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Health and Social Care Update

Volume 719: debated on Thursday 22 September 2022

I am pleased today to set out to Parliament our plan for patients. As the Prime Minister said on the doorstep of Downing Street, she had three clear priorities: growing the economy; tackling energy security and support for households and businesses; and the NHS, with patients being able to get a GP appointment.

Patients are my top priority and I will be their champion, focusing on the issues that most affect them or their loved ones. Most of the time, patients have a great experience, but we must not paper over the problems that we face. We expect backlogs to rise before they fall as more patients come forward for diagnosis and treatment after the pandemic, and the data shows, sadly, that there is too much variation in the access and care that people receive across the country.

The scale of the challenge necessitates a national endeavour. As we work together to tackle these immense challenges, I will be proactive, not prescriptive, in our approach as we apply a relentless focus on measures that affect most people’s experience of the NHS and social care.

Today, we are taking the first step in this important journey by publishing “Our Plan for Patients”, which I will lay in the Libraries of both Houses. It sets out a range of measures to help the NHS and social care perform at their best for patients. The plan will inform patients and empower them to live healthier lives; place an intensive focus on primary care, the gateway to the NHS for most people; use prevention to strengthen resilience and the health of the nation; and improve performance and productivity.

To succeed, we will need a true national endeavour, supported by our making it easier for clinical professionals to return to help the NHS, as well as drawing on the energy and enthusiasm of the million people who volunteered to help during the pandemic by opening up opportunities for them to help in different ways. That could be by becoming a community first responder, or by, for example, strengthening good neighbour schemes across the country. We will also explore the creation of an ambulance auxiliary service.

The plan sets out our work on the ABCD of priorities that affect most people’s experience of the NHS and social care. First, on ambulances, I want to reduce waiting times for patients and apply a laser-like focus on handover delays, so that ambulances get back on the road and to patients, where they are needed most.

Our analysis shows that 45% of the delays are occurring in just 15 hospital trusts. That is why the local NHS will be doing intensive work with those trusts to create more capacity in hospitals—the equivalent of 7,000 more beds—by this winter through a combination of freeing up beds, with a focus on discharge, and people staying at home and being monitored remotely through the sort of technology that played such an important role during the pandemic. In addition, when patients call 999, the speed of answering is critical, so we will increase the number of call handlers for both 999 and 111 calls.

Next is the backlog, where the waiting list for planned care currently stands at about 7 million, exacerbated by the pandemic. This summer, we announced that we have virtually eliminated waits of over two years, and we remain on track to reach the next milestones in our plan. To boost capacity, we are accelerating our plans to roll out community diagnostic centres as well as new hospitals, and we will maximise the use of the independent sector to provide even more treatment for patients.

As well as capacity, we are also getting more people on the frontline, making it easier for people to work in and help the NHS. We know that people are leaving the workforce for a variety of reasons. We have listened, and we are responding and addressing a number of those reasons. For instance, pension rules can currently be a disincentive for clinicians who want to stay in the profession or to return from retirement and help our national endeavour. We will correct pension rules relating to inflation; we will expect NHS trusts to offer pension recycling; and we will extend until 2024 measures that will allow people to stay or return to the NHS.

I can announce today that we will extend the operation of the emergency registers for health professionals for two more years. That is, of course, on top of commitments to boost the health and care workforce, such as our manifesto pledge to recruit 50,000 more nurses by 2024. That will sit alongside the design and delivery of our forthcoming workforce plan.

C is for social care. At the moment, one of the key challenges is discharging patients from hospital into more appropriate care settings to free up beds and help improve ambulance response times. To tackle that, I can announce today that we are launching a £500 million adult social care discharge fund for this winter. The local NHS will be working with councils with targeted plans on specific care packages to support people being either in their own home or in the wider community. That £500 million acts as the down-payment in the rebalancing of funding across health and social care as we develop our longer-term plans.

I know that there is a shortage of carers across the country. We will continue to work with the Department for Work and Pensions on a national recruitment campaign. In addition, since last winter, we have opened up international recruitment routes for carers. We will support the sector with £15 million this year to help to employ more care workers from abroad. We are also accelerating the roll-out of technologies such as digitised social care records, which can save care workers about 20 minutes a shift, freeing up time for carers to care.

Finally, D is for doctors and dentists. I am determined to address one of the most frustrating problems faced by many patients: getting an appointment to see their doctor, or getting to see a dentist at all.

Starting with doctors, we are taking five steps to help make that happen: first, setting the expectation that everyone who needs a GP appointment can get one within two weeks; secondly, opening up time for more than 1 million extra appointments, so that patients with urgent needs can be seen on the same day; thirdly, making it easier to book an appointment; fourthly, publishing performance by practice to help to inform patients; and fifthly, requiring the local NHS to hold practices to account, providing support to those practices with the most acute access challenges to improve performance.

Clearly, clinicians are best placed to prioritise according to the clinical need of their patients. In July, 44% of appointments were same-day appointments, but too few practices were consistently offering appointments within a fortnight.

To help free up appointments, we will ease pressures on GP practices by expanding the role of community pharmacies. I am pleased to announce that we have agreed a deal for an expanded offer over the next 18 months. Pharmacists will be able to prescribe certain medications rather than requiring a GP prescription. As well as other measures involving community pharmacists, we estimate that that will free up 2 million appointments. We are also changing funding rules to give freedoms to GPs to boost the number of staff to support their practice. We estimate that that measure could free up 1 million GP appointments.

For patients, we will make it easier for them to contact their practice, both on the phone—we are making an extra 31,000 phone lines available this winter, followed by further deployment of cloud-based telephony—and online, particularly through the NHS app. As I set out, we will also correct pension rules so that our most experienced GPs can stay in practice. By extending the emergency register, we are creating opportunities for people other than GPs to undertake tasks such as vaccinations.

On dentists, there are too many dental deserts. That is why we are setting out an ambition that everyone seeking NHS dental care can receive it when they need it. We have already started changing the dental contract to incentivise dentists to do more NHS work and take on more difficult cases. I pay tribute to my predecessors in this role for their success in beginning to tackle this long-standing issue.

We will also streamline routes into NHS dentistry for those trained overseas so that they can start treating patients more quickly. We will make it a contractual requirement for dentists to publish online whether they are taking on new NHS patients.

These measures, across a number of important areas, are the start, not the end, of our ambitions for health and care. They will help us to manage the pressure that health and care will face this winter and next, and they will improve these vital services for the long term. My priorities are patients’ priorities, and I will endeavour, through a powerful partnership with the NHS and local authorities, to level up care and match the expectations that the public rightly have. Whether you live in a city or a town, in the countryside or on the coast, this Government will be on your side when you need care the most. I commend this statement to the House.

I welcome the Secretary of State and her team to their new posts. I thank her for advance sight of her statement, but if any evidence were needed of a Government and party out of ideas, out of time and without a clue about the scale of the challenge that our country faces, the statement would be it.

The NHS is facing the worst crisis it has ever seen, with patients waiting longer than ever before in A&E, stroke and heart attack victims waiting an hour for an ambulance, and 378,000 patients waiting more than a year for an operation—and that was in the summer. We have gone from an NHS that treated patients well and on time when Labour was in office 12 years ago to an annual winter crisis, and now a year-round crisis under the Conservatives. But don’t worry: the Health Secretary has a grip on the key issues. She does not have an answer on the workforce, but she has sorted out the Oxford comma. I am sure that the whole country is breathing a sigh of relief about that.

The Health Secretary promised a digital revolution in the NHS. Well, Conservative Health Secretaries have promised a digital revolution 17 times since 2010. [Interruption.] Oh, apparently she did not say that—she is not promising a digital revolution. That is good news, because I do not think that the staff who are slogging their guts out in the most difficult conditions in history will be particularly impressed by the introduction of that cutting-edge modern technology, the telephone. The NHS can finally axe the carrier pigeon and step into the 20th century. I am sure that staff are absolutely delighted.

Madam Deputy Speaker,

“these measures will not come close to ensuring patients who need to be seen can be seen within the timescales set out…they will have minimal impact on fixing the current problems that general practice is facing over the winter”.

Those are not my words; they are the NHS Confederation’s verdict on the Secretary of State’s plans. Are they not the truth? The Secretary of State says that patients will be able to get a GP appointment within two weeks, but her party scrapped the guarantee of an appointment within two days that Labour introduced when we were in government. She made it clear this morning that it is not a guarantee at all, but merely an expectation—and what is the consequence if GPs do not meet her expectation? As we heard on the radio this morning, her message to patients is “Get on your bike and find a new GP.” Are patients supposed to be grateful for that?

Who will deliver the appointments that the Secretary of State is promising: the 6,000 GPs her party promised at the last election but will not deliver, or the 4,700 GPs her party has cut over the past decade? Where will these GP appointments take place? Certainly not in the 330 practices that have closed since the last general election alone. The Conservatives promising to fix the crisis in the NHS is like the arsonists promising to put out the fire that they started.

As if that were not bad enough, the super-massive black hole at the heart of the Secretary of State’s plan is the lack of a workforce strategy. She has no plan to provide the doctors that our NHS so desperately needs. Despite her “Sesame Street” approach to politics, in her A, B, C, D plan—by the way, last time I checked, S was for social care—she has missed the N for nurses. I say to the Secretary of State that without a plan to tackle the staffing crisis, she does not have a plan for the NHS. What is she going to do about the staff shortage of 132,000 in the NHS today?

The Secretary of State talks about £500 million to speed up delayed discharges. Is that a new investment or a re-announcement? She is right to say that if patients cannot get out the back door of hospital because care is not there in the community, we get more patients at the front door and more ambulances queuing out at the front. That is exactly where we are under the Conservatives today. But she misses the crucial point: unless the Government act on care workers’ pay and conditions, employers will not be able to recruit and retain the staff they need. What is her plan to address that?

Patients will have been concerned to read reports that after the Conservatives failed to hit the four-hour A&E waiting time target for seven years, the Health Secretary is planning to scrap it altogether. I notice that she was not brave enough to say that today; I hope that she will not do so. Can she reassure the House and patients across the country that her response to the crisis in the NHS will be not to lower standards for patients, but to raise performance instead?

The Secretary of State is the third Health Secretary in less than three months. The faces change but the story remains the same. There is still no plan that comes close to meeting the scale of the challenge—no plan for staffing and no real plan for the NHS. It is clear that the longer the Conservatives are in power, the longer patients will wait. As Dr. Dre might say: time for the next episode.

I thank the hon. Gentleman for his warm welcome to my ministerial team and me. It has been just two weeks—[Hon. Members: “Twelve years!”] Forgive me. Well, in those12 years there have been more doctors and nurses working in the NHS than ever before. We have record funding going into the NHS. The money that the Government spend through the Department of Health and Social Care is about 40% of our day-to-day spending. That is the reality of the Conservative party investing in the long-term health of our nation.

The hon. Gentleman mentioned a variety of things. I can absolutely say that there will be no changes to the target of a four-hour wait in A&E. I believe that it matters. I will give the House a recent personal experience. In July, I went to A&E myself; I waited for nearly nine hours to see a doctor, and I still did not get any treatment. I was asked to go back the next day, so I went to a different hospital just three miles away and was seen and treated appropriately. That is the sort of variation we are seeing across the NHS, and it is the reason for my approach.

Only last week we started getting some data from NHS Digital about what is happening practice by practice, so we can start to understand it and start to use experts in the local NHS to prioritise helping those patients who are not getting the service that they should rightly expect, while giving freedom to those other GPs who are doing a fantastic job of supporting patients in their practice. That is why I do not intend to be prescriptive, but I am determined on behalf of patients to drive up the performance of those who need help to do things better.

On ambulances, I am very conscious of the issue. The hon. Gentleman is right to say that we have been in power for 12 years, and I am conscious that I have been working for a decade on improving things for my constituents as well. With a particular focus on ambulances, I think it would be helpful for the House to learn about our recent analysis showing that 45% of the handover delays are concentrated in a part of the country. Even so, I appreciate that that is not good enough.

I also understand that although similar numbers of ambulance calls are being made, there are many more category 1 and 2 calls and our fantastic paramedics are treating more people at home without needing to take them to hospital. Nevertheless, that brings me the challenge of how we can do more to help ambulances get back on the road so that they can treat patients. As with many other emergency services, we also need to consider the potential extension of volunteers through auxiliary services or community first responders. In London alone there are about 120 community first responders, but I think I have more than that in my constituency of Suffolk Coastal. It is about recognising that for the million people who volunteered to help, we can find a way for them to help us during these particularly challenging times, as well as working with the NHS to tackle the fundamental issues.

On access to GPs, I am conscious that Labour introduced the 48-hour target when it was in power. We were told by the NHS and by doctors that of course they met it—I expect that was part of their contracts—but that it did not necessarily mean better outcomes for patients at their practice; indeed, they got into a routine of not booking appointments more regularly. It is important that we address that.

I am very conscious that the plan for patients has only just been published. I deliberately tried to ensure that we held back important aspects of it, such as the £500 million adult discharge fund, for the House’s interest rather than speaking about them before coming here today.

I can assure the hon. Gentleman that I am very happy to continue to work in partnership with the NHS. Keeping the focus on patients is critical, as is building on the existing NHS winter plan, developing the workforce, and all the plans and strategies that need to be carefully considered as we set about the long-term improvements that I think he will enjoy and will want me to champion on behalf of patients.

I welcome the Secretary of State to her new role. As I know, it is the hardest job in Government, but she has a zen-like calmness which means that she is well suited to dealing with the pressures that lie ahead.

There is much to be welcomed today, particularly the pension rule changes, the additional funds for social care and the new powers for pharmacists, but may I ask the Secretary of State to rethink the new two-week access target for general practice? If targets were the answer, we would have the best access in the world in the NHS, because we have more targets than any other healthcare system in the world. GPs alone have 72 targets, and adding a 73rd will not help them or their patients, because it is not more targets but more doctors that the NHS needs. Will the workforce plan to which the Secretary of State recommitted herself—I welcome her commitment to publishing it—include hard numbers, so we can know how many doctors we will need in 10, 15 and 20 years’ time and whether we are actually training them, and will she publish it before Christmas so that staff can at least go into the winter knowing that there is a plan for the future?

I thank my right hon. Friend. I remember supporting him from the Back Benches in his passion for the NHS, and I am absolutely committed to continuing that.

I think my predecessors may have committed themselves to publishing aspects of, or conclusions from, the workforce plan, but I assure my right hon. Friend that now that I have spent time focusing on the priorities, work on the plan is already ongoing and I hope to make progress on further elements today, working alongside my new ministerial team, so that we can maximise that progress.

One of the key things that I want to do is make it more straightforward for people—wherever they are in the world, as long as they are of sufficient quality—to be able to come and practise in England. I was astonished to learn that we cannot even allow people who are accredited in Scotland to come here straight away and practise as dentists. We will be laying regulations on the day we return from the recess, which will enable the General Dental Council, for example, to accelerate this aspect of streamlining so we can ensure that when high-quality doctors and dentists are accredited, anywhere in the world, we can take that into account and enable them to help patients in this country more rapidly.

Let me start by welcoming the Secretary of State to her new role and thanking her for advance sight of her statement.

There is no doubt that the NHS, in all four nations, is facing an incredibly difficult winter, with possible rises in covid infections alongside winter illnesses and increases in slips and falls, all of it while recovering from the dire effects of the pandemic and, now, an energy crisis. An inflation-busting uplift is vital to getting our health systems back into good shape, enabling them to get through this winter and support those in need. It has been estimated that the cost of living crisis will add £3.7 billion a year to the cost of social care alone, with far higher rises across the NHS generally. How does the Secretary of State justify her Government’s prioritising of bankers and tax cuts for the rich at a time when investment in public services is more essential than ever, and will she support the SNP’s call for an NHS uplift greater than inflation?

I thank the hon. Gentleman for his welcome. I think that one of the benefits of the United Kingdom is our ability to learn from each other, even with a devolved NHS. For example, we are borrowing, or copying, the pharmacist elements, and we will enact those in this country too. As the hon. Gentleman will know, owing to the Barnett formula the amount per head of population for the Scottish NHS is considerably higher—the health money passed over—but it is at the discretion of the Scottish Government to decide how to use that money to help patients.

The hon. Gentleman will be aware of our ongoing challenge: we want to work together as a United Kingdom in tackling global pandemics, and I look forward to working in preparation for that. He will also be aware that we accepted the recommendations of the independent NHS Pay Review Body in making our own pay recommendations. Let me pursue an example that he has just highlighted. When the Prime Minister was on the doorstep of No. 10 Downing Street she wanted to talk about growing the economy, because it is vital for us not to have managed decline, which would be challenging for the United Kingdom as a whole.

Obviously the Prime Minister was already minded to ensure that we had a generous package in respect of energy bills, but one of the tasks that confronted me and on which I worked was ensuring that that was extended to businesses and the NHS, and we have made it happen. One of the biggest concerns with which I was presented when we arrived was the possibility that people’s inability to afford energy bills would worsen the situation. I should like to think we have already addressed that, and today I have explained why it is important for us to focus on the ABCD to ensure that patients, too, receive the service that they deserve.

I am deeply grateful to my right hon. Friend for her excellent statement. These are issues that are of concern to my constituents, especially the issue of primary care. I welcome my right hon. Friend’s approach of not providing prescriptive solutions to some of these problems, but, while ensuring that there is more access to data on waiting times for primary care appointments in particular, will she also consider more carefully whether patients should be allowed to move to a different surgery if they are unable to access such appointments on a timely basis? Otherwise, the data that she is producing will not result in any action for patients themselves.

I thank my right hon. Friend, and I agree with her that access to GPs is important. At present, we only publish data at the local NHS level—the integrated care board level—which is why I want to go further in relation to general practices. I know that the Minister responsible for primary care, my hon. Friend the Member for Colchester (Will Quince), wants to try to make it easier for people to change general practices. Of course, where people already have choice that may be possible now, but, understandably, I want to ensure that that fairly basic standard of provision for patients is a high priority across the country.

The statement from the new Secretary of State contained three paragraphs on care but not a word about care workers’ pay. I am gobsmacked, Madam Deputy Speaker. I wonder whether the Secretary of State has read the report produced by the Government’s own Migration Advisory Committee, which states:

“Persistent underfunding of the care sector…underlies almost all the workforce problems in social care…Higher pay is a prerequisite to attract and retain social care workers”.

Will she come back to the House with a workforce plan for care workers that will finally give them a decent pay packet?

As the hon. Lady will know, people access care, or work in the care industry, in different ways. That is why I am keen to continue the national recruitment programme, working with the Department for Work and Pensions. As for the £500 million that I have announced today, the local NHS, working with local trusts and local councils, will clearly be in a better position to decide, in a more differentiated fashion, on the best way of spending that money through not just buying packages but support for the sector. Let me also remind the hon. Lady that since last year we have changed the universal credit taper rate so that people keep much more of the benefits they may receive. However, I am also conscious of the need for us to continue to try and encourage people to come into the care sector, and that is a joint endeavour.

I welcome my right hon. Friend to her new post, and I welcome her statement. I especially welcome the social care discharge fund, but, as she knows, the problems of under-capacity in the care sector, which filter into the whole NHS, are not just a winter crisis but a chronic problem. May I therefore urge her to take seriously a suggestion from the leaders of the care sector—I know it is on her desk at the moment—that something equivalent to the Teach First system should be introduced in social care, so that we can get some of the brightest and best young people to take it up as a career in their early years of work? That would not solve the whole problem by any means, but it would be a significant step towards raising the status of the profession.

My right hon. Friend is correct to raise this strategic challenge, which I am confident that the Care Minister my hon. Friend the Member for Harborough (Neil O'Brien), will be looking at carefully. Recognising the challenge, the Prime Minister has set out clearly that she wants to see a rebalancing of funding within the health and social care system. I am sure we will make progress on achieving that, informed by how the £500 million fund will be spent and the outcomes it will produce.

I, too, welcome the Secretary of State to her place and thank her for the four-page ABCD statement, but there were two letters missing from it: M and H—mental health. She is the fifth Health Secretary in my five years in the House, and in those five years I have seen hundreds of desperate families trying to access mental health services for young people in Kent. It can now take between two and four years to secure even an initial assessment. Many young people are sent out of Kent—to Leeds, Hertfordshire and Manchester—putting an additional strain on families already at breaking point. Please will the new Secretary of State help me and other Kent MPs get at least beds or assessments for our desperate constituents?

Of course, the statement and the plan published today build on many of the other activities already under way. For me, it is about setting up priorities on how I think we can best help the majority of people in this country. I am very conscious of the challenges on mental health and provision. I have seen them myself locally as a constituency MP. The Minister responsible for mental health and public health, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), will be focusing on this important aspect. On the hon. Lady’s local situation, I think it is a case of trying to sort a meeting with the integrated care board to address how it will be delivered locally.

I know that my right hon. Friend is committed to reducing the NHS backlog—the B in her plan. Does she agree that it is far better for patients and productivity to prevent ill health, and that robust policy to tackle obesity, a condition that is proven to increase the chance of suffering from diabetes, cardiovascular disease and cancer, has an important role to play in addressing the B of her ABCD? Will she commit to focusing on prevention as a key part of her strategy as we move forward?

Indeed. I pay tribute to my hon. Friend, who was successful in being a Health Minister. I am conscious that ABCD has caught the attention of many people because it has aspects of real focus, but prevention is of course at the heart of what we do so that people do not need to turn to the health service at all for treatment. That is why we will continue with aspects of the strategy to make sure that people have better care and that it is both strong and resilient for their physical and mental health.

I welcome the Secretary of State to her new responsibilities, which, as she has pointed out, are very challenging. I agree with her that there are too many dental deserts. She will perhaps be aware of recent BBC research that revealed that one of those dental deserts is the whole of the Liverpool city region, where not one dental practice is taking on new NHS patients. What measures will she be taking—in the short, medium and long term—to address this disgraceful situation?

I set out in the plan today what we are seeking to do with dentists. First of all, it is the role of the local NHS—the ICB—to take responsibility for such provision, and I expect it to do so. I alluded to the contract earlier. We have started to make some changes—only very recently, admittedly—whereby, instead of it being more profitable for a dentist to do NHS care only on extraction or cleaning of teeth, rather than the more complicated elements, we need to make sure that more dentists are offering NHS provision. On other dental practice features, we need to make sure that people are using their qualifications to their full extent by undertaking particular procedures. For example, some people might not be full dentists, but they will have trained as technicians and will be able to undertake care of children. There are different levels and we need to continue to go into the detail, but, practice by practice, I am going to have to work with the NHS locally a lot more in order to unveil that opportunity.

Obviously, many colleagues want to contribute, but if we are going to get everybody in, that will require brevity. I call Steve Brine.

Thank you, Madam Deputy Speaker. I warmly welcome the Secretary of State to her role and wish her all the best. Her predecessor talked about a new cancer agenda. Could she indicate whether that is in the offing, and will it be accompanied by a genuine cancer workforce plan? Will it involve what my hon. Friend the Member for Erewash (Maggie Throup), the former public health Minister, rightly mentioned about prevention in respect of obesity, the second biggest cause of cancer in this country, and, obviously, smoking, the biggest preventable cause of death in this country?

I thank my hon. Friend. The Prime Minister has said at the Dispatch Box that we will proceed with the cancer plan. I will, of course, be looking carefully at the other plans with my colleagues. Indeed, the Minister of State, Department of Health and Social Care, my hon. Friend the Member for Colchester (Will Quince), has agreed to meet my hon. Friend the Member for Winchester (Steve Brine) to talk this through further.

I congratulate the Secretary of State and will miss her visits to the Work and Pensions Committee. I welcome her recommitment to the four-hour A&E waiting time target—I think she is right about the importance of that. She mentioned in her statement the forthcoming NHS workforce plan. When does she expect to be able to publish it?

I thank the right hon. Gentleman for his warm welcome and I will, of course, miss our interaction on DWP issues. As I said to my right hon. Friend the Member for South West Surrey (Jeremy Hunt), my predecessors committed to publishing the conclusions of the plan. I am still looking into this particular matter, and we still need to finalise and develop it.

I welcome my right hon. Friend to her two new jobs. That is absolutely excellent. I speak on behalf of South Derbyshire residents. She may not know this, but a seventh of all new houses built in England last year were built in South Derbyshire. Could she please use South Derbyshire as a pilot for rolling out more GP services and more dental services?

I thank my hon. Friend and appreciate her warm welcome. The House will be aware that, in effect, GPs and, indeed, dentists are private and independent practitioners. This is important. On primary care, we have already seen reasonably good success with the NHS getting doctors right across the country. I think there is a lot more to be done on dental care.

This is not a plan; it is an ABC of Conservative failures. GPs are now seeing almost 12% more patients than they were just five years ago; the GP sector is facing a retirement timebomb; and one in five patients can only see a GP for less than five minutes. Patients need to have more fully qualified GPs. The Government set themselves a target of 6,000 by 2024. Have they now just given up?

It is not the fault of successive Conservative Secretaries of State that every time they come forward with a plan, the queues just get longer, the NHS asks for more resources, and more people have to be imported from abroad. The fault is with the system: the last example of collective planning and socialist central control, and ever more targets, like today. It simply does not work. Will the Secretary of State—the Conservative Secretary of State—have an open mind to looking at the social insurance systems of France, Germany and Italy—[Interruption.] Opposition Members can mock but, to be frank, the health outcomes in those countries are far superior to ours. People are fed up with paying all their life and being at the end of the queue. It should not just be the rich who can access private healthcare.

I understand why my right hon. Friend makes that point, recognising that many other countries in Europe take that approach. However, that is not the approach we are going to take under this Government.

My constituents face intolerable delays in A&E, for an appointment, for referral for mental health treatment, or for an ambulance. Those who work in the NHS face plummeting morale, effective pay cuts and staff shortages. The Secretary of State’s response is to aspire to a GP waiting time that is seven times longer than Labour actually achieved. Is it not the case that the NHS is not, has not been, and never can be safe in Tory hands?

I welcome the Secretary of State to her place. As she considers her priorities, does she agree that we still need to focus on early intervention? I particularly commend the Start for Life programme, which is designed to help young mothers in family hubs. We should not lose sight of that priority as she tackles the other issues in the NHS.

I thank my hon. Friend, including for the work he undertook as a Minister in the Department of Health and Social Care. I am conscious of the importance of that care and would be very happy to meet him, along with my right hon. Friend who contacted me today about that issue, in order to make sure that we provide not just emergency services but, as my hon. Friend rightly points out, some of the clinical care where an extended intervention is needed, to make sure that we get proper care overall.

For some years now, and at any given time, my local hospital has had the equivalent of around one ward of patients who cannot be discharged because of a lack of social care for them. London has the largest shortfall of care workers of any region in the country. It is September—we are on the edge of winter. How will the Secretary of State’s plan ensure that local authorities are able to meet pay and conditions expectations in order to fill that shortfall of care workers and enable our hospitals to concentrate on new patients, as they should?

I decided to diagnose, in effect, what is happening care by care, and that is really important. Nevertheless, more generally, I will of course be introducing the £500 million care fund to make sure that that happens.

It may be helpful if I explain that I am trying to call people first in this statement who perhaps did not get in during the last statement.

North Devon has a more elderly than average population, with very low unemployment. While I warmly welcome my right hon. Friend’s plan for patients, will she detail how we can recruit for the numerous vacancies we have in dentistry, pharmacy, nursing and social care, especially given the lack of affordable housing available, mostly driven by the surge in holiday lets and second homes.

I assure my hon. Friend that she will be hearing from the local NHS in order to make those functions happen.

I welcome the Secretary of State to her new role. I heard her say earlier that she wants to encourage people to go into social care. Does she appreciate that the main thing discouraging people from going into social care is the very low wages, and that this is a particular issue during a cost of living crisis?

That will vary according to the provision that has been in place. I am sure the right hon. Lady will want to be careful and considerate in how she addresses the local NHS in order to tackle the issue of patients who do not need to be in hospital, in order to help them with some of the features that they enjoy.

I welcome my right hon. Friend’s statement. Does she agree that although we are terribly grateful to people from overseas who are among the very best, kindest and most compassionate of carers, we must ensure that we grow our indigenous workforce, and that to do so, it has to be financially competitive for those people to work in the care sector and a professional career structure must be open to them? If that does not happen, we will not make any inroads into the 13,500 beds that are currently occupied by people who should not be in hospital—who need to be in homely settings in the community—ambulances will continue to queue around the block, and frail elderly people will not get the care they are entitled to.

My right hon. Friend is right to consider the issue on a broader scale, but of course, we will be focusing on that with the local NHS. There are certainly some parts of the country where there is not the same provision and discharges are not happening to capacity, while in other parts of the country there are extraordinary amounts. That is what we need to focus on locally.

Yesterday, the County Councils Network produced a statement saying that there is a crisis in social care, which echoed the findings of the Select Committee on Levelling Up, Housing and Communities. The Secretary of State’s announcement of £500 million is welcome, but all it does is replace the funding stream that was cut in April, and will do exactly the same job. When is she going to recognise the enormous financial gap that councils are facing and the poverty pay that is not attracting care workers into the sector, and actually come forward with a real policy? If she wants the money, why not cancel the cut in corporation tax and use that funding to create real benefits for people in social care?

That will work depending on local areas. I am conscious that, as Chair of the Select Committee, the hon. Gentleman takes a broadbrush approach, but I think it is important that we have a local NHS to achieve that.

I strongly welcome my right hon. Friend’s statement. It has been great to see how elective surgery hubs around the country are helping to tackle the backlog; however, we are yet to have one in Nottinghamshire. I ask my right hon. Friend to look kindly on Nottinghamshire’s bid for a new elective surgery hub. Will she meet me to hear the many merits of its case?

My hon. Friend is right to appreciate those hubs. It is fair to say that we have not responded to that bid, but my Ministers will address it very soon.

I welcome the Secretary of State to her new role. With nine out of 10 dental practices in England not accepting new NHS patients and over 2,000 dentists having left the NHS in the past year alone, NHS dentistry is in crisis. While today’s small changes are welcome, as were the minor tweaks announced back in July, they are underwhelming given the scale of the crisis. When will the Secretary of State complete a full reform of the contract, with prevention at its heart, so that my constituents can access an NHS dentist when they need one?

The hon. Lady is absolutely right, and I completely agree with her: it is a real problem. We have started making some changes already, but we need to do so in more detail right across the country. My hon. Friend the Minister responsible for dentistry will be looking into that more intensively.

In Gloucestershire, the inability to discharge people from hospital because of inadequate social care is the primary reason why we have ambulances queuing, so I welcome the adult social care discharge fund that the Secretary of State has announced. Can she set out how that £500 million is going to be allocated, so that Gloucestershire’s local NHS will know how much it can expect and can work with Gloucestershire County Council to improve matters for my constituents?

My right hon. Friend is correct to raise that question. We are still working on the detail of where that funding will be allocated across the country.

Some 41% of my constituents with a cancer diagnosis are now waiting more than two months for their first treatment. We know that every four weeks that people with a cancer diagnosis wait for treatment means a 10% reduction in their chance of surviving it—this is killing my constituents every single day. There are quick, sustainable fixes that could make a difference, one of which is an up-front investment in radiotherapy now. Will the Secretary of State agree to meet me, the all-party parliamentary group for radiotherapy and key clinicians, so that we can help her get to grips with this problem and save my constituents’ lives?

I warmly welcome my constituency neighbour to her new dual role. I am grateful for her statement and, in particular, her commitment to work closely with the independent sector. She will be aware that figures show that as many as one in 10 adults in England have used the private sector in the past 12 months. Does she agree that without that waiting lists would be even higher? Will she therefore consider the reintroduction of tax relief on private medical insurance, which was first introduced by Ken Clarke in 1989 and was scrapped by the Labour party?

It is great to see my hon. Friend; our constituencies cross the River Deben. I will look into that matter for him and respond to him.

The Secretary of State spoke about the importance of prevention and the impact of the cost of living crisis on health and wellbeing. Will she therefore work with colleagues across government, including those from the Department for Work and Pensions and from local authorities, to maximise the take-up of the Healthy Start scheme, which can address both maternal and child health and wellbeing, and help families with living costs?

I welcome my right hon. Friend’s statement, particularly her focus on access to GPs and on tackling ambulance waits, and her recognition of the importance of social care, including with the £500 million discharge fund. Will she also assure me that she will be taking forward our reforms to social care, not only the cap on social care costs, but increasing the scrutiny of care locally, to drive up quality and make sure that care workers are paid fairly?

I appreciate the requests from my hon. Friend, and it is important that we get through this. It will be done on a local level. I cannot specifically say when that will be confirmed, but I know that in Kent, in particular, there is a lot of work still to be done.

Two weeks to see your GP—is that a target or joke? I know how many of my constituents will see it. Surely the Health Secretary will understand that we must first address the underlying rampant health inequalities in many of our cities. In that regard, will she lend her support to Bradford’s levelling-up bid for £20 million for grassroots, transformational, community-led health centres, which will make sure that we make a real difference to tackling health inequalities in our district?

I am not aware specifically about Bradford; we are still at a very early stage of going through that data and analysis. But of course I expect the local health service to work carefully with local GPs to make sure that people who need care receive it.

Will the Secretary of State meet me and other Members, no doubt including my hon. Friend the Member for South Derbyshire (Mrs Wheeler), whose areas face particular difficulties over access to general practice as a result of tens of thousands of new houses having been built, with more coming, without the commensurate increase in general practice capacity?

I know that my hon. Friend has been concerned about this issue for some time. As I have set out, GPs are, in effect, independent and we cannot force people to be in a particular part of the country. However, I know that the NHS has been working to target and bring doctors into places where there are not that many other doctors. I know that the primary care Minister will be happy to meet him.

Anyone marking the Secretary of State’s A, B, C, D homework would give her an F—an F for failing—as nothing we have heard today addresses the biggest threat to our NHS: the workforce crisis. The shortage of doctors, nurses and care workers is compromising patient safety and driving morale through the floor. So will she explain why the Government are yet again failing to address that and why she has talked today about volunteers and medics coming out of retirement, as surely the Government should be investing in a proper workforce strategy and also increasing the amount of people going through training?

I strongly welcome the statement and congratulate the Secretary of State. She will be aware that Princess Alexandra Hospital has among the highest A&E levels per head in England and that we are in the first wave of the new hospital programme. Will she set out the timing of that programme? Will she meet me and my neighbouring MPs, one of whom is the Deputy Speaker in the Chair at the moment, to discuss the hospital programme and set out the timetable, so that the residents of Harlow can be assured about it?

I am sure that the Minister of State, Department of Health and Social Care, my right hon. Friend the Member for Newark (Robert Jenrick) would be happy to have a meeting on this occasion and to investigate that. It is important that Ministers get on with the creation of both new diagnostic centres and hospitals. I intend to work on Project Speed to make sure we get these hospitals right across the country under way.

In the past year, I have witnessed a seven-year-old having to be locked in a classroom because they were a danger to other pupils and heard from the mother of a nine-year-old who hospitalised their sister. They, along with thousands of other children across the country struggling with their mental health, are languishing on waiting lists for months, if not years. So when the Secretary of State says,

“this Government will be on your side when you need care the most”,

those words are meaningless to the parents who come to my constituency surgery week in, week out. Will she give them hope, and make the mental health of children and young people a priority for this Government?

The Prime Minister set out during the summer that she intends to make sure that there are mental health practitioners available in local GP practices and in schools.

I welcome the Minister’s priorities on GP appointments, pharmacies and dentistry, which are important for Islanders. May I make her aware of the specific needs of what her Department calls “unavoidably small hospitals”? We have 12 in England and Wales, covering 20 mainly Conservative constituencies, of which St Mary’s is the most isolated. We have done good work on improving funding, but there is more to be done to ensure fairness and equality. So will she or her Ministers meet me and other right hon. and hon. Members to discuss what more can be done to ensure support for these small hospitals, which are so important for our communities?

I believe it is in the Isle of Wight where we have a particularly difficult challenge as many patients are still in hospital who do not need to be there. I know we have asked the local NHS to start working with the council on how we can get that discharge going, and I know how important it is to make sure that the hospital can function readily.

This year, I have been in acute care, as have two members of my family; we were in four great Yorkshire acute hospitals. In many encounters with staff, whom I thank deeply for the work they have done, it was clear that they are universally wonderful but that the system is under stress. They were emphasising to me two basic principles of the NHS. The first was that nobody should make a profit from another person’s illness. The second was that the speed of treatment should be directly related to the gravity of the illness and not to the size of someone’s wallet. Will the Secretary of State confirm that she stands by those two principles? Finally, when will those staff get a rise?

GPs, dentists and pharmacists are all independent contractors, and it is up to them how they best manage and help patients. I am setting clear expectations on that. Furthermore, on pay uplift for people in the NHS, the Government have accepted the independent pay review body recommendation, and that is what we will be doing.

I thank my right hon. Friend for her excellent statement and her focus on the A, B, C, D. But none of that will be delivered without E—effort. I refer to the effort our vital nurses put in to keeping the NHS rolling, which will be vital in delivering on her plan. Will she join me in thanking them and encouraging them to get behind this plan as soon as possible?

I thank my hon. Friend, and I agree. We recognise and accept that, after the pandemic, there are still significant issues to address, and that is why this national endeavour is really important and why we want people to help. That is also why we have extended some of the measures we had during covid for a further two years, so that people can come back more readily to help the NHS. It is important that we strain every sinew to make that happen.

Order. Before we proceed, it will be obvious to everyone present that the Secretary of State has now been at the Dispatch Box for an hour—normally, statements run for an hour. I am going to let this one run for a little more than an hour, but I give notice now that not everybody who wishes to speak will have an opportunity to take part. That is simply not practical, so I say two things. First, if you are not very enthusiastic, go now and you will be able to save up your brownie points for tomorrow and the next day. Secondly, the briefer the questions, the more people will get in. I have noticed that the Secretary of State has played the game by giving some very brief answers—thank you.

I note the Secretary of State’s comments about hospital discharge. As she will know, the Government legislated through the Health and Care Act 2022 for a process known as discharge to assess, whereby people’s social care needs assessments can take place after they have been discharged from hospital, rather than before, and that model was already being used under the Coronavirus Act 2020. However, when I asked the Government last May what assessment they had made of the number of patients who had been readmitted within 30 days, I was told that they did not hold the data centrally. It is vital that the Government understand the clinical outcome of this policy, so will the Secretary of State please commit to gathering and publishing that data?

I hear what the hon. Lady says, but I will not go specifically into more data. I have set out the approach we will take—particularly looking at the local NHS with local councils—to make sure we discharge more effectively.

I welcome my right hon. Friend’s announcement today. Healthcare providers in Runnymede and Weybridge tell me that the biggest challenge they face is recruitment and retention. Driving that is the fact that staff are being poached by London. London can offer London weighting, but we face equal, if not sometimes higher, living costs. Does my right hon. Friend agree that the NHS needs more flexibility when setting staff remuneration, and will that form part of the measures she will announce in the upcoming plan on expanding the workforce?

I am conscious that there is London weighting, but it is up to the local NHS, including NHS trusts, to make decisions about how they reward people and encourage them to work in their hospitals.

Under the last Labour Government, patients were guaranteed a GP appointment within 48 hours, but when the Conservatives came to power they scrapped that standard. This is all part of the managed decline of our NHS. After 12 years, GP numbers are down, and more than 300 GP practices have closed since 2019 alone, with many of my constituents unable to get a GP appointment when they want one. Does the Secretary of State agree that the 2019 Tory manifesto promise to deliver an extra 50 million GP appointments and over 6,000 more GPs is not worth the paper it is written on?

I welcome the statement today. The majority of GPs—75%—now work part time. That is an understandable choice for them, but we need to be honest about the impact it is having on the availability of appointments and the cost of training. Will my right hon. Friend look at what she can do to address the barriers to more GPs working full time?

It is a choice for GPs whether they work part time or full time. I am conscious that some of the different things we are doing, including on pension flexibilities, should help, as should diverting people so that they do not have to go to GP appointments but can use pharmacies and other approaches.

This morning I met the Warrington and Halton Hospitals NHS Trust regarding its bid for a new hospital in Warrington, which is desperately overdue. Our bid is through to the final stages of the Government’s tendering process, but there is concern that timetables are increasingly slipping, putting the bid at risk and driving delays in treatment because the current facilities are not fit to meet the need we have locally, despite the best efforts of our NHS staff. Will the Secretary of State therefore please confirm that the Government still intend to honour the previous Government’s plans for new hospitals and that these decisions will be made without further delay?

We are still considering all the proposals—the different business cases—that are coming through, and we will respond in due course.

I welcome the Secretary of State’s statement. The NHS in Cornwall faces a unique set of circumstances, because we are a rural peninsula with an ageing population. However, the impact of tourism also means that, in terms of pressure on the NHS, it is always winter in Cornwall. Does the Secretary of State recognise the unique challenges we face in Cornwall? Will she or one of her Ministers meet me and other Cornish MPs at the earliest opportunity to discuss what support we can give the NHS, not just to get through this winter but to get ahead of the summer season next year?

My right hon. Friend the Minister of State, who has responsibility for secondary care, will be visiting Cornwall to meet the ambulance trust—indeed, he will be meeting trusts more broadly.

Last month, my constituent Alan Suthers phoned 999 at 7 in the evening. His wife had suffered a stroke. He knew the signs—face, arm, speech, time—and the urgency of medical care. That care arrived five hours later, at 1 o’clock in the morning. The Health Secretary can have all the ambitions, expectations and targets she likes, but does she agree that she will not have the human resource to achieve them unless she addresses the workforce strategy and the 132,000 vacancies that currently exist in the NHS?

I am sad and concerned to hear about the case the hon. Gentleman has just mentioned—it is unacceptable. However, I have already set out to the House aspects of how to improve ambulance responses, and it is my intention that those will be delivered right across the country.

I welcome this plan for patients, which recognises the importance of data in the NHS in England. My right hon. Friend will be aware of extreme concern over the state of the NHS in north Wales. Will she therefore affirm her commitment to UK-wide compatible and interoperable data in the NHS and the potential for the Data Protection and Digital Information Bill to bring that about?

I thank my hon. Friend, who is a practising GP and who is very committed to his constituents as their MP as well. He will recognise that the NHS in Wales is run by the Labour Government there. However, he is right to point out that it is important that we work across the United Kingdom by sharing information and putting patients first, and we will continue to work to try to make sure that happens.

Order. I was about to draw matters to a close, it being 17 minutes past 2, but I appreciate that those on the Opposition Front Bench might point out that the people for the next debate are not yet present. Therefore, I will extend the statement for a very short while, but I should note that it is not very good practice not to be here.

As one exasperated constituent put it, having not been able to get a GP appointment,

“It seems there are too many patients and not enough doctors and this has gotten worse over the last few years.”

My constituents can grasp the workforce issue, but it seems that the Secretary of State cannot. I agree with my hon. Friend the Member for Wirral South (Alison McGovern) that it is deeply worrying that the new Secretary of State did not mention the pay of care staff, when that is the crucial issue if we are to tackle the 160,000 vacancies in the care sector. Will the Secretary of State tell me why the Government are choosing not to tackle the shortage of doctors, nurses and care staff, which is leading to such long wait times for my constituents?

We are getting more clinicians—doctors and nurses—into the NHS, and I have already shared with the House the approach on care.

I welcome the greater use of pharmacies to ease pressure on GPs. However, with ongoing treatment, it is essential for patient safety that GPs can see what has been prescribed through the pharmacy module on the GP system. At present, community pharmacists do not have access to it. Will the Secretary of State unlock it?

I welcome the Health and Social Care Secretary to her place. As chair of the all-party parliamentary health group, I have been hearing from people right across the United Kingdom that it is face-to-face appointments with GPs that are really required. Communication by telephone or Zoom is difficult especially in relation to clinically sensitive issues and mental health issues and also for people with autism who find it very difficult to speak through those modes of communication. Can she reassure the House that face-to-face appointments will be a priority going forward?

I thank the hon. Lady for her question, but I trust doctors to have that relationship with their patients directly, rather than my prescribing or mandating a particular approach. With greater transparency and the publication of a lot of this data, we will gradually see that happening more and more, but it is important that I do not directly say that x, y or z have to be seen by a doctor. Clinical need should be what matters.

It is welcome to hear that D is for dentists. As a constituency neighbour, my right hon. Friend is very much aware that there is a crisis in NHS dentistry in Suffolk. There have been some improvements, and it is welcome, as she has said, that work has started on a new NHS dental contract. Can she confirm that she is committed to root and branch reform, which also includes fair funding, a strategic long-term approach to recruitment and retention, a proper prevention policy and transparent and full local accountability?

My hon. Friend is right. In his constituency —in Lowestoft in particular—there has been increasing provision. Meanwhile, in Leiston, not a single dental practice will take up the opportunity to provide NHS dental care at the moment. I entirely accept that the matter needs sorting. That is why we will be putting the priority on the local NHS to make sure that we avoid these dental deserts. In terms of other aspects of the contract, they will continue to evolve.

Thank you very much, Madam Deputy Speaker. When someone has cancer, every day is an emergency. Weston Park Cancer Centre in Sheffield does outstanding work, treating patients not just from my region, but from right around the country. I have been grateful to previous Secretaries of State and other Ministers for their engagement on securing the investment needed for the urgent refurbishment of Weston Park. Will the Secretary of State give me an undertaking that, along with her Ministers, she will continue to work with me to do everything that we can to support Weston Park in its important work?

I do not have specific details about that matter, but I know that my right hon. Friend the Minister of State would be happy to follow up on that with the hon. Gentleman. I am very conscious about the impact of cancer. That is why, instead of having a 48-hour target, which would predominantly be predicted by emergency diagnosis from GPs, I want that to be a broader target, so that people who are showing symptoms and are concerned about seeing their doctor have that assurance that they will be seeing their GP, so that diagnosis can start as quickly as possible, particularly on issues such as cancer.