?

The Secretary of State said in Health questions earlier that his door is open—as if we can just sort of wander in off the street into the Department of Health and Social Care, where there will be a cup of tea and a biscuit waiting, and he will be just waiting for the negotiations. That is not how this works. Everyone knows that is not how it works. He had a nice little meeting with unions after the summer, after Labour complained that we had not seen a meeting between a Secretary of State and the unions since the right hon. Member for Bromsgrove (Sajid Javid). Goodness me, we have had three Secretaries of State since then—and two of them are the Secretary of State on the Front Bench today. Why on earth are they not sitting around the table and conducting serious negotiations? I will tell you why, Mr Deputy Speaker: they know that patients are going to suffer this winter and they do not have a plan to fix it, so instead of acting to improve care for patients and accept responsibility, they want to use nurses as a scapegoat in the hope that they avoid the blame. We can see it coming a mile off. It is a disgusting plan, it is dangerous and it will not work.

If I am wrong, perhaps Conservative Members could explain why the Government are not trying to prevent the strikes from going ahead. Perhaps they could explain why the Secretary of State ignored all requests from the health unions for meetings and conversations this summer while the ballot was under way. Perhaps they could explain what the Government’s plan for the NHS is this winter. Perhaps they could explain why a Government source told The Times newspaper that

“Ministers plan to wait for public sentiment to turn against striking nurses as the toll of disruption mounts”.

They said the quiet bit out loud and they gave the game away.

What else would explain the unedifying and embarrassing spectacle of the chair of the Conservative party going on national television to accuse nurses of doing the bidding of Vladimir Putin? I should not have to make this point, but nurses are not traitors to this country. They bust a gut day in, day out to look after all of us. We clapped them during the pandemic and now the nurses are clapped out. They are overworked, overstretched and undervalued by this Government. Let me say to the chairman of the Conservative party that he would speak with greater authority on what is in Britain’s national interests if he did his patriotic duty in his own tax affairs.

When it comes to sending a message to Vladimir Putin, why does the burden consistently fall on the working people in Britain? Why is it that NHS staff must make huge sacrifices because of the invasion of Ukraine, yet people who live in Britain but do not pay their fair share of taxes here do not have to lift a finger? When it comes to paying the bills, the first and last resort of this Conservative Government is always to pick the pockets of working people, yet the enormous wealth of tens of thousands of non-doms is left untouched. They may blame covid, they may blame health professionals, they may even blame the weather, but it is 12 years of Conservative mismanagement and under-investment that has left the NHS without the doctors, nurses and staff it needs, and patients are paying the price.

I am sure every Member of this House, indeed everyone in the country, knows someone who has been let down when they needed healthcare in recent months. They all say the same thing: the NHS staff were brilliant, but there simply are not enough of them. There is no NHS without the people to run it, yet today there are more vacancies in the NHS than ever before: 9,000 empty doctor posts, 47,000 empty nursing posts, and midwives leaving faster than they can be recruited. There are 4,600 fewer GPs than there were a decade ago, and the right hon. Member for Bromsgrove admitted last year that the Government are set to break their manifesto promise to recruit them back.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I was looking at a message from a constituent this morning who told that he went to A&E having waited four weeks for a GP appointment. Does that not speak to a lack of investment in the NHS workforce over 12 years and a lack of adequate planning? I know how hard GPs work in my constituency, but the lack of GP availability to staff surgeries and provide those appointments is placing unneeded pressure on A&E. That is on this Government’s watch.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. As we see so often with this Government, they make promises but break them. They try to fool the public into thinking they are delivering more GPs—or indeed more police officers—when it was the Conservative party that cut them. They try to give with one hand, but they take with the other, and after 12 years people have had enough.

Of course, it is not only the promise to recruit more GPs that the Conservatives are breaking. We had the promise of 40 new hospitals, which the Secretary of State repeated today, yet in response to the question posed by the right hon. Member for Uxbridge and South Ruislip (Boris Johnson), the Secretary of State said that of those 40 new hospital schemes

“five hospital schemes are in construction, two are now completed and we aim to announce the next eight by the end of this year.”

So, where are the other 25? Where are these 40 new hospitals? As far as I can tell, they exist only in the imagination of the former Prime Minister. Yet the script has not changed—Ministers are still here claiming 40 new hospitals.

When I visited Leeds with the shadow Chancellor, my right hon. Friend the Member for Leeds West (Rachel Reeves), I saw a vast pile of dirt where a new building was due to go up. We heard today that the Government cannot even negotiate an agreement with the hospital to get the site working and get the new facilities built. With every minute, every month and every year of delay construction costs are going up, so taxpayers are left in the worst of all worlds: broken promises, no 40 new hospitals, and paying through the nose for the ones that are being built because of Government incompetence.

We see the tragic consequences of the shortages and broken promises in the NHS. My hon. Friend the Member for Rotherham (Sarah Champion) raised the tragic case today at Health questions of a five-year-old boy who had what his doctor described as the worst case of tonsilitis he had ever seen. He was turned away from hospital, with his parents told there were no beds and not enough doctors. His infection worsened and five-year-old Yusuf later passed away. His death certificate recorded the primary cause of his death as pneumonia and the secondary cause as tonsilitis. What kind of country are we living in when a five-year-old boy can die of tonsilitis? This is criminal.

I met Yusuf’s uncle, Zaheer Ahmed, last week, and I did not know what to say to that poor man and his grieving family, who lost that little boy in the most unimaginable circumstances. I invite the Secretary of State to meet Yusuf’s family to hear how that little boy was failed and to hear at first hand about some of their interactions with the NHS, which I thought were completely unacceptable and intolerable. On that note, I welcome the independent inquiry that has been committed to. That is really important for the family who have been failed in this heartbreaking case. We do not want to see more cases like that.

At the heart of the crisis in the NHS—as with so many of the problems facing our country—is a failure to plan. The NHS has not had a workforce plan since 2003. That would be unacceptable in a multinational company one one-hundredth the size of the NHS. The failure to plan means that short-term fixes are always favoured over what is in patients’ long-term interests. That is why the Government cut the nursing bursary and why, this summer, in the middle of the biggest crisis in the history of the NHS, they took the infuriating decision to cut a third of medical school places.

[Dr Luke Evans]

Will the hon. Gentleman give way?

[Wes Streeting]

The hon. Gentleman has been to medical school; does he think that it was a good idea to cut the number of places this summer?

[Dr Evans]

When we talk about Labour’s record on training, the hon. Gentleman may forget that, in 2007, the medical training application service ended up in judicial review. Many of my colleagues moved out of disciplines that they loved dearly because of Labour’s mess in making those plans. He has been speaking for almost half an hour, setting out his exposé of what is going on in the health service, but I am yet to hear a plan. I hope that he will spend the next half an hour telling us about the detailed plan of how we get to 10,000 new medical places, because when it comes to firms in hospitals, there is not enough space for medical students to get that experience, so I am looking for him to solve that problem.

--- Later in debate ---

[Wes Streeting]

The hon. Gentleman is not looking forward to me solving the problem half as much as I am looking forward to solving the problem. As far as I am concerned, the general election cannot come soon enough. I say to Government Members, “Be careful what you wish for”, because I intend, indeed, to set out Labour’s plans in detail. I am happy to stretch that to half an hour if that is where the demand takes us.

[Daisy Cooper (St Albans) (LD)]

rose—

[Wes Streeting]

I give way to my Liberal Democrat friend.

[Daisy Cooper]

I am grateful for a number of the interventions, not least the most recent one. Is it not true that, as hospital trusts meet with regard to the new hospital programme today, they will discuss how big the new hospitals should be? Given that we need more space to train the doctors and nurses of the future, does the hon. Member agree that it would be criminal if they tried to cut corners by planning hospitals that are smaller than they need to be?

[Wes Streeting]

I wholeheartedly agree. I seemed to hear from the Health Secretary this afternoon a one-size-fits-all approach from the Government, as though every hospital’s needs will be the same and we can import a standardised model for every hospital site. I would be happy to be proven wrong, and I would be even happier if the Secretary of State got the ball rolling on some plans that are already agreed, and on which trusts have spent a significant amount of time and taxpayers’ money. I would be even more delighted if we got some of those hospitals open, but I would wager that when we get to the end of the Government’s life, we will not have seen anything like 40 new hospitals delivered or even in the pipeline.

[Peter Dowd (Bootle) (Lab)]

My hon. Friend is making a compelling case. I think I know where we could get some of the money from for training places, and perhaps he will agree. We forgo about £3.2 billion in revenue from non-doms every year. There are 68,000 non-doms, there or thereabouts, which works out at about £44,000 a non-dom. Does he think that he could do much with that?

[Wes Streeting]

My hon. Friend has led me neatly towards setting out Labour’s plans, which rely on people who come to this country and make Britain their home actually paying their taxes here. That is the right and fair thing to do, and I think people across the country would agree that we need nurses more than we need non-doms.

[Charlotte Nichols]

I have listened with interest to what has been said about the new hospital building programme, not least because we have been waiting for a new hospital in Warrington for a very long time. We recently opened the new Health and Social Care Academy at Warrington & Vale Royal College with some of our town deal fund money, but surely people need excellent, cutting-edge training facilities to go into in a hospital once they leave the college. The Government’s lack of progress on building us a new hospital in Warrington undermines some of the other excellent work that we are doing locally to try to train up the people we need to fill those workforce shortages.

--- Later in debate ---

[Wes Streeting]

I totally agree, and I heard of a really awful case in Warrington the other day. A Warrington resident who contacted me said that they waited 12 hours in agonising pain in accident and emergency before giving up and going home after midnight because she simply could not take it any more. The A&E department was so packed that she could overhear other patients’ conversations with clinicians, including sensitive medical information. Those are the kinds of conditions that patients are experiencing and in which the poor NHS staff have to work. It is simply unacceptable.

[Claire Hanna (Belfast South) (SDLP)]

I thank the hon. Gentleman for being so generous in giving way. Does he agree that keeping the working environment safe is core to workforce planning, retaining the people who are trained and stopping spending eye-watering sums on agency nurses? He outlined many scenarios in which staff are forced to work in unsafe conditions. Does he agree that the core message coming from health unions is their desire to have appropriate staffing levels to provide the service on which all our constituents rely?

[Wes Streeting]

I strongly agree. In fact, I spoke to the general secretary of Unison last week. She said that as the unions look at safe staffing levels in critical services, in their determination to maintain patient safety in the event that industrial action goes ahead, they have found that on non-strike days, the NHS already operates at staffing levels below what the union would intend to operate on a strike day. That is an unbelievable state of affairs.

I am really worried about industrial action. Like patients across the country, I do not want industrial action to go ahead—it will mean ambulance delays, cancelled operations and even greater pressures on the NHS—but the tragedy is that we see the conditions that I just described every single day in the NHS. Pat Cullen from the Royal College of Nursing said, “We are striking for patients”. I have heard that line time and again from RCN members. It is partly about NHS staff’s pay and the conditions in which they work, but more than anything else, they are telling me that they voted for industrial action—some for the first time in their entire careers—because they have had enough and can no longer suffer the moral injury of going to work, slogging their guts out and going home petrified that, despite their best efforts, they still did not deliver the care that patients deserved. What an intolerable situation they find themselves in. Their backs are against the wall, and that is why the Government should negotiate.

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

My hon. Friend is making an excellent speech. Does he agree that it is completely reprehensible for Government Ministers, when talking about potential pay strikes by nurses, to say that by going on strike, they are somehow enabling Putin’s regime?

[Wes Streeting]

That was a reprehensible thing to say and it shows how desperately the Government are scraping the barrel to make excuses for their negligence and mismanagement of the NHS.

As I said, I found it astonishing that this summer, in the middle of the biggest crisis in the history of the NHS, the Government took the infuriating decision to cut a third of medical school places. Thousands more straight-A students in Britain who want to help have been turned away from training to become doctors. It is like the clip of the former Deputy Prime Minister Nick Clegg saying in 2010 that there was no point in building new nuclear power stations because they would not come online until 2022. This country needs Governments who think beyond short-term electoral cycles and put the long-term interests of the country first. That is the approach that Labour would take, but it has been sadly missing for the past 12 years.

Just as the Government failed to build our energy security, leaving us exposed to Putin’s war in Ukraine, they failed to train the staff the NHS need, leaving us exposed as the pandemic struck. Their failure to prepare has left us in the ludicrous situation in which UK universities are now offering medical degrees only to overseas students. That’s right: the Government are refusing to allow bright British students to achieve their dreams of becoming doctors, so Brunel University is forced to take exclusively students from overseas. The Chair of the Select Committee on Education, the hon. Member for Worcester (Mr Walker), has warned that there is a real risk that medical schools will

“only train overseas students who go off and get jobs elsewhere”.

What a criminal mismanagement of our higher education system. What a failure to plan to meet our staffing needs with our own home-grown talent.

[Taiwo Owatemi (Coventry North West) (Lab)]

My hon. Friend is making an excellent point. Given that there were nearly 30,000 medical school applications last year from British students who really want to study medicine, does he agree that it is absolutely disgraceful that the Government have a cap of 7,500? That shows that we are not investing in our workforce or in home-grown British doctors. It is appalling that the Government cannot see the importance of that.

[Wes Streeting]

I wholeheartedly agree. To deal with that problem—and, indeed, to satisfy the demands of the Conservative party, which looks to Labour for answers—we are putting forward a plan today to solve the crisis, to bring down waiting times, to get patients the treatment they need and to build a healthy society.

Where the Conservatives are holding the best and brightest students back from playing their part in the health of our nation, Labour will unleash their talent in the NHS: we will double medical school places, training 15,000 doctors a year so that patients can see a doctor when they need to. Where the Conservatives have left nurses working unsafe hours, unable to spend the time they need with patients to provide good care—where the Conservatives have left the NHS so short of midwives that expectant mothers are turned away from maternity units that do not have the capacity to deliver their child—Labour will act: we will train 10,000 more nurses and midwives every year.

We will go further. The way we deliver healthcare has to change. For many patients, a hospital is not the best place to be, yet in the past 12 years all the other parts of our health and care service have been eroded by underinvestment. When our society is ageing and people increasingly want to be cared for in the comfort of their own home, surrounded by their loved ones, why have four in 10 district nursing posts been cut? Labour is proud to have district nursing at the heart of our plans to modernise the NHS, and we will double the number of district nurses qualifying every year.

Many colleagues across the House have campaigned for years on the importance of the early years of a child’s development. All the evidence says that the first 1,000 days of a child’s life are vital to their development and life chances, yet the number of health visitors has been cut in half since 2015. Labour will ensure that every child has a healthy start to life, training 5,000 more health visitors. That is what our motion would deliver.

[Munira Wilson (Twickenham) (LD)]

The hon. Member raises children and early intervention, but one area he has not touched on is the tidal wave of cases relating to children and young people’s mental health. As we all see in our casework every week, children and young people who have not been treated early get worse and worse and therefore get referred to acute services. In the past year, referrals to child and adolescent mental health services have gone up almost 25% and consultant psychiatrist numbers have come down. In terms of early intervention, we are not seeing enough mental health support in our schools. In Richmond, we cannot recruit clinical psychologists even though we have the money to do so. Does the hon. Member agree that we really need to focus on the future of this country—our children—by training more psychiatrists, counsellors and psychologists?

[Wes Streeting]

I totally agree. We have had lots of perfectly good speeches from Conservative Prime Ministers over the past 12 years, and we have had more than our fair share of unbelievably bad Conservative Prime Ministers over the same period. One thing that each of those speeches has had in common is warm rhetoric and no delivery. We are not prepared to make the same mistake, so although it is not on today’s Order Paper, I am pleased to confirm that my right hon. and learned Friend the Leader of the Opposition has announced a mental health pledge that will mean 8,500 more mental health professionals being recruited. It will enable us to provide mental health hubs in every community, dedicated mental health support in every school and the aim of guaranteeing treatment within a month.

Our pledge will be transformational to mental health support in this country. It will particularly benefit young people, whose mental health and wellbeing have borne the brunt of the pandemic. It will really help to free up capacity for GPs and accident and emergency departments, which are increasingly seeing mental ill health cases coming through their door because the specialist support that people need is unavailable. Our plan, like our motion on today’s Order Paper, is fully costed and fully funded and will make a real difference to patients. Just as the Conservative party is welcome to steal Labour’s NHS workforce pledge, it is very welcome to steal our mental health plan too.

As well as recruiting the doctors, nurses and allied health professionals we need, we also need to keep the staff we have.

[Mike Amesbury (Weaver Vale) (Lab)]

Why does my hon. Friend think Government Members are so keen on protecting non-dom status? What is the interest there?

--- Later in debate ---

[Wes Streeting]

That is an excellent question that the Secretary of State is really well placed to answer. It is not as if people in Downing Street do not know what non-dom status is or how it is currently accessed. I do not know whether the Chancellor’s reluctance to abolish non-dom status is because he does not want bad relations with his next-door neighbour. We have all been in that situation—everybody needs good neighbours—but I think a little neighbourly discomfort on Downing Street is a price worth paying to improve the healthcare available to people on streets up and down the rest of the country.

We need to keep the staff we already have. On a visit to a hospital recently, I spoke to a nurse about whether she was planning to vote for industrial action. She said yes: pay was an issue, but what really motivated her decision was the stress, the burnout and going home at the end of the day with the moral injury of worrying that she had not delivered the care patients deserve because she was too overstretched. I asked her what would make the most difference. She said, “I just want to know that the cavalry is coming—that it is worth staying in the job because things are going to get better.” She knows how long it takes to train nurses—she has been through it herself—and how long it takes to train doctors. She can accept that, but what she cannot accept is a future in which, because we did not act today or because the incoming Government did not act after the general election, she is still working understaffed shifts in overstretched hospitals a decade down the line.

Labour’s message to NHS staff is that the cavalry is coming with Labour. We will train a new generation of doctors, nurses and midwives so that staff are not driven out of the service and patients are treated on time. Of course more can be done to keep staff from leaving. We have been calling on the Government for months to fix the perverse incentives in doctors’ pensions that are forcing them into early retirement. The Government have just launched a consultation that might lead to changes in spring 2023. What good is that when the NHS is on the cusp of the worst winter crisis in its history?

The Government announced in the autumn statement that, for the first time ever, they would count the number of staff the NHS need—a truly groundbreaking act! Counting the number of people we need is a good start, but Labour has committed to an independent workforce body that will look at retention and better professional development so that staff can build and progress their careers in the health service. With the number of care workers falling for the first time, where is the Government action to stop the exodus of care workers to places like Amazon? Providing fair pay and terms and conditions for care workers is not only the just thing to do, but one of the best things that the Government can do to ease pressure on the NHS.

[Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)]

Is there not a need for urgent thinking about the impact of inflationary pressures on all the UK’s health systems in the UK? According to a report published yesterday by the Wales Governance Centre at Cardiff University, inflation will eat into the Welsh budget to the tune of £800 million next year and £600 million in 2024-25. Health is at the heart of the Welsh budget, and this will inevitably have a huge impact on health delivery in Wales. I am not sure what the English figures are, but the cash-terms increases in the autumn statement are highly unlikely to compensate for the inflationary pressures that will also affect the English health budget.

[Wes Streeting]

The hon. Gentleman is right: inflation is a big problem, and it is a problem made in Downing Street. We are all paying a very heavy price for more than a decade of Conservative mismanagement of the economy. Yes, we can all point to the spectacular success that was the mini-Budget, which crashed the economy and left everyone picking up the pieces, but even that does not explain more than a decade of low growth, low productivity and higher taxes. That is where the Conservative party has left us, and that is why it is not just a change of NHS policy we need, but a change of economic policy. Goodness me, the Conservatives have had enough goes at it. They have had enough Chancellors this year. Even The Spectator has lauded the shadow Chancellor as the Chancellor of the year, because she has the plan that the country needs. Business leaders know it, we know it, the country knows it, and I suspect that even Conservative Members know that it is true.

Let me now turn to our NHS workforce plan. When I say that it is a serious plan, the House should not just take my word for it. It has been endorsed by the Royal College of Physicians, the Royal College of Psychiatrists, and Universities UK. It has widespread and cross-party support. I was particularly pleased by the support expressed by one correspondent, who wrote in September:

“I very much hope the government adopts this on the basis that smart governments always nick the best ideas of their opponents. They also ditch the bad ones of their predecessors such as blocking an enlightened amendment to the Health Act that would have sorted out workforce planning”.

I should like to thank the Chancellor for his endorsement. I was with him in the Lobby to support that NHS workforce amendment when Conservative Members, no doubt including the Secretary of State, were voting the other way. May I invite the Secretary of State to use that quote in any future negotiations in which he engages at the Treasury? I am just trying to be helpful.

While the Secretary of State is there, perhaps he could suggest that the Treasury take a proper look at the non-dom tax status. The Chancellor admitted after the latest Budget that his team had not even calculated how much the tax status was costing the Treasury and how much scrapping it would raise, at the same time as expecting us to believe that it would not work and that the sums produced by independent academics would not add up, although he had not even bothered to commission Treasury sums of his own.

Politics is about choices. The Conservatives are choosing to protect non-dom tax status, benefiting a few wealthy individuals, while millions of people cannot get a GP appointment or an operation when they need one. The Conservatives are choosing to protect non-dom tax status, benefiting a few wealthy individuals, while millions of people are left waiting in agony on NHS waiting lists. And, of course, the Conservatives are choosing to protect non-dom tax status, benefiting a few wealthy individuals, when they know that it is not just the health of the nation that is being harmed by record NHS waiting lists, but the health of our economy. Patients need treatment more than the wealthiest need a tax break. Those who live in Britain should pay their taxes. The Labour party is clear about where we stand: we need nurses, not non-doms.

We have a plan. The Conservatives do not. We have a record of delivering in government. The Conservatives do not. It is not just the House that faces a choice today; at the next election, the country will face a choice between more of the same with the Conservatives and the fresh start that Britain needs with Labour.

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

The hon. Member for Ilford North (Wes Streeting) said that Labour has a plan. Let us look at that plan. More than a fifth of the entire population of Wales are waiting for planned care, and 60,000 people in Wales are waiting for more than two years. So we can see exactly what Labour’s plan in government delivers. He asked us to remember when Labour was last in power, and we still do. We remember the letter that said there was no money left. [Interruption.] He has just had plenty of time in which to discuss these matters. I did not feel the need to hector him, because I thought his points had so many flaws that it was important for the House to be able to hear them. He obviously feels that he did not make his case effectively, and would like to have another go. Does he want to have another go?

[Wes Streeting]

indicated dissent.

[Steve Barclay]

He does not want to intervene, so let me deal first with what he left out. His speech, like his motion, ignored a number of salient points. He did not mention, for example, the autumn statement, which one would have thought was fairly significant, providing an extra £6.6 billion for the NHS over the next two years. The NHS Confederation, no less, has described the day of that settlement as a “positive day for the NHS”, and the chief executive of NHS England has said that it should provide “sufficient” funding to fulfil the NHS’s key priorities.

The hon. Gentleman chose not to mention that significant funding. He also—much to the surprise of the House, perhaps—chose not to mention the uplift for social care that was announced in the autumn statement. Opposition Members often call for more funding, so I would have thought that they would be keen to hear about the extra £6.6 billion of additional funding for the NHS, about the biggest funding increase for social care provided by any Government in history, and about the £8 billion that we have committed to elective care. That, bizarrely, was also missing from his speech. He talked about the backlogs—those in England, that is; the backlogs in Wales are much greater—but he did not talk about that £8 billion for elective care, which will fund the building of diagnostic centres and surgical hubs in the constituencies of many Opposition Members.

--- Later in debate ---

[Steve Barclay]

Can I just answer the hon. Member for Bath (Wera Hobhouse)? I have taken a number of interventions. The hon. Lady is intervening on an intervention.

We must look at the increase in doctors in primary care of over 2,300, and we currently have over 9,000 GP trainees, but the hon. Member for Bath’s wider point is correct. It is not simply about the number of GPs; it is about ensuring that the wider primary care force operate at the top of their licence. It is also about access for patients, and avoiding the 8 am Monday crunch when lots of people make calls at the same time. That is why we are looking at the better use of telephony in the cloud and the latest that technology offers. It is also why we have the opportunity, through Pharmacy First, to make better use of what the pharmacists throughout our pharmacy network can do. It is about increasing the number of GPs, yes, but it is about the wider workforce, the use of technology and the use of different patient pathways, too.

Another omission from the motion is that there are around 90,000 more GP appointments every working day, excluding covid vaccinations, than there were last year. When I hear people say that they cannot see their GP, it is worth putting it in context—[Interruption.] The shadow Secretary of State is chuntering again. Does he want to have another go?

[Wes Streeting]

I am surprised and grateful that the Secretary of State has given way. His position seems to be, “You’ve never had it so good.” People cannot get an appointment to see their GP, they are waiting for ambulances and they cannot get into A&E and be seen within a reasonable period of time, but under this Government patients have apparently never had it so good.

[Steve Barclay]

As the hon. Gentleman knows, I have been at pains to point to the huge pressure the pandemic has generated, which he seems unwilling to accept.

In Wales, 60,000 people have been on a waiting list for more than two years, which is a huge example of what a Labour Government deliver in practice. Everyone recognises the huge demand for GP appointments, and there is no single solution, but GPs are seeing more people. Forty per cent. of appointments are booked for the same day, and almost 40% of patients have continuity of care.

--- Later in debate ---

[Steve Barclay]

As part of making things easier, I set up a taskforce in the Department over the summer to look at how we can increase the numbers. We have increased the number of nurses recruited internationally, and care workers are on the shortage occupations list. If there are particular issues that the hon. Lady wishes to highlight, I would be happy to look at them with her, but we are keen to attract talent.

[Wes Streeting]

For clarity, is it the Secretary of State’s position that we are turning away thousands of talented people who want to study medicine and other health professional courses because we do not need them as we are recruiting from overseas?

[Steve Barclay]

No, of course not. The hon. Gentleman knows that is not the case. It is a bit like when he goes around the media to charge the Government with refusing to talk to the unions. Simply misrepresenting our position is not a fair reflection of Government policy.

The motion talks about workforce, and this Government have committed to increasing the number of international recruits in the NHS. The Leader of the Opposition seems to think we should not be encouraging that. That is the wider point to make. Of course, that sits alongside domestic recruitment, which is why, as I said a moment ago—again, the hon. Member for Ilford North has chosen to ignore this—we have had a 25% increase in medical undergraduate places, with five new medical colleges set up by the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May). That underscores this Government’s commitment to increasing the number of doctors in training.

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 1st November 2022 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

I welcome the Secretary of State back and welcome his team, but I have had boxes of cereal with a longer shelf-life than Conservative Secretaries of State. As a consequence of the turnover and chaos, the truth is that the NHS is not prepared for this winter—it cannot even get allocated funds out of the door.

Let us turn to the future. Over the summer, the Prime Minister promised to establish a “vaccines-style taskforce” to tackle the Conservatives’ NHS backlog on “day one” and to have overall waiting list numbers falling by next year. May I ask the Secretary of State who is on that taskforce, how many times it has met and what its programme of work is?

[Steve Barclay]

I am grateful that the hon. Gentleman raises the issue of vaccines; in fact, I raised it in Cabinet today. The UK is the first country in the world to have introduced bivalent vaccines targeted both at omicron and at the original strain of covid-19. We have now made the covid vaccine and the flu vaccine available to all over-50s; I hope that Members across the House will promote that. I think the UK can be very proud of its work to roll out vaccines against both covid and flu, which are a key part of preventing some of the pressure on our A&Es.

[Wes Streeting]

I can forgive the Secretary of State for mishearing the question, but what I find unbelievable is that it seems as if this is the first time he has heard about the Prime Minister’s own proposed taskforce to deal with the Conservatives’ NHS backlog. That is what the Prime Minister promised, and that is what I asked the Secretary of State about. This is obviously another case of the Conservatives over-promising and under-delivering.

If the Secretary of State cannot stand by the Prime Minister’s pledges, what about the views of the man next door? When we announced our policy to train a new generation of doctors and nurses, paid for by abolishing non-doms, it was welcomed by the Chancellor as—and I quote—“something I very much hope the government also adopts on the basis that smart governments always nick the best ideas of their opponents.” In the spirit of constructive opposition that the Secretary of State asks for, Labour has a plan to tackle the staffing crisis. The Conservatives do not. It is fully costed and paid for, so will he nick it?

[Steve Barclay]

The hon. Gentleman skirts over the fact that it is this Government who have opened five new medical schools, who have significantly boosted medical undergraduate training, who are investing more in our NHS as per the long-term plan, who have invested a further £36 billion as part of our covid response, and who are investing in technology and the skills of the workforce as a whole. We are boosting the number of medical trainees and—I touched on this question earlier—we are also boosting the number of doctors in training to be GPs.

Urgent and Emergency Care

Wes Streeting Excerpts

Monday 5th September 2022 Commons Chamber

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

With permission, Mr Deputy Speaker, I would like to make a statement on our support for urgent and emergency care. I know that this is an issue of great concern to right hon. and hon. Members, and I wanted to update the House at the earliest opportunity on the work that has been undertaken over the summer.

Bed occupancy rates have broadly remained at winter-type levels, with covid cases in July still high, with one in 25 testing positive—that compares with about one in 60 currently. This is without the decrease in occupancy that we would normally expect to see after winter ends, and ambulance waiting times have also continued to reflect the pressures of last winter, although I am pleased to see recent improvements. For example, the West Midlands service is meeting its category 2 time of less than 18 minutes.

I would like to update the House on the nationwide package of measures we are putting in place to improve the experience of patients and colleagues alike. First, we have boosted the resources available to those on the frontline. We have put in an extra £150 million of funding to help ambulance trusts deal with ambulance pressures this year. On top of that, we have agreed a £30 million contract with St John Ambulance so that it can provide surge capacity of at least 5,000 hours per month. We are also increasing the numbers of colleagues on the frontline. We have boosted the national 999 call handler numbers to nearly 2,300, which is about 350 more than we had in September last year, and we have plans to increase this number further to 2,500 by December, supported by a major national recruitment campaign. By the end of the year we will have also increased 111 call handler numbers to 4,800. As well as that, we have a plan to train and deploy even more paramedics, and Health Education England has been mandated to train 3,000 paramedic graduates nationally each year, which is double the number of graduates that were accepted in 2016.

Secondly, we are putting an intense focus on the issue of delayed discharge, which, as many Members know, is the cause of so many of the problems we see in urgent and emergency care—I think that is recognised across the House. This is where patients are medically fit to be discharged but remain in hospital, taking up beds that could otherwise be used for those being admitted. Delayed discharge means longer waits in accident and emergency, lengthier ambulance handover times and the risk of patients deteriorating if they remain in hospital beds too long—this is particularly the case for the frail and elderly. The most recent figures, from the end of July, show that the number of these patients is just over 13,000—these are similar numbers to those for the winter months. We have been working closely with trusts where delayed discharge rates are highest, putting in place intensive on-the-ground support.

More broadly, our national discharge taskforce is looking across the whole of health and social care to see where we can put in place best practice and improve patient flow through our hospitals. As part of that work, we have also selected discharge frontrunners, who will be tasked with testing radical solutions to improve hospital discharge. We are looking at which of these proposals we can roll out across the wider system and launch at speed. Of course, this is not just an issue for the NHS. We have an integrated system for health and care and must look at the system in the round, and at all the opportunities that can make a difference. For instance, patients can be delayed as they are waiting for social care to become available, and here too, we have taken additional steps over the summer. We have launched an international recruitment taskforce to boost the care workforce and address issues in capacity. On top of that, we will be focusing the better care fund, which allows integrated care boards and local authorities to pool budgets, to reduce delayed discharge. In addition, we are looking at how we can draw on the huge advances in technology that we have seen during the pandemic and unlock the value of the data that we hold in health and care, including through the federated data platform.

Finally, we know from experience that the winter will be a time of intense pressure for urgent and emergency care. The NHS has set out its plans to add the equivalent of 7,000 additional beds this winter, through a combination of extra physical beds and the virtual wards which played such an important role in our fight against covid-19. Another powerful weapon this winter will be our vaccination programmes. Last winter, we saw the impact that booster programmes can have on hospital admissions, if people come forward when they get the call. This year’s programme gives us another chance to protect the most vulnerable and reduce the demand on the NHS. Our autumn booster programmes for covid-19 and flu are now getting under way, and will be offered to a wider cohort of the population, including those over 50, with the first jabs going in arms this week as care home residents, staff and the housebound become the first to receive their covid-19 jabs.

Over the summer, we became the first country in the world to approve a dual-strain covid-19 vaccine that targets both the original strain of the virus and the omicron variant. This weekend, the MHRA approved another dual-strain vaccine, from Pfizer, and I am pleased to confirm that we will deploy it, along with the Moderna dual-strain vaccine, as part of our covid-19 vaccination programme in line with the advice of the independent experts at the JCVI. Whether it is for covid-19 or flu, I would urge anyone who is eligible to get protected as soon as they are invited by the NHS, not just to protect themselves and those around them, but to ease the pressure on the NHS this winter.

Today I have laid before the House a written ministerial statement on further work that we have been doing over the summer, and I want to draw the House’s attention to one particular feature in that statement which has garnered interest in the House in the past. In November 2021, the Government announced it would make £50 million of funding available for research into motor neurone disease over five years. Following work over the summer between my Department and the Department for Business, Energy and Industrial Strategy, through the National Institute for Health and Care Research and UK Research and Innovation, to support researchers to access funding in a streamlined and coordinated way, we are pleased to confirm that this funding has now been ring-fenced. The Departments welcome the opportunity to support the MND scientific community of researchers as they come together through a network and linked through a virtual institute.

I commend this statement to the House.

[Wes Streeting (Ilford North) (Lab)]

I thank the Secretary of State for advance sight of his statement, and wish him and the ministerial team well as the new Prime Minister appoints her first Government. I also welcome what he said towards the end of his statement about the importance of vaccination and funding for motor neurone disease.

Emergency care is in crisis. After 12 years of Conservative Governments, the NHS can no longer reach patients on time. The outgoing president of the Royal College of Emergency Medicine said earlier in the summer that ambulance delays had got so bad that the NHS was now “breaking its promise” to the public that life-saving emergency care will be there when they need it. Twenty-nine thousand patients waited more than 12 hours in A&E in June, more than ever before. Ten thousand urgent cases waited more than eight hours for an ambulance last month. It is estimated that the collapse of emergency care that we are now seeing could be costing 500 lives a week. If the statistics did not paint a stark enough picture, no one can ignore the case of 87-year-old David Wakeley, whose family had to build a shelter around him as he waited outside for an ambulance, with broken bones, for 15 hours. What a shameful indictment on 12 years of Conservative mismanagement of the NHS.

There have been recent reports that the NHS will tell patients to

“avoid A&E as the winter crisis bites early.”

That was in August. The simple fact is that we have gone from no crisis in the system in 2010, to annual winter crises, to the situation we have today where there is a crisis all year round—the worst crisis in the history of the NHS. There is no point in the Secretary of State blaming the pandemic or, indeed, the extreme heat we saw this summer, although they do not help. The reality is that, before the pandemic, the NHS had not hit the 18-minute response time target for emergency incidents since 2017. Will the Secretary of State, on behalf of the Government and his party, finally take some responsibility and admit what his colleague the Culture Secretary was honest enough to say, that the Conservatives left our health service “wanting and inadequate” when the pandemic hit?

The NHS needs Ministers to grip this crisis and work tirelessly to get patients the care they need, so where have the Government been all summer? It is almost as if, the moment the Conservative leadership candidates hit the road, the Cabinet turned on their “out of office” and hit the beach as the NHS slipped into the worst crisis in its history and the Government did diddly-squat on the cost of living crisis, which will also exacerbate people’s health problems.

I pay tribute to St John’s Ambulance for the vital work it does, and I am pleased it has now been formally commissioned to provide England’s ambulance auxiliary. Can the Secretary of State confirm that this capacity is being used by the system today? Perhaps he might have a word with his colleague the Secretary of State for Education, or his successor, about recruitment, because the shambles we saw on T-levels and the hand-wringing we saw from the exam boards is unacceptable and risks the pipeline of talent we need to staff the NHS.

Although extra capacity is important, let us be honest that it will not solve the ambulance crisis unless we tackle the delayed discharges that are causing logjams in hospitals. The Secretary of State talked about this, but let me be clear that one in seven hospital beds is occupied by someone who is medically fit to leave but cannot do so because there is no support available—some people are waiting up to nine months longer than needed. What is the answer to this staffing crisis? It has not been to pay care workers a decent wage so that we stop losing them to the likes of Amazon, and it has not been to provide a great career so that people in our country enter this important profession. The answer has been to pull the “immigration lever,” to quote the Government, and to recruit people from overseas on lower pay. How fitting that this Prime Minister’s Government ends with yet another broken promise. One year after promising to fix social care by hiking taxes on working people, where is the plan to tackle the work- force crisis without resorting to immigration every time?

Finally, the Secretary of State barely mentioned the cost of living crisis. The Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup), has said the Government are worried that if people cannot afford to heat their home, more will lose their life to flu. Has the Secretary of State made an estimate of the number of people who could fall ill as a result of soaring energy bills? As this is rightly a concern, may I point out that there is a plan right in front of him to freeze energy bills, fully costed and ready to go, paid for by a windfall tax on the oil and gas companies? When will the Government stop dithering, delaying and talking to themselves and start acting for the country? Rising energy prices will also push care providers to breaking point, with some facing closure as they are unable to absorb increases of 500% or more. What plans does he have to prevent care home residents from being booted out this winter and to prevent care home doors from closing?

The reality is that this Government are now out of time. A new Prime Minister will be appointed tomorrow who has suggested charging patients to see a doctor. I did not think anything could be worse than fining people for missing appointments, but our new Prime Minister has somehow managed it. Public satisfaction with NHS services is at its lowest recorded level, and patients are struggling to access the care they need. Under Labour, patients could call 999 knowing that an ambulance would come when they needed it, but the longer we give the Conservatives in power, the longer patients will wait.

[Steve Barclay]

Let me start with the areas where the hon. Gentleman and I agree. The David Wakeley case was shocking, and we accept that there have been severe pressures, particularly linked to certain trusts; just 10% of trusts account for 45% of ambulance handover delays. His second charge was about what the Government have been doing on this over the summer. We have had a 100-day sprint with NHS colleagues, a taskforce has been set up and I have met those troubled trusts, particularly Cornwall, to look at how we better support them.

Some of the factors affecting ambulance delays are within the trusts’ control. Those include understanding why delayed discharge is much lower at the weekend, and things that they can do within the emergency department. However, as the hon. Gentleman recognised, some factors are beyond the trusts’ control, whether that is variance in performance on conveyancing by ambulance trusts, differences in hear and treat or see and treat, or the challenges in social care. We recognise that, as I said in my opening remarks, the heatwave and a covid infection rate of one in 25, compared with one in 60 now, created significant pressure on the ambulance system.

In addition to the taskforce, we have enacted a whole range of other measures. NHS England has tasked the system with putting in place an additional 7,000-bed capacity for the winter. We have been expanding emergency department capacity. One thing we funded in spending review 2020, when I was in the Treasury, was additional funding for trusts where there are emergency department constraints.

The hon. Gentleman did not mention mental health, but I know he takes an interest in it, so he will be pleased to know that over the summer we have particularly targeted action that can be taken in emergency departments and across the hospital estate in support of mental health, led by Claire Murdoch in NHS England. We have increased staffing by 16% and there is an extra £2.3 billion going into mental health next year compared with 2016. There is additional funding and workforce, because we recognise the pressures.

There is also bespoke action with NHS colleagues. Sometimes, relatively low numbers of patients—for example, patients needing palliative care, patients with dementia and patients with Parkinson’s—are particularly challenging in terms of delayed discharge, and their discharge may be delayed for an extended period of time. Although the quantum of patients may be modest, that leads to delay.

The hon. Gentleman recognised other things we have been doing over the summer, such as the St John Ambulance contract that has been put in place to help with auxiliary ambulances, the work on international recruitment—I do not accept that people are being paid less; that is bringing people in to work in important roles in our care sector—and the consultation on retire and return.

Finally, the hon. Gentleman mentioned the cost of living. He will know that the new Prime Minister has made it clear that she will have further things to say on that over the next week, and I know there will be ample opportunity to debate that further in the House.

Women’s Health Strategy for England

Wes Streeting Excerpts

Wednesday 20th July 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

Let me begin by thanking the Secretary of State for advance sight of his statement and adding my thanks to the Minister of State, to his predecessor as Secretary of State, the right hon. Member for Bromsgrove (Sajid Javid), who is sat opposite, and to officials in the Department for the work they have done. I am genuinely glad that this work is out of the door when so much else has been in hiatus because of the wider political change afoot in the Government. I join the Secretary of State in recognising the campaigning efforts of his constituent Kath Sansom, as well as the efforts of my hon. Friend the Member for Swansea East (Carolyn Harris), who has campaigned tirelessly to raise awareness of the menopause and has been a driving force for change on behalf of women everywhere.

For too long, women's health has been an afterthought, and the voices of women have been at best ignored and at worst silenced. Four out of five women who responded to the Government’s survey could remember a time where they did not feel listened to by a healthcare professional, and that has simply got to change. In recent years, we have seen a string of healthcare scandals primarily affecting women: nearly 2,000 reported cases of avoidable harm and death in maternity services at Shrewsbury and Telford; more than 1,000 women operated on unnecessarily by the rogue breast surgeon Ian Paterson; thousands given faulty PIP— Poly Implant Prothèse—breast implants; and many left with traumatic complications after vaginal mesh surgery. Meanwhile, every woman who needs to use the NHS today faces record high waiting times. The NHS is losing midwives faster than it can recruit them. Gynaecology waiting lists have grown faster than those for any other medical specialty. The number of women having cervical screening is falling. And black women are 40% more likely to experience a miscarriage than white women. That is the cost for women of 12 years of Conservatives mismanagement, so I want to address each part of the strategy in turn.

The strategy promises new research, which is of course important. Studies suggest that gender biases in clinical trials are contributing to worse health outcomes for women. There is evidence that the impact of women-specific health conditions such as heavy menstrual bleeding, endometriosis, pregnancy-related issues and the menopause is overlooked. So of course what the Secretary of State has said today about improving data is so important, but will he also set out how exactly the Government intend to make use of this new data to improve outcomes for women?

Improving the education and training of health professionals is essential, because when we do not do that, there are consequences. Almost one in 10 women has to see their GP 10 times before they get proper help and advice about the menopause, and half of medical schools do not teach doctors about the menopause, even though it affects every woman. I challenge the Secretary of State to go further than the proposal he outlined to train incoming medical students and incoming doctors. What plans do the Government have for clinicians who are already practising? We need to upskill the existing workforce, not just the incoming workforce. However, let us be clear: informing clinicians is no good if we do not also improve access to hormone replacement therapy, so where is the action in the strategy to end the postcode lottery for treatment?

Breast cancer is the most common cancer in the UK, and the NHS offers regular breast cancer screening to women aged between 50 and 70. That can prevent avoidable deaths by identifying cancer early, when it is more treatable and survival is more likely. Yet, fewer women in the most deprived areas than in the most affluent areas receive regular breast screening. Even before the pandemic too many women with suspected breast cancer were waiting more than the recommended two weeks to see a specialist. How will the programme announced today make a difference to outcomes for patients if, once diagnosed, they just end up on a waiting list that is far too long and they cannot access the treatment they need?

I welcome what the Secretary of State said about removing barriers to in vitro fertilisation for women in same-sex couples. For far too long they have faced unnecessary obstacles to accessing IVF, for no other reason than that they love another woman. It is high time that we put that right.

I also want to mention endometriosis. Tens of thousands of women provided testimony to the Government about the issues they face with diagnosis and treatment. Will the Secretary of State give the House an assurance that every woman who is treated for this disease will have equal access to specialist services from day one? Will he make sure that they do not have to fight to get the diagnosis in the first place?

On polycystic ovary syndrome, what will the Secretary of State do to make sure that we equalise access to a range of treatments, not least for women for whom the pill is simply inappropriate? We must make sure we end the division between those who receive a prescription on the NHS and those who go private, receiving better treatment.

I also want to raise some points about what has not been mentioned today. In addition to the appalling figures on black maternity deaths, a quarter of black women surveyed by Five X More felt that they received a poor or very poor standard of care during pregnancy, labour and post-natal care. Women who live in deprived areas are more likely to suffer a stillbirth than their richer counterparts. My hon. Friend the Member for Oxford East (Anneliese Dodds), the shadow Secretary of State for Women and Equalities, has pledged a new race equality Act to tackle the structural inequalities in our society, including in healthcare. However, the Government are more interested in stoking culture wars than in acknowledging that these inequalities even exist. Surely that has to change when there is a new leadership of the Conservative party.

In conclusion, the reality that faces women in this country is this: breast cancer waiting times are through the floor, half a million women are waiting for gynaecology treatment, black women are four times more likely to die in pregnancy and childbirth, and too many women still cannot get HRT when they need it. This strategy simply will not solve the depth of the crisis in women’s healthcare after 12 years of Conservative mismanagement. Every day this Conservative Government remain in office is another day when women will have to wait far too long for the care they desperately need.

[Madam Deputy Speaker (Dame Eleanor Laing)]

I call Sajid Javid.

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 19th July 2022 Commons Chamber

[Mr Speaker]

I call shadow Secretary of State, Wes Streeting.

[Wes Streeting (Ilford North) (Lab)]

I welcome the Secretary of State to his first oral questions and, as this is likely to be his last oral questions, also wish him the best for the future. I associate myself with his remarks about his predecessor, who of course resigned from the Government on a point of principle as others chose to remain loyal; on that note, I also pay tribute to the former Minister, the hon. Member for Charnwood (Edward Argar), for the diligent approach he took to his work and the spirit in which he engaged with the Opposition. One of the contenders for the Conservative leadership says that public services are in a state of disrepair. Another describes the NHS backlog as frightening. A third called ambulance waiting times appalling, and of course the Secretary of State for Culture, Media and Sport said that the former Health Secretary’s preparation for a pandemic was “found wanting and inadequate”. They are right, aren’t they?

[Steve Barclay]

The Government are committed to putting increased funding into our NHS. I set out yesterday the position on the resource departmental expenditure limit. Just to remind the House of the capital departmental expenditure limit, capital investment in the spending review was £32.2 billion between this year and 2024-25. The Government are committed to putting record funding into our NHS. We are also committed to funding 40 new hospitals and have allocated £3.7 billion to that programme.

[Wes Streeting]

I cannot believe that the Government are still talking about 40 new hospitals with a straight face. Nobody believes that it is true. As for capital investment, we have the lowest in the OECD and we lag significantly behind.

We have the longest waiting lists in NHS history and record waits for ambulances. People are finding it impossible to book a GP appointment. There are 400,000 delayed discharges each month because the social care support is not there. The Government are finally acknowledging that covid is still a challenge, and that the hot weather is a challenge, but they do not want to talk about their record, which is, I am afraid, at the heart of the challenge. Does the Secretary of State really believe that it is reasonable to expect NHS employers to meet the pay rise for NHS staff from existing budgets?

[Steve Barclay]

We will respond shortly to the independent pay review body, which, as part of its recommendations, weighs up the pressures on the cost of living and the other factors within its remit. The Government are delivering more doctors, more nurses, more appointments and more treatments, investing in our estate and planning for the future. That includes investment in research and development, and in future technology through our life sciences. That not only delivered the vaccine that allowed us to lift the covid restrictions that the Opposition wanted to retain, but will unlock the technologies of the future.

Ambulance Services and National Heatwave Emergency

Wes Streeting Excerpts

Wednesday 13th July 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the new Secretary of State for Health and Social Care if he will make a statement on ambulance services and the declaration of a national heatwave emergency.

[The Minister of State, Department for Health and Social Care (Maria Caulfield)]

Our ambulance service performs heroics every single day, and I put on the record my thanks to every single one of its staff for their dedication and hard work. We have a duty to support this vital service and give it the resources it needs.

The latest figures from the NHS in England show that ambulance service response time performance has improved month on month, and that ambulance hours lost are also improving month on month. However, we fully acknowledge the rising pressures facing the service, and there are three significant factors influencing the situation. First, bed occupancy is currently around 93%, which we would normally see during winter. Secondly, there are high rates of hospital covid admissions—whether “with covid” or “because of covid”—and that puts pressure on A&Es’ ability to admit patients. Thirdly, void beds are running at roughly 1,200, partly due to a 16% increase in the length of stays. Delayed discharges are another significant influence, but they remain flat. We also have record numbers of calls to the ambulance service—100,000 more compared with May last year. There is therefore significant pressure on the system.

We also have to be mindful of the weather in the coming days. We do have a heatwave plan for England, which was published earlier this year—I am sure the hon. Gentleman has read it—and we also have the hot weather plans that NHS trusts have put in place. In addition, we are providing sector-specific guidance setting out the best way to protect people who may be at risk. We are also supporting the service more widely to make sure it has the resilience it needs. We have allocated £150 million of extra funding for the ambulance service this year, and we are boosting the workforce too. The number of national 999 call handlers had risen to nearly 2,300 at the start of June, which is a considerable increase on the previous September, and we are on track to train 3,000 paramedic graduates a year nationally every year until 2024. On top of this, we have invested £50 million in NHS 111 to help give extra capacity to the service.

I will be meeting all 11 ambulance trusts over the coming days to make sure that they have the capacity and the resilience they need not just to deal with the pressures now, including with the warm weather, but to prepare for the forthcoming winter pressures that we know are inevitable. This is an important issue that I take extremely seriously, and I will keep the House updated as the situation develops.

[Wes Streeting]

Thank you, Mr Speaker, for granting this urgent question, but what a disgrace that the Secretary of State is not here. Our NHS is going through the biggest crisis in its history, every ambulance service is on the highest level of alert, patients are forced to wait hours in pain and discomfort, and he is yet to say a word about any of it. The Home Secretary was not at the Home Affairs Committee this morning, and the Health and Social Care Secretary is not here this afternoon. This is not even a Government in office, let alone in power.

One person who is still in office, however, is the Minister. Her boss resigned saying he could not put loyalty above integrity any longer. Well, the Minister obviously made a different choice. Can she say whether any further meetings of Cobra are scheduled beyond the meeting held on Monday? As we saw during the pandemic, public health emergencies require clear communication from Government. Can she tell the House what the consequences of a national heatwave emergency would be for schools, public transport services and other public services, and what guidance will be provided to the general public? What assessment has she made of the suitability of care homes to protect residents from the extreme heat, and what contingencies are in place should further measures be necessary?

Every ambulance service is now on the highest level of alert, so what is the Secretary of State doing about it? The Minister talks about targeted help for ambulance services—she is going to be hitting the phones this week; presumably the Secretary of State is too busy—but, as I think she acknowledged, this is a crisis across the health service. Last month, a crew in the west midlands waited 26 hours outside A&E because clinical staff were not available to hand over to. What are the Government doing to provide additional support to A&Es during this heatwave? These pressures are not new. Average waiting times for stroke and heart attack victims are one hour. Patients in the north-east were told to phone a friend or call a cab rather than rely on emergency services. Is it not the case that, although extreme weather is of course putting further pressure on our emergency services, it is 12 years of Conservative underfunding that has left them unable to cope?

In conclusion, if people such as the Home Secretary and the Health Secretary cannot be bothered to turn up to do their jobs and are not interested in the business of running this country because they are too busy making endorsements for fantasy candidates with far-fetched promises, perhaps it is time they step aside so that Labour can give Britain the fresh start it needs.

[Maria Caulfield]

Can I say how disappointed I am at the shadow Secretary of State’s response? If he is not happy that a female Minister with over 20 years’ experience in the NHS is able to answer a question on NHS waiting times, I find that very disappointing.

As I said in the debate a few weeks ago, I do not want to bring politics into health because I think it is too important, but if the shadow Secretary of State wants to play politics, I will give him politics. If we look at Wales, where Labour runs the NHS service, we see that the ambulance service and A&E departments are facing exactly the same pressures. Only 51% of red calls in Wales are being seen in eight minutes; the target is 65%. If he looks at the call time for strokes, he will see that only 17% of those people are being seen in time. Those numbers are falling month on month, whereas in England our responses are improving month on month. On the four-hour wait in A&E in Wales, 34.9% of people have been seen within four hours.

--- Later in debate ---

[Wes Streeting]

indicated dissent.

[Maria Caulfield]

The hon. Gentleman shakes his head, but he stood at the Dispatch Box just now and said that Labour would do better. It is not doing better in Labour-run Wales; it actually has either similar response times or worse response times.

I have set out a plan. It is clear that the hon. Gentleman has not read the heatwave plan for England, which was published earlier this year, because he would have the answers there. We are making sure that all NHS trusts are prepared. I am happy to work with each and every Member across this House to make sure that the ambulance service, our A&Es and hospital trusts have the support that they need, but if all he wants to do is play politics, I think that is extremely sad.

Access to GP Services and NHS Dentistry

Wes Streeting Excerpts

Tuesday 21st June 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I beg to move,

That this House notes that primary care is in crisis, with people across the country struggling to access GP services and dental treatment; believes that everyone should be able to get an appointment to see a doctor when they need to and has the right to receive dental treatment when they need it; is concerned by the Government’s failure to remain on track to deliver 6,000 additional GPs by 2024-25; and therefore calls on the Secretary of State for Health and Social Care to urgently bring forward a plan to fix the crisis in primary care, meet the Government’s GP target and ensure everyone who needs an NHS dentist can access one.

Mr Speaker, thank you for the opportunity to open this debate on the future of primary care, access to GPs and access to dentists. It is a particular delight to see the Secretary of State here. I so enjoyed our exchange of letters last week that I cannot wait to repeat the exchange in real life.

Primary care is the front door to our NHS—for most of us, the general practitioner is the first port of call when we are worried about our health—but after 12 years of Conservative mismanagement and underfunding of our health service, the front door is jammed. Patients are finding it impossible to book GP appointments, serious conditions are going undiagnosed, patients are waiting longer than is safe for treatment, with backlogs building up and greater pressure placed on the rest of the health service, and millions of people are waiting more than a month to be seen, often in pain and discomfort.

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

My hon. Friend has made an excellent beginning to his speech. What is his view of my local hospital, where, instead of 350 people daily, we have 710 people coming into accident and emergency at the North Middlesex Hospital? What response does he have to that kind of demand? Where is it going to lead if people cannot see a GP? They are going to end up in A&E.

[Wes Streeting]

My hon. Friend is absolutely right to highlight that problem. If the front door of the NHS in primary care is jammed, people end up presenting in A&E. As I shall outline in my speech, this is not only a great inconvenience and burden to patients; it comes at an additional cost to the NHS and we all pay the price for that in every respect.

[Alex Cunningham (Stockton North) (Lab)]

At the GP practice in Norton in my constituency, it is almost impossible to get an appointment on the phone. I have dozens of cases of individuals unable to access vital care. One tried 196 times. The Care Quality Commission has not inspected this practice since 2015. Does my hon. Friend agree that it ought to be doing so now?

--- Later in debate ---

[Wes Streeting]

Even in the context of the pressures that we see right across primary care—I think every GP practice would acknowledge they face challenges—the case my hon. Friend has just described sounds extreme. We cannot allow the decade or more of mismanagement we have seen from this Government to excuse that kind of care, or indeed absence of care, for patients, and that brings me on to the next point I want to make.

We know why patients are forced to wait: Conservative Governments have cut 4,500 GPs over the last decade, they have closed 300 practices since the last election and they have failed to provide any meaningful reform of the system. The public are sick and tired of waiting. Public satisfaction with GP services stands at the lowest level on record as patients become ever more frustrated with not getting an appointment when they need one, or in a manner to suit them.

It says so much about the NHS at the moment that, while we have the lowest level of patient satisfaction since 1997, when we ask the public whom they trust, nurses and doctors are right up at the top of the list. The public understand that the staff who work in the NHS are trying to grapple with the biggest crisis in its history. Of course, the Government will want to pin that simply on the pandemic, but that does not explain why we went into the pandemic with NHS waiting lists already at record levels, with 100,000 staff vacancies in the NHS and with a decade or more of under-investment, leaving us ill-prepared for the pandemic—or, in the words of the Culture Secretary, “found wanting and inadequate”—but also now struggling to get the recovery from the pandemic that we need to build the health and care service we need for the future.

[John Redwood (Wokingham) (Con)]

The shadow Secretary of State says that we need GP reform. What kind of reform does he have in mind? What does he think should be the right balance between in-person, online and telephone consultations?

[Wes Streeting]

I am grateful to the right hon. Gentleman for that intervention. I will conclude my speech by talking about what a Labour Government will do, but let me answer his direct point about the range of options through which people should be able to access their GP. I value patient choice. Thinking back to my experience of accessing NHS services last year—as many people know, I did quite a lot of mystery shopping on the NHS—I had a range of interactions with GPs. Some were face-to-face. Some interactions at my GP surgery were not with my GP but with a nurse, which was entirely appropriate and much appreciated. Some of my engagements with my GP were over the telephone. I also had a video consultation with a dermatologist. I really valued that flexibility and range of approaches.

I think that the future for primary care has to be different courses for different horses. Of course, people should have a right to see their GP when they want to see their GP—I am clear about that—but there is also a range of ways in which we can offer more flexible access to GPs, particularly for working people who do not necessarily want to traipse down to the GP surgery in the middle of the afternoon if it is something that could be dealt with over the phone or on a video call.

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

The shadow Secretary of State is making a powerful speech. I commend in particular the point he made that people still trust their doctors. They are desperate to see them, even if it is online. A 74-year-old constituent of mine contacted me and said that he asked for an online appointment but it would take him 30 days to get there. He appreciates that the issue is not with GPs but with the Government’s lack of planning for the number of GPs who can provide that service in Oxfordshire.

[Wes Streeting]

The hon. Lady makes a powerful point. How is it that the NHS can be one of the largest employers in the world—it employs 1.2 million people—but does not have a workforce plan and strategy that says, “This is the workforce need that we have today, this is what the workforce need will be in the foreseeable future and, in the longer term, this is how we need to change the shape of the workforce to take into account advances in medicine and modern technology, and the changing demographics of our society”?

We gave the Government the opportunity to commission such a report when we debated the Health and Care Bill. It was supported on a cross-party basis, including by the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—sadly, he is not able to be with us at the moment—yet the Government voted against it. What is it about the ostrich mentality of the Secretary of State and his ministerial team—or, I suspect even more, that of the Treasury—that they would rather bury their heads in the sand, pretend there is no problem with workforce and not even count the numbers of doctors and nurses needed because they worry that the Treasury might face up to the reality of what they need to provide?

[Alison McGovern (Wirral South) (Lab)]

Is it not the case that, in the pandemic, the Government fundamentally misunderstood the connection between the health of the nation and its economic success? All the argument the shadow Secretary of State makes about the NHS workforce and what they can achieve for our country shows that the Government are still making the very same mistake.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend, who understands well the link between the health of the nation and the health of the economy. Given the labour market challenges in this country, it is simply not acceptable that we are losing so many people who could be in the labour market to ill health. We are also losing so many people from the labour market who are caring for relatives, because there is a disproportionate burden on families. Who disproportionately bears the burden of that care? It tends to be women, so we are losing a whole tranche of women from the labour market who could be contributing to the growth of the nation and the economy.

[Several hon. Members rose—]

[Wes Streeting]

I will give way one more time and then I need to make some progress.

[Jim Shannon (Strangford) (DUP)]

It is not just about GPs and surgeries; it is about dental access as well. In my constituency and across the whole of the United Kingdom of Great Britain and Northern Ireland, dentists are prepared to take private care and monthly care, but they will not take NHS patients. As poverty levels and prices rise, dentistry is at the end of the queue. Does the hon. Gentleman agree that dentistry is at crisis point and that Government intervention is absolutely critical?

[Wes Streeting]

The hon. Gentleman is right to describe the state of dentistry and I will be getting my teeth into that issue very shortly.

[Hon. Members: “Groan!”] It had to happen at some point. I had to get it in at some point. Let me touch on the other issue he mentions, which is about inequality and inequality of access.

The system in primary care is entirely unequal. Some areas have twice as many doctors as other parts of the country, with as many as 2,800 patients fighting over one family doctor. Patient safety is being put at risk. Last week, the BBC revealed the scale of the crisis in GP surgeries with its investigation into Operose Health. Patients who can get an appointment are seen by less qualified staff, standing in for GPs without supervision. Patient referrals and test results were left unread for up to six months: private profit placed above patient safety. When the Health Secretary was asked about that last week, he said:

“we expect local commissioners to take action.”—[Official Report, 14 June 2022; Vol. 716, c. 140.]

Well, it is not good enough to sit back and wait for others to act. Is an investigation happening? Can he tell us? If not, why on earth has he not launched one? [Interruption.] The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes (Maria Caulfield), from a sedentary position, talks about the last Labour Government. When are the Conservatives going to wake up to the fact that they have been in government for 12 years? Twelve years! It is remarkable. Twelve years they have been in government.

[Felicity Buchan (Kensington) (Con)]

rose—

[Wes Streeting]

Perhaps the hon. Lady could tell us why they want to run away from their record of 12 years.

[Felicity Buchan]

I thank the hon. Gentleman for giving way. He makes grand statements in support of the NHS, but I am afraid his actions do not support the NHS. He has backed these train and tube strikes today, which have meant that in my constituency patients cannot get to hospital, and nurses and doctors cannot get to their places of work. Can we have better action, rather than words?

[Wes Streeting]

I am very, very grateful to the hon. Lady for that intervention. Our party has been clear: we did not want to see the strikes go ahead. We believe the strikes could have been averted if the Government had shown responsible action. The absolute brass neck of the Secretary of State! It is one thing pretending they have not been in government for the last 12 years; now they are pretending they are not in government today and that, somehow, it is down to me, the shadow Health Secretary. Somehow, if I had uttered the magic words, “Don’t go ahead,” the RMT would have said, “Oh no, the shadow Secretary of State for Health has spoken now. We better put a stop to it.” [Interruption.]

[Mr Speaker]

Order. I want to help a little bit. We do not want to open up a debate that is not down for today. We have got a little bit carried away. The hon. Member for Kensington (Felicity Buchan) got in, and I was quite right to allow a response, but I think we have heard enough now.

[Wes Streeting]

Thank you, Mr Speaker.

I was about to quote the great political philosopher, Jonn Elledge, who, in response to what the Secretary of State said, commented on Twitter that we are

“all as ants before the might of the all powerful shadow health secretary”.

When is the Health Secretary going to wake up to the fact that he is in government, he has responsibilities, he is discharging the greatest crisis in the history of the NHS and he is doing nothing about it? Instead of lecturing the Opposition, when is he going to show some leadership and get on with governing?

[Clive Efford (Eltham) (Lab)]

The “Panorama” programme also exposed the fact that GP practices are being hoovered up by the private sector. Operose Health now owns 70 practices, with more than 600,000 patients. That exposes the fact that there is now a value to GP patients lists and that they are being sold on. They are collected by GPs, free of charge and then, as they are amassed in great number, they are sold to the private sector. Is my hon. Friend, like me, concerned about that practice?

[Wes Streeting]

I wholeheartedly agree with the point my hon. Friend makes. It is simply not good enough for the Minister to keep on talking about what the last Labour Government did. If she does not agree with the situation described by my hon. Friend, which is happening on her watch, why does she not legislate? If she is incapable of governing, she should make way for people who can govern.

[Catherine McKinnell (Newcastle upon Tyne North) (Lab)]

I commend my hon. Friend for the tone of the speech that he is making, because it is vital that we stand up for our NHS, which the Government are failing to do. They seem happy to let everybody be angry with their GPs and about their inability to seek the medical help they need, but very unwilling to do something about it. Is this argument not really one to be had with the Government entirely? They should be making sure that we have sufficient GPs to treat the people in this country.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend; it is the trend with this Government to seek division, sow division, pass the buck, devolve the blame and not take responsibility for anything. What Opposition Members would not give for just one day of being able to govern in the interests of the people in this country! This Government want to give the appearance of being in office but not governing at all. That is what is happening on their watch. If that is not bad enough, against a difficult economic backdrop, with scarce resources, not only is the way in which they manage and govern bad for patients, but it is squandering taxpayers’ money.

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

rose—

[Wes Streeting]

I will give way in just a moment. The problems in general practice are storing up problems for the rest of the NHS; as we have heard, people are presenting in accident and emergency because they cannot see a GP. That failure is costing the taxpayer dearly. A GP appointment costs the NHS £39, but a visit to an urgent care centre costs it £77 and a visit to the emergency department costs it £359. The Government’s failure to invest in new GPs may be penny-wise but it is pound-foolish. It is wasting money and inconveniencing patients, and it is not the way to manage the NHS. One of my constituents wrote to me yesterday to say that if she wants a same-day appointment for her baby, her GP sends her to A&E. She wrote:

“I was sent to A&E to check a newborn baby’s suspected ingrown toenail that had no sign of infection. How is going to A&E for a non-urgent matter a good thing for anyone.”

Yet that is what our constituents are forced to do, because they cannot get a GP appointment. I hope the hon. Member for Sleaford and North Hykeham can give us some insight as to why.

[Dr Johnson]

As part of that, I suggest that the hon. Gentleman remembers that GPs take 10 years to train. He is right to say that we have been in government for 12 years, but most of the current GP shortage is because the previous Labour Government did not train those GPs at the time. One of the first things the Conservative Government did was to set in train the opening of five medical schools to increase the number of medical students. We had enough doctors but they do take 10 years to train. The reason I stood up to intervene on the hon. Gentleman was to say that one of the challenges that doctors—I refer to my entry in the Register of Members’ Financial Interests, as a doctor—and members of staff face is being abused in a surgery. I wonder whether he would like to apologise for some of the comments he has made on social media—

[Mr Speaker]

Order. Interventions are meant to be questions. I know that the hon. Member is down to speak. I would not want you to use up your speech now; I want you to save something for later.

[Wes Streeting]

Let me first say in response to the final point the hon. Lady made that there is absolutely no excuse for abusing NHS staff whatsoever. Most people in this country do not blame NHS staff for the state of the NHS; they place the blame squarely where it belongs, with the Government who have been in power for the past 12 years. Her first point would be more powerful if we did not have 1,500 fewer full-time equivalent GPs now than we did when her party came to power. Her point would have been more powerful if her party had not whipped its MPs to vote against having a workforce plan for the NHS, but I am afraid that that is what it did. Conservative Members cannot run way from their choices and decisions, and from the fact that they have now been in government for 12 years and there is no one else to blame but themselves. In communities right across the country, we now see the consequences of their mismanagement.

[Jonathan Edwards (Carmarthen East and Dinefwr) (Ind)]

I regret to inform the hon. Gentleman that the situation in Wales is not much better, but I do not want to make a party political point. Will he commend the potential role that pharmacists can play in alleviating pressure on GPs? I have an excellent pharmacist in my home village of Pen-y-Groes, which provides an invaluable service for the communities in my area.

[Wes Streeting]

I wholeheartedly agree with the hon. Gentleman’s point about the importance of looking at primary care as a whole and the really powerful and valuable contribution that community pharmacies can make, alleviating pressures on other parts of the primary care system, particularly general practice.

Communities across the country are experiencing those problems; let me take one place at random to illustrate the scale of the challenge. Today, after a decade of Conservative mismanagement, the city of Wakefield has 16 fewer GPs than in 2013. In fact, Wakefield has not seen a single additional GP since the Prime Minister promised 6,000 more at the last election, and since Wakefield has been served by a Conservative MP—albeit, thankfully, no longer—it has seen three GP practices close, with some surgeries so short-staffed that 2,600 patients are left to fight over one family doctor. Last month, patients in Wakefield were able to book 25,000 fewer GP appointments than in November 2019, the last month in which they were served by a Labour MP. The only good news for general practice in Wakefield in recent years has been that Simon Lightwood, an NHS worker and brilliant candidate in Thursday’s by-election, has successfully campaigned to save the King Street walk-in centre. [Interruption.] They don’t like it. Conservative Members shout in protest and point the finger at us, but they have been in government for 12 years.

[Richard Fuller (North East Bedfordshire) (Con)]

The hon. Gentleman is talking about problems, but his motion does not include one solution. He has now been speaking for 20 minutes, and he has not outlined one solution. If he wishes to be taken seriously as a politician, will he now turn to some solutions to the problems he has outlined?

[Wes Streeting]

It is certainly true that I am saving the best until last in my speech, but the hon. Gentleman may have missed the point I have made repeatedly, which is that the NHS—an organisation that employs more than 1.2 million people—needs a workforce strategy. It needs a proper analysis of what its workforce needs are today, the workforce needs of tomorrow, and the future shape of the workforce. We gave Government Members the opportunity to vote for that; the hon. Gentleman voted against it, and he wants to lecture me about being taken seriously as a politician. Who is he trying to kid? I do not know how the hon. Gentleman voted, because it was a secret ballot, but the fact that a majority of Government Members voted to keep the current Prime Minister in office means that they are not in any position at all to lecture anyone else on who is and is not a serious politician.

[Andrew Selous (South West Bedfordshire) (Con)]

I am very grateful to the shadow Secretary of State for giving way. I have in front of me figures from the House of Commons Library on the increase in GPs per 100,000 population between September 2015 and April 2022, which show an 8% increase for Wakefield.

--- Later in debate ---

[Wes Streeting]

I notice that the hon. Gentleman has played the old trick of selecting figures from a specific set of years, but nothing he has said contradicts the facts that I have outlined. In any case, the people of Wakefield will draw their own conclusions on Thursday when they go to vote. The fact is that the Government have had more than enough time to reform general practice in this country, and they have no one other than themselves to blame for the crisis we are in.

Since the Conservative party has been in government for the past 12 years, I thought I would take a trip down memory lane to remind us, the House and the British people exactly what they have been promising since they were first elected in 2010. The 2010 Conservative party manifesto promised that GP surgeries would be open 12 hours a day, seven days a week. The Government failed to deliver that—maybe they blame their coalition partners, although I do not think the Liberal Democrats would have disagreed with GP surgeries being open for that long—so they promised the same again in 2015. That time, they set themselves a deadline of 2020, and guess what? They missed that, too.

In 2015, they promised that everyone over the age of 75 would get a same-day appointment—another promise broken. They said they would hire 5,000 more GPs by 2020—another promise broken. In 2019, they promised 6,000 more GPs, but the Health Secretary has already admitted that he is on course to break that promise, too. They promised 50 million more GP appointments a year, but as the British people know from their experience, appointments are down. That is today’s Conservative party: over-promise and under-deliver, never take responsibility, and leave patients paying the price.

[Lilian Greenwood (Nottingham South) (Lab)]

This morning, one of my constituents contacted me to say she was standing outside her GP practice at 7.15 am in order to secure an appointment. She said that she was successful in securing an appointment, but a number of people who were also standing outside did not. Does my hon. Friend remember the Health Secretary promising that people would have to do that in order to secure a GP appointment?

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. This is the problem: they overpromise and underdeliver. If they will not hear it from me, Mr Speaker, let us remind ourselves of what some of the Secretary of State’s colleagues have said. The hon. Member for South West Bedfordshire (Andrew Selous), who is in the Chamber, said in Prime Minister’s questions only last week:

“At one of my surgeries, which has double the recommended number of patients per GP, the bowel cancer diagnosis of a 51-year-old father of four was missed and is now terminal.”—[Official Report, 15 June 2022; Vol. 716, c. 283-4.]

Earlier this month, the hon. Member for Telford (Lucy Allan) read a letter from a constituent to the Health Secretary. It said:

“Trying to get basic healthcare is a joke in Telford. Maybe I would be better off in…a third-world country”.

If the Secretary of State is not going to listen to us, he should at least listen to his own side. Before Conservative Members leap to the defence of their Government’s record, they should probably go back and check the record to make sure that they had not agreed with us in the first place.

As for dentistry, 2,000 dentists quit the NHS last year, around 10% of all dentists employed in England. It is an exodus under the Government’s watch. Four million people cannot access NHS dental care and cannot afford to go private either.

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

My hon. Friend is making an excellent speech. My constituent, Ellie Cokeley, wrote to me. She works as a receptionist in a local dental practice and gets hundreds of calls a week from upset members of the public who are unable to find an NHS dentist. She said that it feels greatly unjust that the poorest in our society are being forced to pay huge amounts for vital dental care or, worse still, having to continue without any at all. Are the Government not failing people in this country when it comes to the care of their teeth? It is vital that we get more dentists in the system.

[Wes Streeting]

My hon. Friend is absolutely right. Some places, such as Somerset, are dentistry deserts because the remaining NHS dentists are not taking on new patients.

[Several hon. Members rose—]

[Wes Streeting]

I will give way first to my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), then to my hon. Friend the Member for Hackney South and Shoreditch (Dame Meg Hillier) and then to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone).

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

My hon. Friend mentioned Somerset, but can I also mention Sunderland, to keep up the alliteration? In Sunderland, we cannot find an NHS dentist and the few good ones we have are now turning to private practice to make it work. It is an existential crisis in dentistry—it really is at breaking point. Does my hon. Friend agree that the blame lies squarely with the Conservative Government, with backlog Britain, and that this is the effect on our constituents?

[Wes Streeting]

My hon. Friend is absolutely right about the state of dentistry. It is not alliterative, but I suspect that my hon. Friend the Member for Hackney South and Shoreditch has similar points to make.

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

A constituent of mine told me that she had a terrible toothache, rang 111 and was assigned to an emergency dentist. The system worked, but does my hon. Friend agree that that that costs the taxpayer so much more money? My hon. Friend talks about overpromising and underdelivering, but with dentistry the Government have not even promised anything and they are underdelivering.

[Wes Streeting]

My hon. Friend knows exactly what she is talking about. Of course, there is no one better in this House to make the point about the waste of public money. That is the outrageous thing about all of this. People are paying more and getting less. Their taxes have been put up, justified in the name of the NHS, but the money is not being directed in the right way to deliver better care. In fact, the Government admit that even with the investment they are putting in, people will be waiting longer for care and that is a disgrace.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I thank the shadow Secretary of State for giving way. He is very civil. Can I also go down memory lane? We have had a Government of a rather different colour in Scotland since 2007, and today I have constituents coming to me and saying, “I cannot get on an NHS dentist’s list”. That echoes the point made by the hon. Member for Strangford (Jim Shannon). Does the shadow Secretary of State agree that in the event of the present Government sorting this situation out, they would do well to share what they did with the Scottish Government? And in the event of a change of Government after the next general election, will the shadow Secretary of State commit to giving advice to the Scottish Government?

[Wes Streeting]

This is the thing that the First Minister of Scotland does not want to acknowledge, but for all her noise, bluff and bluster she knows full well that a Labour Government here in Westminster would be good for the people of Scotland. The investment and reform that we would put into the NHS to deliver the same kind of results as the previous Labour Government did would be good for the people of Scotland. I look forward to the day when I can phone the Scottish Government to give them some advice and I look forward to the day when the Governments in Westminster and Edinburgh are Labour Governments delivering for people across the United Kingdom.

The hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) mentioned the trip down memory lane. The Under-Secretary of State for Health and Social Care, the hon. Member for Lewes, regularly blames Labour for what is happening in dentistry. That is because of something that happened 16 years ago: it was a contract that was put in place by the last Labour Government, which we committed to reform in our 2010 manifesto. Unfortunately, that manifesto was never implemented. The tragedy is that the Conservative manifesto that promised reform of the dentistry contract was not implemented either.

In 2010, the Conservatives promised to introduce a new dentistry contract. In 2017, they also promised to introduce a new dentistry contract. What is the Minister’s policy today? She promises to introduce a new dentistry contract. She must make up her mind: either, the current contract is so good that every time she tries to change it, she cannot find a way of improving it, or, the Minister’s Department, her Secretary of State and her Government are so incompetent, so distracted, or so indifferent, that they simply cannot get the job done. It is no good their blaming the Labour party for the problems in NHS dentistry. They have been asleep at the wheel for 12 years. They have failed to do anything to improve the service, and now 4 million people cannot access a dentist. The consequences are severe.

Let me tell the Health Secretary about a constituent of my right hon. Friend the Member for Normanton, Pontefract and Castleford (Yvette Cooper). She tells me that this constituent cannot get a dentist appointment anywhere for an unbearable toothache, and that they are in too much pain to sleep through the night. When they contacted a dentist, they were told that they would have to wait two years for an appointment. They wrote in an email:

“I am in such agony that I took Ibuprofen, drank whisky and tried to pull it out myself with plyers, but they kept slipping off and it was agony.”

What kind of country have we become when the most common reason for children to go to hospital is to have their teeth extracted? We have 78 children going to hospital every day to have their teeth extracted. [Interruption.] There is no point Members arguing from a sedentary position that it is because of fizzy drinks. That is their approach all the time. The system is broken, so let us blame the patients. It is absolutely outrageous. DIY dentistry in one of the richest countries on the planet, and their answer is to blame the patients. They should get real. This is so far from that original promise of the NHS, where care is provided to all who need it, when they need it.

To be fair to the Health Secretary, he has been in the role for just under a year, and, on that note, I would like to wish him a happy anniversary this Sunday for one year in the job. But I am afraid that that is where the niceties end, because I will now run through what he has said and done in his year in charge. He had a big media splash on “league tables for practices” to pressure them into doing more face-to-face appointments and then he backed down. He achieved great headlines on “nationalising GPs” in January—imagine the excitement—but there has been no action since. He talks about bringing the NHS into the Netflix age. Has he ever actually used the NHS app? I cannot even book a GP appointment through the app because my GP is not on it. Why is it still not available to every patient as a way to book appointments? I visited Israel recently—I refer to my entry in the Register of Members’ Financial Interests—where it has embraced the technological advances in medicine over recent years to massively improve access to healthcare for patients.

I was talking to a start-up, which is developing an app that tracks the recovery of stroke victims, and notifies them when they need to see a physio. I then showed the staff what the NHS app can do and what it cannot do and they laughed. In some senses, the Health Secretary had a point: the NHS is not as modernised as it needs to be to deliver for patients, and nowhere is that more true than in primary care. It is an analogue service in a digital age. Patients should not have to wake up at 8 in the morning and wait on the phone for an hour for an appointment. They should not be told to expect a call back, but given no indication as to what time that will be, and then be considered a missed appointment if they do not pick up because they are at work, or are busy, or are picking up the kids and doing everything else that people do between nine and five.

People have never been so well-informed about their own health. We carry around with us devices that can measure our exercise, our heart rate, how well we sleep, and so much more. Yet our healthcare system puts none of this to use and keeps all the pressure on GPs.

Let me conclude by outlining some of what a Labour Government would do to address this crisis—[Interruption.] I am not surprised that Conservative Members are excited; they must be as fed up as we are. First, we would take immediate practical steps to boost the number of GPs available. Why have the Government sat idly by while doctors are forced to retire early, for no other reason than that the cap on their pension contributions means they pay a financial penalty for staying on? Let us change the rules to keep the good doctors we have. Why is it that, at the last count, 800 medicine graduates had not been able to find junior doctor posts? Let us get them to work immediately—

[The Secretary of State for Health and Social Care (Sajid Javid)]

That is rubbish!

[Wes Streeting]

It is rubbish, but it is his record.

Why is it that so many people are accessing NHS services because of a failure to invest in social care, where staff can be recruited and deployed a lot faster? On the dentistry contract, the last Labour Government acknowledged that the 2006 contract was not good enough, which is why we put the reform of that contract in our 2010 manifesto. The difference is that we will not wait 12 years to deliver the promise after the election of the next Labour Government. Those are just some of the practical steps that we would take immediately and that the Government could take immediately.

Let me tell the House about some of the fundamental issues we would fix. First, mental health services in this country are in such a state that GPs are seeing more and more of their own cases present with mental ill-health. A Labour Government would recognise that there has been a surge in mental ill-health following the pandemic and we would not leave it to overwhelmed GPs to see them. That is why we have committed to recruiting 8,500 new mental health professionals, including specialist support in every school and mental health hubs in every community. We would pay for that by ending the charitable status of private schools and closing the tax loopholes enjoyed by private equity fund managers—and do not tell me the Health Secretary does not know where they are; he was using them before he became a Member of Parliament.

That policy—[Interruption.] Conservative Members are funny. They ask for our policies but they do not like it when we provide the answers, because we have them and they do not. That policy, which would put mental health hubs in every community and support in every school and speed up access to treatment for everyone in our country, would help to reduce pressure on GPs and to deliver better mental health treatment in every community and faster access to a GP for everyone else who needs to see them. It also tells you something about the choices we would make and the priorities we would have as a Labour Government: better public services enjoyed by the many, paid for by closing tax perks for the few.

I know that there is lots of cynicism about politics. We have a Prime Minister who wants people to believe that we are all the same, that things cannot change and that his shambles of a Government are the best that Britain can do. All I would say to the people of Britain is this: judge them on their record and judge Labour on ours. They have been in power now for 12 years. They delivered the highest NHS waiting lists in history, before the pandemic. They delivered record staffing shortages in the NHS with 100,000 vacancies, before the pandemic. They delivered cancer care that worsened in every year since they came to office, before the pandemic. Now they tell us that patients will be paying more and waiting longer.

The last Labour Government were in power for 13 years, and we delivered the highest patient satisfaction in the history of the NHS, the lowest waiting times on record and more doctors, nurses and new hospitals. There were no threats of strikes in the NHS when we were in government because staff could see the difference we were making and so could the patients. We did not get everything right—nobody is perfect—but Labour’s record on the NHS is one that this Government could not even begin to touch. The longer we give the Conservatives in power, the longer patients will wait. Well, people are sick, and they are tired of waiting. This Government’s time is up.

--- Later in debate ---

[Sajid Javid]

As I said—I am glad that the hon. Gentleman was listening—there have been record levels of funding in the NHS, and, as we set out in our spending plans, that will continue. But that is no thanks to the hon. Member for Ilford North and his colleagues, who all voted against that record funding. They wanted to deny those resources to their constituents. He should reflect on the impact of that had their wish gone through the House.

On the changes that we are making, we are going further, from improving telephone services to letting others such as nurses and pharmacists complete fit notes. Appointment numbers are already exceeding pre-pandemic levels—for example, in April, GPs and their teams were delivering 1.26 million appointments per working day. That is a phenomenal achievement, which the hon. Gentleman should be commending, not castigating.

The hon. Gentleman raised Wakefield and primary care. He was using dodgy numbers, so he was corrected by my hon. Friend the Member for South West Bedfordshire. He also gave out further dodgy information by somehow claiming that the King Street walk-in centre was under threat. I do not know if you have seen this in the by-elections, Mr Deputy Speaker, but the Labour party has a history of just making things up and creating fake news to scare local people. That is the respect that they show for local people. The walk-in centre has never been under threat. The local clinical commissioning group has confirmed that it has never been under threat. If he had any decency, he would stand up and withdraw his remarks. I give him that chance.

[Wes Streeting]

I would have thought that the Secretary of State would have learned by now that it is silly to give way to me when he makes these facile points. It is absolutely the case that the walk-in centre’s future was in jeopardy. It is absolutely the case that Simon Lightwood campaigned to save it. If that is what Simon Lightwood can achieve as a candidate, imagine what he will do as Wakefield’s next Labour MP.

--- Later in debate ---

[Maria Caulfield]

I am not frit, but I am conscious that another debate follows this one. I did not want to play politics, but if Opposition Members want to, I will give them politics.

The Labour party is against everything and for nothing. We have not had one suggestion from Labour or the Lib Dems. They are full of complaints without a single solution. We know that the shadow Secretary of State was busy over the weekend deleting his past misdemeanours, but he cannot delete Labour’s misdemeanours with the NHS. As Davina McCall would say, let’s have a look at their best bits. There are the PFI contracts that they mysteriously introduced—£1.4 billion a year is still going to private investors because of the deals made under a Labour Government. Full Fact confirmed that £57 billion will be spent in total on those PFI deals.

Moving on to the 2004 GP contract negotiations, evening and weekend cover was taken away, handed to primary care trusts and given to private companies. Changes to the law in 2007, voted for by Labour Members, allowed bigger businesses to buy up GP practices, resulting in the evidence we saw on “Panorama” last week. The top hit is the 2006 Labour dental contract—

[Wes Streeting]

Oh, here we go.

[Maria Caulfield]

The hon. Gentleman may say, “Here we go,” but Opposition Members acknowledged this afternoon that the Labour contract was causing the problems. We are getting on with dealing with that.

My hon. Friend the Member for Waveney (Peter Aldous) asked what progress is being made. We put the negotiations to the BDA on 24 March and made a final offer—[Interruption.] They don’t want to listen, Madam Deputy Speaker; they don’t care. We put the final offer to the BDA on 20 May, and we are waiting to hear back. We are reforming the dental contract, which perversely disincentivises dentists to take on NHS work.

To correct the hon. Member for Portsmouth South (Stephen Morgan), he did not host that dental summit; it was my right hon. Friend the Member for Portsmouth North (Penny Mordaunt), who invited me. The summit came up with a solution, and I am meeting her team so that we can work on that and take it forward.

In addition to the dental contract, we are reforming how we take on dentists from overseas. We consulted the GDC, which recently ran a consultation, and we will be laying legislation to give it powers to allow dentists to come here more easily—[Interruption.]

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 14th June 2022 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Wes Streeting (Ilford North) (Lab)]

I associate myself with the Secretary of State’s remarks as we remember the anniversary of the Grenfell Tower tragedy and support the families in their ongoing quest for justice. I also associate Opposition Members with your remarks, Mr Speaker, on the 40th anniversary of the end of the Falklands war.

Last night’s shocking BBC “Panorama” investigation into Operose Health revealed the extent of the crisis in GP surgeries, with patient referrals and test results left unread for up to six months, and with patients being seen by less qualified staff standing in for GPs without supervision. This is exactly what happens when private profit is placed above patient health and safety. Why is the Secretary of State asleep at the wheel instead of launching an investigation into this scandal?

[Sajid Javid]

As I said earlier, the hon. Gentleman should reflect on the rule changes made by a previous Labour Government that allowed the management of many GP practices to change hands. When such serious allegations are made, it is right that local commissioners investigate them properly and independently. When it comes to GP access and capacity, I hope he will welcome that we are making a record investment, with over £0.5 billion of support during the pandemic, and recruiting GPs at a record rate.

[Wes Streeting]

The British people are sick and tired of hearing Conservative Ministers, after 12 years in government, passing the buck to everyone else and failing to take responsibility.

Let us look at another scandal that has happened on the Secretary of State’s watch. It has now been weeks since he was warned about the negligence, the cover-up and the bribing of whistleblowers to stay silent about the scandals at the North East Ambulance Service. Since then, he has done precisely nothing to investigate the scandal. When will he address patient safety, get a grip and stop passing the buck? Or is this another case of the Government being, in the words of the Culture Secretary, found “wanting and inadequate”?

[Sajid Javid]

I told Members last week that I will review whether we can have an independent review of the North East Ambulance Service, and the NHS has agreed to an independent review. The hon. Gentleman stands up week after week and tries to claim he is on the side of patients and NHS workers, but we know he is actually on the side of those who are on strike—that is where his loyalties lie. Will he reflect on how many nurses will not be able to get to work and how many appointments will be unattended because of the transport strike? I know he wants to be the second coming of Tony Blair, but he is no more than a pound shop Ed Miliband.

Health and Social Care Leadership Review

Wes Streeting Excerpts

Wednesday 8th June 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

The Secretary of State has picked quite the week to talk about standards in leadership.

I give a huge thanks to NHS staff and leaders for the work they are doing against the most extraordinarily difficult backdrop. I also thank General Sir Gordon Messenger and Dame Linda Pollard for carrying out the review. Its seven recommendations are sensible, and I am pleased the Secretary of State has already committed to implementing them.

As this is a rare example of decisiveness from the Health Secretary, can he tell us when he intends to publish his implementation plan? All too often, the senior leadership of the NHS still does not represent the diversity of the population it serves. Instead of throwing red meat to his Back Benchers, for reasons that will probably be obvious to everyone, I would like to hear how, in particular, he intends to ensure that equality, diversity and inclusion will be improved, so that the best leaders are incentivised into the most challenging roles and are able to provide inclusive healthcare for the breadth of diversity in our great country. Can he explain why the review has not covered leadership in primary care or social care in any detail? Surely this is a missed opportunity. Let us face it: although he is trying to dress this up as the biggest shake-up in history, I am not sure that giving staff an induction on joining the NHS is a revolutionary development, and it hardly meets the scale of the challenge.

The NHS faces the biggest crisis in its history. NHS staff are in a system under pressure like never before, and there are simply not enough of them. There are currently 106,000 vacancies across the NHS, and staff are leaving in droves. In some specialties, such as midwifery, they are leaving faster than we can recruit them. I do not know how the Health Secretary expects NHS managers to demonstrate good leadership and deliver the best outcomes for patients when there are no staff to lead. For an organisation the size of the NHS, one of the biggest employers in the world, not to have a plan for its workforce is unbelievably negligent. What is the NHS meant to do until he eventually delivers his long-term workforce strategy, which he has been promising for some time? How are managers meant to lead effectively when instead of thinking about patient care as their primary driver, they have become buildings and facilities managers, because the ceilings are falling in? The only place where more than 40 new hospitals really exist is in the Prime Minister’s imagination.

The Health Secretary said that we should accept only the highest standards in NHS management, so let me ask him not about the generalities, but about the specifics. Last month, it was reported that North East Ambulance Service bosses oversaw cover-ups of negligence, leaving about 90 families not knowing how their loved ones died. He said yesterday that he is still considering whether to launch a review. Is he seriously considering protecting managers who cover up bad practice, instead of standing up for grieving families? Staff in that service were reportedly paid to sign gagging clauses, and I understand that attempts to get them to sign such clauses are still under way. In a written question, I asked how many non-disclosure agreements had been signed in the NHS since the Government said that they would be banned in 2014. He does not know and he is refusing to investigate the use of gaging clauses in the NHS. So how can he claim to be shaking up NHS culture and dealing with bullying when he has no interest in what is going on under his nose?

Of course the NHS needs good leaders, but when it comes to examples of poor leadership in the NHS, the Health Secretary did not need the Messenger review; he just needed to look in the mirror. This is the man who described the NHS as Blockbuster Video

“in the age of Netflix”,

as if it was the greatest revelation since Moses received the 10 commandments. Who has been in government for the past 12 years? On his watch, on this Government’s watch, we have the highest waiting times in the NHS’s history; the lowest patient satisfaction since 1997; longer waiting times for cancer in every year since 2010; heart attack and stroke victims left waiting for about an hour, on average, for ambulances; and patients at risk of serious injury because the hospital is crumbling around them. He kicked off his own Health Week expecting applause for the fact that, despite his best efforts, there are still 9,000 people waiting for more than two years for treatment. He knows, I know, NHS staff know and the public know that with this Government, NHS staff are lions led by donkeys, wanting and inadequate.

[Sajid Javid]

I am not surprised by the typical response from the hon. Gentleman: not really engaging with the real issues and showing once again that he is more interested in theatrics than in the real issues facing our NHS. He started his comments by trying to make some kind of joke about the leadership news this week, but we all know that he is only interested in one leadership review in a political party in this House, and it is not the Conservative party’s.

Let us look at the issues that the hon. Gentleman raised. He rightly talked about the importance of the workforce overall and how we need more doctors and nurses. He should know that we have more doctors and nurses than ever before and that we are recruiting at a faster rate than ever before, with 10,000 more nurses and over 4,000 more doctors in the past year, and more in training than ever before. However, he will know that dealing with the challenges of getting more workers and building those hospitals, all of which are on track, requires proper funding, yet he and his party voted against the funding that the NHS needed to achieve that.

The hon. Gentleman is right to talk about when things go wrong in the NHS. Of course they need to be properly investigated, as they were in Telford and Shropshire, when we learned about the terrible things that had been going on under successive Governments in that trust. When there is a need for other investigations to take place, including independent ones, such as the one I have just asked for in Nottingham, that will be done. But the hon. Gentleman should understand that the best thing, which is far better than doing a review when things go wrong, is not having things go wrong in the first place. That is why he should have welcomed this report.

North East Ambulance Service

Wes Streeting Excerpts

Monday 23rd May 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the North East Ambulance Service and if he will launch an investigation.

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Can I start by saying how horrified I was to read the concerns raised about the North East Ambulance Service in reports over the weekend? My thoughts are first and foremost with the families affected by the tragic events described. I cannot imagine the distress they are going through. It is hard enough to lose a loved one suddenly, but to have fears that mistakes were made that could have made a difference, and more than that, that the facts of what happened were not revealed in every case, goes further. They have my unreserved sympathy and support.

In healthcare, a willingness to learn from mistakes can be the difference between life and death, and it is because of this that, as a Government, we place such a high value on a culture of openness and a commitment to learning across the NHS. That is why the allegations raised by The Sunday Times this weekend are so concerning. As was made abundantly clear by the Secretary of State’s predecessor almost a decade ago, non-disclosure agreements have no place in the NHS and reputation management is never more important than patient safety.

The Government are wholly supportive of the right of staff working in the NHS to raise their concerns. Speaking up is vital for ensuring that patient safety, and quality of services, improve, and it should be a routine part of the business of the NHS. That is why, over the last decade, substantial measures have been introduced to the NHS to reduce patient harm and improve the response to harmed patients, including legal protections for whistleblowers, the statutory duty of candour, the establishment of the Health Services Safety Investigations Body and the introduction of medical examiners. It is also why, in response to a recommendation of the Sir Robert Francis “Freedom to speak up” review in 2015, the Government established an independent national guardian to help to drive positive cultural change across the NHS so that speaking up becomes business as usual. However, when it comes to patient safety, we cannot afford to be complacent. It remains a top priority for the Government and we continue to place enormous emphasis on making our NHS as safe as possible.

I note the concerns raised in this weekend’s reports. They have been subject to a thorough review at trust level, including through an external investigation, and the trust’s coronial reporting is subject to ongoing independent external audit and quarterly review by an executive director. I also note that the Care Quality Commission has been closely involved. However, given the seriousness of the claims reported over the weekend, we will of course be investigating more thoroughly and will not hesitate to take any action necessary and appropriate to protect patients.

The Government are also committed to supporting the ambulance service to manage the pressures it is facing. We have made significant investments in the ambulance workforce, with the number of NHS ambulance and support staff increasing by 38% since 2010. Health Education England has mandated a target to train 3,000 paramedic graduates nationally per annum from 2021, further increasing the domestic paramedic workforce to meet future demands on the service, while 999 call handlers have been boosted to over 2,400, so we are very serious about improving resources for the service.

I fully appreciate the concerns of right hon. and hon. Members across this House, and we will be pleased to meet any who have constituents affected by the reports this weekend so we can look at the issue more fully.

[Mr Speaker]

Can I just say that it is three minutes—and that means three minutes, not three minutes and 40 seconds —and I am sure whoever writes these speeches can actually time them through? I say to those on both Front Benches that we have to think about Back Benchers, who need to get their hospitals mentioned and their ambulance trusts as well.

I call the shadow Secretary of State, who I am sure will stick to the allocated time.

[Wes Streeting]

I pay tribute to the courage of the whistleblowers, as well as The Sunday Times journalists David Collins, Hannah Al-Othman and Shaun Lintern, without whom none of this would have come to light. But with respect to the Minister, it should not have taken an urgent question to bring her to the House today. On what she said about the Department further investigating, what form will this investigation take, who will be involved and what assurance can she give the families that there will be both answers and accountability, which is what they deserve?

Peter Coates died after an ambulance did not reach him in time. An ambulance two minutes away could not be dispatched because the station door was faulty, and staff did not know about the manual override. The ambulance that was dispatched decided to stop at a service station, even though it had sufficient fuel. Information about these errors was then withheld by the service, statements were changed and staff were asked to withhold the mistakes from the coroner. Peter Coates’ family learned the full truth only when contacted by reporters last week. His is just one of what is thought to be 90 cases involving gross negligence, cover-ups and tens of thousands of pounds of taxpayers’ money offered in exchange for staff silence.

The Minister mentioned the CQC. Why did it fail to spot this, rating the service “good” in 2018? Why did it fail to spot the situation even after being tipped off in 2020? Why is taxpayers’ money still being offered to buy the silence of staff when non-disclosure agreements were supposedly banned in 2014? What role did under-resourcing and understaffing play in this scandal?

Record ambulance waits exist in every part of the country, with heart attack and stroke victims waiting longer than an hour for an ambulance. As for the North East Ambulance Service, it is advising the public to phone a friend or call a cab rather than wait, while presiding over gross negligence, cover-ups and taxpayer-funded gagging orders on staff. That is the record on its watch. It is a national disgrace. What are the Government doing about it?

[Maria Caulfield]

We take the patient safety element of this extremely seriously. To answer the hon. Gentleman’s questions on who we will be meeting, I am happy to meet all the families affected to hear their concerns and the actions that they want taken. We met with the CQC this morning on this specific example, but we will be meeting with the ambulance trust. I also want to meet the coroner, and we want to hear from the whistleblowers. I am very happy to meet any member of staff who wants to raise concerns so that we can get to the bottom of exactly what has happened.

This Government introduced the duty of candour. Mistakes will always happen, no matter how much money is put into the health service or how many staff it has, but when a mistake does happen the hospital trust or ambulance trust should be open and up front about it, start a proper investigation, and learn the lessons so that it never happens again.

--- Later in debate ---

[Maria Caulfield]

As I have said to other hon. Members, mistakes are always going to happen; that is human nature. The difference is that we are trying to introduce a culture of openness and learning in the NHS so that staff feel confident in coming forward, and so that when a mistake does happen, lessons are learned to prevent it from happening again.

Let us look at the record of this Government. It is this Government who are introducing a commissioner to oversee patient safety across the NHS. It is this Government who have introduced a statutory duty of candour so that when mistakes happen, patients and their families are notified and the process of learning starts. It is this Government who have introduced an early notification system specific to maternity—

[Wes Streeting]

It is not working.