Edward Argar MP: speeches

Speeches

• 14 Mar 2025 · Rare Cancers Bill · Hansard source

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  May I start by extending to the hon. Member for Cumbernauld and Kirkintilloch (Katrina Murray) and her family my sincere condolences on the passing of her father? This is an important Bill. I often say to constituents, “If you wish to see the House of Commons at its best, tune in and watch on a Friday.” I say that again today, having heard the debate. It is it is rare for a shadow Secretary of State to take to the Front Bench on a Friday to respond on a private Member’s Bill, but the debate has reinforced my determination to be here. As the hon. Member for Bootle (Peter Dowd) said—I like to call him my hon. Friend—this is a Bill of hope. I pay tribute to the hon. Member for Edinburgh South West (Dr Arthur) for his clear and compelling articulation of the case for the Bill, and for being willing to share something as personal as the loss of his father-in-law and his family’s circumstances. He spoke about that with great dignity. With a debate of such quality, it is always invidious to pick out contributions, but I cannot resist doing so. I have to pick up the contribution of the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh). When I was a Minister, we often worked with each other and spoke on matters relating to health, although not this subject. Her passion, determination and energy for change and for something better comes across in everything she does, and that builds on the fact that this is a Bill for hope. I pay tribute to her for her work and her dedication. I have been a Member of this House for 10 years, and before the election I was a Minister for six. Two and a half of those years were spent as a Minister in the Department of Health and Social Care during the pandemic, in times that were challenging for everyone, but I have to say that I have rarely heard a speech as powerful and moving, or that held the House so completely, as that of the hon. Member for Calder Valley (Josh Fenton-Glynn). Although I did not know his brother, I suspect that he would have been deeply proud of the hon. Member today. “Rare” in this context is often a misnomer, because although individually these cancers are rare, collectively they are sadly all too prevalent. As we have heard from hon. Members, approximately 55% of all cancer deaths are down to so-called rare cancers. The breadth of those rare cancers is huge: they include blood cancers, cancers of the female reproductive organs, head and neck cancers, pancreatic cancer, brain cancer—the hon. Member for Mitcham and Morden spoke about glioblastomas—and, importantly, children and young people’s cancers, which the hon. Member for Esher and Walton (Monica Harding) spoke about. We have all seen the amazing work by powerful campaigners on these issues and by the huge array of charities campaigning in this space: Cancer52, the Brain Tumour Charity, the Tessa Jowell Brain Cancer Mission, Leukaemia UK, Pancreatic Cancer UK and a whole range of other dedicated and amazing institutions. They do a fantastic job. Like other hon. Members, I recently met Pancreatic Cancer UK to hear about its work; the hon. Member for Birmingham Erdington (Paulette Hamilton) may well have done the same. Initially, it was to discuss pancreatic enzyme replacement therapy drug shortages and the urgent need for some sort of solution, but we also had the opportunity to talk more broadly about pancreatic cancer and rare cancers. Pancreatic Cancer UK highlighted issues that are specific to pancreatic cancer but that I suspect are reflective of many rare cancers: the challenge of diagnosis, the challenges posed by late diagnosis, the reliance on a single therapeutic or a small number of therapeutics with complex supply chains, and the challenges of clinical trials. Sadly, so few people with pancreatic cancer, even when they are able to enlist on such trials, survive long enough to provide the data that will make a real difference. The Bill will help to address that. Because each rare cancer is different, each rare cancer needs focused research and treatment. The hon. Member for Bootle set out clearly the orphan drugs regime for rare cancers. Yes, there are incentives; under the 2021 regulations it is possible to incentivise pharmaceutical companies that may not be inclined to invest in research in areas that may benefit only a few, in comparison with the large numbers affected by other cancers. The regime seeks to give market exclusivity rights for 10 years, helping to reduce the costs of market authorisation, but we have to ask the question that the Bill asks: is it actually doing the job it needs to do to genuinely incentivise companies to invest in research in this space? The hon. Member for Mitcham and Morden mentioned the NHS repurposing project. If we make it work effectively, it will be a very practical way in which, while we wait for specialist research to come through, we can still do something. I believe that the Bill goes a long way towards addressing the issues. The review of the orphan drugs regime, particularly the international angle, is hugely important. I welcome all the provisions in the Bill, especially those on the specialist registry and on the sharing of information to get more people into trials. As with any Bill, there are some things that I believe would benefit from further explanation, but that is what Committee is for. As shadow Secretary of State, I am happy to confirm that the hon. Member for Edinburgh South West has our support for the passage of his Bill through Second Reading and into Committee. In this place and in life, there is a time to act. I believe that this is it. We have huge potential and huge talent in this country. Let us help focus that on saving more lives and giving more precious time to more people. I am pleased and proud to offer my support to the hon. Gentleman for the passage of his Bill.

• 11 Feb 2025 · Topical Questions · Hansard source

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  I congratulate the hon. Member for West Lancashire (Ashley Dalton) on her promotion to the Front Bench. Eating disorders affect over 1.25 million people, and this is the last Health and Social Care Question Time before Eating Disorders Awareness Week, which starts later this month. The Secretary of State will be aware of the amazing work done by the eating disorder charity Beat, which I met a few months ago, and to which I pay tribute. Will he back Beat’s call for broader access to intensive community and day treatment for those with eating disorders—there are limited places currently—and set out a timetable in which that will be delivered?

• 11 Feb 2025 · Topical Questions · Hansard source

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  I am grateful to the Secretary of State for that answer. He will know that osteoporosis impacts 3 million people. He is aware of the campaign by the Royal Osteoporosis Society, and the powerful parallel campaign led by The Mail on Sunday and the Daily Mail , for access to fracture liaison services across the country. Pre-election, he committed to support that, and a roll-out plan. People will look for an answer that looks to the future, not the past, so when will he publish the fracture liaison services roll-out plan, to ensure that all who need to access those vital services can, and will he work with campaigners and me to achieve that roll-out before 2030?

• 23 Jan 2025 · Rare Retinal Disease · Hansard source

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  I am grateful to the hon. Gentleman. As a professional optometrist, I am sure his bill will be in the post. Inherited retinal diseases can lead to a gradual loss of vision and can have potentially devastating effects.

• 23 Jan 2025 · Rare Retinal Disease · Hansard source

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  The hon. Gentleman is absolutely right. He and I have known each other since we came to this House, and he has read my mind, because I was about to say that there are examples of life-threatening tumours being detected through a regular eye test and a referral onwards, which has saved people’s lives. As he set out, an estimated 25,000 or so people in the UK are affected by inherited retinal diseases. As the hon. Member for Leicester South said, the most common, which I will mispronounce, is retinitis—

• 23 Jan 2025 · Rare Retinal Disease · Hansard source

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  The hon. Gentleman is absolutely right. One of the key themes of this debate has been the importance of raising awareness and of societal understanding. Before I was a Minister, I co-chaired the APPG on dementia. I think we are making progress, but a large part of the challenge that we face as a society is raising the awareness and understanding of hidden conditions or things that might not be immediately apparent to people, particularly before there is a diagnosis or some sort of visual sign, such as a white cane, or other measures. This debate will play a small but important role in helping to raise awareness of those conditions. The next challenge, as was alluded to, is diagnosis and what more can be done to deliver better and earlier diagnosis. Again, real progress is being made, but, as so often in these spaces, we can do more. It is a pleasure to be taking part in this debate, because although we often to and fro across the Dispatch Box or across the Chamber, I suspect that there is a fair degree of consensus today about where we are, what progress we have made and what more needs to be done, which is all to the good. As has also already been alluded to, when there is a diagnosis, the next challenge is the treatment and what is possible in the way of treatment. In 2019, as has been said, NICE recommended the use of a new gene therapy called—again, I will use the abbreviation rather than the technical term—the Luxturna approach; I am sure that the hon. Member for Leicester South would be able to correct me, if necessary. It was recommended to treat inherited retinal dystrophies that are caused by a specific type of gene mutation. We are seeing real progress with that type of viral vector-based gene therapy. There are also potential new treatments that we have heard about, including further gene and stem cell therapies, artificial vision therapies, electrical stimulation therapies and indeed the use of growth factors and retinal transplants. I have sat where the Minister is sitting now, so I know that there is always a challenge in this space. One of the great successes of our country is in innovation, including the rapid development of new therapies and new treatments. However, there must always be a process to make sure that they are safe and effective, and we must strike the appropriate balance in recognising that there is no infinite pot of money for any Government. In August 2024, Retina Today, a respected journal, reported that there are currently over 30 gene therapies in development for the treatment of a range of retinal diseases, so we can look forward with a degree of cautious confidence to what is being done in that space. The challenge will always be, of course, how we translate such treatments into effective, deployable and—if I am being honest—affordable solutions for people who have such conditions. The situation is similar with artificial vision technologies, including the implanting of microchips. Therefore, there is reason for us be hopeful about treatment and research. I now turn to the UK rare diseases framework, which hon. Members have spoken about today. It was first published in January 2021 and there have been a number of action plans since: there was one in February 2022, with 16 actions; one in February 2023; and one in May 2024. I was encouraged that in December 2024 the Minister’s colleague—the Under-Secretary of State for Health and Social Care, the hon. Member for Gorton and Denton (Andrew Gwynne)—reaffirmed the Government’s commitment to the rare diseases framework. I am also encouraged that there is talk of a 2025 refresh. I hope that the Minister can give a little more information on how she sees that process playing out when she speaks. Some progress was made with those action plans, but if we are being completely honest, it was perhaps not as much progress as we might have wished. There are a range of external reasons for that, but there is now an opportunity for the new Government to continue to take the process forward. From what I see and hear, they are committed to and willing to do that, which is deeply encouraging. With regard to NICE, I have already alluded to the challenges that it always faces. It has a difficult role to assess the clinical and cost-effectiveness of medicines and treatment, which is challenging because if someone is in need of a treatment—indeed, if they are desperate for a treatment—they will obviously want that treatment to be trialled. We therefore need to recognise that NICE does a difficult job in striking the right balance. NICE uses the HST—highly specialised technology—programme. As we heard, refinements to the routing criteria have been proposed, including that “The disease is ultra-rare and debilitating…having a point prevalence of 1:50,000 or less in England…is lifelong after diagnosis with current treatment, and…has an exceptional negative impact and burden on people with the disease”; that there is the “aim to encourage innovation and research”, which is a good thing that we can all support; that “The technology should be limited to the population in its licensed indication… No more than 300 people in England are eligible for the technology for its licensed indication, and the technology is not an individualised medicine”; and that there are “no effective treatment options”. I understand that just before Christmas NICE launched a public consultation, ahead of updating the HST eligibility criteria. That consultation is due to report later this year, following the closure of the consultation on 30 January. As I look at the date on my watch, I can see that hon. Members and other individuals have about a week or so in which to make any representations or put any views to that consultation, should they wish to do so. I hope that the Minister will be able to update right hon. and hon. Members on each of those aspects—where she sees us going with diagnosis, treatment and access to treatment, and where she sees that research going in the long term. I hope the hon. Member for Torbay (Steve Darling) will forgive for not mentioning him before, but I pay tribute to him for bringing to his role and to this subject—as he does to his other speeches in this Chamber and the main Chamber, and to other debates since he has arrived in this House, not limited to this subject—a measured, thoughtful and knowledgeable approach. The House is all the better for those contributions. Once again, I am deeply grateful to the hon. Member for Strangford for bringing forward this hugely important debate. This House is at its best when Members debate not the to-ings and fro-ings that we all put in our election leaflets, but consensual matters where there are genuine points of interest and where we can make a real difference for people. That is one reason why I was very keen, despite being the shadow Secretary of State, to speak in this debate—but also, of course, because it is a pleasure to serve opposite the Minister again for old time’s sake. I very much look forward to what she has to say and I am grateful to have had the opportunity to speak.

• 23 Jan 2025 · Rare Retinal Disease · Hansard source

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  It is a pleasure to serve under your chairmanship, Dame Siobhain, and to do so debating a health matter, as we have spoken many times in the past about health issues. I am very grateful to the hon. Member for Strangford (Jim Shannon), who I call my friend, for bringing forward this debate. I am equally grateful for the opportunity to serve opposite the Minister. She and I have served opposite one another on many occasions in the past—previously with me on the Government side and her on the Opposition side, but I am getting used to this side of the Chamber now. It is encouraging that she is responding because she engages with these debates and gives genuine answers. The debate will be the better for her being the Minister. The hon. Member for Strangford has brought forward a hugely important debate, as he so often does. Many important issues rarely get brought before the House, yet we are the poorer for that. This debate might not otherwise have been tabled, but it is right that we debate the issue. I pay tribute to the hon. Member for Battersea (Marsha De Cordova), who is not in the Chamber but has done a lot in the House to highlight the issue in her work with the APPG—it would be wrong not to recognise that in this debate. I also pay tribute to the Royal National Institute of Blind People for its work and to all those who have contributed to raising awareness. Before I became a Minister in 2018, I was the vice-chairman of the APPG on eye health and visual impairment, so I took an interest in this important issue back then, and it crossed my radar on a number of occasions when I was Health Minister. As the hon. Member for Strangford and the hon. Member for Leicester South (Shockat Adam) set out, while individual rare conditions may be exactly that—they occur rarely, with few people getting them—collectively, rare conditions account for a significant number of the conditions that individuals in this country have. The hon. Member for Leicester South brought his background and knowledge to bear on the subject, as he does when speaking about these matters. He highlighted the potentially devastating impact that optical and retinal diseases and illnesses can have on someone’s life. A few years ago I did something very trivial; somehow—heaven knows why—a tree branch went right across my eye and cut it. I recovered fully, but for the few weeks that I had the treatment and the cream, it had an impact on my daily life. It was trivial in the great scheme of things—although if untreated, it may not have been—and I can only begin to imagine the impact of some of those conditions, as the hon. Member elucidated.

• 23 Jan 2025 · Rare Retinal Disease · Hansard source

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  In which case, I remain very grateful to the clinicians at the Leicester royal infirmary. The hon. Member will be pleased to know that my wife shares his view about the dangers of gardening, particularly when I am doing it. As right hon. and hon. Members can see, I am increasingly reliant on my reading glasses and my regular eye tests at Specsavers—other opticians are available. As the hon. Member for Strangford said, that is a reminder of the importance of the issue. A regular eye test not only can detect optical and retinal illnesses earlier, but can potentially spot other more serious conditions that are not directly related to eye health, but of very great significance.

• 20 Jan 2025 · New Hospital Programme Review · Hansard source

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  And Madam Deputy Speaker. [ Laughter . ]

• 20 Jan 2025 · New Hospital Programme Review · Hansard source

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  I am grateful, as always, to the Secretary of State for his typical courtesy in giving me advance sight of his statement. Labour was prepared to make all sorts of promises in opposition to win power—it promised not to raise taxes on working people, it said that it would not cut the winter fuel payment, and it promised to deliver the new hospital programme—but just as working people, pensioners, farmers and businesses have found, this is a Labour Government of broken promises. They have cynically betrayed the trust of the British people. The Secretary of State and the Chancellor travelled the country to meet candidates who were promising a new hospital in their local area. In fact, despite my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins) calling them out in this very place in May last year, warning that Labour had said in the small print of its health missions that it was planning to pause all this capital investment, the Secretary of State was quoted in the Evening Standard in June last year to have said: “We are committed to delivering the New Hospitals Programme”. Those are seemingly hollow words now that those hospitals are at risk, with the investment and upgrades they deserve pushed back potentially to start in some cases as late as 2039. Voters put their trust in the Labour party to deliver on its promises, yet today they have been let down. In response to claims that that is perhaps because of Labour’s economic inheritance, that simply does not reflect reality. Before the Secretary of State warms to the theme of the mythical £22 billion black hole, he will know that the Office for Budget Responsibility has simply failed to recognise that figure. Let us also be clear that, due to the Labour party and the Chancellor’s financial mismanagement at the Budget and the rise in gilts, the BBC recently estimated that the cost of borrowing could be £10 billion higher over this Parliament. Just imagine what the Secretary of State could have announced today if the Chancellor of the Exchequer had not caused that. To govern is to choose: what to spend money on, what to invest in, and what not to invest in. The Secretary of State rightly pointed out that the Darzi review highlighted the need for more capital investment in the NHS, yet he has decided not to prioritise the delivery of these new hospitals in a rapid fashion. He will also know how the Treasury allocates funding, with cash earmarked to the end of a spending review period but not going across it until that comprehensive spending review formally concludes—that is what his Government are now doing. The Secretary of State will be aware that the previous Secretary of State, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), was very clear about the £20 billion anticipated in the next CSR to fund this. Let me be clear: we prioritised the delivery of these new hospitals, as my right hon. Friend did in his statement on RAAC on 25 May 2023, setting out the Government’s commitment to fund them. This Secretary of State has not replicated that. We had a clear plan, with that funding commitment to be formalised at the CSR, to approve, build and complete new hospitals to a definition akin to that used by Tony Blair when building new hospitals, which were already being designed to a standardised approach with modern methods of construction. The Secretary of State has put that progress at risk. Will he confirm that in his CSR discussions with the Chancellor of the of the Exchequer about the capital departmental expenditure limit—CDEL—allocation for his Department, he will prioritise the new hospital programme? When will the Secretary of State set out to local people in each area exactly when construction will start? I declare an interest: University Hospitals of Leicester NHS trust serves my constituents. In each case, when will the doors actually open? If the Chancellor fails to get the economy growing and starts looking yet again for cuts to fill the hole that she created with her Budget, will the Secretary of State rule out any further delays? What is his assessment of the effect of his lengthening the programme’s timescales on costs, given inflationary pressures? Are all other previously approved capital projects and programmes safe from review? Can he possibly update the House—via the Library if not here—on his latest assessment of the impact of RAAC in those hospitals, which rightly he is continuing to prioritise? Today’s announcement will come as a bitter blow to trusts, staff and, crucially, patients, who believed the Labour party and will now be left waiting even longer for vital investment. Yet again, before the election, they talked the talk, but patients lose out when this Government fail to deliver. In yet again kicking the can down the road, as is increasingly their habit, they have sadly betrayed the trust of the British people.

• 15 Jan 2025 · Health and Social Care: Winter Update · Hansard source

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  As ever, I am grateful to the Secretary of State for his typical courtesy in giving me advance sight of his statement. May I join him in saying that our thoughts are with the nurse in Oldham who was so viciously attacked? Like him, we wish her a full and speedy recovery. May I also echo his words of gratitude to NHS and social care staff for all they do to help and support patients and our constituents? We last heard from Ministers on winter pressures just before Christmas. Yet, as the Secretary of State has set out, the situation has continued to grow more severe. We have all heard about those pressures in the media and from patients, constituents and staff. Indeed, I will take this opportunity to acknowledge the work of the hon. Member for Tooting (Dr Allin-Khan), who I know has been on the frontline and has, I suspect, seen those pressures—the unacceptably long waits in A&Es for ambulances, and corridor care and its impact on patients—at first hand. When someone calls an ambulance, they need to know that it will come, but it cannot if it is sitting in a hospital car park. At my local hospital in Leicester, for example, over 36% of ambulances handing over had a one hour-plus wait, and I am sure that that is replicated around the country. The Secretary of State highlights that the number of patients in hospital with flu is triple what it was a year ago, yet it appears that the rate of flu vaccine uptake for over-65s, at-risk groups and healthcare workers is lower than last year. He wants more people to be vaccinated, and I share that view, but will he set out in more detail what he is doing to further drive vaccine rates and ensure that vaccines are available for all those who need and want them? As the Secretary of State said, more than two dozen hospitals declared critical incidents last week. Although I welcome the fact that the vast bulk of those incidents have been stood down, will he set out what support and additional resource is being offered not only to hospitals that have reached the point of declaring critical incidents, but to others that continue to face pressures? Last year, the Government provided additional funding for hospitals and social care to boost capacity and, vitally, the number of beds in hospitals, as well as to tackle delayed discharges. Will the Secretary of State set out in more detail what he is doing in a similar vein? Will he update the House on how many people currently in acute settings are fit for discharge but have not been discharged for a variety of reasons? The Secretary of State mentioned pay, and said that he had negotiated a deal. I say gently to him that what he did was not negotiation but capitulation to an inflation-busting pay rise. None of these pressures comes as a surprise to me or to the Secretary of State. He was open and candid, as he often is, in acknowledging that there would be a winter crisis this year. NHS England directors were warning that they did not have the resources needed to surge capacity or increase social care packages now, which the Conservative Government provided in previous years. The royal colleges said that nothing had been done to mitigate a winter crisis, and NHS organisations said that they needed more support to prevent ambulance delays, overcrowded A&Es and people being stuck in hospital beds because of a lack of community and social care. He knows—we have spoken about it before—the importance of flow from ambulance to A&E, and from A&E to a bed or to discharge. What extra steps is he taking to increase the number of care packages now rather than in the future, and will he consider allowing community hospitals, such as mine in Melton Mowbray, to play a greater role in providing care to local communities in order to ease pressure on acute settings? Those concerns were all raised in September and October. My predecessor as shadow Secretary of State, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), asked about them, yet the Secretary of State failed to provide an update to the House until Ministers came to the House just before Christmas. Indeed, I recently asked a named day question about when the Secretary of State started chairing his weekly winter preparedness meetings. Despite, one hopes, a quick look at his diary giving the answer, I received a holding answer. I only got the correct answer after that holding answer had been sent to me, stating that it was in December. Can he say on which date in December the first of those meetings was held? Before Christmas, I and the Conservatives called for a winter-specific bed increase plan. We still have not had one. Will the Secretary of State set out what he is doing to increase the number of beds and the amount of capacity now? While the Secretary of State talks the talk, he has not done the work ahead of this winter. Will he now reassure patients and staff that he will urgently boost capacity, resources and support to ensure our constituents get the care they need when they need it?

• 7 Jan 2025 · Topical Questions · Hansard source

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  The Prime Minister’s announcement yesterday of his elective recovery plan mirrored that of Sir Saijd Javid in 2022, but one aspect was different. Our plan explicitly recognised the importance of the workforce being in place to deliver the 9 million extra tests and interpret the results, and it set out proposals to increase that workforce further. What plans has the Secretary of State to boost the workforce in community diagnostic centres specifically, over and above the plans that he inherited from us, to ensure that his elective recovery plan is deliverable?

• 7 Jan 2025 · Topical Questions · Hansard source

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  On hospices, while the Secretary of State’s pre-Christmas hospice funding announcement was, of course, welcome, the vast bulk of it was in fact non-recurring capital funding, which cannot be used to help them cover the hiked employer national insurance tax on hospices’ most precious asset: their staff. What steps is he taking to ensure that they receive recurring revenue funding, to enable them to cover the additional costs?

• 6 Jan 2025 · Health and Adult Social Care Reform · Hansard source

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  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.

• 18 Dec 2024 · Winter Preparedness · Hansard source

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  I am grateful to the Minister for early sight of her statement—as I have said before, it is typically courteous of her. I echo the gratitude that she expressed to those in our NHS, and also those in the social care workforce who will be working hard throughout the festive period. As she alluded to, the NHS is already feeling the pressure this winter. We know that winter is always tough for the NHS, irrespective of who is in government, but services are feeling the strain even earlier than in previous years. A tidal wave of flu infections has led to a 70% increase in hospital cases in just seven days, and the national medical director of the NHS has warned of a “quad-demic” of health emergencies as cases of covid, norovirus, RSV and winter flu are all on the rise. Meanwhile, in October, the longest A&E waits of over 12 hours increased by over a quarter in just one month, reaching the third highest monthly figure since comparable records began in 2010. Of course, all that has come before the cold weather really hits and before more vulnerable pensioners are left in freezing homes, unable to put the heating on after the winter fuel payment was scrapped for a large number. What assessment has the Minister and the Department made of the potential impact of that on hospital admissions this winter? In government, we recognised that the NHS faces unique challenges in winter. We also recognised, as I know the Minister does from our previous discussions, the importance of flow in the NHS, with all parts of the system working together. That is why last year we provided £200 million to boost NHS resilience specifically during the peak winter months, which was accompanied by £40 million to bolster social care capacity and improve discharges from hospital. That followed the £1 billion announced earlier that year to boost capacity by delivering 5,000 additional beds, 800 new ambulances and 10,000 virtual ward places. The Secretary of State himself has admitted that there will almost certainly be a winter crisis. There have been warnings from the Royal College of Emergency Medicine, the Royal College of Nursing and directors at NHS England. Yet in today’s statement, in contrast to the steps we took, we heard a lot about data, meetings and co-ordination, but very little in concrete terms to increase capacity specifically over the winter period. That will give scant reassurance to those working in the system or patients needing the system. In fact, earlier this year, the Secretary of State suggested that there would not be any specific new funding for the NHS to cope with winter pressures. The Minister will know that I have tabled a number of written questions in recent days, met in many cases by what seems to be the standard DHSC response for named day questions of a holding answer. As the pressure continues to grow, I have a number of specific questions for the Minister while she is at the Dispatch Box. Will the NHS receive more resources specifically to increase bed and A&E capacity this winter? Are there enough hospital beds and ambulances for this winter, or is she taking steps to increase them? As of the 1st of the month, how many people who were medically fit to be discharged had not been, for a variety of other reasons? I am grateful for the update that the Minister provided on winter vaccinations. What assessment has she made of the supply of the flu vaccine? There are some suggestions that pharmacies and others have run out and are waiting for more deliveries. How many additional 111 and 999 call handlers have been recruited specifically for this winter? We talked briefly about the need for the system to work as a whole. In that context, what is the impact of national insurance contributions on hospices, social care and GPs? The Secretary of State told the Health and Social Care Committee this morning that hospices would get an update from him before Christmas, but at Prime Minister’s questions in response to the Leader of the Opposition, the Prime Minister appeared to say that it will be after Christmas. Can the Minister clarify that for the House, because it is an important point? Finally, what meetings has the Secretary of State personally had with Julian Redhead and Sarah-Jane Marsh, the NHS winter leads, and when was the first of those meetings specifically on this subject? I am very happy for him to write to me if that is easier, given the complexity. As seasonal flu piles yet more pressure on NHS systems, it is more important than ever that it gets the resources and support that it needs. There are many promises of reform, but the NHS needs an immediate capacity boost in beds over winter. So far, the Government have kicked reform into the long grass in favour of yet more consultation, and their preparations for winter have lacked the urgency and focus that patients and NHS staff demand. In government, the Conservatives always put extra support in place to keep the NHS going through the tough winter period, boosting capacity and increasing support. This Government need to get a grip and do the same.

• 11 Dec 2024 · Puberty-suppressing Hormones · Hansard source

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  I thank the Secretary of State for advance sight of his statement, and for his courtesy in coming to the House to make an oral statement, which gives hon. Members the opportunity to ask him questions. When the Secretary of State is wrong, we will challenge him robustly and hold him to account, but when he is right, we will support him. That is responsible opposition. In what he sets out today, he is right, and he has my support for what he is doing. Protecting children is one of the most important priorities that a Health Secretary can have. My predecessor, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), worked tirelessly to do just that. She set out that it was her priority to protect children and young people from risks to their safety from the prescription of puberty blockers, given the lack of an evidence base. I welcome the Secretary of State’s continuing the work started under the previous Government, and I welcome his support at the time and all that he has done since, including in his statement on 4 September. I associate myself with the three principles that he enunciated when he opened his statement. With increasing numbers of young people questioning their gender identity, NHS England, with the support of previous Conservative Health Secretaries Matt Hancock and Sir Sajid Javid, commissioned Dr Hilary Cass to examine the state of services for children questioning their gender. That historic review cut through the noise and ideology to lay bare the clear facts, so that we as policymakers can seek to make decisions based on evidence, safety and biological reality, and create a service that better serves the needs of children, as the Secretary of State set out. In the review, Dr Cass made it clear that not enough is known about the lifelong impacts of using puberty blockers on young minds and bodies to be sure that they are safe, and that the robust evidence base was simply not there. In March, NHS England made the landmark decision to end the routine prescription to children of puberty blockers for gender dysphoria. With the support of the then Government, it announced that it was stopping children under 18 from being seen by adult gender services with immediate effect. As one of the final acts of the previous Government, my right hon. Friend the Member for Louth and Horncastle used emergency powers under section 62 of the Medicines Act 1968 to extend the ban to private clinics selling puberty blockers to young people questioning their gender. It was the right thing to do, and I agree with and pay tribute to her, as I do to the Secretary of State for what he has subsequently done. The safety and wellbeing of children and young people must come above any other concern. I welcome the fact that the Secretary of State renewed the order; his saying that he will make the ban indefinite, given the absence at present of an evidence base; and his seeking to better understand and build that evidence base. I have a few questions that I hope the Secretary of State can offer clarifications on in a constructive spirit. I hope—I think he alluded to this—that he will confirm that he intends to implement the Cass review’s recommendations in full. Of course, support must be available to children and young people who are questioning their gender identity, and that support must be holistic, multidisciplinary and evidence-led. The Tavistock clinic closed earlier this year, and as he set out, three new regional NHS children and young people’s gender services have opened to provide better, tailored gender services for children and young people—again, that is based on recommendations in the Cass review. Can the Secretary of State provide more detail on the delivery of the remaining regional centres, and say what order they are due to open in, so that children and families can see what is happening in their region? Again, that is about putting the best interests of young people first. Can the Secretary of State reassure the House that these measures will be UK-wide and that he is working in tandem with the devolved Administrations? Will he advise on what progress has been made thus far—I appreciate that it is early days—on further research into patient care and increasing that evidence base? Can he update the House on the steps taken to continue the work of his predecessor, my right hon. Friend the Member for Louth and Horncastle, when she announced to the House in May the decision to work to close any online loopholes to the regulations put in place? Finally, will he commit—I suspect I know the answer to this one—to keeping the House updated in the months and years ahead on developments in this space? Our children and young people deserve healthcare that is compassionate, caring, careful and led by the evidence. I associate myself with the Secretary of State’s concluding remarks on the need for the debate to be conducted in a respectful and sensitive way, with the needs of children and young people at its heart. We will support measures that protect children, and support him in bringing forward such measures; we want to work constructively with the Government to give the next generation access to the right healthcare to meet their needs. I look forward to working with him in the months ahead.

• 26 Nov 2024 · Tobacco and Vapes Bill · Hansard source

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  I am grateful to the hon. Gentleman for most of what he just said. I will address precisely his point in a few paragraphs, but I say to him that my party brought forward legislation in March, which was debated in April, that did not have the mission-creep that I fear the Secretary of State is demonstrating with clause 136 and various other measures in this proposed legislation. I must also challenge the Government on how they anticipate this measure being enforced. Will members of the public be encouraged to call the police if they see a parent smoking in a prohibited place? If there are no children in a park or playground, will it still be prohibited? Concerns are also raised by the new licensing and registration schemes. While it is right that we had planned to expand the existing notification scheme to include non-nicotine vapes and nicotine products involved in the supply chain, this Bill goes a number of steps further. The Secretary of State will be able to create a new licensing regime for retailers for tobacco, vaping and nicotine products. Over 70% of convenience stores selling vapes and tobacco products are independent shops. How will they fare and how will they be assisted with the layers of added bureaucracy and cost that will be associated with the Bill? Do local authorities, which are already under pressure, have the capacity and additional funding allocated to administer such a licensing scheme in their areas? Again, my fear is that we are unable to make a fully informed decision about the impact because the regulations will be set out only after the Bill has passed. The impact assessment states: “A more restrictive licensing scheme would be expected to have a greater impact on public health and a greater economic impact on businesses.” However, we simply do not know if that is what the Secretary of State has in mind or what the regulations will look like. Likewise, there is no detail on the impacts of a new registration scheme for all tobacco, vaping, nicotine and herbal products, as well as tobacco-related devices. In the few months that the Government have been in office, they have sadly shown that they are not particularly a friend of business and have broken a number of their pre- election promises. Although I have confidence in the Secretary of State as an individual and as a right hon. Member of this House, I ask him to forgive the cynicism of those on the Opposition Benches over any attempted reassurances from the Government that they will take businesses’ concerns into account as they consult on their plans. To the point made by the hon. Member for Bracknell (Peter Swallow), if a Division is called, in line with the precedent set last time this will be a free vote; each Conservative Member may vote as they choose. The Bill, as I have said, comes from a good intention to keep the population healthy, to ease costs for the NHS and to prevent children from taking up addictive habits that may follow them for the rest of their lives. I support those objectives, but I call on the Minister for public health, when he winds up, to give the reassurances I seek and roll back the additional measures that have been put in place, over and above what we were proposing. It is important that information is available so that people can make informed decisions and that support is available for those who choose to stop smoking. Adult individuals are best placed to make decisions about their own lives, but we recognise that the same is not true for children. I look forward to the responses from the Minister for public health, which I hope will be constructive. I welcome the Secretary of State’s offer to be collaborative and constructive in his approach to the legislation.

• 26 Nov 2024 · Tobacco and Vapes Bill · Hansard source

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  That will depend on whether the Minister for public health gives the promises I seek that he will withdraw a number of the measures that the Government have added to the Bill. I am grateful to my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who will take the Bill through Committee on behalf of the Opposition, and I know that she looks forward to constructive and collaborative engagement with the Minister. I hope he can offer reassurances when he gets up to the Dispatch Box in a few hours’ time.

• 26 Nov 2024 · Tobacco and Vapes Bill · Hansard source

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  I will briefly, because I have one sentence to go.

• 26 Nov 2024 · Tobacco and Vapes Bill · Hansard source

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  I do not always do this, but I express my gratitude to the Secretary of State for the tone he has adopted in this debate and for recognising the strongly and sincerely held views of right hon. and hon. Members on both sides of it. I am also grateful to him for being typically willing to share with the House in support of his points something as personal as what happened to his grandmother. Sadly, it will not surprise him that no one asks me for my ID these days—I will have to take some tips from him on the moisturiser that he uses. [ Interruption. ] I will ignore the unkind comment that he has just made. In many ways, this Bill is like the curate’s egg: it is good in parts—indeed, it is good in many parts—and started from a place of good intentions. As the Secretary of State set out, smoking has a huge cost to society and to individuals. We know that smoking is the single biggest entirely preventable cause of ill health, death and disability in this country, and we see in our NHS the impact of smoking every day. It is responsible for around 80,000 deaths in the UK each year and is estimated to cost the NHS and social care more than £3 billion a year, including 75,000 GP appointments every month. As the Secretary of State said, almost every minute someone is admitted to hospital because of smoking. It substantially increases the risk of many major health conditions throughout people’s lives, such as stroke, diabetes, heart disease, stillbirth, cancers, dementia and asthma. As the Secretary of State has alluded to in the past, it is often people in more deprived areas who have higher smoking rates, lower healthy life expectancy and higher mortality rates linked to smoking. Some 230,000 households are estimated to live in smoking-induced poverty, and children of smokers are three times as likely to start to smoke, potentially perpetuating the cycle. Over 80% of smokers started before they turned 20—many started as children—yet more than half of current smokers want to quit; as the Secretary of State said, three quarters say that they would never have started smoking if they had the choice again. Let me be clear: reducing smoking, giving people the information and support to quit, and helping to protect children in particular are worthy ambitions. Among all the doom and gloom, there is some positive news: smoking rates are falling anyway. While around 6 million people in the UK smoke, the number of smokers has been falling for decades. In 2023, just 10.5% of people aged 16 and over smoked, compared with 20.3% in 2010, 20.7% in 2000 and 30% a decade before that in 1990. Likewise, the number of children who smoke is falling. While this trend is welcome, it is understandable that there is a strong desire to see continued action to further drive down the prevalence of smoking and tackle the recent rise in vaping among non-smokers, especially among young people, and to protect future generations. As was evidenced by the interventions that the Secretary of State kindly took from many hon. Members, I am sure that many of us in the House have been alarmed by the surge in youth vaping, which has doubled in the past five years. Despite it already being illegal to sell nicotine vapes to under-18s, a quarter of children tried vaping in 2023. While nicotine vapes can and do play an important part in helping adults to quit smoking, we are clear that children who do not smoke should not take up vaping. The nicotine content makes those products highly addictive, while the long-term impacts of the colours and flavours being inhaled are highly unlikely to be beneficial. Of course, the full effects may not be known for some years yet. The uptake in youth vaping has been driven in part by the branding and promotion of products clearly aimed at children, with vapes, packaging, descriptions and marketing all designed to appeal specifically to young people. Grown adults trying to quit smoking are unlikely to see the appeal of cartoon characters on their vapes, but of course, children and young people will. Likewise, the bright colours and fruit flavours are far more likely to appeal to children than to those looking to quit tobacco smoking. For those reasons, the last Government introduced a Bill that primarily targeted our interventions at young people. It would have restricted who could purchase tobacco products without impacting current adult smokers. It sought to tackle youth vaping by restricting flavours, introducing plain packaging and changing how vapes are displayed in shops so that they do not appeal to children. It would also have prohibited the sale of non-nicotine vapes and vaping alternatives such as nicotine pouches to under-18s, just as it is already illegal to sell nicotine vapes to children. In parallel, it would have introduced new fines for rogue retailers in order to tackle the illegal market, seeking to make sure that the law—such as age restrictions on purchasing vapes—was properly enforced. That approach was targeted at the next generation of young people and aimed to prevent the take-up of smoking and vaping and break the cycle of nicotine addiction before it had even started. That Bill was not about demonising people who smoke or curtailing current smokers’ rights or entitlements in any way. None the less, it had challenging practical implementation impacts. I have a lot of respect for the public health Minister, the hon. Member for Gorton and Denton (Andrew Gwynne)—I think that is his new constituency name—and know him well. I hope that when he winds up the debate, he will address some of the points I am about to make. My first point is about the impact on shopkeepers, particularly small shopkeepers, of enforcing and operating within increased restrictions, and the extent to which those restrictions are practically enforceable. In the context of what the Bill sets out to do, how does one avoid the existence of, or an increase in, a black-market economy in vapes or cigarettes? We introduced our Bill before the general election. Since then, the new Government have introduced a Bill that may have the same name, but is not quite the same Bill that was introduced back in March. The Bill before us today gives the Secretary of State new, or significantly modified, powers under the Health Act 2006. It runs the risk of piling an unknown number of regulations on to retailers through a new licensing scheme, and it creates a whole new registration scheme. The challenge is that right hon. and hon. Members will not be told in detail what those schemes will look like, the specific impact they will have on businesses, or the detailed impact they will have on smoking and vaping rates until after the legislation has been passed. A hefty impact assessment—all 294 pages of it—has been produced. Given that the public health Minister has signed it, I fear he had to read every one of those pages before doing so. However, even with that impact assessment, the detailed impact of the individual regulations that may follow is unclear. For example, clause 136 amends the Health Act 2006 to give the Secretary of State the power to extend smokefree places to some outdoor spaces. Of course, adults should be mindful and thoughtful about where they smoke or vape to be considerate to those around them, especially in areas with children or vulnerable young people, but the Bill risks giving the Secretary of State expanded powers to expand smokefree areas with minimal oversight. I acknowledge that the affirmative resolution procedure will be used, but as we in this House know, a statutory instrument and the procedures that accompany it are not as rigorous in their scrutiny as primary legislation. Unlike previous laws, which banned smoking in confined areas such as pubs and bars, the Secretary of State is talking about bans in open spaces where the risks of second-hand smoking may be more limited. Page 64 of the delegated powers memorandum states: “Under Section 4 of the 2006 Act, the Secretary of State could make regulations to designate additional places as smoke-free provided that they were of the opinion that there was a significant risk persons present in such a place would be exposed to significant quantities of smoke without a smoke-free designation…Section 5 of the 2006 Act gave the Secretary of State powers to make regulations for vehicles to be smoke-free.” It goes on to say: “Clause 136 amends the existing power in section 4 of the 2006 Act by omitting the risk condition.” I would be grateful if the public health Minister could explain in his winding-up speech—I suspect he will be able to do so—why that condition is being removed. It was there for a reason: to give a sense of proportionality to anything that was done and to ensure that a particular bar had to be met, given the impact. Its removal effectively gives the Secretary of State much greater discretion to do as he wishes at a future date. I note that the Secretary of State has said today that he changed his mind on banning smoking in pub gardens or outside hospitality venues. I know him well, and he is an honourable man, so I take him at his word on that, but there is nothing in this proposed legislation to prevent a future Secretary of State from coming back, consulting and expanding beyond the areas where he proposes to restrict smoking to other venues and settings at a future date. Under clause 136, that could be done without the crucial risk criteria being applied. I would be grateful if the Minister could address that point, because it is hugely important. Members are being asked to decide now whether they support expanding smokefree places to an unknown list of outdoor spaces in the future, so it genuinely raises significant challenges and concerns if that gateway is not in place.

• 19 Nov 2024 · Topical Questions · Hansard source

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  I am grateful for that response but, just as my hon. Friends have highlighted in respect of the damaging impact of increases in employer national insurance contributions on GPs, hospices and care providers, I fear it was another example of the Government simply not answering the question and not having a plan yet. Either the Government have not done their homework and, as with the impact of NICs increases, they have not thought this through and do not know, or worse, they do not care—which is it?

• 19 Nov 2024 · Topical Questions · Hansard source

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  The Secretary of State knows that every year, irrespective of which party is in government, winter is challenging for the NHS. Possibly, it will be all the more so this year with the potential impact on older people’s health of the loss of the winter fuel allowance by many. What winter preparedness steps has he taken, like previous Governments, to increase A&E capacity and to increase the number of beds this winter, and can he say by how many?

• 5 Nov 2024 · Income Tax (Charge) · Hansard source

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  I will make a bit of progress, if I may. There were no plans for social care reform after the Chancellor broke Labour’s promise to deliver the cap on social care costs. I hear what the Secretary of State says about a willingness to work on what is a challenge facing our whole country and society: with an ageing population, how do we address the challenge of social care? There were no further detailed plans for NHS dentistry, despite the election pledge to deliver more dental appointments. There was no support for pharmacies or for the day-to-day running of general practice, and there were still no additional resources for the NHS this winter—or, indeed, the details of reform to go with them.

• 5 Nov 2024 · Income Tax (Charge) · Hansard source

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  I will make a little progress before giving way to the hon. Gentleman. I congratulate the Health Secretary on winning round 1 with the Treasury—I look across the Chamber and see the Chief Secretary to the Treasury on the Government Front Bench—in securing extra investment. He has secured more than £22 billion announced for the NHS, but without, as yet, any detailed indication of where that funding will go. I look forward to him returning to the House to set out the detail—I think he said that would be next week. What it must do is genuinely improve outcomes for patients and our NHS, rather than simply be focused on the headline figure of the inputs to it. There are, as yet, no clues as to whether it will be spent on wages, recruiting more staff, medicines or equipment; no clues as to how it will deliver the 40,000 additional appointments that have been promised; and no conditions linking the funding, as yet, to productivity improvements, modernisation or better outcomes for patients. What we need to hear next week from the Secretary of State is an actual plan. As he mentioned, the right hon. Gentleman became shadow Health Secretary three years ago. I hope that in that time he has had an opportunity to think about what he wants to do and that he will actually set that out to the House next week.

• 5 Nov 2024 · Income Tax (Charge) · Hansard source

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  It is a pleasure and a privilege to be working once again in health and social care, although a disappointment to be doing it from the Opposition Benches. It is a privilege because, like the Secretary of State for Health and Social Care now, I had the privilege in government of working with the amazing and dedicated people who work in our NHS and in social care up and down the country. It is a pleasure to be back. It is a pleasure to be opposite the Secretary of State, as he now is. I remember our tussles back in the day, when I was sitting over there and he was sitting here. I am sufficiently fond of the right hon. Gentleman to encourage him not to get himself fired out of a cannon, as he alluded to. Although I will say one thing for it: it would not only draw attention to his day job, but possibly even aid him in his ambitions to secure his boss’s job in due course. In respect of his comments about the Leader of the Opposition, my right hon. Friend the Member for North West Essex (Mrs Badenoch), I would only say very gently that she should probably take that as a compliment. When the right hon. Gentleman attacks someone in that way, it probably means that they are somewhat frit of her. I think he will see in the coming weeks and months why that is so. We have already seen and heard over the previous days of debate that this is unequivocally a Budget of broken promises. Despite the pledges made over the course of the election and the commitments given to the British people, in reality those words meant nothing to the Labour party once it secured the keys to No. 10. Instead, we have seen taxes hiked on working people: the people who provide food security and food every day, our farmers, hit hard by the changes that have been made. We see living standards set to fall and mortgage rates likely to rise. We see taxes up, we see borrowing up, we see debt up, and we see that growth will be down on where it could and should be. Unfortunately, I fear, that pattern of broken promises also applies to the NHS and our social care sector.