Health and Adult Social Care Reform

We now come to the first statement. I am sure there must be something left to say.

15:41:00

A happy new year to you, Mr Speaker, and to everyone across the House. With your permission, I will give an update on health and adult social care reform. I start by paying tribute to the NHS and social care staff who worked throughout the Christmas break, including by staffing our hospitals, ambulance services, care homes and call centres on Christmas day and throughout the new year. From visiting hospitals and residential care homes in the south-west of England, Essex, London, South Yorkshire and the north-west over the past two weeks, I know the extent of the pressures they are dealing with. They are going above and beyond to keep the NHS standing, to provide people with the social care they need and to give patients and care users the best care they possibly can against the most challenging backdrop. We have seen more than three times as many patients hospitalised with flu this winter compared with last year, in a service with no slack left to give. Since coming into office, the Government have been doing everything we can to prepare the NHS for winter, including by ending the resident doctors’ strikes. This is the first winter in three years when staff are on the frontline, not the picket line. The Chancellor made an additional £1.8 billion available in-year to fill the black hole left by the previous Government, and we introduced the new respiratory syncytial virus vaccine to protect more than 1.2 million people against the virus. But I am not going to pretend for a second that the experience of patients this winter is acceptable. The Government have been honest about the state of the NHS since the election, and we will continue to be. The NHS is broken but not beaten. It will take time to fix, but it can be done. That is why the Chancellor made an additional £1.8 billion available in-year to fill the black hole left by the previous Government and to enable us to deliver on our first steps to cut NHS waiting times. That is why we are undertaking fundamental reform, and it is why we are acting on social care. These are the honest facts. The social care system in this country is failing, leaving hundreds of thousands of disabled and elderly people without the care they need. The failure of social care is piling enormous pressures on the NHS. In November, more than 12,400 hospital patients a day were well enough to leave but had to stay overnight because they were not able to be discharged. We have an ageing society: by 2050, there will be 4 million more people aged 65 and over in England. If we do nothing, social care costs are expected to double over two decades. Of course, there is plenty of blame to go around. In 2009, when Andy Burnham established cross-party talks on social care, the Conservatives pulled out and leaked details of the talks to attack Labour. In 2017, it was Labour who torpedoed Theresa May’s proposals. And in 2022, the right hon. Member for Richmond and Northallerton (Rishi Sunak) as Chancellor delayed Boris Johnson’s cap on care costs, and then defunded them as Prime Minister. There has not been a shortage of good ideas in the past 15 years, but a lack of good politics. It is time all of us across the House do things differently. I have written to my opposite numbers and the leaders of all UK-wide parties represented in the House to invite them to help break out of the cycle of political failure. I hope all of us across the House will put aside our ideological and partisan differences, and work together on this, to finally find a way through to a long-term plan that can build the broad consensus we need. We do not need to agree on everything, but in April we will launch an independent commission on building a national care service. I am delighted that it will be headed by one of our country’s leading social reformers, and Whitehall’s greatest doer, Baroness Louise Casey. Baroness Casey has served Labour, Conservative and Liberal Democrat Governments. She is a trusted, independent figure, who will take views from all parties and, crucially, the public as she seeks to build a cross-party and national consensus on the future of social care. She will get things done. Her first report will be published next year, making a series of recommendations that can be implemented straight away throughout this Parliament, and her final report will come later in this Parliament. In the meantime, we are stabilising the social care system today. We have legislated for the first ever fair pay agreement for social care, to tackle the workforce crisis—the 131,000 vacancies we see today. In the Budget, the Chancellor provided the biggest increase in carer’s allowance since the 1970s, worth £2,300 a year to family carers, and an extra £3.7 billion for local authorities. On Friday, I visited the home of Keith and Elaine in Carlisle. I saw at first hand how extended doorways and the installation of accessible kitchen and bathroom facilities have changed their lives, thanks to the disabled facilities grant, allowing them to live with renewed dignity, independence and happiness. That is why I announced last week the immediate release of £86 million through the disabled facilities grant, to provide an extra 7,800 home adaptations before April, changing the lives of thousands more disabled people for the better, just as Keith and Elaine have experienced. We are not hanging around on reform either. We are introducing new standards to help people who use care, their families and providers to choose the most effective new technology as it comes on the market. We are joining up care and medical records, so NHS and care staff have the full picture they need to provide the best possible care. And we are training care workers to perform more health interventions to help people stay well and at home. A lot done, a huge amount more to do and, if this House gets this right, the best is yet to come. Turning to the elective reform plan the Prime Minister has launched today, the Government inherited NHS waiting lists at 7.6 million. The NHS standard, that patients should wait no longer than 18 weeks for treatment, has not been met for a decade. Millions of patients are forced to put their lives on hold while they wait. In his investigation, Lord Darzi listed the causes of this crisis: the undoing of new Labour’s reforms, the disastrous top-down reorganisation, and slashing GPs and community health services, all of which have led to a dramatic drop in hospital productivity. Lord Darzi has diagnosed the condition; now this Labour Government are prescribing the cure. In November, the Prime Minister set out the Government’s plan for change—a plan to dig this country out of the hole it was left in and an act of resistance against the status quo of managed decline. It committed to cutting maximum waiting times from 18 months today to 18 weeks by the end of this Parliament. Today, we are setting out how we will hit that ambitious target, so that once again the NHS is there for us when we need it. This will demand faster improvement than even the last Labour Government achieved. That means doing things differently. It had to be a plan for investment and reform. Investment and reform is what Labour promised before the election. Investment and reform is what we are delivering. Our elective reform plan will cut waste and inefficiency, ramp up the number of appointments, scans and operations that the NHS performs, and give NHS patients greater choice, control and convenience. Any patient using the NHS can see the waste and inefficiency in the service when they use it. Staff feel it holding them back every day. When the Government announced significant investment in the Budget, I said that it would come with reform, so that every pound was well spent, and here it is. Resources will be diverted from hospitals to GPs, to get hundreds of thousands more patients cared for faster in the community. Patients will have the choice of whether they want or need follow-up appointments, saving a million pointless appointments a year. GPs will be able to directly refer patients for tests and scans, cutting out the middle man and speeding up diagnoses for patients across a wide range of conditions. For years, restaurants have been texting customers reminders of their bookings, giving them the chance to cancel or rearrange, to cut down on no-shows. The NHS will learn from the hospitality sector, do the same for patients, and cut around a million missed appointments every year as a result. In opposition, we said that investment in new and more productive ways of working would make a significant dent in waiting times. Today, we are announcing 17 new and expanded surgical hubs to run like Formula 1 pitstops and bust through the backlog. Community diagnostic centres will open at evenings and weekends so that patients do not have to take a time off work for their appointment, and can get diagnosed faster. We are rewarding trusts that cut waiting times fastest with extra capital investment as an incentive, and we are publishing a new agreement with the independent sector—the first of its kind for 25 years—to cut waiting times. Over the past 14 years, a two-tier healthcare system emerged in this country. People who can afford it are increasingly going private to skip the queue, while those who cannot are left behind. Working people are going into debt, and others are running fundraisers to pay to get an operation. Those stories belong in pre-war Britain. They should shame the Conservative party. I am determined to end two-tier healthcare in this country, so that whether you are the richest or poorest person in Britain, you get timely, quality treatment, free at the point of use. This new agreement will see more NHS patients able to choose to be treated in a private hospital where there is capacity, paid for by the state. More capacity will be available for people in working-class areas of the country, and for women stuck on gynaecology waiting lists. Where we can treat working people faster, we will, and we make no apology for doing so. Working-class patients in this country deserve the same choice, control and convenience as the wealthy expect—indeed, as we all expect from other apps and services that we use every day, but not the NHS. That is why we are also modernising the NHS app to put patients in the driving seat for their own care. If customers can choose when their Deliveroo meal will arrive, and be kept informed until it is dropped off, why should patients not be afforded the same service by the NHS? With this plan, they will be. Patients will be able to manage their appointments, book tests and scans, view results as soon as they are ready, and choose where they will be treated. We will cut down on letters that arrive in the post after an appointment, and give power back to the patient. In the past six months, we have ended the resident doctors’ strike and invested billions more in our health service, with the biggest investment in hospices and end of life care for a generation. We are delivering investment and reform in general practice to fix the front door to the NHS and bring back the family doctor, and we have started to get NHS waiting lists falling. This plan for investment and reform will press down harder on the accelerator and will change our NHS and the experience of millions of patients. It will put the NHS on the road to recovery, and I commend this statement to the House.

15:54:00

I am grateful to the Secretary of State for his typical courtesy in early sight of his statement, as well for his call last week. Indeed, it was earlier sight than I am used to because I was able to read most of it in the media before coming here, which was not unhelpful. I echo the Secretary of State’s comments in thanking and paying tribute to NHS and social care staff up and down the country, including those in my university hospitals of Leicester NHS trust, GPs and, indeed, all those in Chorley hospital, Mr Speaker, for all they have done over the festive period. They work full-on day in, day out every day of the year, but they particularly feel the pressure over the festive period when they are not able to spend it with their families, so it is important that we across the Chamber share our recognition of that. The Secretary of State set out clearly the challenges facing the system. We all know that clinical care, the NHS and social care must work well and as a whole for our health and care system to function, so it is right that his statement addresses both those issues. He also highlighted the challenges we face as an ageing society. We are all living longer, which is a good thing, but that brings challenges of care and more complex needs. Of course, that comes on top of the ongoing challenges of the legacy of the pandemic, which are still with us in many ways. In his comments, the Secretary of State referred to previous reforms. He opted not to reflect another point in Lord Darzi’s report: his positive remarks about our 2022 reforms, which the Secretary of State knows I took through this House and which laid the foundations on which he is now able to build. Given the serious and cross-party work we have done certainly on social care, I highlight that the challenge is real, and we must address both challenges swiftly. Before turning to the long term, I turn to the immediate and ask the Secretary of State a few questions about winter and the challenges the NHS is facing. We heard from the Minister before Christmas about the work being done for extra co-ordination and new data, but what extra capacity in beds specifically for the winter period has the Secretary of State put in place to help ease pressure? What additional capacity has he put into A&E? We always recognised that winter is challenging, and we always put in extra resource, support and capacity, so I would be grateful for an update. I would be grateful for an update from the Secretary of State on the pressure being felt in respect of the “quad-demic” of various challenges faced by the sector. Also, how many critical incidents have trusts declared since 1 December? I would be grateful if he could update us on the pressures being felt and the response to them in the light of the winter weather. In my Melton and Syston constituency in Leicestershire and in many constituencies across the country, we have seen extensive flooding, which has had an impact on our ambulance services in particular. Turning to reform and elective recovery, I want to support the Secretary of State where he is doing the right thing, and it is important that he is keen to pursue a bold and innovative agenda. It is in all our interests that he is bold, but I call for him to be more ambitious. Those are not words often spoken about him, and I suspect certainly not in No. 10, but I call for him to be bolder and to go further. That is because, as with so much from the Prime Minister with multiple relaunches of previous announcements, what we see here is yet another relaunch of a previous announcement. The difference is the former Secretary of State Sir Sajid Javid’s announcement from 2022 has been reheated and re-served up today. We delivered 160 community diagnostic centres with 9 million additional appointments, and we delivered 18 surgical hubs. How will the Secretary of State’s plan go beyond that? We worked with the independent sector to allow it to be used to help tackle backlogs. We improved technology and the kit available, with £6 billion of investment. The NHS app created during the pandemic was designed and redesigned by my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay) and his team to allow for regular updates. Again, it is right that the Secretary of State is updating the app, but how is he radically changing what was already in place? I certainly already receive text updates—as, I suspect, do others—on treatments and appointments, so my challenge to the Secretary of State is this: what is he doing that is fundamentally different? The key underpinning point in the former Secretary of State’s plan was on workforce, because none of this can be delivered without the staff to deliver and interpret tests. He set out his plan to grow the workforce, and we have record numbers of doctors and nurses, and increased medical school places. What is this Secretary of State’s plan to grow the workforce and deliver on his ambitions? Turning to social care, the Secretary of State will know—because I have said it publicly—that I will work constructively with him and the commission. He is right to highlight the challenges that Governments of all complexions have faced, including a Royal Commission, two Green Papers and a comprehensive spending review that did not deliver under Tony Blair and Gordon Brown. Similarly, Theresa May’s reforms did not deliver. We proposed reforms that were due to come in this year, but the Chancellor scrapped them. I think it is important that we look to the future and at how we can work constructively on social care. I say to the Secretary of State that we will enter into discussions with him and the commission in that spirit, but I challenge him on the pace of his ambitions. The sector is already under pressure, and that has been added to by the national insurance increases, which it does not yet know how it will pay. The real challenge for him is: why 2028? The sector is crying out for a faster pace—be bolder; be more ambitious—and we will work with him to deliver it. It takes a year-plus to deliver a diagnosis—we know the challenges. He has had 14 years in opposition; he should have a plan now. We will call out the Secretary of State when he gets it wrong or simply re-announces what is already happening, but he is right in his approach to social care and finding a way forward, and we will work constructively for the good of patients and all our constituents. Many of them already feel let down by promises broken by the Labour party over just the past six months, so I ask him not to break this promise, and to work with us, across the House, to deliver the change that our constituents deserve and expect us to work on together to deliver.

It seems to be the Conservative line across the board now to say, “You’ve had 14 years in opposition, so why haven’t you sorted it all out in six months?” I say gently that the Conservatives had 14 years in government, and it will take longer than six months to clean up their mess. Honestly, their contributions to discussions in this House might have more credibility and a stronger landing zone if they at least acknowledged their part in the deep mess and malaise that they have created over the past 14 years. None the less, on social care, I very sincerely and warmly welcome the Conservative party’s support for the independent commission. It is important, as a matter of principle, to try to establish in broad terms the level of consensus about what social care should look like and how it should be delivered to meet the needs of older and disabled people in the 21st century, with changing demography, changing challenges, changing pressures and a changing pace of technology, and about the balance of provision between the individual, the family and the state, and the balance of financial contributions for social care between the individual, the family and the state. Of course, those issues will inevitably be contested across the party political divide from one election to the next, but just as we have had broad consensus on the national health service since 1948, just as we have had broad consensus on state education since Rab Butler’s reforms, and just as we have mostly had broad consensus for much of the past century on how public services should be delivered, so too should we try to establish the same consensus on social care. That is not to say that we should agree on everything, but we should agree on as much as possible, because whether it was Gordon Brown and Andy Burnham in 2010 or Theresa May in 2017, we can see the extent to which party political wrangling, rancour and sometimes opportunism has sunk well-meaning attempts to grasp the nettle of reform. On the question of pace, I reassure people that in our first six months we have already legislated for fair pay agreements, delivered the biggest expansion of carer’s allowance since the 1970s, and immediately injected £86 million into the disabled facilities grant, with another £86 million to follow from April—£711 million in total over the next year—as well as the increased spending power for local government in the Budget and £880 million for social care specifically. With respect to the people who are saying, “Go faster”, I urge them to bear in mind that we have already done quite a lot in six months. We do not pretend that we have solved all the problems—we have not nearly solved all the problems—but that is not a bad start for a Government who are determined to show that we understand the pressures in social care today and are willing to deliver. The Dilnot proposals were very good technical responses to a question that Andrew Dilnot was set by David Cameron, but we should reflect on why it was that every single Prime Minister since Lord Cameron, including Lord Cameron himself, did not implement those reforms. There has always been something else in health and social care that has been more pressing and urgent. I am sure that Baroness Casey will consider the Dilnot proposals alongside all the other challenges and potential solutions to the wider issues in social care, but we are determined to respond at pace. That is why the first phase of the Casey commission will report next year, setting out an action plan throughout this Parliament. I hope that we can achieve broad consensus on those actions too. Turning to the winter situation, the right hon. Gentleman has asked what capacity there is. According to the latest figures, there are 1,300 more acute beds this year than last year. Of course, those figures flex up and down depending on pressures, but the pressures are enormous. The number of beds occupied by flu patients is much higher than this time last year—somewhere between three and four times higher. The number of adult beds closed due to norovirus has reduced in the latest figures, but it is still above last year, when 485 beds were closed—the latest figure is 666. On ambulance responses, we have seen many more call-outs this year. There has been a 3.8% increase in emergency admissions compared with the same period last year, with the highest November on record for A&E attendances. Ambulance response times are nowhere near where we would want them to be because of the enormity of the pressure, which is why I have been out on the frontline, including over the Christmas period. We are not just looking at what we can do to mitigate challenges this year; we are already beginning to plan for next year, because I want to see year-on-year continuous improvement in urgent and emergency care. I now turn to the challenges on the reform plans we have proposed and set out today. Starting with the workforce, one of the reasons we have emphasised the importance of not just investment but reform is the need to free up the staff capacity that we already have in the NHS to best effect. That means dealing with the number of non-attendances by sending reminders to patients and giving them ease and convenience in rebooking. It is why we are getting rid of unnecessary, low-clinical-value out-patient appointments, with the consent of patients in every case. It is why we are asking general practitioners to do more to manage cases in the community with more advice and guidance, and funding them to do so, working with colleagues in secondary care to ease pressure on hospitals. Today’s reform plan answers the challenge we have heard from people across the NHS: how do we tackle the elective backlog without doing so at the expense of general practice, urgent and emergency care, community care or social care? The truth is that this is a systemic challenge, and we will only be able to deal with the challenge in the elective backlog by also acting on urgent and emergency care, general practice, community care, and delayed discharges in social care. We are taking a system-wide approach to meeting this essential target. A number of things are different from under the previous Government. For example, on the deal with those in the independent sector, giving them the stability and certainty of working with this Government gives them the confidence to open and invest in new capital estate and new kit, particularly in parts of the country that are relatively underserved by the independent sector. We have insisted they do that with their own staff and resources, and that they put their money where their mouth is in relation to training new staff to deal with some of those pressures. That is how we will ensure that we will not be taking Peter from the NHS hospital to treat Paul up the road at the independent hospital. Finally—I am happy to take more questions on the detail of the plan—the shadow Secretary of State asked what is different from 2022? In fact, I think he asked me to commend my predecessor Sir Sajid Javid for his work in 2022. In the bipartisan spirit of the new year, let me commend the work that he and Sir Sajid Javid did in trying to undo Lord Lansley’s disastrous top-down reorganisation, and that was a very good thing to do. There will be a very big difference between this Government and our Conservative predecessors: real delivery, shorter waiting times and an NHS fit for the future.

Does the Secretary of State agree that his plan to transform adult social care services has already started with Labour’s Employment Rights Bill ensuring that social care workers will get fair national pay and conditions, and increased access to training and progression? Does he further agree that we will never have a quality social care service in this country if we do not value the people delivering it properly, as this Labour Government intend to do?

My hon. Friend is absolutely rightly. The Employment Rights Bill, introduced in our first 100 days, contains provisions for a new fair pay agreement for care workers, and who better to be leading the charge on that than the care worker turned Deputy Prime Minister, my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner).

I call the Liberal Democrats spokesperson.

I add my thanks to those of the Secretary of State and the shadow Secretary of State to all those who worked in our health and care services over Christmas and the new year. Our health and social care system is in crisis, so the Liberal Democrats are broadly supportive of the measures that the Government have announced today. However, we do have some concerns, not least that action on social care may arrive too late and that the focus on elective care may come at the expense of emergency care. The Liberal Democrats have long called for cross-party talks on social care, so we are glad that the Government have listened and we look forward to working constructively with the Secretary of State and other UK-wide parties as the review develops. However, carers, care providers and councils are on the brink of bankruptcy and they need solutions right now, not in three years’ time. There have been many such reviews, and what is needed now is action on the recommendations they have made. It is absolutely crucial that waiting times for elective care are cut radically, so the action announced today to speed up scans and treatment is very positive. A waiting list of more than 6 million people is one of the worst legacies left by the Conservatives, but those legacies include overcrowded A&Es and unacceptable ambulance delays, which can mean the difference between life and death, as people in North Shropshire know only too well. Emergency care is under immense pressure at the moment—one visit to Shrewsbury hospital demonstrates that—and we need bold action if we are to ensure that this is the last ever winter crisis. As the MP for a rural area, I hear every week from constituents suffering because of the crisis, so they will be following today’s developments closely. Many of my constituents are elderly—far more than average—and they are the people most likely to need the NHS and the most likely to be digitally excluded. According to Age UK, around 29% of people aged 75 and over do not use the internet, and around a third do not have a smartphone. They deserve as much choice and control as everybody else, so can the Secretary of State outline how those without access to the NHS app will be able to benefit from the same options and information as those who do have access? Will the Secretary of State consider fast-tracking the social care review so that the sector can get the urgent attention it needs? Will he commit to rescuing our emergency services by supporting Liberal Democrat calls to make the NHS winter-proof with a new winter taskforce that builds resilience in hospital wards, A&E departments and patient discharging? Finally, will he define what a working-class area is, because the health and care crisis is acute in rural Britain and we cannot afford to be left behind?

I thank the Liberal Democrats for their support for the commission and for the way in which their party has put the issue of social care much higher up the political agenda, particularly during the general election campaign. That has been very helpful to me in the last six months and to the Government, and we look forward to working with the Liberal Democrats to build as broad a consensus as we can on the solutions to the social care crisis. As I have mentioned, we have hit the ground running in a number of respects, including the biggest expansion of carer’s allowance since the 1970s. On investment in health and social care, I just point out that the £26 billion the Chancellor allocated to the Department of Health and Social Care alone at the Budget dwarfed what the Liberal Democrats promised in their manifesto. I know that not all the funding decisions the Chancellor and the Government have made in the last six months for the desperately needed investment in our public services have been popular, but I respectfully say to people who disagree with the decisions the Chancellor has made that they need to spell out which services they would cut or which other taxes they would increase, because those are the choices. We have made our choices; we stand by them. What people cannot do is welcome the investment but not say how they would fund it if they oppose what we have done. The Prime Minister, the Chancellor and the entire Government have been willing to make unpopular choices in the last six months because we believe they are the right choices to get Britain out of the hole it was left in by our predecessors. People will not thank us for resorting to the short-termist, sticking-plaster, government-by-gimmick politics that plagued this House during the last Parliament. I turn to some of the other issues that the hon. Lady mentioned. We will make further proposals on urgent and emergency care reform. I want to take the best of the NHS to the rest of the NHS, whether it is “hear and treat” over-the-phone triage—a more appropriate community response that is often faster than ambulance response times—or getting ambulances and ambulance handover speeded up at all our hospitals with the “release to respond” approach. We have seen that working successfully in some parts of the country, but it needs to be consistently rolled out. The hon. Lady talked about patient choice for those who are digitally disconnected or do not want to organise their lives around their smartphones. That is why I believe very strongly in choice—different courses for different horses. Those of us who do not book appointments over the phone free up the line so that those who prefer doing their business and booking appointments by phone can get through. The hon. Lady asked us to fast-track the social care work. The first phase of Louise Casey’s commission will report next year, but we are of course willing to talk to parties across the House about how we move forward. The hon. Lady urges us to set up an urgent and emergency care taskforce. Let me reassure her that the Minister of State for Health my hon. Friend the Member for Bristol South (Karin Smyth) and I have every week—and often more frequently—convened health and care leaders virtually and in the Department to keep a grip on what is going on, to provide as much central support as possible, and to respond to crises as they emerge. If only that was just about setting up a taskforce. We already have one; what we need is sustained improvement from one year to the next and that is what we are determined to deliver.

May I suggest that we help each other by asking short questions—with short, punchy answers, I am sure? Ben Coleman will set a good example.

Mr Speaker, I take that personally, in a positive way. This is a very encouraging statement. It is great to start the new year with some good news and to be so clear that we are keeping our promises as a Government. It is also very good that we are taking the necessary time to create this cross-party consensus on social care while keeping the show so firmly on the road. Carers will be supported to carry out more health tasks, as they do already in my constituency with wound dressing and medicine management. The problem is they do not have any possibility of career progression. [Interruption.] I am sorry, Mr Speaker, I forgot your initial encouragement; I will bring this to a close. Does the Secretary of State agree that as carers are encouraged to do more health tasks, they need proper opportunities for career progression even within the NHS, in collaboration with local authorities?

Brevity was not my hon. Friend’s new year’s resolution, but at your encouraging, Mr Speaker, it is mine. We will provide more training to care professionals to deliver a wider range of tasks in the home, making better use of their skills and the career progression that my hon. Friend describes. Crucially, that career progression must be in status and in pay. That is what we will work with the staff to deliver.

I call the Father of the House.

I welcome the consensual parts of the Secretary of State’s statement, but I wonder whether we have been entirely honest with the public about the sheer unaffordability of the cap proposed by Dilnot. I do not absolve my own Government from this: maybe we should start telling the truth to the public. Does the Secretary of State think we need a new social compact on bringing in social insurance so that people can plan for their entire life? They would know that they will have to pay more in taxes during their life for their old age, but at least they would have certain rights.

The right hon. Gentleman is right to say that we need a debate as a country about the balance of financial contribution between the individual, the family and the state. I well understand why David Cameron was so concerned about catastrophic care costs and people having to sell their homes to pay for their care and the problem he was trying to solve. With every Government since, the issue has been seen as less urgent than others, but that does not mean it does not matter or that we should not consider it as part of the Casey commission. We need to consider all these issues in the round and, as much as we can, build a consensus not just in this House, but throughout the country about the balance of financial contribution and what is fair, equitable and sustainable.

Just before Christmas, one of my constituents visited my surgery and gave me pause to reflect on the massive, often lifelong impact on loved ones who have someone in the social care system, and the devastating impact on their ability to work and to live healthy, fulfilling lives. Does the Secretary of State agree that the commission will lay the foundation for real change so that people in the social care system and their families can live the healthy, fulfilling lives they deserve?

I strongly agree with my hon. Friend, who has done much already in the past six months to champion social care. Whether people are in residential care home settings or we are doing everything we can to ensure that they can stay in their own homes, everyone deserves to live comfortably, well supported, with independence and with dignity. That is why the steps we are taking, particularly through the disabled facilities grant, will be immediately impactful on thousands of people across the country in just the next three months. We have so much more to do, and that is why I am genuinely excited by the work of the commission.

I call the Chair of the Select Committee.

Given that the Health and Social Care Committee’s first inquiry is “Adult social care reform: the cost of inaction”, we welcome any action. As the name of the inquiry suggests, we are concerned about the length of time taken, because every year without reform costs money, not only to the NHS, but to the wider economy and in people’s lives. We have Andrew Dilnot in front of us on Wednesday, and it is 14 years since his report, which has been put into legislation twice. I ask the Secretary of State to be specific: what will stop the next iteration of the Committee having Louise Casey in front of it in 15 years’ time? What will be different this time, so that we get that cross-party consensus and it sticks?

That is a great question. First, I will put on my shin pads and crash helmet if Andrew Dilnot is in front of the hon. Lady’s Select Committee this week. I can well understand his frustration. He is a decent man who did an excellent piece of work. It must be frustrating to see one Government after the next not implementing something that was welcomed. The issue for us as an incoming Government is that the money was not there, and even if it had been, the system had not been set up to deliver for the October 2025 deadline. We chose to act on other immediate pressures in other areas, because we saw those needs as more pressing. That does not mean for a moment that I think Andrew Dilnot’s work is no longer valuable—I think it might well be. However, we have to consider the issues in the round and come up with a clear and sustainable plan that we can stick to. On why the Casey commission will be different and will work, it is important to have as much political consensus around the House as possible. The national consensus and getting the public on board will be important. Anyone who has ever met Louise Casey will know she is a difficult woman to say no to. I have no doubt that if Louise Casey says something needs to be done, this Government and future Governments—whoever is in government—will make sure that it happens.

Happy new year, Mr Speaker. Yesterday and over the Christmas recess I was working shifts in my local A&E at St George’s in Tooting. Up and down the country, doctors like me were seeing older and disabled patients who could not be discharged from hospital due to a lack of good, affordable social care in the community, so I welcome the steps that have been outlined. What steps will the Secretary of State outline to ameliorate the imminent pressures sooner?

I thank my hon. Friend for the work that she does on the NHS frontline, particularly when Parliament is in recess but often alongside her everyday work as a Member of this House. It is truly above and beyond the call of duty. She sees at first hand the pressures and failures that the NHS is experiencing. My hon. Friend is right about delayed discharge. In fact, when I was at Burnrigg Court, a residential care home in Carlisle, last week, I saw wonderful ensuite room facilities with people in intermediate NHS care—there are NHS-funded beds in those care homes—and those people were in better settings at half the costs of the hospital beds they left behind. Delivering better care in the right place at the right time is often not only great for patients but better value for taxpayers. That is why I will be reforming the better care fund to ensure that we make good use of NHS and social care budgets together to get people out of hospital as quickly as possible, freeing up vital bed capacity for others.

I congratulate the Secretary of State on taking community diagnostic hubs and expanding their hours, which is something that the last Conservative Government established. Will he outline what impact that will have on his workforce plan and expand on that? Have the unions accepted the extra hours—they are not excessive by any stretch—that he has proposed? Will he have a serious conversation with me, please, about Fareham community hospital, which has space for a community diagnostic centre that would be welcomed by my constituents in Hamble Valley?

Persistence pays off: I would be happy to receive representations from the hon. Member about his local hospital and the potential to provide more community diagnostics. On the workforce, when we were consulting on this in opposition, we found a real willingness on the part of NHS staff to put in the extra hours, so long as they are fairly remunerated, which they will be. I am grateful for the investment that the Chancellor has provided to enable us to do that. NHS staff want to see progress to beat the backlog. They are as frustrated as anyone else—and demoralised, actually, at work—seeing people waiting for so long, so I have no doubt about their willingness to assist. I am looking forward to working with NHS staff across the country so that we can all feel that together we are delivering an improving NHS.

We are going to finish at about 10 to 5, so the speedier we go, the more that will help.

I thank NHS staff for working under severe duress over this winter. One way of ensuring better patient flows is to have better rehabilitation, so will my right hon. Friend say what he is doing to improve rehabilitation access not only in acute sectors but out in the community?

Further to the previous question, we will be refreshing and updating the NHS workforce plan alongside the long-term plan that we will publish in May, and my hon. Friend is right that rehab is key not just to good recovery but to prevention of future demand on the NHS. I saw a great example of that rehabilitation delivered in social care settings only last week. Whether in the NHS or in social care, we definitely need to do more on rehabilitation, because rehabilitation is often secondary prevention.

I agree with the Secretary of State that community-based services are crucial. My local NHS trust contacted me in the week before Christmas about Hereford community diagnostic centre, which is currently in the process of being built. It was told to be ambitious with this project, but in December it was told that only a sixth of the funding that it needs is available. Does today’s announcement mean that the Government will fully fund Hereford community diagnostic centre?

We will certainly write to the hon. Member with further information about Hereford CDC. On capital investment, I say to her and to other right hon. and hon. Members that we were very pleased with what the Chancellor was able to deliver in the Budget. We recognise that the stop-start we saw on a number of capital programmes under our predecessors was frustrating and we are determined not to repeat that. That is why we are setting out clear and consistent proposals for capital investment in the NHS.

Last summer we celebrated the 25th anniversary of the elective orthopaedic centre in south-west London. The driving force behind that was Professor Richard Field, who came to my surgery every week after the 1997 election. With the help of the Prime Minister Tony Blair and the late Health Secretary Frank Dobson, he made it real. It has the lowest blood use rate for hip and knee replacements, the shortest stays and lowest levels of infection. Will my right hon. Friend congratulate Professor Richard Field and agree that his elective hubs are the way to cut waiting lists?

I warmly congratulate Professor Richard Field on his clinical leadership, which has made a difference to countless lives, not only in my hon. Friend’s part of London but because of the national example that he set, which many others followed. That confirms my strong conviction that the best innovations will come from great clinicians. It is our determination to make sure that senior leadership in the NHS and in government back great clinical leadership and innovation, and take the best of the NHS to the rest of the NHS.

The Secretary of State said that 12,000 patients had to stay in hospital beds because of a lack of social care, yet we have it kicked down the road once again. What will Louise Casey tell us that we do not already know about the tough political trade-offs that have led successive Governments to fail to create a truly coherent health and social care system, and what will he do to make sure that we meet needs today, as he exemplified in November?

Once again, the arsonist is complaining that the fire brigade is not doing a quick enough job. We are a bit sick of it on the Government Benches, but we are at least rolling up our sleeves, getting on with the job and making improvements, and we will continue to do that. I heard the same complaints about Darzi: “What can Darzi tell us that we did not already know?” Quite a lot, actually. The Conservatives should hang their heads in shame for it.

I thank the Secretary of State for his clear commitment to action. There are 131,000 vacancies in the social care sector, and low wages are the prime culprit. Last year, Unison found that three quarters of care staff who do home visits continue not to be paid for journey times between appointments. Will my right hon. Friend commit to ensuring both a £15-an-hour minimum wage in the social care sector, and paid travel time as a contractual requirement?

I thank my hon. Friend for that question. I am a proud member of Unison, and I am proud of its work to stand up for its workforce in the social care sector. She and Unison are absolutely right to argue that fair pay is essential to recruitment and retention. That is why I am delighted that the Deputy Prime Minister included fair pay agreements in the Employment Rights Bill in the first 100 days. I am looking forward to working with Unison, GMB and others to negotiate the first ever fair pay agreements for care professionals in this country.

I would appreciate it if the Secretary of State could unpack a phrase in his statement. He said: “Where we can treat working people faster, we will”. That phrase is ripe for misinterpretation. Please could he explain what that means? Does it mean stay-at-home mums waiting for an appointment, and family carers, 26% of whom are on waiting lists?

It does. I was talking about the fact that working class people are often left behind in a two-tier system where those who can afford it pay to go private, and those who cannot are left behind. It is the determination of this Government to bring back to life the essential Bevanite principle of an NHS that is there for everyone when they need it: healthcare available to all on the basis of need, not on ability to pay.

I welcome the commission, which hopefully will lead to some certainty on the future of social care. However, a 2023 National Audit Office report found that 17% of local authority directors of social services were concerned about their ability to meet statutory obligations last year, and a further 18% are concerned about their ability this year. I have concerns about what will be done to fix the immediate crisis in social care. Will my right hon. Friend outline what he will do to guarantee the sustainability of our care system now, while we await the further structural reforms that we dearly need?

I am grateful to my hon. Friend for his question. That is why in the Budget the Chancellor delivered a big uplift in the spending power of local authorities, with £880 million ringfenced specifically for social care. We are also delivering through measures such as the disabled facilities grant to deal immediately with the pressures—[Interruption.] It is no good the right hon. Member for Beverley and Holderness (Graham Stuart) complaining. He voted against the investment, so he cannot very well complain about it.

The previous Labour Government did a hatchet job on community hospitals, including in Wiltshire, with a consequent uptick in the amount of delayed discharges in the acute sector, notably at Bath, Salisbury and the Great Western in Swindon. Will the Casey commission look at that and find ways of unpicking the damage that was done?

The previous Labour Government delivered the shortest waiting times and the highest patient satisfaction in history.

There are very worrying reports of cash-strapped universities reducing the numbers of clinical academics; indeed, some are being made redundant at a time when there is increased demand for doctors. Does the Secretary of State agree that this is an extremely concerning development?

Clinical academics have an important role to play in the national health service and in innovation in medicine. My right hon. Friend the Secretary of State for Education is focused on university finances, and I think universities should ensure that they prioritise efficiently and effectively, making best use of the resources available to them. I would gently say that universities have not struggled as much as other parts of the public sector over the past 14 years.

During 14 years of austerity, the NHS has been starved of the resources it badly needs. Four months ago, the Secretary of State for Wales made a big announcement about cross-border NHS partnership to tackle waiting lists; however, the First Minister of Wales later poured cold water over the idea, and today’s plan for England does not mention Wales. Was this so-called partnership ever real, or was it just another empty promise?

By definition, an elective recovery plan for England does not include Wales. However, I can assure the hon. Lady that we have a great working relationship with Jeremy Miles, the Health Minister in the Welsh Government, and with the First Minister herself. Not only are we providing support to the Welsh Government on elective reform to help them to cut waiting lists and waiting times, but we are receiving advice from the Welsh Government on areas where health and social care services are doing better than in England. Together, we will create a rising tide that lifts all ships across the UK.

Bassetlaw has an increasingly older population, with 22% now over the age of 65. As the needs of my constituents change, I welcome the additional £198,000 in funding for local disabled facilities grants. Does the Secretary of State agree that it is vital to shift care out of our hospitals and into our community?

I am so grateful to my hon. Friend for her question and for championing that issue since she arrived in the House six months ago. The disabled facilities grant is not just about new handrails, new ramps, new accessible kitchens and bathrooms and home adaptations; it is about freedom, independence, dignity and happiness. It is really good investment in preventing demand on other health and care services by giving people back their own independence and happiness.

My constituents will welcome the opportunity to get more services delivered through their GP surgeries, of which there are many excellent examples in West Worcestershire, and through community hospitals. However, I hear from those very same GP surgeries their concerns over the national insurance rises, and how that is leading them to think about reducing services. When will the Secretary of State be able to square that circle?

Before Christmas—I appreciate that it was just before, but I wanted to get out the certainty to general practitioners before we all went off for Christmas—we announced the biggest uplift in funding for general practice in a considerable number of years, and we will now negotiate the contract in the usual way. That should give general practitioners the stability and certainty to know that this Government are determined to fix the front door to the NHS. The other thing I would say to the Opposition is that they cannot continue to welcome the investment while opposing the means of raising it, unless they spell out which services they would cut or which other taxes they would increase. They do not have an answer; they do not have a leg to stand on.

I warmly welcome the Secretary of State’s statement, and his emphasis on investment and reform. Will he say a little more about the important role of training for staff and investment in new technologies such as AI to speed up diagnostics?

Of the many great possibilities and opportunities facing this country are our strengths in life sciences and medical technology. If we can combine the strength of our scientific and technological base with the ingenuity and care of our NHS staff and our ability to deliver at scale with the model that was designed in 1948, which is well served to take us well into the 21st century, the sky is the limit for what we can achieve. We will have to support staff through that revolution. I appreciate that for many staff working in the NHS today they would be grateful if the machine simply turned on when they turned up for work.

I am concerned about the lengthy timescale set out in the social care review, with the second phase not due to report until 2028. The care system is broken and it particularly affects rural areas such as Glastonbury and Somerton. For example, a resident in Castle Cary, a 105-year-old D-day veteran, is facing moving care homes due to high care costs. This will have a negative impact on his health, wellbeing and quality of life. What actions will the Secretary of State take in the near term to reform the social care sector and provide older people with the dignity they deserve?

I am very grateful for that question for two reasons. First, it gives me the chance once again to say that the first part of the Casey commission will be reporting next year, so we can set out a whole range of further actions that will be needed throughout this Parliament. We have taken a great number of actions already in the first six months and I dare say there will be more to follow in the next 12 months. I must say it is very encouraging that one thing we are hearing from across the House on the Casey commission overall is to go faster. I think that shows genuine cross-party appetite on this issue and that is a really good place to start.

I welcome the Secretary of State’s commitment to tackling the backlog of appointments—all our constituents would benefit from that—and his honest recognition that there is a risk, because there are not two separate workforces. Unless we have sensible safeguards, we could end up paying the same NHS doctors more to do operations in the private sector. The Secretary of State for Education set a cap on the profits that can be made in the children’s care sector. Is the Secretary of State considering a similar cap to protect the NHS and ensure value for money in his work with the independent sector in the NHS?

I am grateful for that question. I am not sure that the level of exploitation in either independent healthcare or adult social care mirrors what we have seen, disgracefully, in children’s social care, but we keep a sharp eye on that. I remind my hon. Friend of the commitments we made in opposition around tackling the excesses and the worst kind of behaviour of some private equity-owned care homes that are leeching money out of the system. We will not tolerate that. We will act to regulate further. I hope that provides Members across the House with the assurance that we are taking both a principled and a pragmatic approach to the constructive and positive relationship we want to build with the independent sector, as we rebuild our national health service and build a national care service we can be proud of.

I would love to see a consensus evolve on social care. I welcome the Secretary of State’s appointment of Louise Casey and the talk about the balance between the individual family and the state. However, in every fiscal event that I was part of in the Treasury, more money was put into the NHS, so I respectfully ask the Secretary of State this: what does he say about wide variance in performance across the NHS? Secondly, what does he say about consumption patterns? I understand his emphasis on the Deliveroo concept, but we have to come to terms with the fact that most GPs would say that they have excessive demand from people who do not really need to see their GP. That is a delicate and difficult subject to grasp, but one that we really must grasp, collectively, in this place.

I am grateful for that thoughtful question. Let me say two things to the right hon. Gentleman. The first relates to the wider fiscal pressures on the Chancellor. I find it difficult enough to manage the different choices and trade-offs to be made between different parts of health and social care and the competing challenges that I hear from Members in all parts of the House, so I am always thankful that I am not the Chancellor of the Exchequer, who has to balance demands from the NHS alongside the demands of education, a rising welfare bill, rising child poverty and the threats to our nation. These are enormous challenges, which is why I am determined to ensure that every penny that goes into the health service is well spent. My second responsibility, in addition to ensuring that patients are treated at the right time, in the right place and in the right way, is ensuring that we have a sustainable healthcare system in which there is reduced demand. That means doing more on the prevention side, so that we can keep people out of hospital and not needing to knock on the door of their GP surgery, so that they do not achieve the frequent flier status in the NHS that so many people do achieve—the one frequent flier status to which they do not aspire. We can deal with this only through both health service reform and public health reform, and I want very much to build cross-party consensus on the latter.

Order. That was a very lengthy answer.

Just before Christmas, I met care workers in my constituency, who told me about the day-to-day work that they do supporting the most vulnerable people in our community. Does the Secretary of State agree that just as access to GPs helps to relieve pressure on hospitals and A&E departments, an adequate number of adult social care workers will help to relieve the pressure on our GP services, which also have to deal with huge demand?

I wholeheartedly agree with my hon. Friend, who has done much to bang the drum on this issue during the six months in which she has been a Member of this House. That is why we are taking a systematic approach to health and social care reform.

I thank the Secretary of State for advance sight of his statement, and for writing to the leader of my party. I am sure that the Scottish Government will co-operate and engage fully with Baroness Casey as she does her work. The Secretary of State spoke of failure. One such failure—the elephant in the room, in fact—is the labour shortages that the NHS and social care are experiencing as a result of Brexit. I ask him not to pass the buck, but to tell me what steps he will take, after consultation with Cabinet colleagues, to address those shortages by making it easier for migrant workers to come to this country and fill the vacancies.

We had a referendum and two subsequent general elections on the issue of Brexit, and I can tell the hon. Gentleman that none of those three democratic events went the way that I wanted. As we said to people at the time, the country chose a path that would have consequences and implications. However, we have a constructive working relationship with our friends and allies in the European Union, and while we cannot change the past, we can build a new partnership and a brighter future for our country.

As my right hon. Friend will know, a large number of elderly people are admitted to hospital, through A&E, with respiratory conditions. What plans does he have to strengthen the community respiratory teams, who do a great deal of good work but could do more work, if they had the resources, to prevent admission, and certainly readmission?

My hon. Friend is right, and that is why the vaccination campaign has been so important this winter. He is also right about the importance of community-based teams. One of the Darzi conclusions was that since 2019, we have significantly increased staffing in our hospitals, but because we had the wrong people in the wrong place, we ended up with falling productivity in hospitals. We need a shift out of hospital into the community, which is what our 10-year plan will deliver.

Most residential social care in England is delivered by the private sector. Is the Secretary of State able to give local authorities the resources necessary to allow them to reopen residential care facilities, or to open the new facilities that are so desperately needed? Will he assure me that in the review that Baroness Casey is undertaking, the primary objective will be the delivery of a public sector national care service, not a privatised service?

Thanks to the decisions taken by the Chancellor in the Budget, we are boosting the spending power of local authorities significantly, and £880 million has been ringfenced specifically for social care. I appreciate that a single Budget cannot undo 14 years of Conservative failure, but this is an important start, and of course we want year-on-year improvement in the delivery of social care. Baroness Casey will consider all these issues, and also how we can improve ease of access and care quality across the public and private sectors.

I strongly welcome the Government’s action to help my constituents in Leyton and Wanstead get the care that they need faster. Our local hospital, Whipps Cross, continues to struggle, despite the hard work of its staff and leaders, NHS workers and carers, who continued to provide services to our community over Christmas. In November, 36% of patients at Whipps waited more than four hours for emergency care. In recent weeks, 16% have waited longer than 12 hours. Does my right hon. Friend agree that this welcome package of long-term reforms will address both elective care and emergency care for our constituents by moving the effort from hospital to the community?

My hon. Friend is absolutely right about that. If we improve the service at Whipps Cross hospital for his constituents, it will have the added benefit of improving the service at Whipps Cross Hospital for my constituents, too.

What is missing from today’s announcement is any sort of update on the new hospitals programme review, which is vital in my constituency of South West Devon, because Derriford hospital needs its urgent and emergency care centre to bring down ambulance waiting times before it can even start to tackle its general waiting list issues. When will Derriford hospital hear whether it has been successful in the new hospitals programme review?

I was grateful to staff at Derriford hospital for showing me at first hand the emergency department pressures when I visited just before Christmas. I have also visited Derriford at the height of summer, when it experiences high pressures. There are year-round difficulties at Derriford, and I thank the staff and leadership of the hospital for what they are doing in difficult circumstances. We will come forward shortly with the timetable for the new hospitals programme. I expect that it will be published sooner than the Conservatives apologise for their appalling record.

I welcome my right hon. Friend’s statement, but can he expand a bit more on the new agreement with the private sector? For example, he mentioned that the surgical hubs will be delivered solely by the private sector, but what arrangements will there be for emergency care, when the occasion arises?

Some of the new capacity announced in today’s elective reform plan will come through the independent sector, and some of that new capacity will be in the NHS. It is our ambition to rebuild the NHS so that it is available for everyone where and when they need it, and we will work with the independent sector. We are publishing full details of our independent sector agreement, so that people can see the deal that we have reached, and the sensible and effective partnership, including safeguards and protections, that we have come to. I look forward to working with the sector to make sure that everyone, whatever their income and background, can get faster access to care.

When the Casey review reports, if its recommendations are implemented, it will have a significant impact on local government. As the Secretary of State will be aware, large parts of the country are going through local government reorganisation, and the outcomes of the Casey review will determine the right reorganisation for those areas. In the best interests of joined-up government, to use an old Blairite phrase, is there any way to bring forward the review, so that the best choices for local government reorganisation can be made?

I can definitely reassure the right hon. Gentleman that the Deputy Prime Minister and I are working very closely on this issue, which is close to her heart; she has a huge amount of experience in this area. We will follow her progress as she embarks on her local government reforms. Baroness Casey will take those reforms into account when she considers what the long-term future for social care will look like. Once again, I note the exhortation to go faster.

When I raise concerns about GP appointments, GPs tell me that they have difficulty recruiting to posts in their practices. Too few newly qualified doctors choose general practice as their profession. What can we do to get those doctors in place, so that we can make diagnostics in the community work?

That is an excellent question. Having put in place funding to ensure that there are 1,000 more GPs on the frontline before April, and having announced just before Christmas a significant uplift for general practice, I hope that in the first six months of this Government, we have sent the strong message to people who aspire to long careers in medicine that general practice has a huge role to play in the NHS in the 21st century. It is an exciting place to be, but I recognise that we have to fix the front door to the NHS to make it more attractive. The situation is even worse than my hon. Friend has described, because when the Conservatives left government, there were qualified GPs unable to find jobs, at a time when patients were unable to find GPs. We got to work on that issue within weeks of taking office, and we will do more over the next 12 months.

It is good to hear the latest announcements on overhauling the increasingly costly care for older and disabled people, and I very much welcome what the Secretary of State has said. I understand that this will happen through a three-year review, and that we will be clearer on the plan to introduce this in 2028. Health is devolved to Northern Ireland, but thousands of care packages in Northern Ireland are not fulfilled. What can he do to assist Northern Ireland in achieving its goals? Goals that are set here for England and the United Kingdom need to be in place in Northern Ireland as well.

The ministerial team and I have enjoyed working with counterparts in the devolved Governments over the last six months, and we will continue to do that. Thanks to the decisions that the Chancellor took in the Budget, we see significant investment in health and care services here in England, and the Barnett consequentials will create a rising tide that will lift all ships across England, Wales and Scotland. I might even say that all roads lead to Westminster. I say this to Scottish National party colleagues: down the road to Westminster lie the resources for the SNP Government, so they do not have an excuse not to act.

I am sorry that we could not get everybody in. I tried to go as fast as I could. The names of those who did not get in have been noted.