Health and Social Care Committee
Oral evidence: The Work of the Department for Health and Social Care, HC 236
Wednesday 4 November 2026
Ordered by the House of Commons to be published on 4 November 2026.
Watch the meeting
Members present: Layla Moran (Chair); Danny Beales; Ben Coleman; Josh Fenton-Glynn; Dr Allison Gardner; Andrew George; Paulette Hamilton; Joe Robertson; Gregory Stafford.
Questions 154-257
Witnesses
I: Yvette Cooper MP, Secretary of State for Health and Social Care, Samantha Jones, Permanent Secretary, Department for Health and Social Care, and Sir Jim Mackey, Chief Executive Officer, NHS England.
Examination of witnesses
Witnesses: Yvette Cooper MP, Samantha Jones and Sir Jim Mackey.
I will get right into it. Secretary of State, you have set out your priorities: maternity is one, and early years and children is the other. We have our 10-year plan, and we also have a Prime Minister who has put a lot of stock in social care. Are you making any tweaks to the 10-year plan to reflect your priorities, and what are they?
Yvette Cooper: Thank you for having me, Chair. It is actually 25 years since I last gave evidence to a Health Committee, so thank you very much for having me back. It is a huge privilege for me to be back in the Health Department as Health Secretary, and to be covering social care at a time when it is such a priority for the Prime Minister, with his strong commitment to building a national care service. Of course, we have been reviewing all of the work around the 10-year plan and all the work of the Department over the past few months.
What I would say is that the commitment to improving the performance of the NHS, and the turnaround that we need after the deterioration in performance under previous Governments, but also through covid, is crucial. The three shifts set out in the NHS plan—to prevention, to community services and to digital—all remain as important as ever, but you are right that we are adding to that both the commitments to the national care service and the priority that I am giving to maternity and child health, because I just think that that was getting lost and we were not putting enough of a priority on it.
Yvette Cooper: As a result of our focus on maternity and child health? Obviously, the maternity taskforce is under way at the moment, and we expect to publish an action plan—it will be interim, in terms of the things that we do—before Christmas, and a new modern services framework, with the national standards around maternity and neonatal care, in the middle of next year.
Interestingly, when I checked what I had given evidence on 25 years ago, the last time I gave evidence, it was on national service frameworks, which have since been cancelled. Establishing that modern services framework of standards will be important.
The other thing that I am seeking to do is bring back the Sure Start principles and the Sure Start approach to maternity and the early years. That is why we have announced the roll-out of the Healthy Babies programme—really, Sure Start health services—to all the family hubs across the country. Those are things that are either being strengthened or are different.
Yvette Cooper: As you say, Baroness Casey is doing the commission and consultations, hearing from the public and looking at what the long-term plan for a national care service looks like. We are approaching it almost from the other end, looking at what the building blocks are—what are the things that we need to do? What are the step-by-step measures that we can take? That means the workforce, but it also means looking at how we better integrate health and social care—for example, around dementia and frailty. We are looking at what the steps are, and we are also working very closely with Baroness Casey’s commission so that we can anticipate the direction of travel.
Yvette Cooper: We have a small ministerial group that meets, and meets with Louise Casey at intervals throughout, so that we can get updates on the direction of travel and do some of the preparation work. Louise will decide herself what further reports or interim arrangements she wants between now and the summer; that is for the commission.
Let me list some of the building blocks that we are looking at. One is the workforce strategy, and I can say more about that if you want me to. We are also looking at how you better combine health and social care on prevention and preventing frail elderly people going into hospital in the first place; how we improve the discharge processes, which I think have gone backwards since 25 years ago; progress around things like dementia; and some of the issues around palliative care and end-of-life care, which is an area where social care and healthcare already work closely together but not in the way all of us want them to, as part of a new modern service framework. Ally McGovern is also looking in some detail at the structures we have in place at the moment, the way in which commissioning works and what improvements we can make step by step. We are looking at building blocks step by step, while Louise works through the vision of a national care service that the Prime Minister wants to see.
Yvette Cooper: Sure, I would be happy to.
Let me now turn to the change in pharmaceutical pricing, also known as the UK-US pharmaceutical deal. This Committee has been concerned about the lack of transparency in the impact assessment, what it is going to affect downstream in the NHS, what the money might be spent on and the sorts of drugs that we might end up having to commission as a result. Regardless of whether one feels it is a good or bad idea—there is a range of views—the lack of transparency has really concerned us. You might be aware that the National Audit Office announced just yesterday that it is starting a workstream on this. Secretary of State, bluntly, why should it take the NAO to get the transparency that this Committee and Parliament have been wanting from the Department?
Yvette Cooper: Let me give a bit of overview, and then Sam may want to come in on more of the detail.
Yvette Cooper: As a former Select Committee Chair, I think the NAO always plays a crucial role across a whole series of areas. It will always have a role to play in these processes. I know there is interest from a series of Select Committees on this issue, and we therefore welcome that as a process.
The big conclusions of the agreement are the increase in spending on innovative medicines over the next 10 years and the impact that that has on long-term investment in the UK—that all clear as part of the agreement. So, too, are the immediate changes on the NICE guidance that we brought in in the spring. As a consequence of those changes we have had 10 new crucial drugs granted NICE approvals for the NHS, including Enhertu, which make a big difference for patients and families across the country. On some of the clear, crucial building-block decisions that are part of that, there is a lot of transparency, as there always is around the NICE processes. Perhaps Sam wants to come in with more of the detail.
Samantha Jones: Thank you to you and the Secretary of State. This is the subject of a number of discussions, as you are obviously aware, on the release of the commercial information associated with it, and there have been initial conversations with the NAO. I know you appreciate, because we discussed it before, that some of the more technical aspects and pilots currently under way as a result of the arrangement are currently being worked through, including what the impact is on drugs that we would not have received or drugs that we might have received. That in itself is informing the specific cost of the deal over the SR period, which has been set out. To your original question and the commitment to transparency, we are working through the commercial arrangements on how best we do that on a cross-Government deal with a number of different Select Committees and the different Departments involved.
Chair: Let’s move on. Danny Beales is next.
Yvette Cooper: As you can imagine, our public health teams were extremely excited by the Treasury announcement about PDEL. We think a lot of our investment across not just public health but across the NHS has benefits in terms of keeping people healthy and in work. A lot of those treatment budgets have a consequence in helping people work as well as in the direct prevention. We do not know yet how this is going to play out. I think these will end up being the crucial decisions for the spending review and ultimately decisions for the Treasury. We are already looking at, from our budget point of view, what would count in that way. To be honest, we are already doing this, anyway, because one of the challenges for us is how you shift to neighbourhood health.
Yvette Cooper: As a former Treasury Minister, I would say the benefit of this is keeping that focus and discipline around the things that you invest in now that have the long-term benefits. Those are the areas that always come under shortest-term pressure. At the moment there are challenges with it. We know that, for example, if you can keep frail elderly people out of hospital, that is much more effective for the patients and also for the NHS as a whole, instead of having costly NHS acute care. Later on, once somebody has become more ill, you will save money.
That is hard, because of the current ways in which the NHS works, but we are trying to achieve that. Having that PDEL process could help with the discipline of doing that.
Yvette Cooper: Mine would be quite broad; we do not yet know what the Treasury’s will be. Primary prevention clearly is, and I strongly think that secondary prevention is. I also think that a lot of our treatment services have an impact, in saving money elsewhere. Mental health is a really good example, as we know that a lot of young people who are not in work could benefit from mental health support.
Yvette Cooper: We need to make the shift, regardless of how the Treasury categorises the money. That shift is part of our 10-year plan, so we will need to do that. I hope that the Treasury and the PDEL process will support us and will strengthen that in an effective way.
Yvette Cooper: You are right that there is always pressure, and there can be short-term pressures on some of the prevention budgets. I think the Treasury is trying to achieve greater protection for prevention. The only area on which I would disagree with you is on the DIP, because ultimately, the funding for the defence investment programme is about prevention, as it is about our national security and safety. Of course, that means all Government Departments doing their bit, but that is a shift from one area of investment and capital to another to keep the country safe.
Yvette Cooper: The mental health strategy has to bring all of this together. In Peter Fonagy’s review into prevalence, we saw the real, significant increase in distress in mental health, particularly among younger people. With common mental health conditions such as anxiety and depression, we want to expand and do more on talking therapies, which can be effective. We also know that there are areas where we have real problems with waiting lists. So many people could benefit from much earlier intervention, rather than letting that distress worsen, become embedded and have a huge impact on people’s lives later on.
The challenge for us is how to get earlier intervention. That means working and rolling out our new mental health teams in schools, but it also means doing more on community services. In the summer, I announced new community walk-in services for mental health, located on high streets and in communities. Being able to do more of that kind of early intervention will be hugely important.
Yvette Cooper: The mental health strategy needs to look at all these issues. Obviously, I cannot pre-empt where the strategy gets to. On the waiting lists picture, there are some areas where waiting lists are very short, but there are others, including some children’s ADHD and autism assessments, for example, that are very long. You saw some of the things that Peter Fonagy’s review said about those, as well as some of the problems with independent sector assessments. In other areas, the talking therapies are proving to be positive and effective, as are some of the community services. What need to pull all that together in a strategy. We are absolutely going to have to look at waiting lists and waiting times as part of the strategy. That is clear.
Yvette Cooper: I am not going to spell out what we will say in the mental health strategy. I can say that we will have to look at waiting times and waiting lists as part of the strategy, but they are different for different bits of the system. People often talk about overall mental health waiting lists. Actually, they are very different. The most acute waiting times for some of the most serious things, like eating disorders and so on, have already come down very substantially, so we can intervene quickly, but we have to look at these across the board.
Yvette Cooper: I totally understand why you are pressing me on this. I am just going to say that I am not going to pre-empt the strategy, because that is work that we still need to do and announce in the normal way. I will come back to you as soon as I can on that.
Yvette Cooper: Our plan is to produce the mental health strategy before the end of the year. We are also working in combination with the response to Alan Milburn’s review on NEETs, so we may end up doing things on slightly different timescales for different bits of the system, depending on the timetable of the cross-Government work on that.
Yvette Cooper: Again, all these things need to be part of the strategy. As you know, we are attempting to do multi-year planning for the NHS. Of course, when there are continuing financial pressures, that has to be kept under review, but we are attempting to do more long-term planning and have more long-term ability and stability for the service across the board.
Yvette Cooper: I do not think any Secretary of State is going to have any choice but to continue to ensure proper investment in mental health services, because the scale of need and the impact that it is having, including on the labour market, as well as on the distress for families, is significant.
There is a big issue for us about how we look more at prevention. We cannot simply think about mental health services’ response to the increase in anxiety and depression among our young people. We need to look at the causes, whether those are around social media or the pressure on young people’s lives, and at what early interventions should take place. I would go right back to the early years. Part of the reason I feel so strongly about Sure Start is that, if you look at the evaluation of it, it led to improvements in mental health, and you see those benefits a decade later, in the teenage years. When I talk about early intervention, I would go right back to those very first early years.
Yvette Cooper: It is right for us to be clear to ICBs about the importance of mental health funding. I think that is really important. There will be different ways to look at how we ensure that there is proper investment in mental health in the future. We are also interested in devolution, particularly around the response to young people who are out of employment and training and around mayoral strategic authorities being able to respond and bring services together in their local areas. That might be another way to strengthen the priority for mental health.
Yvette Cooper: PDEL will be an issue for the spending review, and I expect us to have a strong focus on that. What we do have a commitment on is to increase our focus on prevention and to make sure that we can do that as part of the 10-year plan. That is our overarching commitment: we have to increase prevention. Of course, that means you have to look at where you invest, but we will certainly do that, even separate from whatever happens on PDEL.
Chair: We have a lot to cover, so let’s move on to Dr Allison Gardner.
Yvette Cooper: I will turn to Sir Jim on the detail of that. One of the things we are trying to do—you are right that we do need that specialist assessment. That has an impact not just in terms of getting that patient to the right care, but also on other patients and staff. For someone who is in a mental health crisis, A&E is often really not the right place to be, certainly for long periods of time.
The other thing we are trying to do is invest in, effectively, separate mental health crisis A&E centres, so urgent care. One of the things we announced in the summer, as part of the £300 million investment, was new, separate mental health emergency care centres, so that you can have much more appropriate support for people who are going into mental health crisis.
Sir Jim Mackey: Just to add to that—we covered this a bit on Monday with the PAC—I think everyone would agree that the assessment service you have described is really valuable and really effective, but the whole system has to work together. Once the assessment is done, there has to be capacity and provision for the individual involved. That is usually where the service gets let down: there is not enough capacity there to move that person into a more appropriate setting. Colleagues are working on that around the country.
Another issue for you to consider for the mental health strategy is that, when people have long-term mental health issues, they can do talking therapies, which, I agree, have great benefits. But when they hit a crisis situation and move into crisis care, often they come out of those talking therapies and have their very short-term crisis support, and then they are back at the bottom of the waiting list, waiting to go back to those therapies. Are you integrating these things, so that people have continuous support going through? That is really important with the mental health strategy. We have to accept that people will go into crisis and will require additional support, but they cannot lose pre-existing support.
Sir Jim Mackey: Absolutely. When I talk to NHS leaders, they see that as an issue and are trying to deal with it. They are also trying to build out the neighbourhood mental health services. Importantly, it looks to me at times like we have services that are built for very discrete definitions—we have discussed this here before, I think—and sometimes packages stop when something else starts, but people are moving in and out of different levels of escalation. People are trying to address that, but it requires an awful lot of things to change at the same time.
Yvette Cooper: The centre I went to in Sheffield is one of our first community-based mental health services. What they were doing was bringing together all the different mental health teams, because you have multiple different teams that might deal with, or provide support in, different circumstances. Having them co-located, changing the way in which health services work so that, as Sir Jim said, they are based around the patient rather than in different silos, has to be what we try to do on this.
Chair: To be clear, the recommendation was to “review” section 75 arrangements, because they can happen with local authorities but too often do not. That was rejected by the Department, which was a real blow to the Committee, because we see it as a really important way of solving some of these issues.
Sir Jim Mackey: The mechanisms are great where there is agreement locally to use them. I have experienced that in my trust life. Really effective section 75 agreements have tied people together where there was a mutual will to do that. The issue is that you cannot mandate it everywhere. You cannot force people to do it. There has to be a local will. There has to be a purpose around what they are trying to solve.
Sir Jim Mackey: Everybody can do it now. There are no barriers to people doing it. But you need the will of local partners, a plan, a focus and a purpose around what you are trying to achieve through the section 75.
Yvette Cooper: I think this gets to the heart of the devolution question and the rewiring of the state that the Prime Minister has raised, and is one of the issues that is at the heart of looking, now, at how you do greater devolution. It has to be in a way that gets local organisations to properly work together around place, so that you don’t have that sense of, “Look, we have individual organisations doing their own thing, and based on different national requirements. It’s okay: we work in this silo; they work in that silo,” where you don’t get that partnership working. I think the biggest question that the Prime Minister is asking the whole of Government and these others, whether it be mayors or local government across the country, is, how do we rise to that challenge and get organisations working together?
You can look at whether there are legislative duties and responsibilities on people to work together, at different ways of organising how funding flows—for example, different kinds of requirements on pooled budgets—or at giving the mayoral strategic authority oversight of the whole thing, so that they can go in and bash heads together. Different things are being looked at. The Prime Minister has said we want the devolution White Paper to be published very soon, and a lot of that work is being led by No. 10 North, so I do not have a precise answer for you on this issue, other than to say that this is exactly the thing that the Prime Minister wants to solve, based on his experience in Manchester and seeing areas where people are able to bring things together.
Yvette Cooper: We are looking more broadly at devolution and what such arrangements should be, as part of work being led by No. 10 North. The reason I use the passive voice is that this is being led by No. 10 North, rather than the Department, but of course we are contributing to it. No. 10 North is looking at the legislative issues, and at the powers, responsibilities and budgets. We are, rightly, one part of that picture. The whole point is to make it a cross-Government focus on rewiring the state.
Sir Jim Mackey: May I add to that? Often with this sort of partnership thing, we default to the better care fund being the solution. It is generally the first tool we go to in the box. That is a useful challenge we should take away, to make sure that section 75s are appropriate—
Chair: That was a specific recommendation we made to you, so I am pleased that you are coming around.
Yvette Cooper: The first thing is that we want to get to coterminosity. I think that having the same boundaries for different services is far more effective for local delivery of public services than not. That is being worked through at the moment, which is why we have paused some of the ICB work—in order to align with the mayors and the approach to strategic authorities across the rest of government. If we can get that prize and much better coterminosity, in some areas—depending on the local government geography—that might mean an ICB covering two areas. It might be different in different areas, because the point about having the ICBs was to have a big enough footprint to be able to do effective commissioning of services, but that is what we are currently working through. I think that, with boundary alignment, it just makes it so much harder for local agencies if they do not have that.
Yvette Cooper: Yes. It is harder because of patient referral patterns in the health service; it is not as simple as having the same historical local government patterns. That is exactly what we are having to work through, recognising that complexity. If organisations can work in partnership, it is much more effective, but you are totally right that the acute service pattern—
Yvette Cooper: The next steps will be the devolution White Paper. Once we have the devolution White Paper, which has brought together the cross-government approach, we will set out the next steps.
Chair: Okay. I am sure we will come back to this.
Yvette Cooper: We have a record £16.3 billion of investment going into NHS mental health spending now. I think we have to be able to use that investment as effectively as possible. Of course, there are always financial pressures—that is the case for the NHS and the Health Department just as it is for the public finances overall, as a result of everything from the strait of Hormuz to the different things that have been impacting the whole economy—but I do think that we can do better. With the budgets that we have, we can provide better services and have earlier interventions, and that is what we are looking to draw up as part of the mental health strategy.
Yvette Cooper: There are a series of things. The first is that we need much earlier intervention. People should not be waiting for diagnoses before they get the support that they need. That is the case when we are looking at the SEND reforms in schools, for example, and making sure that you can get that earlier support. It is also the case in terms of the response from the NHS. What we want to do is shift the way the NHS works, as well as the way education support works, to being based more around need and early intervention rather than long, slow processes that wait for diagnosis. We should focus on earlier intervention, which is all about what people need to be able to keep working, to be able to stay in school or to be able to keep learning.
Secondly, there is a particular issue that Peter Fonagy raised around some of the independent provider diagnoses and how those independent providers are not regulated in the same way, because they are not doing prescribing and are only doing diagnostics. We think that that is a problem; we agree with Peter Fonagy’s assessment on that. That is a problem, and we are introducing regulation for those providers.
What I think Peter Fonagy said was that there is still underdiagnosis in some areas and that there is misdiagnosis in other areas—for example, someone who is getting a neurodevelopment diagnosis when actually they should be getting a mental health diagnosis. He also talks about the risk of overdiagnosis for the future, because of the way some of those independent provider services are not regulated.
Yvette Cooper: I accept Peter Fonagy’s expert report. That was why Peter Fonagy was asked to do this review. He has brought together all of the expertise. He talks about that complicated picture of underdiagnosis, misdiagnosis and overdiagnosis and how you actually need a system that can respond to that whole picture, not just one bit of it.
Yvette Cooper: You obviously still need diagnosis services; that is still immensely important for lots of people. It can also be what means that there may be medication prescriptions as a result of that. There may be other support services that are linked to that. We recognise that mental health distress has increased, and issues around ADHD and autism. We know that there are very acute cases, where people have very severe needs, distresses and challenges, but we also know that there are milder cases, where currently people are not working, whereas actually being in work could be really good for their mental health. If they have the right support, we absolutely want people to be in work.
There is a mix of things. The mental health strategy needs to make sure that we have proper diagnosis services, but also that we do not have a whole load of people who end up waiting a huge length time, in distress, for diagnosis services. For some people, getting early access to talking therapies might be much better than waiting a long time on a long referral pathway. The strategy needs to respond to different things for different people.
Yvette Cooper: We do think that the NHS has to play its part in supporting the workforce. A lot of the original arguments around the NHS—we are 80 years on from the passing of the first NHS Act—were about how it would support the workforce by helping people stay healthy or get treatment quickly so they could get back into work. The NHS has to see itself as part of that, which is why we want stronger responsibility around ICBs, so they support the process and so that people can get back into work if they have health issues or health conditions. We know that that is a particular issue around mental health for young people.
We are part of the work responding to Alan Milburn’s review. The only thing I would say, though, is that while things like mental health services have an important role to play, they cannot be an alternative to providing people with support and job opportunities as well. There are lots of people with a mental health condition who, with the right support, really should be in work. Their mental health will be improved. That is the evidence from Carol Black’s review and from reviews going back many years: that employment and education is good for your mental health.
Yvette Cooper: It is definitely the case that the NHS should be working with other bits of the system to prevent people needing to go on welfare, whether that is because of treatment or because of mental health needs and so on. It is not the only bit of the system, because there is also support in employment that can help to improve your mental health.
Samantha Jones: Thank you very much for giving me the opportunity to discuss this here today at the Committee; I think I had previously offered to do this in private.
Can I just be very clear? All interests were appropriately declared, as a non-executive director, as I was previously, and prior and subsequently to my appointment as permanent secretary, which is also subject, outside of the Department, to overview and oversight in terms of individual permanent secretaries. Specifically, I did not have and was not part of any involvement in any commercial arrangements around ADHD360, or indeed any of those services, including any commercial or private interests.
Assuming that you agree with what the permanent secretary said on your behalf, can you let me know what is happening with the GIRFT clinical leads? In your letter to us and to the staff in the reorganisation, there was no mention of those, and their contracts expire in March next year. Will they all be rehired in the new system?
Yvette Cooper: I will pass on to Sir Jim to follow up, but I have made two things clear in the Department.
First of all, we need to strengthen clinical leadership across the board. It is one of the things that feels different to me from the last time I was in the Health Department 25 years ago. It actually feels as though, in some areas, some of that clinical leadership has been lost compared with what we had back in the day. I want to strengthen that, which is why I have talked about a clinical council being set up so that we have that strengthened voice, and I want to see that in different parts of the NHS.
I have also been clear that I do not want a situation in which we have a whole series of clinical leads being terminated in the spring. I do not want that to happen; I do not think that that would be appropriate. Of course, there may be areas where roles should evolve or be strengthened or changed and so on, but I have made that clear, because that would be an accidental consequence of the timings of the change and of NHS England moving into the Department. We need to be clear about all that critical work and clinical work continuing.
Sir Jim Mackey: Just to flesh this out a little, there is an interpretation that is part of the change programme that all fixed-term contracts and secondments needed to end on the date of abolition. That affected some of these GIRFT leads. The Secretary of State and I discussed this, and we discussed it on Monday with the PAC. I have asked the medical director, Dr Frankie Swords, and her deputy, Ramani Moonesinghe, to communicate with all the clinical leads involved and assure them that that will not be the case and that their employment will continue beyond April. There are normal reviews going on all the time about who does what and stuff, but there is no cliff edge in application. Everybody who is involved will be assured on that; they hopefully have been this week, but they certainly will be through the rest of this week.
Having clinical expertise at the top of the organisation is very important, but having the right clinical expertise at the bottom is also vital. Prior to the election and at the Dispatch Box on 15 October 2024, your predecessor but one, the right hon. Member for Ilford North, said that the Government were “committed…to doubling the number of medical school places”. Then the now Welsh Secretary tried to row back on that in April of last year. I want to get this clearly from you, as the new Secretary of State: is it your intention to carry out the commitment that you made before the general election and that your predecessor made at the Dispatch Box to double the number of medical school places by the end of the Parliament?
Yvette Cooper: I think we have already been increasing the medical training. I am reaching to find the figures in my file.
Gregory Stafford: Secretary, I just want to know whether that is still your intention. As the new Secretary of State, is your commitment to doubling the number of medical school places by the end of the Parliament?
Yvette Cooper: We will publish a workforce plan, which will set out—
Gregory Stafford: You are anticipating my next question.
Yvette Cooper: We currently expect to do so in the new year. It is worth me setting out some of the uncertainties that have led to some of the delays in doing this. There is probably a level of uncertainty around what the future staffing and specialism needs are for the NHS, and that is probably greater than at any time in its history, for a series of reasons. First of all, we know that there is an unmet need in a series of areas. I would highlight speech and language therapists, for example, as an area that we need to increase. We are also keen to shift areas into community services, increasing GPs, increasing community services—
Yvette Cooper: Just to finish the previous sentence, the other area that is changing things substantially is AI. That will lead to us wanting to increase certain areas, but also potentially to reduce certain areas too. Part of what we need to do is to have some humility around the idea of a 10-year plan—the idea that we can predict what we are going to need in 10 years. That is so much harder now than it was even two or three years ago as a result of technology changing. We therefore need to recognise that in what we do.
Of course, because the training of doctors takes seven years, you have to do that long-term planning, but the uncertainty around the areas that we need has become much greater than it was previously. I recognise that that means that there are challenges around workforce planning as a result of this. One of the things we have been looking at is whether, rather than trying to continually focus on precise modelling, we should also look at where we can indicate to the training providers, “These are the areas that we know we need to significantly increase.” Alongside that, we are doing further modelling.
Yvette Cooper: I will just say in the new year. I understand that you have asked this to many different Health Secretaries, but you will appreciate that, as the Health Secretary for three months, after 25 years, I am going to look at this properly and carefully. The consequences of the workforce planning are so important to the whole of the system, and I am concerned that some of the planning assumptions need to be looked at.
Yvette Cooper: We are already saving. Hundreds of millions of pounds have been saved already as a result of the transformation process so far. We expect it to save further funding.
Yvette Cooper: We do expect it to, yes.
Yvette Cooper: The special health authority will also be set up for 1 April. The reason for doing this is that all the national functions will transfer into an NHS group within the Department. To be honest, the model that we have set out is broadly similar to the one that operated before 2012 and the deeply damaging reforms brought in by Andrew Lansley. It is also similar to the model that operated when I was a Health Minister 25 years ago. You have a strong NHS group, but it is within the Department of Health, so you have an NHS chief executive and the ability for teams to work much more effectively together on things like social care.
We have a different arrangement for the regions. We have seven regional teams across the country that do performance management very close to trusts and health organisations across the country. We think it is better for them to stay close to the NHS locally, rather than be brought into the centre. We also recognise that we have this devolution process under way, led by the Prime Minister, so the precise arrangements around regions, ICBs, integrated health organisations and all those things are still changing. To move regions into the centre and then out again as part of devolution would therefore be counterproductive. We are setting the underpinning special health authority so that the regions can get on with the work.
Yvette Cooper: The capital budget increased from around £11 billion before the election to nearly £14 billion this year, rising to £15 billion by the end of the spending review. We are finding a 1% saving this year, and then 2% next year and the year after. We believe that we can manage those savings without it having any impact on things like the new hospital programme and the major capital programmes. As we know, capital programmes have a timetable and a process that often depend on local planning as well, but our assessment is that we can continue to do all those major projects and focus on the patient safety budget and the £6.5 billion we have put into that.
Yvette Cooper: It is also about looking at efficiencies and having to be harder-headed about how the capital budget is managed.
Yvette Cooper: I think the actual answer is that doctors need continual training throughout. They will do continual professional development as well.
Yvette Cooper: That was not intended as a comment about policy. It was just a passing remark about the long-term planning we need; it was not me changing policy on the training of the medical profession.
The BMA estimates that 20,000 doctors could miss out on specialty training this year. How did we get to the point where the bottleneck in workforce planning is the training pathways?
Yvette Cooper: I might bring in Sir Jim on the implications for how things are operating through the NHS at the moment.
The result of a lot of the work we have done is a substantial increase in the number of consultants. The additional funding we put into the NHS is also funding additional consultant places, and we will be expanding the work of things like NHS Online as well. I will pass to Sir Jim on the training point.
Sir Jim Mackey: It goes back to your earlier point, Secretary of State, about how complicated it is to plan these things. My interpretation of the problems we felt last year and the year before—we are still partly experiencing them, but they are much reduced—is that, when there had been an expansion in medical school placements a long time ago, the follow-up placements in the training system at every level had not been fully modelled through, or there were inaccuracies in the way they were followed through.
Adding to that, there was a lot of international recruitment a few years ago, as you will be aware, and that created extra competition for places. We ended up with an unhealthy situation that was a key part of the resident doctors’ dispute. We are working our way through that now. We have expanded places again to try to ease the problem, which is all part of the resident doctor deal, but we are not out of the woods yet.
Yvette Cooper: A lot of work has been done to make sure that we have as many specialist training posts and as many different jobs in the NHS as possible. That is really important. There is always a time lag between the numbers going into training and what is needed in five years’ time, seven years’ time or 10 years’ time. That is just a reality of how you manage a service with a big workforce. Overall, we have about a 12,000 increase in the number of doctors over the last two years. That is a significant increase. That is hugely important, and that reflects a lot of the work that has been done.
Yvette Cooper: That is the number of doctors working in the health service.
Sir Jim Mackey: That will be worked through in the workforce plan. What we are keen to do, as the Secretary of State said, is to try not to make similar mistakes or create similar problems from the past, and to try to get the planning right. It has to work at every stage, as you have described—medical school places, foundation programme, core training, specialty training and then into the consultant and GP workforce as well. We have been significantly out of sync.
Sir Jim Mackey: Again, it will be dealt with in the workforce plan.
Yvette Cooper: The plan as part of the spending review—these may be the figures Mr Stafford asked for earlier—is that there should be up to 4,500 postgraduate medical training places over the next three years, and we are increasing the numbers going into GP training by 750 over the period to 5,000 by 2028-29. Those are the training places we have set out as part of the spending review.
As part of the workforce plan, if we are serious about shifting to greater community services rather than everything being acute, that leads us to say that we need more emphasis on GPs. It also means greater emphasis on things like mental health services in the community and less focus on the acute hospital workforce over time.
We do not actually have a recruitment problem, do we? We have a training problem. How are we going to fix it, and in what timescale? I have heard from three Secretaries of State now that we are prioritising palliative care and mental health, yet the numbers remain the same. How are we going to fix it?
Yvette Cooper: For me, palliative care is the reason for having a modern service framework. The point of having the modern service framework is to give a sense of the standards that need to be met, and to have a holistic approach that looks at everything from the workforce through to the standards and what you want to achieve. I also think the work that Ally McGovern is currently looking at, on how palliative care becomes some of the first steps towards the national care service, requires an increase in this.
Getting the training places in the system is not just about the training decisions; it is about what the trusts themselves and NHS institutions think they need and can support in the system. That is why sending a clear signal about the importance of things like palliative care to the whole system is hugely important.
Yvette Cooper: Trusts will always want additional support from the Department—
Josh Fenton-Glynn: Are we going to give it to them?
Yvette Cooper And from the NHS. They also have a responsibility to make sure that they are providing the training that the NHS needs. They have a long-term responsibility, which I think they recognise.
Sir Jim Mackey: It is not just the trusts, either. It is the colleges. The whole thing has to be agreed. It made me think, Josh: more as a trust chief exec rather than in this national position, I would generally be confident overall, in aggregate, that I would have more candidates than jobs to fill, but specific specialties were always a worry.
You have pointed to a couple of those specialties, whether you are running a mental health service, paediatric pathology or some of the very highly specialist areas, where the training system is very small in the number of trainees. You are very reliant on very small numbers of people. There is the medical training review that the CMO kicked off a couple of years ago. Jane Dacre is carrying it through now. Hopefully that will address these issues.
Sir Jim Mackey: The expansion and the conversion from locally employed doctors to formal training positions is part of the resident doctor deal. That was all done in collaboration with trusts. Glen Burley has led that work. It has been pretty successful so far, but it has not resolved the problem entirely. It has made a dent, but it has not completely made it go away.
Yvette Cooper: Every single day and night of the week, consultants right across the country are doing a phenomenal job. They are very much the spine of our national health service and the quality of care that is provided.
One thing we need to improve on and do better is strengthening the role of consultants and their clinical voice. At the local level, within trusts and organisations, there is a sense from some consultants that their voice has been lost when it comes to the kinds of innovations, care improvements and service improvements they want to see. It is about how we strengthen that, and how we strengthen it at national level as well. I also want to work with consultants on some of the areas where it is in everybody’s interests for consultants to be able to do more innovation and have more training time. That is obviously better for consultants, but it is also better for the NHS as a whole. It can improve productivity and improve services for patients. All of that is different from pay.
Yvette Cooper: Not only does this need to be part of the workforce plan, it is also part of setting up a clinical council. I do think this is different from pay. Consultants have had, on average, about a £25,000 pay rise over the last four years. This is not a pay issue; it is about how we work with consultants on training time and their role within hospitals.
Yvette Cooper: Yes, and there are certainly key workforce areas that we can highlight. That can be part of things like the modern service frameworks, and so on.
Yvette Cooper: That is an area where we have not done enough yet. The plans were set out as part of the 10-year plan, but I do not think we have yet done enough to make it real and turn it into something substantial. Over the next few weeks, I hope to say something more about our approach to neighbourhood health, for example, and the way we need to bring services together to deliver more services in the community. I would very much like neighbourhood health to focus initially on frailty—the frail elderly—and how to have primary care, community services and acute services working together through things like Hospital at Home and other services that help to provide that support and treatment in the community. If you are asking about current budget allocations, I do not think we are going far enough on that yet. We will have to shift and develop that over time.
Yvette Cooper: We are not yet at a position to be able to do that. As you know, in the end, we also have to make sure that things like accident and emergency services are there for when people need them. All of us want us to be able to do that.
Yvette Cooper: We can set that out for you. We should probably do that in writing, or maybe Jim can follow up on the current allocations that we have.
Sir Jim Mackey: Yes.
Yvette Cooper: I recognise that I do not think the plans we have do enough yet to shift that service provision into the community.
Chair: Writing would be brilliant, because we have a report on that coming out soon. We would be very interested if you can give us the detail in writing.
Andrew George: That would be very helpful.
Sir Jim Mackey: When we set off on this last year, we considered whether we should set out an overt, up-front reduction in acute spend. Overall, if you remember, we had to get rid of a £6.7 billion deficit last year. That was largely in the acute sector, so the view was that if we just made a cut there and an investment in community services without shifting the flow, it would probably be a risk that we could not manage. Since then, the approach we have been following is that we want people to develop neighbourhood care and new pathways that move patients, allowing them to be treated somewhere else, and incentivise it so that the workload drops in the acute setting, and then the funding drops in the acute setting as well.
We are having discussions about various means of incentivisation. I have a discussion coming up with a group of GPs who want to own the out-patient budget, take that work out, innovate and disrupt the model. We are walking a tightrope. We don’t want to remove the money but not the work, as that would cause more financial distress.
Andrew George: Right, and you will send us a written note about the quantification question?
Sir Jim Mackey: Yes.
Yvette Cooper: We have rightly had a process of trying to refocus the system on patients and communities across the country. The big component parts of the Health Bill are about bringing NHS England back into the Department of Health—I have set out today how we would do that as part of an NHS group—and the single patient record. Those core elements of the legislation are now going through the House of Lords; they are incredibly important and absolutely the right thing to do.
You are right that I have looked at details. I took a different view on Healthwatch because I think it is important to have an independent patient voice in local areas. In the end, I thought that all the other things that were attempting to reinvent that in different ways were going to become too complicated. It was far better just to keep the system we have, to keep that independent voice. The other change I made very swiftly after becoming Health Secretary was to keep the local government voice in ICBs. The pause on some of the ICB mergers is simply about broader devolution and the Prime Minister’s plans. Again, I think that is sensible.
Those are all sensible reforms and changes as part of an overall direction, but they have to keep patient care and support for communities at the centre. We should not make changes for change’s sake; we should keep that focus on patients and communities.
Yvette Cooper: Absolutely, and she continues to play a crucial role as the chair of NHS England. I met her last week. The work that she did on patient safety is also incredibly important and has led to significant improvements in the CQC and its quality work for patients.
Yvette Cooper: One of the things we are looking at now, which Greater Manchester and South Yorkshire are doing as the first wave or trial, is having the chair of the ICB also be a deputy mayor, so doing joint appointments. That is exactly a way of better aligning and linking up what the ICB does in commissioning and what the mayoral strategic authority can do. You are right that that has huge potential when it comes to things like social care, although, obviously, most social care is done at local government level rather than mayoral level. Baroness Casey’s commission is looking at what the commissioning arrangements for a national care service should be, so it is really too early to pin that down.
Yvette Cooper: There is huge variation. That is one of the purposes of having the modern service framework: to be clear what the standards are. I pay tribute not just to the work of hospices in general, but to the Prince of Wales hospice in Pontefract, which does incredible work. Before becoming Health Secretary, I was involved in many discussions with the hospice about getting more funding from the West Yorkshire ICB, because it has not been getting the same funding as other hospices. It is an issue right across the country, and it will continue to be so; that is why we want the modern service framework in place.
Yvette Cooper: I’ll give it a mention.
Sir Jim Mackey: We did a lot of work on this last year. I cannot remember whether it was here or the PAC, but we had a discussion about hospice and end-of-life care. I met Toby from Hospice UK a couple of weeks ago about all of this, and it was its annual conference on Monday. We had set out the plan to have an MSF this year and to be clear with commissioners that they all need to review their commissioning arrangements and start actively commissioning in a more even and consistent way this year, in line with the MSF and the overall direction.
The hospice sector was quite clear: they really wanted to retain their independence, to continue to be charitably funded and, largely, to have charitable status as well. They did not want us to get too intrusive and to bring them too close into the NHS. But they obviously want a fair deal. They want to be rewarded appropriately and to be seen to be at the table as a key part of the infrastructure. We have been clear about all that.
We are currently doing another round of checking on financial stability in the sector, because that was a concern last year, and I will pick that up with ICB colleagues as we get into the planning round, to make sure they have actually addressed the things we said we would do.
Yvette Cooper: Sorry—to which?
Paulette Hamilton: The Thirlwall inquiry.
Yvette Cooper: First, there was a lack of focus on safeguarding. Every bit of hospitals and every bit of the NHS should be steeped in safeguarding. It is just a core underpinning, and there was a lack of focus on safeguarding.
Secondly, it seemed to me, from reading the report, that maternity and neonatal services had been shunted to one side. To give you an example, the trust board had a big focus on the fact that the medical director reviewed every death in the hospital personally, but it turned out that that was only adult deaths. Despite the fact that there had been real problems in the neonatal services, neonatal deaths were not taken to the board and to the medical director in the same way.
To me, then, it was about two things: first, focus on safeguarding, and secondly, do not allow maternity and neonatal services to become a sidecar to the rest of the hospital, so that if and when things go wrong, they are not surfaced and taken seriously at board level.
Yvette Cooper: On the safeguarding issue, we are strengthening the safeguarding processes—Jim or Sam can follow up on that. We set out some of that work immediately in response to the Thirwell inquiry.
On the focus on and prioritisation of maternity and neonatal, there are three key things. The first is the new modern services framework that we will do in the middle of next year; the second is the maternity taskforce, which includes some bereaved families—I pay tribute to them for being part of it, because I know how challenging that is; and the third is the introduction of the new maternity and neonatal commissioner in the amendments to the Health Bill that have been introduced in the House of Lords.
Yvette Cooper: This is incredibly important. It is perhaps seen at its most acute around some of those maternity services issues, but it has wider ramifications across the health service. For us to be in a situation where maternal mortality is three times higher for black mothers compared with white mothers—to have that kind of health inequality—and also to have things go wrong in maternity services and not be highlighted and focused on is a huge problem.
At the heart of this it is about making sure that women’s voices are heard, that mother’s voices are heard and that families’ voices are heard, as well as ensuring that we raise standards across the board. It is going to be central as part of the modern services framework, and before Christmas we will publish a maternity action plan. That will only be some of the first steps, but it is important to maintain progress in this area and to recognise that some of the issues are cultural as well as at a system level.
Yvette Cooper: There are two things. We are setting up a hub in the Department to pull together all the recommendations. Baroness Amos did that in looking particularly at maternity, but this is a broader thing to keep track of what those recommendations are. There may be some from five years ago that are now out of date, but some may have been recommended multiple times and still not implemented. That is the purpose of having the hub. We are also taking forward the regulation that we set out, I think, in our manifesto around managers. I do not have the detail in front of me—maybe Sam has more on that.
Samantha Jones: That is absolutely correct. The Government accepted all the recommendations in Thirlwall, including, of course, on the regulation of managers. We are working through the detail for the Secretary of State in terms of who, what and how that works in practice. I suspect that Jim would want to pick up on the cultural issues.
Sir Jim Mackey: I was thinking, Paulette, that if you had asked me the same question, the thing I would lose sleep about was, when things go wrong, is a board curious enough? Is it data driven enough? Is it objective enough? Is it seeking to find a problem and get underneath it? Can it seek external opinion when something is complex, or there may be tensions internally? Through the leadership development work, the college and our board development work, we are trying to get at this and reactivate boards. There is a lot we can do nationally, but in the end boards are where the culture is driven in an organisation. They set the tone in the organisation. Where things go wrong, that is our first line of protection. It feels like we have a bit of a rebuild job to do.
Sir Jim Mackey: I completely agree. Part of the board development work, which we are just about to set off on, is about board composition skills, having different voices in the room and diversity. I have been involved in work in the north-east about encouraging more diversity, which is using the evidence to drive that and try to restore the health of the board.
We are also—I personally got involved in a bit of this—trying to stop people being on multiple boards at the same time, unless there is purpose, such as where organisations are coming together. This has shrunk the pool, and it has contributed to a closed mentality. There is a lot going on to try to deal with this. The key things are the composition of the board, having the right skills and diversity of thought, being able to challenge things objectively and owning the problems.
My concern is with the 50% cuts to ICBs that Allison highlighted earlier. These pilots are really successful. Given a lack of funding and that some of these groups are small—you have the issues around equality again—how are you going to assure us as a Committee that we are not going to lose these pilots? Might it not be better to keep financing them on a more national level, not putting them into ICBs, where they are then lost?
Sir Jim Mackey: Absolutely. I met a group of largely sickle cell sufferers a few weeks ago. I was not aware of the issue you have described. I will take that away, Paulette, and we will have a discussion after this. I would agree in principle with what you said. It is a very specialised area and the skills are very concentrated.
Sir Jim Mackey: If we can get the detail today or tomorrow, I can come back to you next week.
Paulette Hamilton: Thank you.
Yvette Cooper: Obviously, NHS England comes into the Department.
Yvette Cooper: Well, there isn’t one, if there is no NHS England.
Can I move to the federated data platform, please? As you know, it is a subject of interest to a lot of people, including me. Palantir’s contract runs to the end of March, and you are deciding at the moment whether to extend it. It ends in March, unless you choose to extend it. It is not a break clause. In June, this Committee recommended no extension. People said they did not trust Palantir. Its benefits are contested and other tools could deliver the same or similar advantages. Palantir seems to have become an albatross around the federated data platform’s neck. Perhaps we can explore that.
I would also like to explore whether the FDP itself, as currently constituted in its aims, is fundamentally flawed, and whether simply replacing Palantir with a British “Palantir” would not do enough to end the NHS’s dependence on a single supplier. If we moved to change the current approach, we could get better patient outcomes and help to build British sovereign AI in healthcare.
I want to start by talking about what is often referred to as lock-in, or dependence. We could look at how dependent the NHS is on Palantir at the moment. As I understand it, you have got NHS teams to build applications on Palantir’s platform. The NHS owns the applications but rents the platform—I think that that is correct. Owning an application is no use, is it, if it’s not going to work anywhere else?
Ministers have assured us that the NHS is not locked in and that it can move all the applications without a problem. A letter from Minster Frith to the Committee in August said that some arrangements would end with the contract, but did not specify which. The letter said that migration to other places would be explored only if the contract ended—I would have thought that you would be exploring that now—and declined to audit which Palantir tools trusts depend on. I would have thought that all that work would be taking place at the moment. The Minister also wrote that, “exit plans enable the NHS to replatform”. Is an exit plan being prepared? Have you seen it?
Yvette Cooper: We are part of the way through the contract review process, which as you know was built into the contract, at this point in the contract. We therefore need to complete that contract review this autumn. I have been a Minister in many different Departments through the years, and have dealt with many different contract issues, and I am going to disappoint you in terms of answering on the details in this Committee today. I just want to recognise that, because there is a proper contract process that we need to go through. I do not want to cut across that contract process with any partial comments or remarks on it.
Yvette Cooper: We have detailed plans for all eventualities that are part of the contract process.
Yvette Cooper: We always have to ensure that we do that as part of the contract process. You raised a wider point about how we use technology, especially with the rapid nature of AI, data platforms and so on, and what things we need to think about as we go forward. You will have seen that there was an announcement in the Budget on AI and health. We have the additional investment in sovereign AI in health. There is a huge long-term benefit to using the NHS to develop UK sovereign AI, both in ensuring reliability and security in our NHS services, and developing the capabilities and capacities that will be world-changing over the next few years. We are focusing on that.
The National Data Guardian has told Ministers that lock-in and data sovereignty must be addressed, including by considering open data standards. That means published rules for recording health information, so that all suppliers’ software can work together, in just the same way that any UK plug fits any UK socket. Regions could then choose their own suppliers and swap them without having to start again, and there would not be worries about lock-in. That would help the development of sovereign AI and provide a better service to patients. Will you commit to developing open data standards across the country?
Yvette Cooper: Again, because we have the contract review under way—
Ben Coleman: But that’s a separate issue.
Yvette Cooper: I know; you are talking more about the long-term priorities. I am obviously not going to say anything that cuts across that contract process. The key things that we are thinking about for the future are how we develop UK sovereignty and how we have the flexibility to innovate. Of course, data sovereignty for the UK is essential. We already have that built in, but—
Yvette Cooper: I suspect the Committee is able to draw on some fabulous expertise from that session. I would be very interested to see a full report of it, because that sense of bringing people together has huge potential.
I would go back to the principles of what we are trying to achieve; I accept that that is only a partial answer to your question, because of the processes we are going through. We want the sovereignty. That has to include sovereignty for UK data. That is already built in, with a lot of safeguards on that as well. We also want to support greater AI sovereignty across the board for the UK across different areas. We also want the flexibility. I think your point is about how we build the flexibility to innovate, rather than have everything based on one process and one system. It is about how, when there is so much innovation going on at the moment, you have systems that allow you to innovate.
Yvette Cooper: I understand that, but that is the principle we are trying to support.
I would just like to turn to whether the FDP actually works as it is now and what this might mean for the single patient record. It is absolutely clear to me—again, I appreciate your limitations in being able to respond—that the evidence for Palantir’s effectiveness and therefore the FDP’s effectiveness is deeply uncertain and contested. It claims certain results in discharge delays, but the Health Foundation found no noticeable change. I could give you chapter and verse. You simply need to read the endless reports in the Financial Times and The Guardian or from Medact and Foxglove. There are all sorts of contestations.
I do not think there is the evidence to prove that Palantir is effective. The NHS responded to the Office for Statistics Regulation when it said to NHS England, “You cannot keep saying that there’s a cause and effect here.” The NHS now says on its website that it cannot draw conclusions about cause and effect, but Palantir continues to present the figures as if there is cause and effect.
Another point for context is that usage is patchy. You again only have to read recent reports in The Guardian and the Financial Times to see how many people are not using it out there in the NHS. Opt-outs are also rising, which brings the whole question of trust to the fore. Do you think that the trust factor, as the National Data Guardian thinks, should be given substantial weight in deciding the future of the FDP?
Yvette Cooper: Much as you seek to draw me into commenting on the contract process, we look at a whole range of issues as part of that contract review, and you would expect us to do so. However, I really am going to do this by the book in terms of the contract process and the review process. I have been through too many of these different kinds of contract processes, and I know that you do this kind of thing properly and in the right way. That means looking at the costs and benefits around different contracts and at the wider systems—you just do it in the right way. We have clearly seen significant benefits from the federated data platform and from having ways to use data in particular trusts.
Ben Coleman: That is a claim that you are prepared to make—
Yvette Cooper: I am not going to say anything more about the assessment of relative costs and benefits at this point, when we are undergoing a contract.
Yvette Cooper: I do recognise that these are very different. However, that is another angle into the same issue, which is effectively an assessment of a contract. We are in the middle of this process. Of course, when we have completed that process, I expect the Committee will have lots of questions for us to answer about our conclusions, which we will, of course, be able to provide at that point. Again, apologies to the Committee, but I am going to do this one by the book.
Sir Jim Mackey: There is a response coming to you. I reviewed it yesterday. We will write to Palantir and tell them that they have to share with us and clear any benefits claimed. That will be part of it.
Sir Jim Mackey: In the future.
Sir Jim Mackey: I will explain it properly in the letter. There is a provision, but as I understand it, we cannot bind them to it. They should share them with us, but contractually it looks hard to enforce. However, we will write to them, and I will be clear that I would expect them to clear—because this is contested—any benefits claimed with us before they publish them.
Yvette Cooper: This is an entirely separate process. It is an entirely separate set of systems, contracts and so on that we will have to ensure. I go back to the points that I would make in terms of the principles for the future. Yes, we want to be able to support UK sovereign AI—that is why we have the specific funding—and we also want flexibility to innovate, but we need systems where different NHS institutions can talk to each other. That is what the single patient record is all about.
Yvette Cooper: Could we come back to you in writing? I am not aware of the detail on that.
Ben Coleman: Absolutely; thank you so much.
Chair: As you can imagine, we will be looking at this very closely. We will have a couple of quick follow-up questions.
Yvette Cooper: The things we have to take into account include value for money and the effectiveness of any contract and any program. Of course, that is affected by issues around take-up and the potential future of different things. Those are the issues around any contract that we would have to do. If you are asking about a wider issue about trust and confidence, I see those as being the foundations of any public service. It is the same whether you are talking about the NHS or policing. Issues of confidence and trust around the use of data are always sensitive.
Yvette Cooper: I am not going to cut across the decision-making process for this individual contract. I have been through too many of these processes—I am going to do this in the right way.
Yvette Cooper: We have to make sure that we have proper safeguards on any use of data, any use of technology, and so on. Of course, trust and confidence have to be built into the use of any new technologies and programs. For example, using AI in the health service has massive potential benefits—potentially life-changing and lifesaving benefits—but if people do not have confidence in the systems, you can end up with it unravelling down the line. So you have to take that into account, but that is not a comment on an individual contract process.
Chair: You have made that very clear; this has nothing to do with that.
Yvette Cooper: Nobody should be treated in a corridor; that undermines the dignity of patients and it is very difficult for staff. It is simply not fair for patients and families at a time of acute health crisis to find themselves being treated in a corridor.
You are right that this is about a whole system. We also should not have people being treated in car parks. You need the whole system to work effectively. That is why we have a new urgent and emergency care and planned care strategy, which will be set out, and why we are looking at reforms right across the system, from doing more to prevent frail elderly from being taken to hospital in the first place, when it is really not the best—
Yvette Cooper: I completely agree. I went to Watford to see the work that they have done, and it is really impressive. They have gone from huge problems with corridor care to a massive turnaround to clear the corridor care. It struck me that they said they have a whole-hospital approach, where, if they monitor the ambulances going out to respond to cases, they can anticipate how many of those are going to come in their doors. If they can see a pattern of rising pressure, in advance they then signal right across the hospital and the whole hospital has to engage in the response. That might involve sending additional staff down to help in A&E or clearing beds in some other areas where there are people waiting for a pharmacy prescription. The whole hospital responds. We have the teams from Watford and Walsall now providing advice to trusts right across the country. Frankly, if they can do it, trusts right across the country can do it as well.
We had significant additional pressure through the summer at a time that we would normally expect to be quieter. July had the highest number of A&E attendances ever in any month at any time of the year. I pay tribute to our NHS for responding to that additional pressure in the summer, but it means that there is more pressure as we go into the winter. I have been clear, as has Sir Jim, that we have to have progress to address corridor care, but that is going to require some transformations in trusts.
It strikes me as interesting that, if you added £190 million to the £400 million, that would more or less cover the probable overspend that we are predicted to have in this coming winter. We could have frontloaded some of those systems to take care of the winter to come. Secretary of State, why was there an underspend, and what are you going to do about the likely overspend as a result of corridor care?
Yvette Cooper: I will make a quick point and then I will pass to Sam. The last financial year was the first year, I think, in about a decade that the NHS had effectively come in on budget and not had its normal overspend. That was a result of new financial controls and systems being brought in. It is always challenging, because the NHS has to respond continually throughout the year to huge pressures. This year, because of the extreme heat in the summer and the demand on different parts of the system—from 999 calls, 111 calls and so on—it was broadly over 5% higher than at the same time last year. That is a significant pressure as we go into winter, and the winter planning is therefore focusing intensively on that.
The £190 million additional funding in the Budget will help to address the pressures right across the system. This is not just specifically about one bit of the system; it is about recognising the pressures over the course of this year. The earlier the planning that we can do on winter, the better the system will be able to respond, but I am concerned about the additional demand and the pressures on the system as we go into this winter. Thank you to all the NHS staff who are working on this.
Samantha Jones: The only thing I was going to specifically add was that it was the DHSC group rather than just—I do not mean just—NHS England that came in without requiring additional—
Chair: Yes, that’s right—that is why I pointed at you and not Jim.
Samantha Jones: Well, we are one group and NHS England is of course part of that. I will take the specific question, if I may, and come back to you on the detail of the underspend. I want to check with our CFO specifically, but I am very happy to then come back to you next week.
I have a good example of that. I was contacted by Councillor Unger from Brent, who co-founded the PPG there. She points out that in the new expanded central and north-west London ICB, they do not have any patient voice sitting on their board. That was an active decision that the board made. She asked me what I could do about it, and the answer is that I can’t do anything other than raise it here publicly as an example.
It is brilliant that we have retained Healthwatch. The idea behind Penny Dash’s reforms was that they would be brought into these boards and feed in at all levels, but clearly, when decisions are being made about new boards, that is not happening as a matter of course. What can you do as Secretary of State, not at some point in the future but now, to tell ICBs that they must have patient voice in all parts? How do we make sure that we do not just consult badly, as we have always done?
Yvette Cooper: I remember the old CHCs—Pontefract community health council—when I first started, so we can go round those same circles and still not solve this. We are appointing a new patient experience director in the Department, and we are focusing on a dedicated team. I think sometimes the support and engagement with patients and families who have been through some of the most distressing circumstances in the NHS have not been strong enough in the Department, so we are strengthening them as well. The question will be how we strengthen that local voice.
Yvette Cooper: That needs to be a core part of what they do. It is also why we are bringing the patient experience director into the Department to keep driving that and driving those reforms. It is one of the things we are conscious of as part of the trials around Greater Manchester and South Yorkshire. If they have a deputy mayoral voice as well, that is very much about reflecting the concerns of the community and having greater accountability. I would probably describe this as unfinished business, really, in terms of the further work we need to do on it.
Yvette Cooper: Yes.
Yvette Cooper: There is still a lot of work under way under the Casey commission. One of Baroness Casey’s recommendations that I am keen for us to move forward with as rapidly as possible was about motor neurone disease. It was about recognising that we should just look initially at that group of patients, who we know have acute care needs—progressive acute care needs, over time. Many of them are working age and have very different circumstances and needs, and the system does not respond effectively.
Having been to the Rob Burrow MND centre in Leeds and having talked to people there, they do phenomenal things. That is the result of Rob—he was one of my constituents—and Sir Kevin Sinfield’s fundraising. They have obviously been able to build an amazing centre that, crucially, puts family at its heart and looks at the whole patient experience. Care has not really been part of that; it has been looking at the NHS side.
We have been working with the MND Association and we want to draw up what that pathway looks like. How would you pull together all the different services and agencies, and the assessments for disabled facilities grants or whatever, into something that looks much more like a national care service approach—something that looks more co-ordinated? There will be different needs and circumstances for working-age adults who need care and for the frail and elderly. There are different kinds of circumstances that we should be sensitive to, but we are using that MND pathway as an opportunity to work through the different kinds of pressures you might have as a working-age adult.
Chair: Thank you very much. We will draw our session to a close. I will point out that at various points in our questions we have been drawing on our reports. For example, when we were talking about Palantir and trust, we said that the contract should end because it undermines trust in other parts of the shift to digital. There are many examples of that. We look forward to continuing to work with you, Secretary of State, and Sam and Jim. Thank you again for your time.
Yvette Cooper: Thank you for having me.