Spending Review: Health and Social Care

With permission, I would like to make a statement on the outcome of the spending review for the Department of Health and Social Care.

This Government were elected on a manifesto to fix our broken NHS and make it fit for the future. Our job is twofold: first, to get the NHS back on its feet and treating patients on time again; and secondly, to reform the service for the long-term so that it is fit for the future. That is why, in her autumn Budget, my right hon. Friend the Chancellor took the necessary decisions to give health and social care a record uplift in day-to-day spending at the conclusion of the first phase of the spending review. The Department for Health and Social Care received a cash injection of £26 billion covering day-to-day spending and capital investment in 2025-26, compared with the 2023-24 out-turn.

All Opposition parties have rejected that investment and those changes to repair the damage done to our NHS and move it forward. They have rejected two above-inflation pay increases for our NHS staff, the recruitment of 1,700 more GPs and the agreement of a GP contract for the first time since the pandemic, the biggest investment for hospices in a generation, the biggest expansion of carer’s allowance since the 1970s, a boost for older and disabled people through the disabled facilities grant, and the biggest real-terms increase to the public health grant in nearly a decade.

We have also given pharmacies the biggest funding uplift in years, ensured that women across the country can access the morning after pill free of charge, frozen prescription charges for the first time in three years, enabled an extra 3.5 million appointments for operations, consultations, diagnostic tests and treatments—reaching and surpassing our manifesto pledge seven months early. I can update the House on waiting lists, which, as of this morning, have fallen by over 30,000 compared with last month, amid a reduction of 232,000 since this Government took office.

I could go on, but I have only 10 minutes, Madam Deputy Speaker, and I would not like to try your patience, so I will make this point briefly. To govern is to choose, and anyone who opposed the decisions that the Chancellor took in her Budget must tell us what they would have subtracted from that list. We cannot spend money if we do not raise it.

As the Minister of State for Secondary Care, I regularly hear appalling anecdotes from colleagues across the House whose local hospitals, GP surgeries and community services are crumbling, with rusty equipment, leaky pipes and buckets catching rainwater. Phase 1 of the spending review has allowed us to arrest 14 years of shocking neglect and undercapitalisation in the NHS, with a record capital investment of £13.6 billion in 2025-26. [Interruption.] The Conservatives do not like it, but I will go on. That money has gone towards repairing our crumbling hospitals, supporting over 1,000 GP surgeries to modernise their buildings, and installing state-of-the-art scanners across the NHS estate, including the latest linear accelerator machines. However, as my right hon. Friend the Secretary of State has made clear, investment must come with reform. This year we have unveiled our plan for change, our elective reform plan, our urgent and emergency care plan and a crackdown on agency spend in order to reinvest £1 billion into the frontline.

Yesterday, my right hon. Friend the Chancellor set out the conclusion of phase 2 of the spending review, setting budgets that will enable us to make firm plans to deliver on the people’s priorities in the coming years, while going further and faster on reform. Our settlement increases day-to-day spending on health, bringing the budget for my Department and our NHS up to £232 billion by 2028-2029. That means £29 billion more day-to-day funding for the NHS in England, in real terms, than in 2023-24. We have also secured the largest-ever health capital budget, with a £2.3 billion real-terms increase in capital spending by 2029-30, compared with 2023-24, representing a more than 20% real-terms increase by the end of the spending review period.

Let me hammer this point home: investment must be matched by reform. This will be a critical year for the NHS as we achieve better value for taxpayers, who must see their money being spent well and delivering results. We would rather take those difficult decisions now, to save our NHS so that it is there for future generations. NHS England is a top-down organisation—the biggest quango in the world—with a less efficient system than the previous Government inherited in 2010 and twice the headcount at the centre. That is why my right hon. and learned Friend the Prime Minister announced in March that we will bring together NHS England and the Department of Health and Social Care to form a new joint centre. That will put an end to duplication and enable substantial efficiency savings, while bringing the management of our NHS back under democratic control. We will also unlock £17 billion of savings over the spending review period through 2% annual productivity growth in the NHS—money that will be either reinvested in the frontline or used to support radical transformation to make the health system more agile and efficient.

Our elective reform plan set out how we will ensure that by the end of this Parliament 92% of patients will not have to wait more than 18 weeks for elective care. This settlement will drive us further towards that goal, with over £6 billion of additional capital investment over five years across new diagnostic, elective and emergency and urgent care capacity, which could deliver more than 4 million additional tests and procedures.

We will build on the record capital investment from phase 1 to repair the NHS estate. That means continuing the delivery of 25 new hospitals; investing £30 billion in maintenance and repairs, with £5 billion of it to address the most critical building repairs; and reducing by half the number of hospitals containing RAAC—reinforced autoclaved aerated concrete—over this Parliament.

This spending review provides for an increase of over £4 billion for adult social care in 2028-29 compared with 2025-26, including an increase in the NHS contribution via the better care fund. Local authorities with responsibility for adult social care will also benefit from wider reforms to better align funding with need, multi-year settlements and simplification of the funding landscape that enables them to plan more effectively. Last but not least, we have taken steps to simplify targets and better monitor delivery, and we will continue to work with local systems to improve financial and operational performance, to get the most from every penny.

A key part of our 10-year plan is driving progress on the three shifts: from analogue to digital, hospital to community and treatment to prevention. On digital, we will invest up to £10 billion in technology and transformation, to start making the NHS app a digital front door and deliver a single patient record. We will work in partnership with the Wellcome Trust to launch the world’s first health data research service, backed by £600 million, to accelerate the discovery of lifesaving drugs.

On primary and community care, we will invest in training thousands more GPs, helping to bring back the family doctor through millions of extra appointments a year; in 700,000 additional dentist appointments annually; in at least 8,500 extra mental health staff by the end of this Parliament; and in mental health support teams for every school within five years. Finally, on prevention, our world-leading immunisation programmes will be supported by £2 billion, and we will invest £80 million in tobacco cessation programmes and our Tobacco and Vapes Bill.

I want to end by thanking the Chancellor for her unwavering commitment to getting our NHS back on its feet. Fixing broken Britain will not be easy, but nothing that is worth doing ever is. Today I have set out how every penny from the public purse will be matched by reform, to make our NHS fit for the future. We remember we were elected on a manifesto to end sticking-plaster politics and do the hard yards of fixing our country, and we will never betray that promise to the British people. The public have a right to know how public money will be spent, and this is something we take extremely seriously. They can put their trust in this Government, because we have fixed the NHS before, and with the help of this Chancellor, we will fix it again. I commend this statement to the House.

I call the shadow Secretary of State.

Yesterday, yet again, we saw the Chancellor do what the Labour party always does: default to high spending, more borrowing and higher taxes, leaving the public finances vulnerable. The Minister has spoken of additional funding for the NHS. To use the same comparison as the NHS England chief executive, the NHS budget will now be roughly the equivalent of the entire GDP of Portugal, yet we are still none the wiser as to how the Government actually intend to use most of the money—there is no real detail and no real plan. Just last September, the Prime Minister pledged that there would be no more money without reform. Despite the Minister’s words, that is exactly what the Government have done. There is still no plan for reform, and the Secretary of State is unwilling to set out the bold reforms that are needed.

Despite 14 years in opposition and nearly one year in government, the Labour party has failed to come up with a plan for the NHS, with the exception of the abolition of NHS England, which will not happen for years and appears to be delayed and in chaos. Ministers respond to every written parliamentary question about it by saying they cannot set out the savings, how the people will change or how the structure will change at this stage—yet again, there is still no plan. We have been very clear that where the Government are wrong, we will oppose it, but where they get something right, we will work constructively with them. That includes reform, but there is still no reform for us even to consider supporting.

Can the Minister tell us where the £29 billion she set out will be spent? The chief executive of the NHS Confederation said yesterday that increases in NHS staff pay will

“account for a large proportion”

of the funding increase. The former NHS chief financial officer echoed that view at the Health and Social Care Committee in January, saying that pretty much all the last tranche of additional spending was absorbed by pay rises, national insurance and inflation. Can the Minister confirm how much the pay offers from the independent pay review bodies, alongside increased national insurance, will cost, how much of this funding will have to go to cover that and how much will actually make it to the frontline to improve patient services?

I am entirely unclear, after that run-through of a number of different issues, whether the Conservatives welcome the extra investment in the NHS or oppose it. We know they oppose the means of funding it, but after that, I have no idea. At some point, they have to make up their mind whether they support that extra investment or not. As I said in my statement, if they do not, what out of the list of the improvements that we have already made would they not do?

As Lord Darzi made clear, under the Conservatives’ watch for 14 years the NHS was broken. Staff were left with out-of-date equipment and unable to do the job they needed to do. We agreed with Lord Darzi’s diagnosis, but Conservative Members have still not said whether they agree with it, or apologised for the state they left the system in. I do not know whether the right hon. Member for Melton and Syston (Edward Argar) has not been able to read the elective reform plan or the urgent emergency care plan that we published recently. It is up to him to read those plans properly and try to understand what is happening.

The right hon. Gentleman has started to do my job for me again, because he cites various think-tanks and people who have said that this cannot be done. Well, I can tell him that we were told, for example, that waiting lists would not drop in April because of seasonality, but we have shown—by keeping a relentless focus on the system, working closely with leaders on the frontline and being clear with officials in the Department—that it can be done. That is what we heard this morning.

We are taking a relentless approach to spending, line by line, throughout the NHS and the Department of Health and Social Care. We have rolled up our sleeves and we will not accept putting more and more taxpayers’ money into a leaky system, which is what happened under the right hon. Gentleman’s Government. If he had read the patient satisfaction survey, he would know that taxpayers across the country, in all our constituencies, love the NHS. They understand that the Tory party broke it and that it will take long time to fix. They also know that they are paying more taxes for it and getting a worse service, and they expect us to do much better. That is what we have already shown we are doing, and what we will continue to do.

I welcome my hon. Friend’s statement about the record funding going into our NHS. We are already seeing the benefit in my constituency, with millions of pounds going into investment in our hospital; that is so desperately needed to get waiting lists down. People were left behind by the Conservative party, and I note that there is still no apology to any of my residents who were left in pain and agony for years and years under their watch—not one word of an apology.

One of the big challenges facing my constituents is accessing an NHS dentist—my hon. Friend knows about that from the time she came to visit me during my campaign. I am campaigning to get new dentists for my constituents in Gloucester, so will she help me to get a meeting with the relevant Minister to ensure that some of this record funding comes to Gloucester to get an NHS dentist for all my constituents?

As my hon. Friend said, this is a health area that I know well, and he has been the most amazing campaigner for Gloucester and the health service there since he became the Member of Parliament. He is absolutely right: dentistry is a key worry. It is one of the key areas that the Conservative party neglected for 14 years. That is why it was a manifesto commitment, and why I was able to outline today that meeting the target of 700,000 is front and centre, and part of the plan as we go forward. I know that the Minister for Care, who is responsible for dentistry, is keen to meet many hon. Members, and I will make sure he has heard that request.

I call the Liberal Democrat spokesperson.

To reiterate: after years of Conservative mismanagement, the NHS is in crisis, with patients left waiting hours for ambulances, women giving birth in unsafe maternity units, and children turning up at A&E with rotting teeth because an NHS dentist cannot be found. That is the Conservative legacy, and they must never be trusted with our health service ever again. So yes, we welcome this funding boost—we really do—and we agree that funding must come with reform, because unless this funding is targeted properly, it will not bring the change that patients urgently need.

When it comes to reform we need to talk about fixing social care, because putting more money into the NHS today will be like pouring money into a leaky bucket. Last year, the Secretary of State for Health and Social Care stated that £1.7 billion a year is wasted because patients who are medically fit for discharge cannot leave hospital, simply because no care is available to support them at home. The hospital in Winchester that supports both your constituency, Madam Deputy Speaker, and mine has up to 160 people waiting to be discharged at any given time, and they would be better cared for with social care packages.

We need urgent action and a higher minimum wage for care workers. We need proper respite and financial support for family carers, and a clear commitment to conclude the social care review, hold cross-party talks, and deliver the real reform that the Minister has been talking about. We also need to tackle the crisis in primary care, because that is where prevention happens and where pressure on hospitals is eased. Will the Minister confirm that the funding boost will deliver the extra 8,000 GPs that are needed to guarantee everyone an appointment within seven days, or within 24 hours for urgent cases? Can she also confirm that the funding will bring dentists back into the NHS, and bring an end to dental deserts? That will not happen without urgent reform of the NHS dental contract, which is outdated, unworkable and driving dentists out of the system.

I thank the hon. Gentleman for welcoming, on behalf of his party, the commitment that the Chancellor has made and the extra funding that she has identified, but I think his party still opposes the way in which we have raised the funding to do just that. It is good to have your cake and eat it, but we are clear that the funding does come with reform. As I said in my statement, we are committed to improving the front door—primary care—as well as social care and discharge. That is why the NHS contribution, as part of the settlement to the better care fund, increases. He will be aware that we previously revised the better care fund to make it better and more targeted on discharge, which is important.

The urgent and emergency care plan that we published a couple of weeks ago also confirms our recognition that flow through the hospital system is important for patients and staff; we must ensure that we do not face that continued crisis of corridor care over many years. We are committed to the fair pay agreement, and our colleagues in the Ministry of Housing, Communities and Local Government will make more statements in the coming weeks about how that will work.

I draw the attention of the House to my entry in the Register of Members’ Financial Interests, as chair of the all-party parliamentary group for dentistry and oral health. Access to NHS dentistry is in crisis, including in my constituency. New analysis by the British Dental Association shows that the share of NHS funding spent on dentistry has more than halved since 2010, from over 3% to just 1.5%. I know how committed the Government are to reforming the dental contract, but the Public Accounts Committee made it clear that reform will work only if it is backed by proper, sustainable funding. Will the Minister ensure that NHS dentistry gets a fair share of the £29 billion announced in the spending review, so that we can end forever the crisis that is affecting millions across the country?

I thank my hon. Friend for her question and for the work she does to support NHS dentistry as part of the all-party group. As I have said, this issue is of huge importance to our constituents, and the shocking state in which the Conservatives left dentistry is there for all to see—particularly the shocking state of children’s oral health. That is why we acted rapidly to introduce the toothbrushing campaign—which, if I remember rightly, was ridiculed by Conservative Members when we discussed it in opposition—and the arrangement with Colgate to ensure that we improve children’s oral health. We are absolutely committed to reform of the contract; the Minister for Care is working hard on that and he will continue to update the House regularly. It is our confirmed commitment, as I have reiterated today, to increase access to dental services.

I call the Father of the House.

Our spending on the NHS is now as much as the entire GDP of Portugal. We used to be a country with an NHS attached to it, but we are almost becoming an NHS with a country attached to it. Of course we would welcome this spending if we got the same outcomes that people get in civilised countries, like the Netherlands or Australia, but every time I mention fundamental reform, I am dismissed as wanting to bring in privatisation, so it is hardly worth raising that issue. Australia has an extremely successful pharmaceutical benefits scheme; I know that the Secretary of State for Health and Social Care went out there, and I have talked to Australian doctors about it. Will the Minister at least look at the successful outcomes, including some of the highest life expectancies in the world, that are being delivered in countries like Australia and the Netherlands, to see how we can deliver better outcomes? There is no point spending more money if people’s only right is to join the back of a queue.

I was expecting the right hon. Gentleman to talk about the funding model, and I am disappointed that he did not; it is something that he has talked about for many years. I do not know the details of the Australian model, but will ensure that he gets a proper answer. I am always happy, as is my right hon. Friend the Secretary the State, to look at models from across the world. We want to learn from the best, and we want to deliver the best in the NHS.

The Conservatives seem to have an obsession with input into the health service. It is true that the last Government put more money in, but it went into a leaky bucket and they got nothing out. This Government have taken a different approach. We are not just taking money from the Treasury, handing it out and then coming back for more. We are being very clear with providers and the system more generally. My right hon. Friend the Secretary of State is talking at the NHS Confederation conference this afternoon; we are working with them to ensure that we look not just at the inputs, but at what goes on in the system. We want to ensure value for taxpayers’ money in all our constituencies. There are outstanding examples of both financial and operational good practice across the country. We want to take the best to the rest, and make the best of every taxpayer pound.

The Minister has demonstrated the difference that a Labour Government make to our NHS, and to the people of our country. As she mentioned, reform is needed. May I draw her attention to the report by the independent Commission on Palliative and End of Life Care? Around 100,000 people cannot access hospice care, and too few people are able to access specialist palliative care. The report demonstrates a new system of end of life and palliative care that will transform people’s end of life experience. To go alongside the reform agenda, will she ensure that we invest in that precious time in people’s lives, and deliver a comprehensive palliative care service?

My hon. Friend is right to highlight end of life care. We know it has been neglected. I worked on it during my time in the health service, over 15 years ago, and I feel very passionately about it. It is important that we support people. We must have a system that allows people to have those conversations, and that ensures there are options for people throughout the pathway of their life. The Minister for Care is working hard to ensure that happens as part of our overall development of the health service over the next 10 years.

Will the Minister confirm that the funding envelope that she set out in a letter to the Queen Elizabeth hospital in King’s Lynn in April stands unchanged after this spending review?