I draw the House’s attention to two minor corrections that have been made to the text of resolution 59 and the title of resolution 98. A revised version of the resolutions paper is available in the Vote Office and online. It includes a note setting out the corrections that have been made.
With the exception of Front Bench speeches, there will be an immediate four-minute time limit. I call the Secretary of State.
I begin by addressing the British Medical Association’s reckless call for resident doctors to strike in the run-up to Christmas. That is a cynical choice, coming as flu cases surge and we enter the most dangerous time of year for hospitals, and it is completely unjustified. After a 28.9% pay rise, the Government offered to create more jobs and put money back in resident doctors’ pockets. The BMA rejected that out of hand. My door has always been open, I have never walked away from the table and I stand ready to do a deal that puts patients first. We will prepare for this round of strike action.
I am extremely proud of the hard work and performance of NHS leaders and frontline staff who did so well to minimise costs and disruption during recent rounds of strike action. In fact, during the most recent round, we were able to maintain planned elective activity to cut waiting lists at 95%. Yet I must be honest with the House and with the country: if this strike goes ahead, this time will be different. Our hospitals are running hot and the pressures are enormous. That is why I urge the BMA not to go ahead. Not only does it put the progress we are making together in the NHS at risk; it threatens to do so in the worst way and at the worst time possible.
Does the Secretary of State agree that the hard-working staff at St Thomas’ hospital across the bridge, who deal with patients from right across the country, including many who have had surgeries and operations booked for many months, still kept the show going during the last rounds of strikes? Will he please do everything in his power to make sure that the strike does not go ahead?
I can certainly give my hon. Friend that assurance, and I absolutely endorse what she says about our local hospital, which I know very well. I genuinely thank frontline NHS staff, without whom the performance and improvements we are seeing simply would not be possible.
Let me turn to the substance of this debate. There was once a time, not long ago, when this place was bound in consensus on a number of issues addressed by this Budget. We used to be united on the need for a national health service as a publicly funded, public service, free at the point of use. The last Labour Government built a shared conviction that in 21st-century Britain, no child should grow up shackled by the scourge of poverty. We could go back as far as the Government of Benjamin Disraeli and find a Conservative Prime Minister committed to public health in a way that Labour and Conservative Prime Ministers have been in my lifetime. We did not always agree on how to get there, but there was at least agreement on the destination. However, as the opposition parties lurch to the right, consensus after consensus is breaking. [Interruption.] Admittedly, the Liberal Democrats have moved further to the left since their days in coalition; that is true. Maybe do not lead with your chins on that one, comrades.
Regardless of our friends on the centre left, old battles that were won must now be fought all over again, so it falls to Labour not just to cut waiting lists, improve the health of the nation and lift children out of poverty, but to win the argument, as well as hearts and minds. It falls to Labour to persuade people that we can and must help people lead healthier, longer lives, free from preventable disease; rebuild our national health service as a public service, free at the point of need; and give every child the best possible start in life, free from the scourge of poverty. Labour has won those fights before, and we will win them again.
The Secretary of State knows, because his Department shares responsibility for special educational needs and disabilities education, that that is a major challenge facing the young people whose opportunity he so rightly champions. How will the announcement that the Government will take responsibility for that from 2028 alleviate the growing deficits facing many county councils across this country, which it is estimated will grow to nearly £17 billion by the time the national Government take over?
That is a good question, and I give the hon. Gentleman the assurance that my Department is working closely with the Secretary of State for Education and colleagues right across Government to make sure that we get that right. We have growing levels of need for provision for children with special educational needs and disabilities. We can all see in our casework, let alone through debates in the House, the unmet need, and its impact on children’s education, health and life chances. We are committed to modernising and reforming the system so that it meets needs and sets children up to not only survive but thrive. That is the ambition of this Government.
On Sunday, the Leader of the Opposition said that she would reinstate the two-child benefit limit. At the stroke of a pen, she would plunge half a million children back into destitution, shame and hunger. Gone are the days when David Cameron attempted to ape Gordon Brown on issues of inequality and poverty; in fact, the 2010 Conservative party manifesto included the word “poverty” 20 times and committed to an anti-poverty strategy. The 2024 Conservative manifesto mentioned the word once, in a chapter on foreign affairs. Was that because, after 14 years of Conservative rule, the stain of child poverty had been removed from our nation? No, of course it was not. The Conservatives plunged 900,000 children into poverty, more than a million children relied on food banks last year, and children are being admitted to hospital for malnutrition in 21st-century Britain—but now, this Conservative party does not even pretend to care.
On public health, remember it was George Osborne who introduced the sugar tax, and Boris Johnson who introduced legislation to ban certain “buy one, get one free” deals and free refills of fizzy drinks, yet today their successors dismiss these policies as nanny state. Their party is more apologetic about their record on public health than it is about Liz Truss’s catastrophic mini-Budget.
I am grateful to the Secretary of State for intervening, but this is my intervention, not his. Why was he part of a Cabinet that stood by and punished his colleagues for voting against the two-child benefit cap? Why do we now see this sudden conversion and revisionism? Why does he think that most people in this country who were polled are against the removal of the child benefit cap?
Let me say two things in response. I am almost certain that my hon. Friends will be delighted that he has intervened in defence of their plight at the hands of the Labour Whips, but he knows as well as I do that the Whip was removed from some of my hon. Friends not because of the substance of the issue they were raising but because we never, ever accept people voting against a King’s or Queen’s Speech. [Interruption.]That was the issue. He asked me a fair question, and he has got an honest answer. He should take it on the chin.
The hon. Member also asked why many people in our country believe that the two-child cap was right. It is because our Conservative predecessors peddled the myth and the lie that people in receipt of welfare are on the take, and are just looking for handouts, rather than help. We Labour Members take a different view; we recognise, as I have set out, that so many people affected by the two-child cap are in work and in poverty. That is one of the many scandals of the damage that more than a decade of Conservative rule did. The Conservatives broke the link between a hard day’s work and a fair day’s pay. In addition to the measures that we are taking on child poverty to remove the two-child limit, we are also increasing the national minimum wage. We are increasing it even higher for young people. We are doing this because this is the party of work, the party that wants to make work pay, and the party that is genuinely committed to waging war on poverty.
Just as we must win the argument for lifting children out of poverty, we must win the argument for the founding principles of our NHS. Having left the NHS in the worst crisis in its history, the right now argues that it is unaffordable and should be abandoned. The NHS was broken, but it is not beaten, and Labour is already breathing new life into our health service. Waiting lists are falling for the first time in 15 years. Ambulances are arriving 10 minutes faster in stroke, sepsis and heart attack cases.
I appreciate the announcement about the 250 new neighbourhood health centres, but I am concerned for my constituency—a more affluent constituency that has health centres that were built in the ’60s. They are genuinely falling apart and need significant investment to ensure that GPs can continue to deliver outstanding service to my constituents. Could the Secretary of State provide some reassurance, or agree to meet me to discuss how we can ensure that deprivation is not the only aspect considered in that excellent initiative?
My hon. Friend is absolutely right. Of course, we want to ensure that investment is deprivation linked. We want to reverse the damage the Conservatives did when they pursued what I would characterise as the Royal Tunbridge Wells strategy, when our former Prime Minister, the right hon. Member for Richmond and Northallerton (Rishi Sunak), declared with pride to Conservative party activists that he had taken funding from the poorest communities in the country and funnelled it to the richest. There could be no shorter or clearer exposition of Conservative party values and politics in action than that claim.
To my hon. Friend’s point, he is absolutely right that within many affluent communities there are also pockets of deprivation, and we have to ensure that the NHS is there for everyone in every part of the country. We are dealing with enormous undercapitalisation in the NHS, totalling some £37 billion as identified by the noble Lord Darzi. It will take time to address that challenge, but I think my hon. Friend’s constituents know from his assiduous hard work and visible campaigning as a constituency MP that he will ensure that their needs and interests are not forgotten or overlooked by this Government.
Of course, as we improve the health of our health service, we also need to address the health of our nation. Children in England face some of the poorest health outcomes in Europe. Obesity in four and five-year-olds is reaching record levels—a health time bomb that leaves them at greater risk from cancer and heart disease later in life. What kind of start in life are we giving our children, and if we allow it to continue, what kind of future are we leaving to them? Our children will lead shorter, less healthy lives; our NHS will buckle under a tidal wave of chronic conditions; and our economy will suffer because businesses will be denied the potential of the next generation.
This Labour Government are tackling the sickness in our society. Whether it is the extension of the soft drinks industry levy, free school meals, a warm home discount that reaches millions more, the generational ban on smoking, Awaab’s law, cutting pollution and cleaning up the air that our children breathe, we are combating the drivers of ill health in children’s lives: poor diets, damp homes, dirty air and a lack of opportunity. In short, we are tackling poverty, because every child deserves a healthy start in life, and prevention is better than cure.
This Government are trying to tell the public that this Budget was all about taking tough decisions to deliver change, about raising taxes to support the NHS and about pursuing growth and backing business. Those are commendable aims, but it is simply not the reality of what was delivered in the autumn Budget. This was a Budget for benefits paid for by hard-working people.
Last year, taxes were hiked by £40 billion, borrowing went up, inflation went up, unemployment went up and living standards fell, but at least we were promised by the Chancellor that this was a one-off. She categorically said that she would not be coming back for more. But like the promises made during the general election, that was just not true. Then, as Halloween approached, we had briefing after briefing, that infamous press conference, markets affected and consumer spending depressed, particularly in the hospitality sector, all leading to one Cabinet Minister reportedly saying that
“The handling of this budget has been a disaster from start to finish.”
I wonder who that could have been.
Now we have another £26 billion in tax rises to fund more welfare, because the Prime Minister lacks the backbone to stand up to Labour MPs and make the real hard choices. At the previous Budget and spending review, big promises were made to the public about how the Labour Government would solve the challenges in the NHS through a financial settlement that they said would improve patient care, including by bringing waiting times back to the 18-week standard within five years. We warned at the time that that money would be swallowed up, in large part by decisions of the Government’s own making. The then chief financial officer of NHS England said that it would go almost entirely on pay awards, national insurance contributions and drug price increases.
What does Labour actually have to show for that? Elective care waiting lists have fallen by less than 2% since October last year. Meanwhile, waiting lists for community health services and diagnostic scans are rising. Waits to start cancer treatment are increasing. Trauma and orthopaedic waits are up; ophthalmology—up; neurosurgery—up; gynaecology—up. Winter pressures are growing, and long waits in A&E have hit record highs. The truth is that the Labour Government do not have a plan for the NHS; they have fallen into the classic Labour trap of thinking that issuing a press release about cutting waiting lists will magically make it so, just because they are in charge. I am afraid that is not how government works.
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We are seeing the NHS’s founding principles contested for the first time in generations. The Leader of the Opposition says,
“we need to have a serious, cross-party national conversation”
about charging for healthcare. Well, if she wants one, she’s got it, and it will be a short conversation. The answer from this side is “No, over our dead body.” We will always defend the NHS as a publicly funded public service, free at the point of use, owned by us, and there for all of us. Of course, it is not just the Leader of the Opposition saying these things; the leader of Reform wants to replace the NHS with an insurance-style system. [Hon. Members: “Where are they?”] They are obviously not here to advocate for their policies. They find it increasingly hard to defend them. They want a system that checks your pockets before your pulse, and asks for your credit card before providing your care.
Where is the hon. Member for Clacton (Nigel Farage)? He is not normally the shy, retiring type—unless, of course, he is being asked challenging questions, like whether paracetamol is safe, whether he believes in science or whether he racially abused schoolchildren. In fact, it is reported that he told a Jewish contemporary at school that “Hitler was right”. Admittedly, he was at school a lot longer ago than me, but had I grown up in the aftermath of the second world war, I think I would remember if I had supported the losing side. His politics are a disgrace. He cannot stand by his record, and that is why he is not here to defend it, and why he is regularly referred to in his constituency as “Never-here Nigel”. But as we are in a debate on these issues, let me take on the Opposition parties’ arguments, whether they are here or not.
The Conservatives say that the route out of poverty is work, not welfare. I do not disagree that those who can work should work, but six in 10 households impacted by the two-child limit have at least one parent in work, and they are still in poverty because of low wages and a high cost of living. The Conservatives say that it is the responsibility of families, not the state, to ensure that children are well fed. I agree that parents have a responsibility to look after their own children, but life is a bit more complicated than that. It is far too easy for others who have never walked in the shoes of parents like mine to pass judgment on people whose lives they will never understand.
The Conservatives sneer about “Benefits Street”. They have never been there. They have not got the first clue what life is like for people living on welfare. They say that lifting the two-child limit helps only the feckless and irresponsible, so let me tell them about the mum who came to see me at my advice surgery one Friday afternoon with her three children in tow. She had fled domestic violence and had been rehoused on the other side of London in a bed and breakfast. That remarkable woman was hand-washing her girls’ uniforms, doing a three-hour round trip every day to get her kids to school and holding down three separate jobs. Please do not tell me that women like her are feckless or irresponsible, or on the take. She is facing down hardships and challenges that would break many of us. I will tell Conservative Members who is feckless and irresponsible. It is the people who exploited the covid pandemic, ripped off Britain and lined the pockets of the Conservative party.
Conservative Members say that abolishing the two-child limit is not affordable, but the policy is fully funded. It is paid for by cracking down on tax avoidance and evasion, and a tax on online gambling. What they really mean is that they would make different choices. They would put the interests of gambling firms over the wellbeing of children. By labelling it as unaffordable, they betray their view that the prosperity of our country has nothing to do with the talent of its people, but we know that by investing in our people, we are investing in a more prosperous future. Growing up in poverty is not an inconvenience; it is a trap. On average, the poorest children start school already behind, get worse exam results, are less likely to make it to university, earn less, are more likely to develop long-term illness, end up paying less tax, and are more likely to need welfare support and the NHS.
Investing in our children is a moral mission; morally, we do not believe it is right to punish children for the circumstances of their birth, or the choices of their parents. This is also a down payment on a better future. It is far better and more cost-effective to invest in children now than pay the price for social failure later. I stand here today as the product of the wise investment of the British taxpayer. It was taxpayers’ contributions that clothed me, housed me, fed me and educated me when I was growing up. As a result, I am now in a position to pay back that debt to society—and to pay it forward to the next generation, too.
We should all be proud that this Budget funds the biggest reduction of child poverty of any Budget this century. My right hon. Friend the Chancellor takes that prize from Gordon Brown, who took it from Denis Healey, because lifting children out of poverty is what Labour Governments do. And why is it that every time Labour enters office, there is the moral emergency of child poverty? It is because, since records began, every single Tory Government left child poverty higher than they found it. That is why they must never be allowed back in power.
Patient satisfaction with GPs is up from 60% to 74%, and nearly 200,000 more patients were given a cancer diagnosis or the all-clear on time.
With Labour, the NHS is on the road to recovery. That is in no small part because the Chancellor is reversing 14 years of austerity and investing in our NHS. We promised an extra 2 million appointments; we have delivered 5 million. We promised to recruit an extra 1,000 GPs; we have recruited 2,500. We promised to end the 8 am scramble; we have widened the window that patients have to request appointments and have made booking available online. A lot done and a lot more to do.
At this Budget, we announced the next steps on the road to recovery: 250 new neighbourhood health centres with the first ones in Birmingham, Barrow, Truro and Southall, and £300 million more to invest in technology to modernise healthcare. Next year, we will receive recommendations from Baroness Casey on laying the foundations to build a national care service.
The NHS does not just face an existential political challenge from the Conservatives and Reform UK; it faces a sustainability challenge.
The leader of Reform, the hon. Member for Clacton, says we should instead be educating people to make healthier choices—I assume that he will not be leading from the front on that campaign. But we know that Reform and the Conservatives oppose our agenda to improve public health. They oppose our investment in the NHS. They should just be honest and admit that they now oppose the NHS itself. [Interruption.] Conservative Members do not like it, but I challenge them to dispute a single claim I just read. Let me repeat the charge sheet for their benefit: they oppose our investment in the NHS. Have they not opposed every budget spending review since Labour came to office? [Interruption.] Honestly, from a sedentary position, the hon. Member for Kingswinford and South Staffordshire (Mike Wood), who does not want to intervene because I think he knows he is leading with his chin on this, wants to suggest that somehow the Conservative party left a legacy that they could be proud of. They inherited the shortest waiting times and the highest patient satisfaction in history. They left us the longest waiting lists and lowest patient satisfaction on record. No wonder so few of them have turned up to defend that shoddy record.
The Conservatives oppose our public health agenda, do they not? I thought this was an area where we had built consensus, but not under their present leadership. I have already quoted what their leader, the right hon. Member for North West Essex (Mrs Badenoch), has said. Maybe they were not listening—the country certainly is not. I would have thought, though, that their own side would at least listen to what she said. She says she wants a debate about charging for healthcare. I do not know whether they have heard that or whether they stand by it. Maybe we could just see a simple show of hands—how many of her own side want to see charging for healthcare in the NHS? Not a single hand has gone up. That does not bode well for the future of the Leader of the Opposition, but let’s leave the Conservative party to revel in its irrelevance.
In fact, I was probably one of the few people who paid any attention to what the shadow Health Secretary, the right hon. Member for Daventry (Stuart Andrew), said at the Conservative party conference. I noticed that he did not mention a single policy. I say to the Conservatives: if we are doing such a bad job, why would they not do anything differently? Would they cut the £26 billion this Labour Government are investing in the NHS, and if not, if they oppose this Budget, how would they pay for it? The Conservatives seem to think that the British people are so stupid that they will forget which party wrecked the NHS and led it to the worst crisis in its history.
To conclude, this is a Government who are cutting waiting lists, giving children a healthier start in life and lifting 500,000 children out of poverty. In doing so, we are restating the case for universal healthcare that is publicly owned, publicly funded and free at the point of use. We are showing that progress is possible after 14 years of decline, that things can get better. Abolishing the two-child limit is not a handout, it is a hand up. Our country cannot prosper while 6 million people languish on waiting lists, 4.5 million children grow up in poverty and 1 million young people are not in education, employment or training. But if we protect people’s health, give them the opportunities to put their talents to use and give them a strong foundation, they will build a good life for themselves and a better Britain for all, and we can fulfil the lost promise that tomorrow will be better than today.
What has the Secretary of State been focused on? A top-down reorganisation of the NHS—which not only did he not tell anyone about before the election but he explicitly said he would not do. As Conservatives, we support the principle of cutting duplication, reducing bureaucracy and saving on administration costs. The House will remember that a recent Conservative Health Secretary, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), reduced in a single year the number of civil servants in the Department for Health and Social Care by around one in six.
Let us be clear: this is yet another announcement made by the Government without any plan for delivery. For months, not one Minister has been able to answer any of our questions about how much NHS restructuring will cost or who will be expected to cover redundancy packages. For months, integrated care boards have been warning that frontline patient services were at risk because they simply do not have the money to do what is asked of them. For months, staff were left in limbo, not knowing whether their job would still exist or for how much longer. We welcome the fact that the Budget finally provided some clarity, but shifting money between years means significant risk. The NHS is already behind on its efficiency targets. If this reorganisation falls short of its goals—no small risk given the Government’s performance—there is an even more significant shortfall to make up in future years, which will hit patient care.
There are other elements of the Budget that we welcome for the health service. Focusing on improving productivity is the right thing to do, but whether the extra investment will make any difference in the grand scheme of things remains to be seen. Neighbourhood health centres can be cautiously welcomed. They build on the great success of the Conservatives’ efforts to bring care closer to where people live through the community diagnostics centre programme. However, has Labour truly learned the lessons of all the private financial initiative deals that it botched back in the 2000s, which NHS trusts are still paying for decades later? Will the Government simply move resources around or will there be genuinely innovative new ways or working, joining up services and improving the patient care experience? I hope that it is the latter, because shuffling the deck chairs into new buildings will not deliver the benefits that patients deserve.
Despite those few bright spots, it simply is not right for the Prime Minister, the Chancellor and others to justify this latest tax grab by saying that it is to protect the NHS. As the NHS Confederation noted, this year’s Budget did not have a health focus. That means that we are left with a lot of unanswered questions. The Office for Budget Responsibility specifically raised two risks to health spending. The first was the doctors’ strikes, which the Health Secretary has failed to resolve, despite making that sound very easy to do when he was in opposition. I will give him credit, because he did briefly end them, for a few short months, but only by caving in to the demands of the British Medical Association, in return for no productivity or modernisation reforms. We warned him that giving in to the trade unions would only see them come back for more—and indeed, here we are, with patients and taxpayers paying the price, and no end in sight. The OBR confirmed that strikes have already cost £500 million, and warned about further strikes. Now it has been confirmed, just before Christmas—the worst time of year for it—that the doctors are out again.