The Minister for Secondary Care (Karin Smyth)

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I thank the hon. Member for Sleaford and North Hykeham (Dr Johnson); I could not have asked for a better set-up. I pay great tribute to my hon. Friend the Member for Great Grimsby and Cleethorpes (Melanie Onn). This is an issue she has pursued for some time, and I am grateful for her securing this important debate. I know many more Members would have liked to speak. I will not take any interventions in the short time I have to respond because I want to address some of the questions raised.

This issue continues to be a matter of great concern to Members and all our constituents. Poor oral health can have a devastating effect on individuals, as we have heard, impacting their mental and physical health alike and, indeed, their opportunities for work, as my hon. Friend the Member for Leigh and Atherton (Jo Platt) made clear. Yet it is a largely preventable issue through good oral health hygiene and regular visits to a dentist. We inherited a broken NHS dental system, and our ambition is to rescue and restore NHS dentistry so that we deliver more NHS dental care to those who need it. Fourteen years of neglect, cuts and incompetence by the previous Government have left NHS dentistry in a state of decay. That is simply unacceptable and needs to change, which it will.

As of March 2024, more than 36,000 dentists are registered with the General Dental Council in England, and yet less than 11,000 full-time equivalent dentists were working within the NHS. Lord Darzi said in his report:

“There are enough dentists in England, just not enough dentists willing to do enough NHS work”.

That is why this Government are prepared to take strong action. Since coming into office, we have made good progress on our plan for change. We have already taken action to address the immediate needs of patients in pain and requiring urgent dental care through our manifesto commitment to deliver an additional 700,000 urgent dental appointments per year. Integrated care boards started to deliver those appointments from April, and each area has been given expectations for delivery based on their local needs.

That point was noted by my hon. Friends the Members for Filton and Bradley Stoke (Claire Hazelgrove) and for Amber Valley (Linsey Farnsworth), who campaigned studiously in opposition and continue to bring this to the House. ICBs have returned detailed plans for delivering against the expectations, and the Minister for Care is holding regular meetings with officials in the Department and with NHS England to monitor and drive progress against those plans. I commend my hon. Friend the Member for Gloucester (Alex McIntyre) for pursuing the matter with his ICB—that is exactly the right thing to do.

To have a truly effective dental system, we cannot focus just on those already in pain. We must have a system that prioritises prevention, particularly for children—a point well made by my hon. Friends the Members for North Ayrshire and Arran (Irene Campbell), for Blackpool South (Chris Webb) and for Morecambe and Lunesdale (Lizzi Collinge). That is why we have invested over £11 million to roll out a national supervised toothbrushing programme for three to five year olds. That will reach up to 600,000 children a year in the most deprived areas of England. Alongside that, we have launched an innovative partnership with Colgate-Palmolive, which is donating more than 23 million toothbrushes and toothpastes over the next five years. That is incredible value for the taxpayer and a fantastic example of how businesses and Government can work together for public good.

We have also taken the decision to expand community water fluoridation across the north-east of England. That is the first expansion for decades and will bring benefits to an additional 1.6 million people in the region.

Our workforce is crucial, as we have heard this afternoon. A strong dentistry system needs a strong workforce, and we recognise the incredible work that dentists and dental professionals do. I pay tribute to Mr Dobranski mentioned by my hon. Friend the Member for Leigh and Atherton—what amazing service. I also mention my own dentist Aidan Moran, who has been seeing me for the best part of three decades.

A central part of our 10-year health plan will be our workforce and how to make sure that we train and provide the staff, technology and infrastructure the NHS needs to care for patients across our communities—a point well made by my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley). We will publish a refreshed workforce plan to make sure the NHS has the right people in the right places with the right skills to deliver the care that people need.

As my hon. Friend the Member for South Norfolk (Ben Goldsborough) highlighted, we are all sadly familiar with the term “dental deserts” to describe parts of the country where access is especially difficult. We are continuing to support integrated care boards through the golden hello scheme, but of course dentists are only part of the team; dental therapists, hygienists, nurses and technicians all play a vital role, and we need to make the NHS a better place to work for all of them.

We are committed to fundamental reform of the dental contract. It could have been done sooner; it could have been done at any point over the last 14 years by the coalition or the Tories, but they left it for us to do. It will take time, but I assure everyone here that development of these proposals is under way. We continue to work with the British Dental Association and other representatives to deliver our shared ambitions for dentistry. My hon. Friend the Minister for Care met the BDA recently and they have a productive relationship.

In the spirit of honesty, let me be clear: there are no perfect payment models, and any changes to the complex dental system must be carefully considered, so that we deliver genuine improvements for patients and the profession. It is an immense challenge. There are no quick fixes and no easy answers, but people across the country deserve better access, and we are determined to make that happen.

We know we must deal with the immediate crisis. That is why we will deliver 700,000 extra appointments each year, get more dentists into the communities that need them the most, and make sure that everyone who needs an NHS dentist can get one. NHS dentistry will not be rescued overnight. It will take time, investment and reform, but improving access to NHS dentistry is key to our mission to get the NHS back on its feet and fit for the future.

The Minister for Secondary Care (Karin Smyth)

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It is a pleasure to serve under your chairmanship this morning, Mr Dowd. I thank the hon. Member for Christchurch (Sir Christopher Chope) for raising GP surgeries, which is a vital matter to so many of our constituents. That is because GP surgeries are the front door to our NHS, and visiting a GP represents far better value for taxpayers’ money than accident and emergency departments. That is why, since coming into office, fixing general practice has rightly taken up a lot of our bandwidth, energy and focus.

It is worth remembering that we inherited a system in total disarray, and a bizarre situation in which we simultaneously had a GP shortage and newly qualified GPs looking for work. I am proud of everything we have done to turn GP services around in the nine or 10 short months we have had. However, before I come on to that, let me address some of the hon. Gentleman’s points.

Ahead of this debate, I asked my office to get in touch with the integrated care board locally so that we had a fuller picture of what is happening on the ground. My understanding is that Burton surgery was previously a branch of Christchurch medical practice, which is just under two miles away. The surgery closed in August last year because the owners wanted to sell. Although the ICB did not approve of the closure, it recognised that it had little influence over the sale as GPs are independent practitioners.

I am informed that the local community were—as they often are—understandably unhappy with the news about changes to the services, and that the hon. Gentleman got in touch with Dorset ICB. When a veterinary business tried to buy the site, the application received over 100 objection letters and the sale did not go ahead. The ICB then received two further applications to renew the site, about which it considered a number of factors, as is normal practice: whether there is good access to surgeries in the area; what the impact would be on patients and on community needs; how it would affect the quality, equity and safety of provision; and how it might affect the stability and ability of other local GP services to run viable surgeries in their area.

I have been assured that the decision that Dorset ICB took was not taken lightly but based on the needs of and the benefits to all prospective patients in the area. The surgery catchment area for Burton is covered by Christchurch medical practice and Farmhouse surgery. As the hon. Gentleman outlined, reopening would have required additional costs, which were not justifiable given the financial challenges facing the NHS—something that we all understand. Consequently, Dorset ICB felt that those costs would reduce provision in the area and lead to significant financial pressures on other local surgeries, which could lead to further closures.

Dorset ICB has seen no degradation of services for patients since the surgery closed and the number of appointments has not decreased overall. I take the hon. Gentleman’s point about the numbers, and I do not know why that information is not available; I am happy to take that question back to the Department. Local MPs should have as much information as possible about services in their areas. These are taxpayer-funded services, so I will check as to why that information is not available. Dorset ICB has not received what it calls formal complaints from patients, but it has received communications from a local campaigning group, which is important. On balance, however, it decided that it could not reopen the practice.

On the point about housing needs, which I talked about for many years when I was an Opposition Member of Parliament, the Government absolutely understand the issue of additional demand and the challenge it poses to primary care infrastructure.

Karin Smyth

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I will not, because the hon. Member for Christchurch wants me to answer his questions.

We are working closely with the Secretary of State for Housing, Communities and Local Government to address the issue of additional demand in national planning guidance and ensure that all new and existing developments have an adequate level of healthcare infrastructure for the community. The NHS has a statutory duty to ensure that there are sufficient medical services, including general practice, in each local area, with funding and commission reflecting population growth and demographic changes. The hon. Gentleman highlights an important point that we will continue to pursue.

Those are the facts about the decision made by the ICB, which was its decision to make. I am not going to stand here and tell the hon. Gentleman that he is not right to do what he is doing; he is absolutely right to fight for the best possible service provision for the people of Christchurch, and I would do the same for my constituents—all hon. Members do that. These decisions are best made locally, however, and it is for Dorset ICB to use its autonomy to make them, not Ministers in Whitehall.

Karin Smyth

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I could talk for a long time about the accountability of health services, but we do not have time for that. The legislation, as set up by the previous Government and others, is clear that ICBs have responsibility for commissioning services on behalf of the local population within the resources that they have available. They need to do that under particular guidelines, which I have outlined, and it is important that they keep up communications with Ministers and local people.

I am not au fait with the day-to-day running of Dorset ICB—that is not for Ministers—but at a strategic level, I recognise that Dorset currently has the fifth-highest ratio of GP clinicians to patients in the country. I know that everyone wants to be in first place, but I am sympathetic to the ICB’s arguments that other practices may suffer if the surgery were reopened. Closing the former site has made the services at Christchurch medical practice and other neighbouring practices slightly larger, which has given them greater resilience in the long term.

The hon. Member for Christchurch mentioned the new Labour Government and what we are trying to address. I do not have the figures in front of me, but every hon. Member present will know there have been hundreds of GP service closures—not just branches but practices—over the past 14 years. The trend has been for primary care to receive a smaller share of the NHS budget, and as a result, secondary care has had much more activity. We all know about the 8 am scramble, and some GPs have been forced to work in appalling conditions with leaky roofs and buckets catching rainwater.

That is why our priority is to stem the flow of resources away from primary care, shift the focus of the NHS from hospital to community, and begin building a much better neighbourhood health service. Our objectives are to hire more GPs, reach an agreement on a new contract, rebuild surgeries through increased capital spend, and bust the bloated bureaucracy that has built up. In the summer, we committed to bringing in an extra 1,000 GPs through the additional roles reimbursement scheme, which we backed with an extra £82 million of funding after changing a technicality that prevented primary care from hiring more new doctors. We have surpassed our initial target and 1,500 more GPs are now serving patients on the frontline. Since we took office, I am happy to confirm that 11 have been recruited by Dorset ICB, including, as I understand, three in the hon. Member’s constituency.

In conclusion, we are committed to shifting the NHS from hospital to community and to building a neighbourhood health service. We are bringing back the family doctor.

Karin Smyth

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As I said, decisions about how the additional costs are borne and the resilience of the rest of primary care in the area are for the ICB. It has been very clear that that is not the case, so the hon. Member may want to take it up with the ICB.

Since we came into office, we have been doing the hard yards of restoring the role of general practice at the heart of our health service, including in the hon. Member’s constituency, by investing in people, places and programmes that cut bureaucracy. We are laying the foundations for an NHS that is fit for the future, particularly based around primary care and neighbourhood health centres.

Question put and agreed to.

The Minister for Secondary Care (Karin Smyth)

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I thank the hon. Member for giving me the opportunity to speak about this topic and highlight the important role that volunteering plays in our health and social care system. The NHS has always benefited from the generous contribution made by volunteers, who play a vital role in supporting our patients, staff and services. We are grateful to the thousands of volunteers who donate their time to support the NHS in a wide variety of roles, from helping patients to leave hospital faster and settle in at home, to supporting emergency cardiac incidents and providing companionship to patients during end-of-life care.

The national NHS and care volunteer responders programme was first established as part of the covid response, and then adapted to respond to other organisational pressures. However, a model that worked well in that national crisis is no longer the most cost effective way of facilitating the important contribution of our much valued volunteers, so NHS England has recently taken the decision to close the current programme. Instead, a new central recruitment portal for NHS volunteers will be fully launched this year, providing opportunities for the current pool of volunteer responders to continue to play their part. Volunteers will have had that information emailed to them recently.

NHS England will also work with NHS providers that draw on the support of the volunteer responders programme to ensure that they are helped in developing other volunteering interventions that meet their service needs.

The roles of 50,000 additional volunteers who are recruited and supported by NHS trusts directly will be unaffected by the closure of this programme. That is in addition to many more thousands of volunteers who support the NHS either directly or indirectly via other local and national voluntary sector organisations.

Successive volunteering programmes in the NHS are primarily run locally by individual trusts and integrated care systems identifying the best opportunities for volunteering interventions that meet their specific service needs. That means local NHS action to build relationships with voluntary sector organisations and co-developing volunteering programmes and pathways that support patients, staff and NHS services. There will continue to be opportunities to strengthen and encourage innovation in NHS volunteering at national level. The Government recognise the need for sufficient and agile volunteering capacity and capability of support in particular scenarios, such as pandemics and flu seasons, when the health and care sector is particularly stretched.

Karin Smyth

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The hon. Lady is right to highlight the tremendous effort that went into establishing the programme very quickly at a time of great crisis, and to thank the hundreds of thousands of volunteers across the country who took part and stepped up. It was a huge effort to get the scheme running and we were all very grateful for it. Everyone learned a great deal from that; as I outlined in my initial response, we will be taking forward those lessons as we look at the role of volunteering in the future.

The hon. Lady says that the changes have come out of nowhere; they have not. We are looking critically across the piece as we fix the foundations of our NHS and ensure that it is fit for the future. We are looking at the most cost-effective means of delivering the same outcome, which is why we will be moving to a centralised portal for part of this work. We have emailed people about that; some people may not have scrolled to the bottom of that email, where there is an option to push a button to register their details, so that they will be updated as new systems come online and we can make sure that we do not lose that great volunteering spirit. That is about digital techniques for the future, using the most cost-effective means and developing clear outcomes.

Karin Smyth

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I am happy to give my hon. Friend an absolute assurance. Volunteers support and complement the existing workforce; they do not replace it. Including volunteers signals a recognition of the important role they play in supporting staff, services and patients. Many hon. Members are volunteers and we have all seen how those volunteers can support the wider system. However, it is important that we keep our staff and respect their important roles.

Karin Smyth

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I thank the hon. Lady for her work volunteering and supporting the scheme during covid. The announcement is about NHS England. The organisation will continue to work with the NHS and voluntary organisations to ensure that where people are volunteering, that will continue, and that volunteers continue to be recruited, ahead of a fuller launch of the recruitment portal later this year. On her wider point, this Government are not dropping talks with other parties about social care, which is being taken forward by the independent commission under Louise Casey.

Karin Smyth

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This is a good opportunity, which I very much welcome, to highlight again how important volunteering is to the NHS and the care system. It will remain an important part of our plans going forward that. People may have had an email and thought that something is stopping and that there is not more to do, but they should ensure that they press that button and register for upcoming opportunities and are in contact with their local NHS systems. As I said, volunteering is done locally, and it is important that we support those local systems and encourage more and more people to come forward to undertake this important work.

Karin Smyth

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I agree with the hon. Lady about the roles that people play, particularly by having conversations and connecting with people who feel disconnected. To be very clear, this decision is about particular arrangements: it does not mean that things are stopping across our country or with local health systems ensuring that volunteers are still available. We want to ensure that we use that knowledge in building systems for the future. I was very pleased to host a roundtable with organisations as part of our 10-year plan process. There are some fantastic ideas and opportunities out there to use the knowledge we have learned, particularly during covid, to use technology to link with people and to recognise where people are not linked by technology and ensure that they remain connected. All of that will form part of our future plans.

Karin Smyth

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I thank my hon. Friend for her work, expertise and knowledge. She is absolutely right—she almost pre-empted my answer—that embedding knowledge where it is needed in the frontline in our communities is exactly what we need to look to do, and we need to recognise where we can use volunteers well. We have micro-volunteering these days, which can help people to link in where it suits them, so that we can take advantage of people—I do not mean “take advantage”; that sounds bad. We can utilise people’s opportunities—perhaps they are working different or irregular shifts—so that they can give more, because we know that there is a great appetite out there to support the system more.

Karin Smyth

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I am afraid that I have to disagree with the hon. Gentleman—it is not muddled. The analysis undertaken by NHS England indicates that the current system is not providing good value for money, and we are making sure that we produce something better for the future. This Government will continue to act in the best interests of volunteers, patients and taxpayers in setting up the NHS of the future.

Karin Smyth

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Well, we could—[Interruption.] Sorry, the hon. Member for Farnham and Bordon (Gregory Stafford) is chuntering from a sedentary position. I partly agree with my hon. Friend. Yes, the Conservatives did run down the NHS and we inherited a broken system, but volunteering has always been a really important part of the NHS and the care system, so I pay tribute to those people who come forward. It is both good for the system and the people they help, and for many individuals. We talked earlier about people feeling disconnected, perhaps as receivers of volunteering, but we know how valuable it is for individuals themselves to be giving and volunteering, and we want to see more of that.

Karin Smyth

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The hon. Lady makes an important point: it is important to make sure that people do not suffer from changes and that the impact is minimised. As I said, the programme was not delivering effective value for money, and we think the future system will. We encourage more people to come forward, to increase the sustainability of volunteering in local systems.

Karin Smyth

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My hon. Friend is absolutely right. We want to make sure that people in her constituency and all our constituencies who have volunteered or who want to—those who perhaps could not at the time, but want to in the future—can do so. Those who are already on the system and have received an email can register via that portal, and we will make sure it is easy for people to do so in future.

I have been reminded by a note that people who volunteered in the very early weeks of the pandemic might have been on a slightly different system from those who volunteered later on, so I think there will be a slightly different process for them. We do not want to lose them. Those who have received an email can register through that portal, but we will make sure that more opportunities are available when that is launched, and I will be happy to update the House when that happens.

Karin Smyth

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The hon. Gentleman makes an excellent point on behalf of his community, as well as rural communities more widely, about the role of volunteer drivers. We need volunteer drivers across a range of areas—in fact, my husband is out volunteering as I speak, driving for another charity. We need more of these people. There are plenty of opportunities for people who have time, and NHS England will continue to work with ICBs to make sure we take forward the best of what we already have into the rest of the NHS.

Karin Smyth

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I thank my hon. Friend for that contribution and her service in that role. She is absolutely right to highlight not just the people who come forward, but the people who run that local infrastructure. As I said in my opening remarks, much of this work is done at a local level. The learning we must take from what the national scheme did is how we bring that together in a crisis. We want to make sure that the learning is spread across the country and that we can use digital technology and a portal, where that suits the many people coming forward. She is absolutely right about local infrastructure and people to make sure things happen. They are best placed to know where the service gaps are and where the people are who can support them. They provide an important link. We will make sure that that is part of our 10-year plan.

Karin Smyth

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The hon. Member is absolutely right. We should be clear that the NHS and the care system need people. He is right about many hospitals being a maze and the importance of that friendly face to greet someone when they go into hospital. They are knowledgeable and know that most people go into hospital not for a good reason, so they recognise the anxiety people have when they enter those places. We know the cheer that is brought by hospital radio and so on.

I just gently correct the hon. Member: we are not losing the volunteers. This is a change to a contractual arrangement, so the volunteers are still there. We still want to make sure that they come forward, as we have discussed. Volunteering is more generally handled by local situations, and this is about the best way we can get the national system to spread into a local system. We need the local infrastructure, and we need to keep encouraging people to come forward. I hope that, as a result of this urgent question this afternoon, we are highlighting the role of volunteers and that more people will come forward.

Karin Smyth

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We are learning so much about each other this afternoon, are we not? I am pleased to hear that that is how my hon. Friend started her journey, and I am so impressed that she is continuing to do that. I was out with the ambulance service last week talking to staff, who highly praised those community first responders. The work that she and others are doing is valuable, and I know she will continue to use that knowledge to feed into the work we want to do in the future.

Karin Smyth

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I thank my hon. Friend for what he has said, and I thank the Butterfly Volunteers. Supporting people at that really important end of life stage is hard and critical work, and I commend them for it. The local link is also critical: we need to ensure that people can be directed from the national system to local systems, through NHS England and perhaps—if it is appropriate, Mr Speaker—through the House. It is in the interests of local Members of Parliament for us to ensure that what we have learnt from the national scheme is continued into the local scheme, and, as my hon. Friend says, we need the local co-ordination and infrastructure about which we have heard this afternoon.

The Minister for Secondary Care (Karin Smyth)

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I am pleased to announce today the publication of the NHS very senior managers (VSM) pay framework.

This Government’s 10-year plan to reform the NHS will focus on three big shifts; from analogue to digital, hospital to community, and sickness to prevention. To do this, this Government believe that providers and integrated care boards (ICBs) should be given greater freedom and flexibility to meet the needs of their patients and communities. We want to move to a system where freedom is the norm and central grip is the exception to challenge poor performance.

First-class leadership will be essential in achieving this and we will need to recruit and retain the very best to realise our ambitions. Accordingly, it is vital that we ensure the way we reward our very senior managers (VSMs) reflects the challenges they face and the responsibilities they carry while ensuring that we act where performance falls below our expectations.

This new pay framework will support the changes that we need to see in the NHS through the Government’s plan for change, so we can deliver on the public’s priorities to cut waiting lists for patients and drive-up standards across the NHS. It will bring together arrangements for trusts and ICBs, further driving consistency in the approach to pay across NHS organisations. In doing so, it removes the differentiation between different types of trusts and introduces pay benchmarks that account for organisational size and turnover more appropriately.

We need our very best managers to work in the most challenged NHS organisations to make the necessary improvements and turn them around. The new pay framework enables employers to apply a temporary increase to pay as a means of encouraging top talent to come and work in poorly performing organisations.

Across all ICBs and providers, employers will be able to reward the highest performing leaders with a bonus of up to 10% where they have demonstrated exceptional performance in, for example, cutting waiting times, managing finances or improving services for patients.

However, as the Secretary of State has made clear, there will be no more reward for failure in the NHS. Going forward, those very senior managers who are leading the poorest performing organisations will have their annual pay award withheld, with an exemption for those who have been newly appointed to turn things around.

The new pay framework will use the segmentation derived from the NHS performance assessment framework (NPAF). The NPAF segments providers and ICBs ranging from segment 1 to 5 with 1 being the best performing, based on their performance against published metrics. From this year those VSMs in organisations in segment 5, the lowest performing, will not be eligible for pay uplifts unless an exemption applies.

By introducing a greater focus on performance, this new framework will ensure that pay is closely aligned with the delivery of outcomes and will incentivise improvements where these are needed most.

This Government want to see trusts and ICBs deliver more efficiency, ensuring patients get more for taxpayers’ money being invested. NHS organisations will be accountable to the public on very senior managers’ salaries, as we will be requiring them to explain their pay decisions in annual accounts and also submit an annual pay report to NHS England. The new framework will drive consistency of pay and ensure greater transparency.

The new VSM framework is part of a broader package of reforms to ensure we support and invest in NHS managers. This includes our commitments to introduce professional standards for, and regulating, NHS managers, and establishing a college of executive and clinical leadership to help train and develop excellent NHS leaders.

We are determined to get the NHS back on its feet, and this framework aims to boost the efficiency and productivity of providers and ICBs so that they can focus on delivering the care that people need. I look forward to seeing the leadership of the NHS rise to the challenge, as we take the NHS from the worst crisis in its history and make it fit for the future.

[HCWS641]

The Minister for Secondary Care (Karin Smyth)

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I beg to move,

That the Committee has considered the draft Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations 2025.

It is a pleasure to serve under your chairmanship, Sir Desmond. Before I turn to the detail of the statutory instrument, I would like to highlight the important role that the Medicines and Healthcare products Regulatory Agency plays in safeguarding public health, and the importance of the agency’s continuing to be properly funded to deliver its role.

The MHRA is a world-leading regulator of medicines, medical devices and blood components for transfusion in the UK. It charges fees for its services; the fees are set to recover the cost of delivering a service, in line with His Majesty’s Treasury’s guidance, “Managing Public Money”. To ensure that it continues to recover its costs, it aims to update its fees every two years, which is standard practice for Government bodies that operate on a cost recovery basis, and for other regulators, here and abroad.

All fees are set by taking into account various factors to reflect the cost of the activities involved in delivering a service, such as the time taken and the number and grade of staff involved; this is also informed by staff activity recording. In addition, in line with “Managing Public Money”, the MHRA includes the cost of services, of necessary corporate overheads and of system investments. Regular fee uplifts are necessary to ensure the MHRA’s long-term financial sustainability and enable it to deliver the responsive, innovative and efficient regulatory service that its customers expect, and one which protects and improves patient and public health.

The draft instrument will do three main things. First, it will update the fees that the MHRA charges for its activities regulating medical devices and blood components for transfusion. These fees were last updated in April 2023. The implementation date for the proposed changes is June, and they will ensure cost recovery until 2027.

Secondly, the draft instrument will introduce a fee for a new optional service: a regulatory advice meeting for medical devices. This new service will support manufacturers in interpreting regulations and requirements, particularly for complex, innovative products.

Finally, the draft instrument will introduce a new payment easement for small and medium-sized enterprises for clinical investigation fees. The easements will not reduce the overall fee, which would require cross-subsidisation, but will enable the fee to be paid in two instalments, providing some flexibilities for SMEs.

I should note that the draft instrument will not change the MHRA’s fees for activities relating to medicines regulation. Given the different legal positions in relation to the powers to make regulations about fees relating to medicines, medical devices and blood components for transfusion, the MHRA has used two instruments for this fees uplift. A second instrument for human medicines fees has already been laid before the UK Parliament and the Northern Ireland Assembly and has already come into force.

Karin Smyth

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I thank the hon. Members for Sleaford and North Hykeham and for Chichester for their comments, which I will try to address.

As I think everyone agrees, the MHRA provides essential services that play a crucial public health role, and it is important that it recovers its costs, which is what these fee increases are set to do. The main benefit of the draft regulations will be that patients and innovators have the faster and better-delivered service that has been committed to. I meet the MHRA regularly, and I will be meeting with the new chief executive and chair later this week to make sure that the improvement that we have seen recently continues. I know that the whole House is interested in that, because, like all regulators, the MHRA is a huge contributor to the growth that we want to see as part of our growth agenda. I expect patients and the industry to see the impact.

Recovering the fees is crucial. It is also right that the regulated bear the cost of regulation, rather than it falling to UK taxpayers to subsidise it. By supporting the draft regulations, we will ensure that the MHRA continues to contribute to the Government’s health mission, balancing the responsibilities to maintain product safety and to champion innovation. It has made progress in responding to the recommendations set out in Baroness Cumberlege’s independent medicines and medical devices safety review. It has listened carefully to the people who gave evidence and to the findings of the independent review team, which are a matter of concern to many Members and constituents across the country, as the Liberal Democrat spokesperson, the hon. Member for Chichester, quite rightly highlighted.

The MHRA is committed to bringing about the changes that have been identified and to achieving ambition to be a regulator that absolutely delivers for UK patients, as well as delivering at speed to give confidence to the industry. We absolutely do not want to deter innovation; that is why in the draft regulations we are making some changes to support SMEs, which may find regulation more burdensome. We will keep that under review.

We expect the organisation to look closely at staff costs and make sure, like all organisations, that it produces the efficiencies needed to deliver a good service.

Karin Smyth

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I am happy to answer any questions, but as far as I am aware, they are NHS-employed staff, so they will be dealt with in the usual way. I am happy to write to the shadow Minister with any specifics if that is helpful.

In conclusion, the draft regulations are important to ensure that the MHRA has the resources that it needs to continue delivering reliable services and its public health role. I commend them to the Committee.

Question put and agreed to.

The Minister for Secondary Care (Karin Smyth)

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Nurses play a critical role in our healthcare system, and this Government recognise the vital role that nurses play in delivering safe, effective and compassionate care. Today we are proposing to protect the title “nurse” in law to ensure that only those registered with the Nursing and Midwifery Council can use it, with limited exceptions.

The protection in law of certain professional titles is important for public safety. Protected titles are used by healthcare professionals to indicate their field of practice to patients and the public, providing assurance to the public that the person using that title is competent and safe to practise.

Currently, the title “registered nurse” is protected in law. However, the Government are aware of concerns, most recently raised by my hon. Friend the Member for Brent East (Dawn Butler) and the #ProtectNurse campaign, that this is not sufficient to safeguard the public, as it does not address the misuse of the title “nurse” by unregulated professionals.

This Government intend to amend the criminal offence of “misuse of professional titles” so that the title of “nurse” is protected. This amendment will be made as part of the Government’s professional regulation reform programme, which will modernise the legislative frameworks for the General Medical Council, the Nursing and Midwifery Council, and the Health and Care Professions Council during this Parliament.

As part of reforms to the Nursing and Midwifery Council’s legislative framework, we will create a new protection of title offence, making it a criminal offence for an individual who is not a registered nurse with the Nursing and Midwifery Council to call themselves a nurse.

The Government are aware that the term “nurse” is used across multiple professions, for example, “dental nurse”, “veterinary nurse” and “nursery nurse”. It is not our intention to prevent the legitimate use of the title “nurse” within these instances. The legislation will therefore include exemptions to allow other professionals to use the title legitimately, without the risk of prosecution.

The Government will continue to work with key stakeholders, including the Nursing and Midwifery Council, the devolved Governments, the Royal College of Nursing, trade unions, other professional representatives and the social care sector, on developing the protection of title offence.

This proposal demonstrates the Government’s respect for the nursing profession, dedication to patient safety and the pivotal role nurses have in our society.

[HCWS628]

The Minister for Secondary Care (Karin Smyth)

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We expect all women to be shown the utmost care and respect when receiving maternity and neonatal care. This year’s planning guidance requires integrated care boards and providers to deliver the key actions in this final year of NHS England’s three-year delivery plan. It is clear from listening to the harrowing stories of bereaved and harmed families, however, that we must do more. The Secretary of State is urgently considering the significant action needed to ensure that all women and babies receive the care they deserve.

Karin Smyth

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The hon. Gentleman is not correct: maternity funding is not ringfenced at the same level—I think that is what he is referring to. It has, however, absolutely been committed to as far as ICB allocations are concerned. Local leaders will decide how best to allocate that money. We will continue to work with Donna Ockenden and the families who have been affected by previous incidents and ensure that the recommendations of her report and the maternity review are fully implemented.

Karin Smyth

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My hon. Friend is absolutely right to highlight that point, which has been found in all the reviews that have been undertaken. It is completely unacceptable. That is why the Secretary of State has continued to meet families and hear their experiences to ensure that we learn from them, continue to support the implementation of those recommendations and, crucially, ensure that women’s voices are taken forward as part of our 10-year plan.

Karin Smyth

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To be clear for the shadow Secretary of State, the Secretary of State is continuing to look at all those recommendations and consider how best to respond.

Karin Smyth

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I know the Liberal Democrat spokesperson follows this issue very closely in her own local community. As she knows, we are committed to ensuring that the recommendations of the reviews are fully implemented as part of that three-year plan, but I gently say to her that the Liberal Democrat party has consistently opposed the extra £26 billion that this Government raised to support the wider health service. Without that extra funding and the decisions that the Chancellor has made, we would not be able to make the progress that we are now starting to see.

The Minister for Secondary Care (Karin Smyth)

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Our mission-driven approach to this issue means that we are working with all Departments to deliver an NHS fit for the future. We expect integrated care boards to work closely with their mayors to maximise public health and contribute to the Government’s health and growth missions.

Karin Smyth

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The hon. Member tempts me slightly on local accountability, on which he has been a strong campaigner. As he knows from meeting me, I agree that it is important that such local bodies respond properly so that where there are expansions of housing, which we want to see, they are supported by local infrastructure. I am happy to come back to him with any further detail.

Karin Smyth

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My hon. Friend is right to campaign on behalf of her constituents to make sure that more services are delivered in communities. We want to see services brought out of hospital and into local communities. It is up to the ICB to decide how those are commissioned, but we will certainly make sure that, as part of our commitments under our 10-year plan, we see more of those sorts of services working together in neighbourhoods.

The Minister for Secondary Care (Karin Smyth)

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I commend my hon. Friend for her work on such an important topic; I know it is very personal to her. Specialist perinatal and maternity mental health services are available across England, providing vital support to parents before, during and after pregnancy, including increased access to evidence-based psychological therapies. We are training thousands more midwives to better support women throughout pregnancy, with mother and baby units and community services providing postnatal support.

Karin Smyth

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I absolutely join my hon. Friend in recognising the importance of supporting women’s health throughout pregnancy and into parenthood on Maternal Mental Health Day. We are committed to improving the support available, and it will form an important part of our 10-year plan. We are investing £126 million in family hubs and Start for Life services, to support parents from pregnancy to their child’s early childhood, and we will continue to work with her on this.

Karin Smyth

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I congratulate the hon. Member on taking forward that work. The Minister responsible will be happy to continue to work with him in any way possible to support that work on this important aspect of parenthood.

The Minister for Secondary Care (Karin Smyth)

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Driving down waiting times is one of this Government’s top priorities, and my colleagues at NHS England continue to keep in regular contact with ICBs on improving waiting times and delivering the ambitions set out in our elective reform plan. Since July, we have cut waiting lists by more than 219,000 across England, and by 6,000 for University Hospitals of North Midlands, and have delivered 3 million more appointments.

Karin Smyth

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I am sorry for the experience that my hon. Friend’s constituent has had, and he highlights a really important aspect of the patient journey through the system. I want him and the House to be assured that we are looking at the entire patient journey, both into hospital and between hospitals. We are determined to improve patient experience and quality of care, and to get back the patient satisfaction that was squandered by the last Government.

The Minister for Secondary Care (Karin Smyth)

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My hon. Friend is absolutely right that this is exactly the sort of thing that is being rolled out across the country, and that we are committed to delivering care closer to where his residents live.

Karin Smyth

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I am absolutely willing to give the hon. Member that commitment, and I know he worked on this programme in his previous role in Northern Ireland. It is delivering results, and we want to see results. We want to take the best to the rest of the NHS, and we absolutely want to work together across the United Kingdom to make sure that all our residents benefit from the programme.

Karin Smyth

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I am pleased to congratulate the pharmacies that are on the frontline on their hard work, and also to congratulate all those in the Department and elsewhere who ensure that our supply chain is as resilient as possible. I know that this issue concerns many Members and many of our constituents, and we hope to arrange a parliamentary event to ensure that Members have more information. Those people do a great deal of work; we know that the issue is important, and I will update the House on other measures that we intend to take to ensure that Members and their constituents are better informed.

The Minister for Secondary Care (Karin Smyth)

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It is a pleasure to serve under your chairmanship, Ms Lewell. I congratulate the hon. Member for Reigate (Rebecca Paul) on securing this debate, on the constructive tone in which she has engaged with me and my Department, and on the way that she opened the debate.

The Government’s approach is governed by three principles. First, the health and wellbeing of children and young people is our primary concern—a point made by the hon. Member for Strangford (Jim Shannon). Secondly, evidence-led, effective, ethical and safe healthcare must be provided to all who need it, when they need it—a point well made by my hon. Friend the Member for Macclesfield (Tim Roca). Thirdly, this Government believe in the dignity and equality of every single one of His Majesty’s citizens.

Since the election, we have been calmly and cautiously guided by the evidence. We take children’s healthcare extremely seriously. That is why we remain committed to implementing the Cass review, and ensuring that children and young people who are looking for support in relation to their gender receive the highest quality of care, as one would expect of any other child health service in the NHS.

Karin Smyth

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I thank my hon. Friend for that intervention; I hope to get on to that subject in my speech. It is important that people are aware of that progress.

I know that many people are concerned about the ethics of this research, as the hon. Member for Reigate and the right hon. Member for South Holland and The Deepings (Sir John Hayes) both noted. I assure hon. Members that the UK has, as we know, extremely rigorous and robust ethical approval pathways, and that no clinical trial can proceed without the necessary independent scientific approvals.

We already regularly use those processes to consider clinical trials in children so that we can evaluate new treatments for a whole range of conditions, including cancer, depression, respiratory infections, or any illness. Many aspects of the methodology of this trial are still being looked at, such as how long it will follow children, how many children will be on the trial and how the demographics of the trial will be constructed. That is all still to be confirmed and approved; many hon. Members asked about those points today. All participants in the trial will also be part of the ongoing observational study.

Following the decision by the Secretary of State for Health and Social Care about puberty blockers, which was based on the evidence, we needed to make sure that we got on with helping scientists, researchers and clinicians to do their jobs. Some people have called for the Government to stop those experts from pursuing this line of inquiry, and we have heard such calls again in this debate. They have argued that the decision to halt the sale and supply of puberty blockers should be the end of the matter, and that young people should not have access to this medication, come what may. That would be to ignore the distress and real experiences of young people, and the Government have no doubt that it would drive people towards possible illegal and underground routes, shutting off young people’s access to conversations with professionals and the opportunity to pause and consider other options.

Instead, as Dr Cass suggests, we can set out a proper path to treatment that involves young people, their parents, clinicians and mental health professionals. Knowing that they are on a path will reassure young people that they are being taken seriously. The cautious process that they will have to work through before joining a trial means that young people will have access to support and counselling, which may result in them deciding against joining the trial and pursuing a medical route. That is an approach entirely missing over recent years.

We all agree that treatment should be offered based on the best available evidence, and clinical trials in the UK are considered to be the gold standard for evaluating healthcare interventions. The Cass review found:

“The evidence base underpinning medical and non-medical interventions in this clinical area must be improved.”

That is why we have commissioned the PATHWAYS programme of research, one aspect of which includes the world’s first clinical trial designed to help us to better understand the relative benefits and potential wider effects of the use of puberty blockers in affected children.

We must look at the most appropriate medical and non-medical approaches to support physical, emotional and psychosocial health. That is why the trial forms just one component of a wider study and a growing portfolio of research, jointly hosted by NHS England. That includes looking at the experiences of the 9,000 adults who, as children, were cared for under a previous model of NHS care, which I know the hon. Member for Reigate has described as a “medical scandal”. Dr Cass was clear in her review that both a clinical trial on puberty blockers and a data linkage study, which many hon. Members have raised today, are important to improving the evidence base on gender incongruence in children and young people.

Regardless of individuals’ views on the practices of the Tavistock, I hope we can all agree that learning from the experiences of those thousands of people who have accessed puberty blockers is important; it will provide different and separately valuable information from the clinical trial. That data alone, however, will not provide the answer as to whether we should—or should not—consider routinely prescribing these drugs in the future, or continue the ban indefinitely.

The adult gender services have now committed to sharing their data, a point also raised by hon. Members. I acknowledge that we need to move quickly, and I expect to be making progress on this soon. We will consider all data that is relevant to puberty blockers, including from the adult gender clinics.

As with all clinical research, the team leading the trial must ensure that approval is obtained from the regulatory authorities, including one of the Health Research Authority’s independent ethics committees and the Medicines and Healthcare products Regulatory Agency. Those are all standard steps where the research receives full scrutiny. Once approvals are granted, the study protocol will be finalised and published, and only then can the trial commence. I am not able to comment on the finer details of that today, but we will issue further updates when they are available, and I commit to keeping Members updated.

I assure hon. Members that entry into the trial will be guided by strict eligibility criteria. It will involve only young people under the care of the NHS children’s gender services who have received a full assessment, where other appropriate forms of support have been offered and where their clinician supports a referral to the trial. Under the law, if a child is under 16, a parent will have to consent to their participation, and the child also needs to agree.

I am repeating myself slightly, but that level of caution was entirely missing over recent years. This is a more considered and evidence-based approach. In the past, puberty blockers were presented as the magic pill that young people needed to access; this trial will give children and young people the support they need to make these major decisions.

As we have heard today, we are currently in a situation where some people think it is unethical not to provide these treatments, and some think it is unethical to provide them. The reality is that we do not have definitive evidence. When that happens, we routinely ask for the study to be checked by an independent ethics committee. We spell out the uncertainty to young people and their parents, so that they can balance any such risk against their desire to join the trial before deciding whether they wish to participate.

Karin Smyth

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I am sorry, but I am tight on time.

Uncertainty is common to many new treatments, but through that process, we ensure that those treatments are no longer used in the absence of such evidence. During the trial, an independent committee checks whether new results have emerged from other countries around the world—a question that was raised several times—and, if those results provide evidence that the benefits or risks are clear, such that we could issue clinical guidelines based on them, the trial would be stopped.

We need better-quality evidence to support the NHS in providing reliable and transparent information and advice to children and young people, and their parents and carers, in making important treatment decisions. That is exactly what NHS England and the National Institute for Health and Care Research programme will provide.

I was asked to provide an update on implementing the Cass review, which, beyond that research, we are absolutely committed to doing. From what we heard this afternoon, I am not entirely sure what the Liberal Democrat position is, but we are very clear that we will continue to work on that in lockstep with NHS England. We have opened the three services, and a fourth is planned in the east of England from this spring.

Those services operate under a fundamentally different clinical model, where children and young people get the tailored and holistic care they need from a multidisciplinary team of experts in paediatrics, neurodiversity and mental health. At first, those services saw patients transferred from the now-closed gender identity development service at the Tavistock, but I am pleased that all the services now take patients from the national waiting list. NHS England aims for there to be a service in every region of England by 2026. That will help to reduce the waiting list and bring the services closer to the homes of the children and the young people who need them.

The Minister for Secondary Care (Karin Smyth)

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I beg to move,

That the Committee has considered the draft Health and Social Care Information Standards (Procedure) Regulations 2025.

It is a pleasure to serve under your chairship, Ms Jardine. The statutory instrument was laid before the House on 25 March 2025. I am grateful to be here to debate the draft regulations which, if approved, will make provision for the new procedure that the Secretary of State for Health and Social Care and NHS England must follow when preparing and publishing information standards.

Information standards relate to the processing of health and adult social care information. They provide a common set of requirements that must be followed when health and adult social care providers use, process and share information. They might cover quite technical issues relating to IT systems, or they might relate to how information is collected or managed. They provide the common language or languages through which the systems and organisations of the NHS and adult social care can interact.

For the health and adult social care system to work effectively, data needs to be processed in a transparent and standardised way, using common specifications, so that it can be understood and used by health and care professionals across different settings. Information standards can ensure that information is shared easily and in real time between organisations. That supports the co-ordination and delivery of care, clinical safety, planning and research.

Let me talk briefly about the benefits of this instrument. Information standards are not new; under powers set out in the Health and Social Care Act 2012, public health and care providers must have regard to information standards. However, low compliance makes it hard to deliver the improvements required across health and adult social care. The Health and Care Act 2022 made provision for information standards to be mandatory, and the regulations set out the process that must be followed in developing and publishing all mandatory information standards. That includes requirements to seek views and/or advice from those with relevant expertise during the development of an information standard, which will ensure that future information standards are able to meet the needs of the system.

The procedures outlined in this instrument are proportionate and transparent. They will ensure that information standards are fit for purpose, kept up to date and reviewed regularly, as needed, and that they keep pace with technical developments and evolving priorities.

In closing, a significant burden is created when information held in one system or organisation is not easily available in another—something I think we have all seen. In the health and care system, such constraints are a significant barrier to achieving the aims of the Government’s health mission. We need to create a modern health and adult social care service, and improvements to interoperability, enabled by the establishment of a robust information standards framework, are an important step towards delivering that. I commend the regulations to the Committee.

Karin Smyth

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First, I thank the shadow spokesperson for the Conservative party’s support in bringing forward the regulations. As he rightly said, some of this work continues work done under the last Government and results, as I said in my introductory remarks, from the 2022 Act.

As I also said, standardisation has not been taken up across the system in the way that we would like, and this instrument provides a framework everybody can lean into. To go to the hon. Gentleman’s last question first, that reflects our need to make sure that, for the benefit of patients, clinical safety, patient support and efficiencies in the system, we have a framework that everyone works to and brings their standards into—I will not veer into something more technical that is beyond my ken, on the detail of computer systems. We wanted to make sure that we had that framework in place, and we were keen to bring it forward in an SI that is transparent for the House, so that we can all understand how this proposal is part of the wider Government mission.

As I said, this proposal started off under the last Government, and it has been brought forward now. There was an engagement exercise with stakeholders, and the response was published in November. We therefore need to issue the regulations now, particularly in advance of the Data (Use and Access) Bill. So that is the timing issue. I cannot comment further on trade deals, but that is why we are doing this: to make the system in England work better for all our patients.

To the hon. Gentleman’s point about cross-border issues, I am an MP in Bristol, and I understand those issues. We are looking at our responsibilities for England. We are keen to work with the devolved Administrations on all healthcare and cross-border issues. The Department will continue to talk to them, and I hope they are willing to continue to work with us. If there is anything further to add, I will make sure that it is communicated to the hon. Gentleman.

On the hon. Gentleman’s point about the CQC, he will be aware that the organisation has undergone a number of difficult issues in the recent past. We have had new leadership in place since before Christmas, and it is keen to provide support on wider issues. Safety, in particular, is in its remit, and the hon. Gentleman, as a practising clinician, will be acutely aware of the need for different systems to be able to talk to each other to highlight issues of safety and so on. We will absolutely ensure that the CQC is working as part of this wider system.

Colleagues and staff at NHS England obviously have concerns about changes, but the need to have data that works across the whole system—that has that interoperability at its core—is a priority for everybody working in it. That is clearly part of what the NHS needs to do, and although some people may move, that is absolutely a priority for the NHS moving forward.

To the hon. Gentleman’s point about the RNID, I had not heard that. Clearly, accessibility for all is important. I am happy to make sure that we get back to him and the RNID on that issue.

Karin Smyth

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I thank the hon. Gentleman for that, and I am sure that officials have talked with the RNID. It is absolutely right that he brings that issue to my attention, and I will make sure we get a reply back to him and the RNID on the detail and on the time it will take to enact these standards. I visited the NHS England team up in Leeds, where we spoke about providing wider access—for example, by using the app—and about working with groups such as the RNID to make sure that what we produce is accessible for disabled people. The hon. Gentleman raises a really important point, and I will make sure that we get back to him on it.

With that, I will make sure that we check the record, and if there is anything else, we will get back to the hon. Gentleman. Otherwise, I would be grateful if the Committee could support the SI.

Question put and agreed to.

The Minister for Secondary Care (Karin Smyth)

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It really is a pleasure to close this debate on behalf of the Government. I think there have been 33 contributions from hon. Members from across the House.

Nowhere is it more apparent that the NHS is broken than in our crumbling hospitals. Over 14 years, the NHS was starved of capital and the capital budget was repeatedly raided to plug the holes in day-to-day spending. Lord Darzi’s investigation into the NHS in England made it clear that we have crumbling buildings and IT, mental health patients sharing showers in Victorian-era cells infested with vermin, and parts of the NHS operating in decrepit portacabins. Some 20% of the primary care estate predates the founding of the health service in 1948.

I thank the Liberal Democrats for bringing forward this debate. We broadly agree on the disgrace that the backlog of repairs, the decades-long cannibalisation of capital budgets and the unfunded fantasy of the new hospital programme had become. Where we disagree is on the cause and the solution. As we have heard today, the Liberal Democrats are completely silent on the part they played as members of the coalition Government. They were active and enthusiastic partners in the decision to impose austerity, and our NHS was starved of funding on their watch. The practice of raiding capital budgets to keep things afloat started in 2014, on their watch. The disastrous top-down NHS reorganisation, which wasted billions of pounds and contributed to record-high waiting lists, happened on their watch.

As for the solution, the Liberal Democrats are silent on how they would pay for and accelerate the new hospital programme. They are playing the same cynical game that we saw from the Conservative party: they are dangling the prospect of a new hospital while being unable to explain where the funding would come from or how the construction industry could deliver it within the timeframe. It is indeed opportunism, as my hon. Friend the Member for Gateshead Central and Whickham (Mark Ferguson) said. We all remember the Rose Garden, as my hon. Friend the Member for Watford (Matt Turmaine) said. The Liberal Democrats opposed the autumn 2024 Budget, which delivered record investment in our NHS. In sharp contrast, this Government are prepared to take the decisions needed to back up our promises with the funding needed to deliver them, and we are determined to rebuild confidence and trust in politics by promising only what we can deliver.

I have met many hon. Members in person and heard them in the Chamber today, and I know others are not here who would have wanted to contribute. As the Minister, let me say plainly that I agree with everyone’s anger. I share that anger because, when I tour hospitals up and down the country—I did so recently in Doncaster and in Oxfordshire, where I visited the Warneford hospital—I often see equipment and infrastructure that was procured 20 years ago when I was working for the NHS in Bristol. Seeing these physical reminders of the past when I tour hospitals fills me with a mixture of pride and shame. I feel pride because I was part of a generation of leaders who delivered hospitals fit for patients in the biggest hospital programme in NHS history delivered under the last Labour Government, and I feel shame because our legacy was squandered and patients have paid the price. We understand the legacy, and Lord Darzi was very clear that the task for us is to take action. That is why the Chancellor took the necessary decisions in her Budget to meet this challenge, and why we have put the programme on a firm financial footing.

As my hon. Friend the Minister for Care said, we are not just writing the wrong; we are taking pressures off hospitals, shifting the focus of our NHS from hospital to community, recruiting over 1,500 more GPs to take the pressure off A&E and harnessing the power of AI to help people who depend on care to stay at home. That point was well made by my hon. Friends the Members for Stroud (Dr Opher), for Aylesbury (Laura Kyrke-Smith), for Milton Keynes Central (Emily Darlington) and for Calder Valley (Josh Fenton-Glynn). As he made me sponsor him, may I wish my hon. Friend the Member for Calder Valley good luck in the marathon this weekend? The challenge before us is immense, but every member of this Government is up for the fight.

Members made a number of points, and I will try to get through them in the time available. I could not agree more with those who made the point that we have to break out of the vicious cycle of false economy. This Government were elected on a manifesto to end short-termism, easy answers and sticking-plaster politics. When we came into government we were saddled with a bill of almost £14 billion in backlog maintenance. My right hon. Friend the Chancellor has given us the funding this year to back NHS systems with over £4 billion of operational capital. A lifesaving cash injection of £750 million for targeted estate safety funding is a vital first step towards fixing our crumbling estate. That is crucial not only for patients, but for staff morale, as my hon. Friend the Member for Carlisle (Ms Minns) said. There is also £440 million to tackle crumbling RAAC concrete, keeping patients and their families safe. We are opening new mental health facilities, with more in construction, and that state-of-the-art provision will give the best possible care outcomes.

Furthermore, I assure Members that, unlike the previous Government, we will never raid capital budgets to plug day-to-day spending, and the Treasury has updated its fiscal rules to make that impossible. My hon. Friend the Member for Crewe and Nantwich (Connor Naismith) said that big promises with no plans are what got us into this mess, and that was echoed by my hon. Friend the Member for Mid Cheshire (Andrew Cooper), who talked about the false hope and the waste of the past. My hon. Friend the Member for Banbury (Sean Woodcock) echoed that point and reiterated the point about trust, which was almost shared by the hon. Member for South Devon (Caroline Voaden).

Members have called on the Government to reverse course and commit to a timeline that is unfunded, unrealistic and undeliverable. That has been recognised by a National Audit Office report, which stated that

“some schemes publicly promised in 2020 now face substantial delays and will not be completed by 2030…with implications for patients and clinicians.”

The delivery of these hospitals existed only as a figment of Boris Johnson’s imagination and this Government are doing the hard yards of putting the new hospital programme back on track. The NHP previously received a red rating from the Infrastructure and Projects Authority, now known as the National Infrastructure and Service Transformation Authority. Its latest review, which it carried out in January, rated the NHP as amber. That reflects the measures that we took to put the programme on a firm footing, as my hon. Friend the Member for Harlow (Chris Vince) rightly said.

Some Members, including the Chair of the Select Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), have asked us to publish the individual scores of each scheme following the outcome of the review, but may I just take issue with the hon. Lady’s use of the word “shady”? The Secretary of State and the Department will continue to co-operate with her Committee, but to be clear, as part of our analysis, schemes were prioritised into upper, middle and lower thirds, which gave a delivery schedule for the programme to align with the funding envelope, and there was no final individual score for each scheme. There is no formal delineation among schemes in wave 2, and schemes remain scheduled to start construction as outlined in our plan for implementation.

I briefly say to my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) that it was a pleasure to meet Councillors McCabe and Garrod from her constituency and to understand their passion about the loss of resources. That is echoed in many low-income areas, and we have to reverse that loss of resources as we go forward with our 10-year plan.

We are taking a systematic approach to building the next generation of hospitals, known as Hospital 2.0, allowing trusts to benefit from economies of scale, provide excellent patient care and facilities, and ensure that staff are supported with technology for decent working environments. It contributes to our growth mission, putting more money in people’s pockets and supporting our supply chains. In response to my hon. Friend the Member for Milton Keynes North (Chris Curtis), we do abide by the Hospital 2.0 scheme. It is a systematic and centralised approach that will save taxpayer money, while driving innovation and laying the foundations for a new relationship between Government and industry. I am disappointed if it is official Liberal Democrat policy to oppose that approach.

I know the clock is against me but I want to end by saying that I completely understand why colleagues are so concerned about the plans, when previous Governments have so badly let them and their constituents down. I also hear the point made by the hon. Member for South Antrim (Robin Swann) about Northern Ireland. Northern Ireland benefits from the Barnett consequentials for revenue and capital. It is devolved and it can look at alternative means. The Department will continue to work with all devolved Administrations across all issues, but they do have particular problems.

Staff and patients deserve better, so I want to offer them some reassurance about our record since July. We promised to sit down with resident doctors and end the damaging strike action—promise made, promise kept. In October, we said we would recruit more GPs by April and we recruited more than we said—promise made, promise kept. We promised 2 million extra appointments in our manifesto and we smashed that target seven months early—promise made, promise kept. Last month, over 80% of patients in England referred for cancer had it ruled out or diagnosed within 28 days, the first time that target has been met for years, and waiting lists are now consistently falling.

We have gripped this critical issue since July, from day one with the review. The Secretary of State and I met MPs and the NHP team before the completion of the review. I met all colleagues the day after the announcement in January and I have had individual meetings. I will keep my promises to visit, when the diary allows. I am really looking forward to North Devon. I am also visiting Hillingdon, where I grew up, with my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales), and possibly visiting some old haunts. I have committed to visiting Basingstoke, with my hon. Friend the Member for Basingstoke (Luke Murphy). We will progress at pace on RAAC and wave 1. I am committed to holding more meetings with wave 2 and wave 3 MPs in the coming weeks and months to keep colleagues abreast of updates and to provide them with the opportunity to ask questions directly of the team. That is how I will work with colleagues across the House to make sure the programme happens.

Finally, the hon. Member for Sleaford and North Hykeham (Dr Johnson) talked about her experience of the PFI scheme she worked under and the nonsense she had to deal with. Her Government could have changed that at any point. My experience of a PFI scheme in Bristol was waking up about a year ago after I had had my melanoma removed, in an almost brand new hospital with fantastic facilities in a single, individual ward with my husband beside me. Maybe it was the drugs that made me feel a little bit bleary-eyed, but what I thought then was how proud I was to have been part of the development team, as part of the primary care trust board, bringing forward a fantastic hospital for north Bristol that serves patients so well. That would never have happened under another Administration. We rebuilt the hospitals under the previous Labour Government. I am proud of that record. We did it before; we are going to do it again. That is what a Labour Government do.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

Karin Smyth

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On a point of order, Madam Deputy Speaker, could you advise me whether it is in order that the hon. Member for Sleaford and North Hykeham (Dr Johnson), who opened the debate for the Conservatives, was not in her place for the close of the debate? I think that is discourteous to the House, and I would like your advice on how we rectify this matter.