Karin Smyth MP: speeches

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Speeches

22 Jul 2025 · 10-Year Health Plan: Perinatal Mental Health · Hansard source
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The hon. Gentleman makes an excellent point about the important need to share the learning across the United Kingdom, and I will make sure that we do indeed make efforts to do that.
22 Jul 2025 · 10-Year Health Plan: Perinatal Mental Health · Hansard source
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I recognise my hon. Friend’s great work in this place to support women on this issue. We recognise that newly qualified midwives are experiencing challenges in gaining that first role. That is partly due to the record number of midwives in post and to better retention rates. NHS England is working with employers, universities and regional midwifery leads to help midwives find those roles after qualification and to transition into workforce, and we will keep a close eye on that with them.
22 Jul 2025 · Topical Questions · Hansard source
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The business case for the rebuild of the health centre has been submitted to NHS England for review, and NHS Property Services will in parallel be asked to approve the capital funding. Subject to those approvals, a new health centre will be fully completed in 2027.
22 Jul 2025 · Topical Questions · Hansard source
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Phlebotomists are paid on an “Agenda for Change” pay scale, which is underpinned by the job evaluation scheme. It is something the Secretary of State and I discussed with the trade union Unison last week; I should declare that I am a member of Unison. It is working closely with the trust in question, but I am happy to discuss the matter with my hon. Friend further.
22 Jul 2025 · NHS Hospitals: Parking · Hansard source
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The Department has published guidance that trusts are expected to follow to manage the provision of car-parking spaces for patients, hospital users and staff. Responsibility for hospital car parks lies with each individual trust, and provision must be managed alongside the existing policy, providing free parking for those in the greatest need.
22 Jul 2025 · NHS Hospitals: Parking · Hansard source
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As the hon. Gentleman knows, the discussions about any advanced works arising from the new hospital programme are ongoing. I am very happy for the Department to continue to discuss with the trust how future investment can best meet the needs of the future.
22 Jul 2025 · NHS Hospitals: Parking · Hansard source
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The provision of car parking remains an issue for trusts. I recognise the stress caused by trying to get patients to hospital, particularly if they have mobility problems. I commend the many hospitals across the country that have really good active travel plans and are working with their local communities to resolve some of these issues. We need to hear more from the trust about what provision it is putting in place to serve my hon. Friend’s constituents.
17 Jul 2025 · NHS Pensions: Frontline Patient Care · Hansard source
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The hon. Gentleman tempts me to stray further from the urgent question, but he raises an important point, further to the one raised by the hon. Member for West Worcestershire (Dame Harriett Baldwin), who is a trustee of the parliamentary contributory pension fund. The NHS pension scheme is an extremely important part of the reward package that NHS staff at all levels absolutely deserve. We want to ensure that it, like the rest of the NHS, is fit for the future. If hon. Members have suggestions for how to make it work better, as part of ongoing discussions, I am happy to hear them.
17 Jul 2025 · NHS Pensions: Frontline Patient Care · Hansard source
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As the House knows, the NHS pension scheme is administered by the NHS Business Services Authority, which is facing challenges, as are all public sector pension schemes, as a result of the coalition Government’s public sector pension reforms in 2015, which in 2018 were found to have been discriminatory—known as the McCloud remedy. The work to remedy that is complex, and much of that I have already detailed in a written ministerial statement on 31 March and a subsequent urgent question. It is complex, technical work, and as the NHSBSA began to produce individual statements, it became clear that its initial estimate of the time needed for each one was too low. My written statement of 1 July updated the House that the NHSBSA did not meet its deadline to deliver statements to certain classes of member by that date and set out the actions that I was taking. Let me be clear that this Government remain absolutely committed to providing affected members with their statements at the earliest opportunity, and that is what we are doing. The authority is developing a revised plan, and I will hold it to account against the new deadlines. I met the chief executive of the authority and was very clear about my disappointment in the progress, my expectation for the authority to remedy the situation for members, and the need to have a more robust assessment of the delivery plan. I also ensured that the independent chair of the NHS pension board is ready to set up an independent review of the delivery plans. I met her yesterday and was clear that I expect a thorough review of the process and a realistic assessment of delivery, and to hear her initial assessment. She will give her full report after the summer recess. I will set new deadlines, including for members who are expecting statements this month. I will update the House as soon as possible, of course, both on the progress with the assessment and on the revised deadlines. Let me be clear that members will not face further financial detriment as a consequence of remediable service statement delays, interest on related pension arrears will be paid at 8%, and my Department and the authority have already put in place compensation arrangements for direct financial losses that members may have incurred. People who have served in our NHS deserve their dues, and we will prioritise members based on need. Let me end by reassuring the House that there will be no direct impact on frontline care. I will continue to update the House.
17 Jul 2025 · NHS Pensions: Frontline Patient Care · Hansard source
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I congratulate the hon. Gentleman on, yet again, shoehorning in a reference to his local hospital, for which he does a great job. People are determined to work in and support the national health service. We take remedying confidence in pensions seriously. I will not give further deadlines before we hear from the assessor. I have asked her to come back and make a very clear statement as soon as possible after the summer recess. I will then be happy to update the House. Coming forward to work in the NHS is a matter of choice for individuals, and we particularly want to work with consultants to ensure that their career progression is the best it can be. We very much value their work in the service.
17 Jul 2025 · NHS Pensions: Frontline Patient Care · Hansard source
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I thank the hon. Lady for those questions. She highlights a number of important issues regarding the complexity for the NHS Business Services Authority of dealing with this. There is a large number of high earners in this scheme. With regard to tax liabilities, that makes the system complex, as does the movement of doctors throughout the system in their career. One issue I discussed with the independent reviewer yesterday is the need to ensure there is a technical look at solutions to issues such as missing years. The hon. Lady is right to highlight that changes make a difference to following people’s careers through the system. There are wider lessons, which I have already started to discuss with the reviewer, about how we make the best use of technology so that we can track people through their careers and give confidence to the current workforce that we are addressing this not just for the cohort who have immediate issues but for the future. That is the sort of action this Government are taking. We do not do sticking plasters. We are looking at this very seriously.
17 Jul 2025 · NHS Pensions: Frontline Patient Care · Hansard source
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As I outlined in my initial response and further to the written ministerial statement, we have asked for an independent review of the process and will report back as soon as possible with a realistic deadline for that. With regard to the strikes, we will continue to be open to discussing the avoidance of those strikes, and I hope that the Opposition will support us in that.
17 Jul 2025 · NHS Pensions: Frontline Patient Care · Hansard source
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We are working very closely to ensure that resident doctors do not go on strike. We are very clear that we cannot negotiate on pay this year, but we will work with everybody to improve conditions. Some of those conditions are shocking, and we want to work constructively with them to avoid disruptive strike action.
17 Jul 2025 · NHS Pensions: Frontline Patient Care · Hansard source
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I am totally focused on remedying this situation and learning from the mistakes. If further action is required, I will happily update the House at that point. My absolute focus at the moment is on getting everybody in that organisation and the independent review focused on sorting out the pension situation for those who have already lost out.
17 Jul 2025 · NHS Pensions: Frontline Patient Care · Hansard source
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I thank my hon. Friend, who is a superb advocate for his constituents. I met him again yesterday as he advocated for services in his constituency—that is the focus of Labour Members. He is absolutely right; as I said in my statement, this is part of the overall mess that we inherited from the Conservatives. As I said in my previous response on this issue, the problems outlined by Lord Darzi are wide and deep. It is still shocking, after a year in government, to be faced with the level of disaster that was left to us after a complete abdication of responsibility for sorting out the problems. We will continue to focus on getting more of the appointments that people so need and on reducing waiting lists, which is what our constituents expect.
17 Jul 2025 · NHS Pensions: Frontline Patient Care · Hansard source
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I thank the hon. Lady for that really constructive suggestion. In my discussions with the NHSBSA, the reviewer and officials at the Department, I have raised similar issues. I am a member of the NHS pension scheme and the parliamentary pension scheme. I tell my young people that this is a really valuable asset, and I encourage my constituents who are looking for jobs in the NHS to consider the pension scheme, because people sometimes do not look at it immediately. We should look at ways to encourage people to take part in the pension scheme—particularly for lower earners, it is a really valuable and stable contribution—and the value of it from the public purse should be well known. I am not across the detail of the hon. Lady’s point on the Pension Schemes Bill, but I will talk with my colleagues across Government about how we can look to do that and come back to her, because I agree that it is a really valuable thing—it rewards the contribution of public service, and we should make the most of it.
17 Jul 2025 · NHS Pensions: Frontline Patient Care · Hansard source
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The hon. Gentleman highlights yet another mess that we inherited due to his party’s lack of proper engagement with the workforce over the last decade to resolve the disincentives to making the system work more effectively. Making the system work more efficiently and more effectively is a key part of our 10-year plan announced, I think, only last week—the days keep rolling by. We not only involved the public in those conversations but had valuable conversations and received insights from all staff groups. There is a real spirit of optimism that everyone wants to pull together to ensure that the incentives are right for staff at all levels—over 1.5 million of them—to make the NHS fit for the future, and that is what we are focused on.
15 Jul 2025 · Women and Girls with Autism: Mental Health Support · Hansard source
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I will come on to talk about what we expect local providers to do, but obviously no one should languish on a list as she describes.
15 Jul 2025 · Women and Girls with Autism: Mental Health Support · Hansard source
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The hon. Lady raises another terrible case concerning a teenager on behalf of her constituent. We must of course be mindful of that provision for children and young people. My hon. Friend the Member for Bournemouth West spoke of her constituent’s campaign to retrain mental health staff, to improve understanding and acceptance of autistic women and girls. As we have heard, we know there can be differences in how autism presents in males and females, which can make autism harder to identify in girls.
15 Jul 2025 · Women and Girls with Autism: Mental Health Support · Hansard source
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My hon. Friend makes an excellent point about carers. We should address that. She made an excellent point about support for parents wanting to support their own children. With regards to training, we are taking action to increase awareness and understanding of autism in health and adult social care services. Under the Health and Care Act 2022, providers registered with the Care Quality Commission are required to ensure that their staff receive specific training on learning disability and autism appropriate to their role. To support that, we have been rolling out the Oliver McGowan mandatory training on learning disability and autism to the health and adult social care workforce. The first part of the training has now been completed by more than 3 million people. NHS England has also rolled out additional training across mental health services, and 5,000 trainers have been trained as part of the national autism trainer programme. That training covers autism representation in women and girls, as well as exploring misdiagnoses, including of personality disorders, for example. These trainers will cascade their training to teams across mental health services. NHS England also commissioned the Royal College of Psychiatrists to deliver the national autism training programme for psychiatrists, with over 300 psychiatrists having been trained in the past three years. My hon. Friend the Member for Bournemouth West spoke about her constituent’s campaign on suicide prevention. We have committed as a Government to tackling suicide through the suicide prevention strategy for England. It identifies autistic people as one of a number of groups for tailored or targeted action at a national level. To support that, the Department, through the National Institute for Health and Care Research, has commissioned a review to understand what is known about the effectiveness, cost-effectiveness and experience of interventions to reduce suicide among autistic people. More broadly, we also know that autistic people can face challenges in accessing mental health services. While it is the responsibility of local NHS bodies to ensure services meet the needs of their local populations, we are taking actions to support them to address the challenges that autistic people face. In addition to the training I have outlined, NHS England has published guidance on how to improve the quality, accessibility and acceptability of care and support for autistic adults to meet their mental health needs, as well as taking guidance on adaptation of NHS talking therapies for autistic people. NHS England has also developed a reasonable adjustment digital flag, which enables the recording of key information about a patient and their reasonable adjustment needs to ensure that health support can be tailored appropriately. We are taking action to support early intervention and improve access to mental health services more broadly. Through the 10-year health plan, we will continue to roll out mental health support teams in schools and colleges to reach full national coverage by ’29-30. We will also ensure that support for the mental health of children and young people is embedded in the new young futures hubs, alongside a wellbeing offer to ensure that there is no wrong front door for young people seeking help.
15 Jul 2025 · Women and Girls with Autism: Mental Health Support · Hansard source
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I understand that the previous debate was on SEND; I am sure my hon. Friend will pick up that point with the relevant Minister. As I have said, we are rolling out more support into schools, so that should join up to support those young people. We are also transforming mental health services through the 24/7 neighbourhood mental health centres, to support our ambition to shift care from hospitals to communities. People will also get better direct access to mental health support and advice 24 hours a day, seven days a week through the NHS app, without needing a GP appointment. Our ambition is that, through improving access to mental health support in the community, we will prevent the escalation of mental health needs for all people, including autistic people. My hon. Friend the Member for Bournemouth West asked a number of questions that I hope I have largely addressed. Regarding anti-ligature doors and specialist suicide prevention for in-patient units, I know that she has received a letter from the Department. I will make sure that officials provide a more thorough answer on the issues outlined in that request. She also raised the issue of the transformation programme, and support for and work with families. We have committed to developing a new national autism strategy to help support the direction of local systems to include families. I will ask officials to consider the specific issues that my hon. Friend raised, and make sure that she gets an answer. I also assure my hon. Friend that, on out-of-area placements, ICBs have published plans to localise in-patient care under the national in-patient commissioning framework. To support that, we have allocated £75 million in this financial year to help stop mental health patients being sent far away for treatment. I know from my own constituency work that that is an issue of great concern. We will make sure that we are focused on it. I am happy to request that the Minister responsible for this policy area, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), meet my hon. Friend the Member for Bournemouth West and her constituent. I know that he wanted to attend this debate, but could not do so for family reasons. We will get that meeting in train. I again thank my hon. Friend for raising such an important issue, and recognise the tireless efforts of her and her constituent to raise awareness of mental health needs, and the need for support for autistic women and girls. I also thank all hon. Members in this debate who raised issues on behalf of their constituents. This is a really important issue for many of us, and I hope that my comments have gone some way to assure people that we take it very seriously, and are committed to working with them to make life better for people. Question put and agreed to .
15 Jul 2025 · Women and Girls with Autism: Mental Health Support · Hansard source
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It is a pleasure to serve under your chairmanship, Sir Edward. I am grateful to my hon. Friend the Member for Bournemouth West (Jessica Toale) for securing this debate and raising this extremely important topic. We know that, sadly, autistic people are at the wrong end of statistics on a range of mental health conditions: 70% to 80% of autistic people will experience mental health problems during their lives, and tragically many are more likely to die by suicide. We have heard the devastating impact that can have on individuals and families. I pass my heartfelt condolences to my hon. Friend’s constituent, Ms Bridges, on the loss of her daughter. My hon. Friend spoke of the campaign for Lolly’s law, and I commend her for her tireless work to ensure that autistic people get the mental health support and treatment they deserve. As my hon. Friend said, that is exhausting, and too many parents are forced into campaigning roles. As she rightly said, Lauren should still be here. It is clear that the number of autistic people and those with a learning disability who are in mental health hospitals is unacceptable. There are still too many people being detained who could be supported to live well in their communities. We want to ensure that people get the support they need in the community, improving care and keeping people out of hospital. The Mental Health Bill, currently before Parliament, would limit the scope to detain autistic people and those with a learning disability, so that they can be detained under part 2 section 3 only if they have a co-occurring mental disorder that requires hospital treatment. The Bill would also introduce a package of measures to improve community support for autistic people and those with a learning disability. It is also critical, however, that when autistic people do need to be admitted to mental health in-patient settings, due to a co-occurring mental health condition, they receive the right care and support.
26 Jun 2025 · IVF Egg Donation: Young Women · Hansard source
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It is a pleasure to serve under your chairmanship, Mr Efford. I thank the hon. Member for Strangford (Jim Shannon) for securing this debate on egg donation in young women. He raises a number of important points, which the Government take seriously. I absolutely assure him that there are rules and regulations around egg donation in this country. Hon. Members in this debate have talked about the potential concerns of the long-term impact of egg retrieval, and the potential incentive of the compensation offered for egg donation, particularly for young women on low incomes. I hope to address those points in my remarks. For people who are struggling to conceive, which may be for a variety of reasons, receiving donor eggs can be life-changing—as we have heard in this debate—and enable them to start a family of their own. Donating eggs should be a purely altruistic act, and choosing to become a donor is a complex decision. In the UK, the average egg donor is between 31 and 32 years of age. That average has remained stable since records began in 1991. Egg donors are typically UK-based, with around 3% of donor eggs imported from abroad. There were around 3,800 IVF cycles using donor eggs in 2023, which is an increase from around 3,600 in 2019. Those donors support around 2,000 to 3,000 people a year who would otherwise not be able to have a baby. I recognise their generosity, although, as my hon. Friend the Member for Newcastle upon Tyne East and Wallsend (Mary Glindon) said, we also recognise that egg donation procedures come with risks, and they should not be undertaken lightly. The HFEA ensures that licensed fertility clinics are following law and guidance in relation to egg donation. The Government agree with the point made in this debate that young women should be fully informed of any risks when making the decision to donate their eggs, and that clinics must ensure that women are fully informed and supported throughout the egg donation process. It is mandatory for clinics to provide counselling to women before egg donation to ensure that they understand all the potential risks, and legal and social implications, of donation. Donating eggs is generally very safe, and most women do not experience any health problems beyond discomfort during the stimulation of the ovaries and the egg collection procedure. I do not want to minimise that experience of discomfort, but where women wish to donate eggs, the HFEA and the Government are committed to making it as safe and accessible as possible. In the short term, there is a potential risk of having a reaction to the fertility drugs used for the donation procedure. If that happens, the effects are normally mild, and can include headaches, nausea or feeling bloated. Donors are advised to let their clinic know if they experience any of those side effects. In some very rare cases, as we have heard, women develop OHSS. It is a serious and potentially fatal reaction to fertility drugs, which happens about a week after eggs have been collected. Fortunately, it is rare, occurring in less than 0.1% of cycles. Because of the serious nature of OHSS, all severe or critical cases must be reported to the HFEA within 24 hours by the patient’s clinic. They are categorised by the HFEA as grade B incidents. A grade B incident involves serious harm to one person, or moderate harm to many. The HFEA’s latest “State of the fertility sector” report found that fewer OHSS incidents were reported in 2023-24, with 53 severe and critical cases reported by UK clinics. In recent years, there has been widespread interest in donation, and figures show that the number of egg donors is rising. We heard from my hon. Friend the Member for Newcastle upon Tyne East and Wallsend and the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), about the importance of having conversations and asking questions about the long-term impact on women’s health, which is generally an under-researched area. The Government recognise that and would welcome studies in this area. If there is anything I can add to that following this debate, I will follow up with hon. Members on the opportunities for understanding the wider long-term implications for women’s health in this area. At the public board meeting last year, the HFEA discussed the rates of compensation offered to egg and sperm donors. Since 1 October 2024, egg donors have received £985, which is up from £750. That increase in donor compensation was the first since 2011, and reflects the rise in inflation. The compensation offered to them is intended to reflect their time and the nature of the procedure, rather than being an attempt to monetise donation in the UK. I want to address some of the points raised by Members to do with the variability of access to fertility services more broadly. Infertility affects one in six women of reproductive age worldwide. It is a serious condition that impacts wider family, relationships and mental health, as we heard from the Liberal Democrat spokes- person, the hon. Member for Chichester (Jess Brown-Fuller). I congratulate her friends, Lottie and Marvin, on the arrival of their child. This Government expect integrated care boards to commission fertility services in line with the National Institute for Health and Care Excellence guidelines. NICE is currently reviewing the fertility guidelines, and will consider whether the current recommendations for access to NHS-funded treatment are still appropriate. I look forward to the guidelines being published; we will work with integrated care boards to determine how best to improve their local offer and ensure equity of access for affected couples.
26 Jun 2025 · IVF Egg Donation: Young Women · Hansard source
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I have addressed the issue of compensation. It rose in response to inflation, for the first time since 2011. We have no further plans to start a study specifically on health. As I said in my remarks to others, we understand that broader outcomes in women’s health is an under-researched area. Bringing forward trials is the usual response. If we need to add anything else to that, I will make sure we do so, but there are no other plans currently. Advertising is governed in this country by the Advertising Standards Authority, which issued a joint enforcement notice in 2021 with the HFEA to ensure that fertility clinics and others were aware of the advertising rules and treating customers fairly. I am afraid I cannot comment on Scotland, where I understand there has been a large advertising campaign. That is not in my ken, although it is covered by the HFEA, which is a UK-wide body, so that is a bit of a complication. If there is anything to report back on with regard to Scotland, without me stepping on devolved issues, I will make sure we do so. I again thank hon. Members for securing the debate and acknowledging the altruism of the women who choose to donate their eggs and help to give others a much longed-for baby. I assure Members that this Government will monitor the issues raised this afternoon. Women’s health and tackling inequalities are central to the priorities that we will take forward in the 10-year plan.
24 Jun 2025 · Department of Health and Social Care · Hansard source
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I thank the interim Chair of the Health and Social Care Committee, my hon. Friend the Member for Birmingham Erdington (Paulette Hamilton), for securing this debate, and all colleagues for taking part. I have been asked to condense my comments, so I hope that I can address her questions, but if I do not cover them, we will of course make sure that she has a written response. We are honest about the challenges facing the health service, and we are serious about solving them. That is why we published the independent review led by Lord Darzi, which provided a full and frank assessment of the state in which the nation’s health service was left by the Conservatives after 14 years of government, aided in the first five years by Liberal Democrat colleagues. That investigation highlighted the critical challenges facing the NHS, and we have heard about more of them today. They include a significant increase in people living with multiple long-term conditions, and growing demands for mental health services, particularly among children and young people. That is why we are taking the steps that we are taking. The investment we are already making in 2025-26, the outcome of the recent spending review and the forthcoming 10-year health plan will address these root causes by delivering our plan for change commitments, investing in preventive health care and modernising NHS infrastructure, so that we radically reform the NHS. We will deliver three shifts to ensure that the health service can tackle the problems of today—caused by the Conservatives—and of tomorrow. They are: shifting care from hospitals to community; shifting from analogue to digital; and shifting from sickness to prevention. My hon. Friend the Member for Birmingham Erdington said that there were highly optimistic assumptions in the planning process, and that robust, detailed plans and efficiency savings were needed if we are to deliver on those assumptions. I agree. I am optimistic about our ability to deliver, but I am also realistic and very focused on delivery. Like my hon. Friend the Member for Chelsea and Fulham (Ben Coleman), I am already seeing improvements, as are most Members in their constituencies. May I wish him a happy birthday for July, while we are here? My hon. Friend the Member for Altrincham and Sale West (Mr Rand) rightly said that the Labour Government did this before, and we will do it again. The estimates set the Department of Health and Social Care a resource spending budget of £208.1 billion and a capital DEL—departmental expenditure limit—budget of £13.6 billion, an increase from the 2024-25 supplementary estimates budget of £9.6 billion and £2 billion respectively. On capital, we have, as my hon. Friend the Member for Shipley (Anna Dixon) said, reversed the shocking decision by previous Governments to keep raiding capital budgets in order to keep the revenue going. That is why NHS buildings across our constituencies are in the state that they are in, and why we do not have the infrastructure that we need. I was pleased to visit Airedale hospital recently to see the work being done to repair it. On digital and tech, my hon. Friend the Member for Birmingham Erdington will notice that we have a £10 billion dedicated spend for the issues that she quite rightly raised. The Department covers a wider family of organisations, and I can assure the House that we are focused on all parts of the departmental family to make sure that taxpayers’ money is spent as efficiently and effectively as possible. Everybody here has raised particular issues to do with the NHS, so I will briefly remind Members of the outcome of the spending review that my right hon. Friend the Chancellor recently announced. The spending review includes £29 billion more day-to-day funding in real terms than in 2023-24 and the largest-ever capital health budget; there will be a £2.3 billion real-terms increase in capital spending over the spending review period. That is our commitment to the British public. My hon. Friend the Member for Sunderland Central (Lewis Atkinson), with his great experience of the health service, said that we need to make sure that we have good public administration. The multi-year settlements can help the system to plan much better. This record investment puts the NHS on a sustainable footing to deliver for the British people. We will cut waiting lists so that, by the end of the Parliament, 92% of patients will start consultant-led treatment for non-urgent health conditions within 18 weeks, delivering on the Prime Minister’s plan for change commitment to prioritise people’s health. We will support the shift from analogue to digital with the investment of £10 billion in NHS technology and transformation between 2026-27 and 2028-29—an increase of almost 50% from 2025-26. We will repair the NHS estate, continuing to deliver the 25 hospitals, with £30 billion over the next five years for day-to-day maintenance and critical safety risks, including the eradication of RAAC. None of that happened under the Conservatives. We will enable 2% productivity growth per year, unlocking £17 billion of savings to be reinvested in frontline services. As well as delivery, the British people rightly expect us to ensure value from this huge investment in the health service. The Secretary of State has marked 2025-26 as a financial reset year with the publication of this year’s planning guidance. He has been clear that all systems must live within their means, exhausting all opportunities to improve productivity, tackle waste and take decisions on how to prioritise resources to best meet the health needs of their local population. All systems are now planning to achieve a balanced financial position in 2025-26, recognising that £2.2 billion of deficit support has already been provided. We will therefore close the £4.4 billion initial gap in full. Financial plans support the delivery of key operational performance targets for elective, cancer, and urgent and emergency care at a national level set out in the guidance. We are working closely with NHS England on key aspects of delivering that. I assure the Chair of the Select Committee that I meet colleagues from across the Department of Health and Social Care and NHS England weekly to go through those plans in a robust manner. There is a lot to get through, so I am sorry that we have lost a lot of time to respond to colleagues. We are particularly looking at productivity and efficiency targets. We are ensuring that the financial performance and improvement programme for 2025-26 learns the lessons of the past. We will focus on cost variation and on upskilling finance teams and wider leadership to ensure that there is good governance in our reporting practice. We will issue the NHS performance assessment framework and have a targeted approach to recovery because the current model does not work. We are looking at ICB reform, as has been discussed. We want to ensure there is a reduction in the variation of cost across the system so that we can get more care and support to the frontline. We are focusing much more on medium-term planning to have a long-term financially sustainable system for systems and providers. Thanks to this Government’s record investment, we are taking steps towards fixing the foundations of our NHS to make it fit for the future. We will set out more details on our plans shortly in the forthcoming 10-year plan, which will lead the NHS to meet the challenges set out in the plan for change and build an NHS fit for the future.

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