Oral Answers to Questions

Debate between Wes Streeting and Steve Barclay

Tuesday 17th October 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

To listen to the Secretary of State, you would think it was all going so well, so let me give him a reality check. In Tamworth last year, only a third of patients said it was easy to get through to their doctor on the phone, one in three GP appointments were not conducted face to face and fewer than half of patients were offered a choice of appointment. The Government are not listening to the people of Tamworth. Perhaps the Secretary of State would like to explain to the people of Tamworth why, after 13 years of Conservative Government, this is the case, and better still, adopt Labour’s plan to cut red tape, incentivise continuity of care and bring back the family doctor.

[Steve Barclay]

I am glad that the hon. Gentleman raised GPs in Tamworth. The GP lead for the Doctors Association said that his plans for general practice filled them with despair, and his proposal for GP nationalisation was mocked by the Nuffield Trust, one of the respected think-tanks. The reality is that this Government are investing in more tech in primary care, have recruited 31,000 additional roles into primary care and have over 2,000 more doctors working in primary care than before the pandemic. Those are the facts. His plans have been mocked by respected think-tanks because he talks a good game on reform but we know that he will never stand up to the trade unions.

--- Later in debate ---

[Wes Streeting (Ilford North) (Lab)]

In Mid Bedfordshire last year, 165 children—[Interruption.] I do not know why Government Members are laughing; perhaps they should listen, as it is not our party that has let down the people of Mid Bedfordshire. Last year, 165 children in Mid Bedfordshire had teeth removed due to tooth decay. Some 800 patients were forced into A&E for the same reason and 100,000 people across the region cannot get access to an NHS dentist. Instead of laughing, the Government might like to adopt Labour’s plan to provide 700,000 extra dentistry appointments every year.

[Steve Barclay]

Since 2010, we have had 6.5% more dentists, a quarter more appointments and, as we have just touched on, increasing flexibility in regulation and boosting overseas recruitment. It is striking that one area of the country that the shadow Secretary of State does not want to talk about is Wales, which has a record of what a Labour Government will deliver. Indeed, the Leader of the Opposition says that he wants Wales to be the “blueprint” for what the NHS would be in England. There, this week, we have seen a fiddling of the figures on health. Even without that fiddling, we know people are twice as likely to be on a waiting list in Wales as in England—

[Mr Speaker]

Order. One of us has got to sit down and it is not going to be me. I let you have a good crack at the beginning, Secretary of State. Your opening statement took quite a long time, which I do not mind. I do not mind your having a go about Wales, but I am certainly not going to open up a debate between the Government and Opposition Front Benches. Topical questions are for Back Benchers and about short questions with short answers. I want it to be kept that way, so please understand that. There must be too many by-elections, because Members are getting carried away.

[Wes Streeting]

It is not just Mid Bedfordshire. Across the country, the No.1 reason children aged six to 10 are admitted to hospital is tooth decay. Given that, will the Secretary of State at least adopt the modest measure that Labour has proposed to introduce national supervised tooth brushing for small children—low cost, high impact—to keep their teeth clean and keep children out of hospital?

[Steve Barclay]

We are reforming the NHS workforce more fundamentally, looking at how we expand the roles that dental hygienists and dental therapists can perform. We are looking at how we can boost training, which is why we have made the commitment for more dentists in the long-term workforce plan, backed by £2.4 billion. How does that help? It increases the number of dentists being trained and we have a quarter more activity compared with last year.

Countess of Chester Hospital Inquiry

Debate between Wes Streeting and Steve Barclay

Monday 4th September 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I strongly echo the sentiments of the Secretary of State and thank him for advance sight of his statement. I welcome the appointment of Lady Justice Thirlwall to lead the inquiry into the crimes committed by Lucy Letby, and I strongly welcome his appointment today of Baroness Lampard to lead the statutory review in Essex. I look forward to receiving further updates from the Secretary of State as soon as possible.

Turning to the case of Lucy Letby, there are simply no words to describe the evil of the crimes that she committed. They are impossible to fathom. Although she has now been convicted and sentenced to a whole-life order, the truth is that no punishment could possibly fit the severity of the crimes she committed. With Cheshire police’s investigation having expanded to cover her entire clinical career, we may not yet know the extent of her crimes. What we do know is that her victims should be starting a new school term today. Our thoughts are with the families who have suffered the worst of traumas, whose pain and suffering we could not possibly imagine, and who will never forget the children cruelly taken from them. We hope that the sentencing helped to bring them some closure, even though the cowardly killer dared not face them in court.

I wish to pay tribute to the heroes of this story: the doctors who fought to sound the alarm in the face of hard-headed, stubborn refusal. This murderer should have been stopped months before she was finally suspended. Were it not for the persistent courage of the staff who finally forced the hospital to call in Cheshire police, more babies would have been put at risk. I am sure the whole House will want to join me in recognising Dr Stephen Brearey and Dr Ravi Jayaram, whose bravery has almost certainly saved lives.

Blowing the whistle on wrongdoing is never easy, which is why it should not be taken lightly. Indeed, we can judge the health of an institution by the way that it treats its whistleblowers. The refusal to listen, to approach the unexplained deaths of infants with an open mind and to properly investigate the matter when the evidence appeared to be so clear is simply unforgivable. The insult of ordering concerned medics to write letters of apology to this serial killer demonstrates the total lack of seriousness with which their allegations were treated.

I welcome the fact that the Secretary of State has changed the terms of the inquiry and put it on a statutory footing. There must be no hiding place for those responsible for such serious shortcomings. It is welcome that the inquiry will have the full force of the law behind it, as it seeks to paint the full picture of what went wrong at the Countess of Chester Hospital, and it is right that the wishes of the families affected have been listened to. I welcome the fact that they will be involved in the drawing up of the terms of reference.

I ask the Secretary of State, people right across Government and people who hope to be in government to make sure that, in future, in awful cases such as this, families and victims are consulted at the outset. Can he assure the House that the families will continue to be involved in decisions as the inquiry undertakes its work?

Mr Speaker, no stone can be left unturned in the search for the lessons that must be learned, but it is already clear that there were deep issues with the culture and leadership at the Countess of Chester Hospital. This is not the first time that whistleblowers working in the NHS have been ignored, when listening to their warnings could have saved lives. Despite several reviews, there is no one who thinks that the system of accountability, of professional standards and of regulation of NHS managers and leaders is good enough.

Why were senior leaders at the Countess of Chester Hospital still employed in senior positions in the NHS right up to the point that Lucy Letby was found guilty of murder? The absence of serious regulation means that a revolving door of individuals with a record of poor performance or misconduct can continue to work in the health service. Does the Secretary of State agree that that is simply unacceptable in a public service that takes people’s lives into its hands?

The lack of consistent standards is also hampering efforts to improve the quality of management. I am sure the Secretary of State will agree that good management is absolutely vital for staff wellbeing, clinical outcomes, efficient services and, most of all, patient safety. The case for change has been made previously. Sir Robert Francis, who led the inquiry into the deaths at Mid Staffs, argued in 2017 that NHS managers should be subject to professional regulation. In 2019, the Kark review, commissioned by the Secretary of State, called for a regulator to maintain a register of NHS executives, with

“the power to disbar managers for serious misconduct”.

In 2022, the Messenger review commissioned by the right hon. Member for Bromsgrove (Sajid Javid) recommended a single set of core leadership and management standards for managers, with training and development provided to help them meet these standards. We must act to prevent further tragedies, so I welcome the Secretary of State’s announcement that his Department is reconsidering Kark’s recommendation 5. Labour is calling for the disbarring of senior managers found guilty of serious misconduct, so I can guarantee him our support if he brings that proposal forward.

The Secretary of State should go further. Will he now begin the process of bringing in a regulatory system for NHS management, alongside standards and quality training? Surely we owe it to the families and the staff who were let down by a leadership team at the Countess of Chester Hospital that was simply not fit for purpose.

Finally, I know that I speak for the whole House when I say that the parents of Child A, Child C, Child D, Child E, Child G, Child I, Child O and Child P are constantly in our thoughts, as are the many other families who worry whether their children have also been victims of Lucy Letby. We owe it to them to do what we can to prevent anything like this from ever happening again. As the Government seek to do that, they will have our full support.

[Steve Barclay]

I thank the hon. Gentleman for the content of his response and the manner in which he delivered it. I think it underscores the unity of this House in our condemnation of these crimes, and our focus on putting the families at the centre of getting answers to the questions that arise from this case. I join him in paying tribute to those consultants who spoke up to trigger the police investigation and to prevent further harm to babies. I note the further work that the police are doing in this case, and also pay tribute to the police team, which I had the privilege of meeting. They have worked incredibly hard in very difficult circumstances in the course of this investigation.

As the hon. Gentleman said, the families are absolutely central to the approach that we are taking. That is why I felt that it was very important to discuss with them the relative merits of different types of inquiry, but their response was very clear in terms of their preference for a statutory inquiry. I have certainly surfaced to Lady Justice Thirlwall some of the comments from the families in terms of the potential to phase it. Of course, those will be issues for the judge to determine.

On the hon. Gentleman’s concerns around the revolving door, clearly a number of measures have already been taken, but I share his desire to ensure that there is accountability for decisions. As Members will know, I have been vocal about that in previous roles, and it is central to many of the families’ questions on wider regulation within the NHS.

The hon. Gentleman mentioned the importance of good management. I am extremely interested in how, through this review and the steps we can take ahead of it, we give further support to managers within the NHS and to non-exec directors. The Government accepted in full the seven recommendations of the Messenger review. The Kark review was largely accepted. There was the issue of recommendation 5, which is why it is right that we look again at that in the light of the further evidence.

It is clear that a significant amount of work has already gone in. A number of figures, including Aidan Fowler and Henrietta Hughes, have focused on safeguarding patient safety, but in the wake of this case we need to look again at where we can go further, which the statutory inquiry will do with the full weight of the law. I am keen, however, that we also consider what further, quicker measures can be taken. Indeed, I have been in regular contact with NHS England to take that work forward.

Oral Answers to Questions

Debate between Wes Streeting and Steve Barclay

Tuesday 11th July 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

Last week, the Health Secretary said that he was willing to offer doctors a higher pay rise. Last night, the Chancellor slapped him down, saying that any increased offer will have to be paid for by cuts. How can the Health Secretary negotiate an end to the NHS strikes when he cannot even negotiate with his own Chancellor?

[Steve Barclay]

We have been clear throughout that Government decisions on the pay review bodies’ recommendations are taken on a cross-Government basis. The agreement that we reached with the largest group of NHS staff, those on “Agenda for Change”, has demonstrated that we are willing to work constructively with trade union colleagues, but the demand from junior doctors for a 35% increase is not affordable—indeed, the hon. Gentleman himself has said that he does not support it.

[Wes Streeting]

But the worst strikes in the history of the NHS are still to come. The impact of the junior doctors’ strikes and the consultants’ strikes will be devastating for patients. The Secretary of State has failed to stop these strikes for seven months. He has lost the confidence of nurses, radiologists, junior doctors and consultants, and he cannot even successfully negotiate with his Chancellor, so what is his plan to stop these strikes going ahead?

[Steve Barclay]

The hon. Gentleman’s message is not even consistent with what he said at the weekend in the media: that he was not in a position to offer more money to the NHS, and that the shadow Chancellor had made that clear—in a vain attempt to demonstrate some sort of fiscal responsibility. The hon. Gentleman has been clear that he does not support the 35% demand from doctors in training. We are demonstrating that we are working constructively with groups such as the “Agenda for Change” group—the largest staff group, made up of over 1 million staff—with which we have reached a deal. We have also been responding constructively to the British Medical Association’s principal demand for consultants, which was for changes to pension taxation. We are willing to engage constructively with trade union colleagues, but the 35% demand is not affordable. He needs to decide on his position. Which is it: his position at the weekend that the Opposition are not offering more money, or his position today, which seems to be that they will?

Oral Answers to Questions

Debate between Wes Streeting and Steve Barclay

Tuesday 6th June 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

First, I congratulate the Health Secretary on his recent write-up as the next Leader of the Opposition. According to the i newspaper, his supporters are calling him “Mr Consistent”. Is that because of the consistent rise in waiting lists since he became Health Secretary, the consistently longer waiting times that patients are facing, or the consistent delay to the NHS workforce plan?

[Steve Barclay]

The point of consistency is that we gave a manifesto commitment to have 26,000 additional roles in primary care, and we have delivered that. We made a commitment to the largest ever hospital building programme, and we have announced over £20 billion of investment in it. The Government are standing by their manifesto commitments—that is what we are delivering.

[Wes Streeting]

I am sure that will do it.

I want to turn to the most recent reports about the NHS workforce plan, because apparently not only is that plan delayed, but we now read in the media that it is unfunded. Labour will pay for our workforce plan by abolishing the non-dom tax status. [Interruption.] Conservative Members do not like it, Mr Speaker, but it is the only tax they have been unwilling to put up. We have a plan, and we have said how we will pay for it. How will the Health Secretary fund his plan when it eventually arrives? Will it be cuts to the NHS, more borrowing, or even more broken promises?

[Steve Barclay]

The hon. Gentleman is recycling this question almost as often as he recycles the non-dom funding. As I said at the last Health and Social Care Question Time, it is like the 1p on income tax that the Lib Dems used to promise, which was applied to every scheme going.

We touched on this issue at the last Question Time, and indeed at the one before: we have a commitment to a long-term workforce plan. The Chancellor made that commitment in the autumn statement, but it is a complex piece of work that NHS England is working on. It is important that we get the reforms in that plan right, and that is what we are committed to doing.

New Hospitals

Debate between Wes Streeting and Steve Barclay

Thursday 25th May 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

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

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

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

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

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

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

[Steve Barclay]

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

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

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

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

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

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

Patient Choice

Debate between Wes Streeting and Steve Barclay

Thursday 25th May 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I thank the Secretary of State for advance sight of his statement. I also join him in paying tribute to the late Karen Lumley and, even more important, extending condolences to her family and her many friends on both sides of the House —but particularly on the Conservative Benches—for their loss. I know that the sadness is felt very deeply throughout the Chamber.

Let me now turn to the first of today’s two statements from the Health Secretary. It seems that quantity is not matched by quality. In a week in which the Leader of the Opposition announced Labour’s plans to give patients more choice, with regional waiting lists for care and more power through the NHS App, the Conservatives’ big idea to cut waiting times is to give patients a choice that they already have. It is thanks to the last Labour Government that patients waiting for planned treatment already have a right to choose an alternative provider if they have been waiting too long.

Beneath the spin, the Health Secretary’s announcement is actually a watering down of the measures that are already in place. He says that patients will have the right to choose an alternative provider if they have been waiting longer than 40 weeks, but in 2019 the Conservatives said that they should have that right after 26 weeks—which, even then, was worse than the 18-week standard to which patients were already entitled thanks to the last Labour Government. Is it not the case that he is once again shifting the goalposts because he cannot even meet his own standards, let alone those that patients expect?

The Health Secretary concluded his statement by talking about his Government’s record. That was a bold move, because 7.3 million people— the highest number on record—are currently waiting for planned treatment in England. As usual, the Health Secretary said that that was because of the pandemic, but the figure was already at a record high before the pandemic. Behind this shocking statistic are real people, waiting, waiting, waiting in agony. It does not matter how often the Health Secretary says that the Government are committed to reducing the waiting lists; people can see with their own eyes the numbers that do not lie, which show that waiting lists are getting higher and things are getting worse, not better.

The Health Secretary’s total incompetence when it comes to preventing strike action in the NHS has inflicted untold misery on patients. So far the total number of appointments affected by NHS strikes in recent months is more than half a million, a figure that the Health Secretary called “deeply disappointing”. Well, that is something on which he and I can agree, for once, but with another round of strike action planned by junior doctors, he must surely see the risk to patient choice and waiting lists. What is his plan? Ministers blame strikes as if they were mere bystanders, but it was their refusal to speak to nurses, paramedics and junior doctors that forced them out on strike in the first place. I am afraid the Health Secretary’s warm words today are not going to cut it, when all he is doing is giving more patients more choice over where their next appointment or operation is to be cancelled because of the strikes that he and the Prime Minister have failed to prevent.

Finally, let me turn to the supermassive black hole that is at the heart of today’s announcement. I will keep on reminding the Health Secretary of this until the penny drops. It does not matter which hospital patients choose; they can only receive care on time if there are enough staff to treat them—so why are we still waiting for the NHS workforce plan that the system is crying out for? Why do we have net migration at the highest level ever, with the Government over-reliant on recruiting staff from overseas because they cannot be bothered to train home-grown talent? Where is the plan to train the doctors and nurses whom the NHS is so desperately short of? Labour has set out our plan to double medical school places and train 7,500 more doctors and 10,000 more nurses a year, which we would pay for by abolishing non-dom tax status. [Interruption.] I am afraid that Conservative Members like non-doms more than they like nurses, but the public are not with them on that. Let me once again, in the spirit of generosity, before we break for the recess, offer the Secretary of State our fully costed, fully funded plan. It is available to him—[Interruption.] Conservative Members should not laugh too much now. I wager that, before we break for the summer, the Government will finally swallow their pride and announce the doubling of medical school places. We will wait and see.

After 13 years of Conservative Government, people can see for themselves where it has landed this country and compare it with 13 years of Labour Government, which delivered the shortest waiting times and the highest patient satisfaction in history. We will offer real choice and cut waiting times, so that the NHS is there when people need it. We did it before; we will do it again. We have the ideas and we have the plan. That is why only Labour can build an NHS that is fit for the future.

[Steve Barclay]

Not since the famous 1p on income tax from the Lib Dems, which was to be spent on every issue going past like a passing bus, have we heard of money being spent in as many different ways as the non-dom money. No wonder the hon. Member for Ilford North (Wes Streeting) said it with a smile; the whole House could see how credible that proposal is.

The theme of the hon. Gentleman’s response was comparison, so I think we should compare the substance of the announcement on patient choice with the situation where Labour is in office. In Wales, patients do not have the ability to choose where they receive treatment; that right is not offered to patients. In NHS Wales, patients registered with a GP in Wales do not have a statutory right to choose at which hospital they receive treatment. We can compare what a Government in England are doing—empowering patients, giving them that choice as well as the information and technology they need to make it—with NHS Wales, run by the Labour party, which deprives patients of their choice.

I hesitate to draw the comparison with Wales, however, because another Labour Front Bencher, the hon. Member for Denton and Reddish (Andrew Gwynne), says that he does not want Labour to be judged on its record in Wales. That is slightly confusing because the leader of the Labour party, no less, says that he wants Labour in Wales to be

“a blueprint for what Labour can do across the UK”.

So they cannot even compare among themselves, never mind compare between England and Wales.

The hon. Member for Ilford North talked about strike action but seemed to skirt around the fact that the Government have reached a deal with the NHS Staff Council in relation to Agenda for Change staff—a deal that his own union, Unison, voted 74% in favour of. His own union—the union that gives him money—supported the deal. He chides us about junior doctors, but those of us who were present in the Chamber the last time heard him say that he did not support the junior doctors’ demand for 35%. When we did negotiate with them, they even increased their demand to 49%, when next year is added in, further confusing the position.

It will come as no surprise to the House to discover that people in Wales are almost twice as likely to be waiting for treatment as people in England. That is the true comparison that we are addressing. We can see that situation play through to people waiting more than 18 months. In England, we have virtually eliminated 78-week waits—at the end of March, it was under 11,000—but in Wales, it will come as no surprise to Members, the number was closer to 75,000, and of course Wales has a smaller population. So we can compare waiting times, which we in England are bringing down. We have an electives plan, we cleared virtually all the two-year waits in the summer and over 90% of the 18-month waits at the end of March, which contrasts with the situation in Wales. We are giving patients choice, enabling them to move if they want to in order to get quicker treatment elsewhere. We are on the side of patients. We can see what the Labour party is doing by its disastrous performance in Wales.

Recovering Access to Primary Care

Debate between Wes Streeting and Steve Barclay

Tuesday 9th May 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

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

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

[Steve Barclay]

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

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

The Boots chief executive says that this is

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

The Company Chemists Association says that it is a

“real vote of confidence for the future profession”.

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

“a real game-changer for patients”,

and that is what our focus has been.

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

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

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

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

Oral Answers

Debate between Wes Streeting and Steve Barclay

Tuesday 25th April 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

[Steve Barclay]

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

[Wes Streeting]

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

[Steve Barclay]

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

NHS Strikes

Debate between Wes Streeting and Steve Barclay

Monday 17th April 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

[Wes Streeting]

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

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

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

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

[Steve Barclay]

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

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

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

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

Junior Doctors’ Strikes

Debate between Wes Streeting and Steve Barclay

Thursday 30th March 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

[Wes Streeting]

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

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

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

[Steve Barclay]

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

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

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

Oral Answers to Questions

Debate between Wes Streeting and Steve Barclay

Tuesday 7th March 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

I am afraid that talk is cheap. I was at Worcester University’s medical school yesterday, where I was told directly by the vice-chancellor that that university, which has great facilities, can only recruit international students because the Government will not fund places for domestic students. The NHS has asked for medical school places to be doubled. Labour has a plan to double medical school places, paid for by abolishing the non-dom tax status. Why do the Government not swallow their pride and adopt Labour’s plan in next week’s Budget?

[Steve Barclay]

First, as I said a moment ago, we are funding a 25% increase in medical undergraduate places, and we have given a commitment to a workforce plan, as the Chancellor set out in the autumn statement. The question that the shadow Secretary of State should address is his party’s opposition to international recruitment. We have more than 45,000 doctors who have been recruited internationally, yet the Leader of the Opposition says he wants to move away from international recruitment, which is an important source of additional doctors.

--- Later in debate ---

[Wes Streeting (Ilford North) (Lab)]

When nurses and paramedics voted to take strike action, the Secretary of State refused to negotiate and said that the pay review body’s decision was final. He has now U-turned, but not before 144,000 operations and appointments were cancelled through his incompetence. Will he now apologise to patients for this avoidable disruption?

[Steve Barclay]

What the hon. Gentleman omits to remind the House is that at the time the demand from trade unions was for a 19% consolidated pay rise, which is very different from the basis on which talks have been entered into. The point is that we are in discussions with trade union colleagues. Trade unions and the Government have a shared purpose—to address the very real challenges that we recognise the NHS workforce have faced, particularly in the context of the pandemic—and a shared desire, which is to focus on patients and ensure that they get the right care to support them.

[Wes Streeting]

I think patients know who to trust, and it is nurses, not the Secretary of State. The Government have still learned nothing: despite a 98% vote in favour of strikes, the Secretary of State was sent to meet junior doctors without a mandate from the Prime Minister to negotiate. What is the point of this Health Secretary if he is in office but not in charge?

[Steve Barclay]

I have come to the House literally from a meeting with the trade unions: I met the NHS Staff Council this morning. Once again, hon. Members on the Opposition Front Bench are writing their questions before they see what is actually happening.

Urgent and Emergency Care Recovery Plan

Debate between Wes Streeting and Steve Barclay

Monday 30th January 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

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

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

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

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

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

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

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

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

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

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

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

[Steve Barclay]

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

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

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

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

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

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

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

Oral Answers to Questions

Debate between Wes Streeting and Steve Barclay

Tuesday 24th January 2023 Commons Chamber

[Steve Barclay]

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

[Wes Streeting]

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

[Steve Barclay]

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

NHS Winter Pressures

Debate between Wes Streeting and Steve Barclay

Monday 9th January 2023 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

Happy new year to you, Mr Speaker, and to the rest of the House. I thank the Secretary of State for Health and Social Care for advance sight of his statement.

This winter has seen patients waiting hours on end for an ambulance, A&E departments overflowing with patients, and dedicated NHS staff driven to industrial action—in the case of nurses, for the first time in their history—because the Government have failed to listen and to lead. I notice that the Secretary of State did not talk about the abysmal failure of his talks with nurses and paramedic representatives today. Let me say to him: every cancelled operation and delayed appointment, and the ambulance disruption due to strikes, could have been avoided if he had just agreed to talk to NHS staff about pay. Today, he could have opened serious talks to avert further strikes. Instead, he offered nurses and paramedics 45 minutes of lip service. If patients suffer further strike action, they will know exactly who to blame.

Of course, the Prime Minister has already shown that he is not interested in solving problems; he resorts to the smokescreen of parliamentary game playing by bringing in legislation to sack NHS staff for going on strike. I ask the Secretary of State, in his sacking NHS staff Bill, how many nurses is he planning to sack? How many paramedics will he sack? How many junior doctors will he sack? The Government have the audacity to ask NHS staff for minimum service levels, but when will we see minimum service levels from Government Ministers and the entire Government?

After arriving at the Derriford Hospital in Plymouth, an 83-year-old dementia patient waited in the back of an ambulance outside A&E for 26 hours before being admitted. That was on 23 December, when no strikes were taking place; the Secretary of State should listen. The patient’s family found him in urine-soaked sheets, and since arriving in hospital, he has contracted flu. His daughter said of the hospital staff:

“They’re polite, they’re caring, and they are trying their best. It’s just impossible for them to do the work they want to do.”

Let me say what the Health Secretary and Prime Minister refuse to admit: the NHS is in crisis—the biggest crisis in its history. That is clear to the staff who have been slogging their guts out over Christmas and to everyone who uses it as a patient; the only people who cannot see it are the Government.

What has been announced today is yet another sticking plaster when the NHS needs fundamental reform. The front door to the NHS is blocked, the exit door is blocked, and there are simply not enough staff. Where is the Conservatives’ plan to fix primary care, so that patients can see the GP they want in the manner they choose? After 13 years of Conservative government, they do not have one. Where is the plan to recruit the care workers needed to care for patients once they have been discharged from hospitals, and to pay them fairly so that we do not lose them to other employers? After 13 years of Conservative government, they do not have one. Where is the plan to train the doctors, nurses and health professionals the NHS needs? After 13 years of Conservative government, they do not have one.

Well, we do. The Secretary of State is welcome to nick Labour’s plan to abolish non-dom tax status and train 7,500 more doctors and 10,000 more nurses and midwives every year; to double the number of district nurses; and to provide 5,000 more health visitors—a plan so good that the Chancellor admitted that the Conservative Government should nick it. After 13 years of mismanagement, underfunding and costly top-down reorganisations, however, all the Conservatives have to offer the NHS is a meeting and a photo op in Downing Street.

The collapse of the health service this winter could be seen coming a mile away—health and social care leaders were warning about it last summer—so why is the Secretary of State announcing these measures in the middle of January? Why have care homes and local authorities been made to wait until this month for the delayed discharge fund to reach them? It is simply too little, too late for many patients.

In fact, this Government are so last minute that, after announcing this plan last night, they found an extra £50 million and sent out another press release. I know most of us are happy to find a spare fiver lying around the house that we did not know was there, but this Prime Minister seems to have 50 million quid stuck down the back of the sofa. What on earth is going on? No wonder they cannot get money to the frontline: the left hand does not know what the right hand is doing.

It is intolerable that patients who are fit and ready to leave hospital are then stuck there for months because the care they need is not available in the community. They are not bed blockers, and they are not an inconvenience to be dropped off at a hotel and forgotten about. They need rehabilitation at home, rather than a bed in a care facility. Vulnerable patients deserve proper support suited to their needs, or they will fall ill again and go back to hospital. What about all these beds the NHS is procuring, and what about the capacity that families need? I will tell hon. Members what will happen: they will not get the care, and they will be coming right back through the front door of A&E, with the cycle of broken systems repeating itself again and again. Where is the choice and control for patients and their families who may not want to be discharged to a hotel?

I am afraid that, after 13 years, this just is not good enough. The Prime Minister might not rely on the NHS, but millions of ordinary people do. They are sick and they are tired of waiting. There have been 13 years of Conservative Government now—13 years—and look at what they have done to the NHS. Did the Health Secretary listen to himself as he described the situation in hospitals of people waiting on chairs for discharge, the trolleys in the corridors and people waiting longer than ever? Whose fault is it? It is not that of the NHS staff he is threatening to sack, but of the Conservative Ministers who have made disaster after disaster. After 13 years of Conservative Government it is clear that the longer they are in power, the longer patients will wait. Only Labour can give the NHS the fresh start and fresh ideas it needs.

[Steve Barclay]

The hon. Member talks about a fresh start, but even his own shadow Cabinet colleagues do not seem to agree with his plans. His own deputy leader seemed to distance herself from his plans to use the private sector, and his own shadow Chancellor seems to have distanced herself from his plans for GPs. Perhaps he can share with the House exactly how much his unfunded plans for GPs will cost, because the chief executive of the Nuffield Trust has said:

“It will cost a fortune”,

and is

“based on an out of date view”.

The point is that he has no plans that his deputy and his own colleagues support, and he has not set out how he would fund those plans in a way that does not divert resource from other parts of the NHS.

The hon. Member talked about pressure, yet there was no mention of the fact that the NHS in Wales, the NHS in Scotland and, indeed, health systems across the globe have faced significant pressure as a result of the combination of covid spikes and flu spikes, particularly in recent weeks. This is not a phenomenon limited to England and the NHS; this is a pressure that has been reflected internationally, including for the NHS in Wales.

The hon. Member refers to talks with the trade unions, and it is right that we are engaging with the trade unions. I was pleased to meet the staff council of the NHS today. Indeed, the chair of the NHS staff council, Sara Gorton, said the discussions had made “progress”, notwithstanding one trade union leader who was not in the talks giving an interview outside the Department to comment on what had and had not been said in those talks. We want to work constructively with the trade unions on that.

The hon. Member says that we are only announcing measures today, but again, he seems to have written those comments before he got a copy of the statement. The integrated care boards took operational effect in July last year—[Interruption.] Because they are scaling up, we are putting control centres in place and we are integrating health and social care. In the autumn statement, we announced £500 million for discharge, a further £600 million next year and £1 billion the year after, recognising that there is significant pressure, and that is ramping up. NHS England set out its operational plans in the summer, including the 100-day discharge sprint. That, for example, set out the greater use of virtual wards, which is new technology being rolled out at scale. It also announced the extra 7,000 community beds. Indeed, we also set out the additional measures in our plan for patients.

What is clear when we have a sevenfold increase in flu in a month—50 cases admitted last year compared with 5,100 this year—is that there is a combination of a surge in demand on top of the existing high-level position, and the surge in demand corresponds with a constraint on supply as staff absences also increase because of flu, so during the Christmas period community services are more constrained. Those two things together have created significant pressure on our emergency departments. That is why in the engagement I have had with health leaders the two key messages they gave to me were the importance of getting flow into hospitals, which is constrained by the high bed occupancy—that is why getting people out of hospital is so central to relieving pressure—and, within the emergency departments specifically, the need to decompress those services with same-day emergency treatment and having short stay post-emergency departments. That is a better way to decompress those emergency departments—through the triaging and bringing other clinical specialties closer to the front door. We have listened to the NHS frontline and those were the two key requests made to me, alongside other issues such as care quality inspections and how to make them more flexible. However, alongside those immediate pressures, we need to recognise that we had pressures last summer during the heatwave and we had pressures in the autumn, which is why we have announced a wider set of measures today.

So we have listened and we have acted; we have taken measures to deal with the immediate pressure, but we have also set out how we will build further capacity that will go through into the autumn. Alongside that, we have signed deals, for example with Moderna and BioNTech, and we are bringing forward the life science investment so that that has a better impact on pressures on the frontline.

NHS Workforce

Debate between Wes Streeting and Steve Barclay

Tuesday 6th December 2022 Commons Chamber

[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

Debate between Wes Streeting and Steve Barclay

Tuesday 6th December 2022 Commons Chamber

[Wes Streeting (Ilford North) (Lab)]

The chairman of the Conservative party claims that NHS strikes are exactly what Vladimir Putin wants, so why is not the Health Secretary negotiating to prevent them from going ahead?

[Steve Barclay]

I have seen the hon. Gentleman make that claim across the media a number of times. Just to reassure him, my door is open and I have been clear with the trade unions that I am available; I am available to them this afternoon or tomorrow. It is not I who set a precondition for those talks. When I met the trade unions, they raised a number of issues; not only pay, but safety of staff and other conditions, the estate, tech and so forth, and I am happy to engage with them on those points.

[Wes Streeting]

We get the warm words about wanting to negotiate, but a Government source briefed The Times last week that the Secretary of State’s plan is to wait for public sentiment to turn against striking nurses, saying:

“This is going to affect a lot of people…it could have a big impact on a lot of them and…in the end they will get fed up”.

He knows that this winter is going to be the most difficult that the NHS has ever faced, and he is using nurses as scapegoats to avoid the blame. That is the shameful truth, isn’t it?

[Steve Barclay]

First, it is a bit bizarre that, at departmental questions, the best the hon. Gentleman can manage is “a Government source”. Secondly, the revelation from that Government source is that this will affect “a lot of people”. I do not think that comes as any surprise. That is why we regret the action and are very open to having talks. The point is that he himself does not support the 19% pay demand of the trade unions. He stands here saying that we should be talking while he himself does not accept their proposal.

Oral Answers to Questions

Debate between Wes Streeting and Steve Barclay

Tuesday 1st November 2022 Commons Chamber

[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

Debate between Wes Streeting and Steve Barclay

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.

Oral Answers to Questions

Debate between Wes Streeting and Steve Barclay

Tuesday 19th July 2022 Commons Chamber

[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.

Draft Restriction of Public Sector Exit Payments Regulations 2020

Debate between Wes Streeting and Steve Barclay

Monday 21st September 2020 General Committees

[Steve Barclay]

The reality, without wanting to stray into the issue of litigation, is that this is a cap on payments, so a body representing members may have concerns about that. The issue before the Committee is what constitutes value for money for the taxpayer. I remind the Committee of the fact that payments can be more than six times the national living wage and four times the average earnings. During the time of coronavirus, those are very substantial payments. You will be familiar with, Sir Christopher, some of the payments that were read out on the Floor of the House—those of NHS managers for example, who receive very large payments and then reappear elsewhere in the NHS very shortly.

[Wes Streeting]

Of course, it is easy to point to those examples. I wonder how the six-figure pay-off to Mark Sedwill could have been considered value for taxpayer money, and how much the wider cull of top civil servants under the Government is costing the taxpayer.

[Steve Barclay]

I was going to come to local authorities, but to address the issue of senior civil servants, that flowed from the decision to split the role of the Cabinet Secretary and the head of the civil service with that of Sir Mark’s other role as National Security Adviser, which meant that he was stepping down before the end of his tenure. It was therefore appropriate that Sir Mark was compensated in line with the civil service compensation scheme, and the sum is in line with the normal rules governing civil service pensions and compensation. Since 2015, in anticipation of the introduction of a cross-public sector cap on exit payments, any civil service exit costing more than £95,000 requires approval by Cabinet Office Ministers to ensure that it provides value for money to the taxpayer. As someone who worked with Sir Mark, particularly in my role as Secretary of State for Exiting the European Union, I place on the record what a fine public servant he was and how much I valued working with him during his time in office.

The hon. Member for Bermondsey and Old Southwark, who made a number of interventions—I hope that comment is not untoward—also raised a legitimate point about local authorities. As I say, it is something I looked at in particular. Local authorities’ ability to restructure should not be dependent on six-figure taxpayer-funded payouts. Councils will still be able to restructure and exit staff in any way they wish, provided the sum of any exit payment does not exceed £95,000. The Government accept that there might be instances where it is in the interests of urgent workplace reform to relax the restriction imposed by the regulations, so there is flexibility within the system.

Finally, the hon. Member for Ilford North raised the issue of index-linking. The point is that we want to retain the flexibility to revalue the cap both upwards but also downwards. If one looks at the economic consequences of coronavirus, ensuring that there is flexibility in the system is a prudent way to manage the public finances.

Oral Answers to Questions

Debate between Wes Streeting and Steve Barclay

Tuesday 7th July 2020 Commons Chamber

[Steve Barclay]

This is an area where I agree with the hon. Gentleman. That is why, in addition to the fund I mentioned a moment ago, the Prime Minister also confirmed £12.2 billion of funding for affordable homes, and there is the £400 million brownfield land fund to get schemes working immediately with Mayors for exactly the reason he sets out.

[Wes Streeting (Ilford North) (Lab)]

The Conservative manifesto promised £9 billion for energy efficiency schemes, but the Committee on Climate Change described even that as

“welcome but not enough to match the size of the challenge”.

Given that the Chancellor is about to announce a £2 billion scheme, why are the Government scaling back their ambition when they should be scaling up to bring down people’s bills, tackle climate change and create the jobs we need to get Britain back to work?

[Steve Barclay]

If the hon. Gentleman had listened to the answer I gave a moment ago, he would have seen that we are learning from the lessons of the 2008 crash. One of the measures that was put in place then saw a fall of a third in the number of small house builders, so part of the £450 million fund is providing the finance to enable small house builders to build the schemes that Members on both sides of the House agree on. It is about learning the lessons of the schemes that Labour put in place in 2008, which led to a fall in construction work.

Self-employed Persons: Financial Support

Debate between Wes Streeting and Steve Barclay

Tuesday 24th March 2020 Commons Chamber

[Steve Barclay]

My hon. Friend will recall that the Budget included targeted action specifically on council tax, with a £0.5 billion package to allow targeted support on council tax. I think he is drawing his attention to a slightly wider issue of concern, particularly where one member of a household works in the NHS as a key worker and one is at home, but of course that draws attention to the fact that this is a complex scheme that we are seeking to design. Those are the sort of issues we are working through.

[Wes Streeting (Ilford North) (Lab)]

I have so many self-employed workers in my constituency, including more than 1,000 taxi and private hire drivers. They will understand from what has been said this morning that the Government have good intentions, but they will respond to me that good intentions do not pay their bills. Given that there will be a lag with the new system coming in, what more can the Government do in the meantime, through offsetting tax bills and also encouraging banks to be more generous with free overdraft facilities to help families through this? Let us not forget that we all bailed out the banks when they needed it, so maybe it is time for them to do something now.

[Steve Barclay]

The hon. Gentleman is right in terms of the role of the banks, and a clear message has been sent by the Bank of England Governor about the importance of banks showing forbearance at this time. That applies to things such as credit card debts, but also he will be aware that, for example, for many of his constituents in a London constituency, their rent is a significant issue, as well as the measures we have taken on mortgages. We have looked at what we can do to assist on some of those fixed costs, but the banks have had a clear message from the Governor about the need to show forbearance.