With permission, Mr Speaker, I will make a statement on the independent leadership review of health and social care.
This is an important report that comes at a critical time. This Government are embarking on a huge programme of reform to tackle the covid backlogs, to improve people’s experience of the NHS and social care, and to place this system on a sustainable footing for the future. But we cannot seize this opportunity and deliver the change that is so urgently needed without the best possible health and care leadership in place, because great leaders create successful teams, and successful teams get better results. So a focus on strong and consistent leadership at all levels, not just on those who have the word “leader” in their job title, will help us in our mission to transform health and care and to level up disparities and patient experiences.
This review, which I have deposited in the Libraries of both Houses, was tasked with proposing how to deliver a radical improvement in health and social care leadership across England. It sets out a once in a generation shake-up of management, leadership and training, as well as how we can make sure that health and care is a welcoming environment for people from all backgrounds, free from bullying, harassment and discrimination.
The review was led by General Sir Gordon Messenger, former Vice-Chief of the Defence Staff, and Dame Linda Pollard, the chair of Leeds Teaching Hospitals NHS Trust. I thank them both for taking on this role and providing their varied experience of leadership, along with everyone in their review team who has contributed to this important review.
Before I turn to the recommendations of the review, I shall update the House on its findings. The review found that, although there are many examples of inspirational leadership within health and social care, from ward to board, these qualities are not universal. The report states that
“there has developed over time an institutional inadequacy in the way that leadership and management is trained, developed and valued.”
As a result, careers in management are not viewed with the same respect and prestige as clinical careers. The review also found
“too many reports to ignore” of poor behaviour, and that the acceptance of bad behaviours like discrimination, bullying and responsibility avoidance has become “almost normalised” in certain parts of the system.
We must only accept the highest standards in health and care, where failures in culture and leadership can make the difference between life and death. So we must do everything in our power to share and promote brilliant, innovative management and to act firmly where standards fall short. This means culture change from the top of the system to the frontline. The review identifies a number of areas where improvement is needed, and it makes seven transformative recommendations. I will quickly update the House on each of them in turn.
First, the review recommends new measures to promote collaborative leadership and to set a unified set of values across health and care. This includes a new national entry-level induction for new joiners to health and care, and a new national mid-career programme for managers.
Secondly, the review recommends that we should agree and set uniform standards for equal opportunities and fairness, with more training to ensure that the very best leadership approaches become ingrained. The Care Quality Commission must support this work by measuring progress through regular assessments. This does not mean more people working in diversity but fewer. In my view, there are already too many of these roles and, at a time when our constituents are facing real pressures on the cost of living, we must spend every penny with care. Instead of farming out this important work to a specific group of managers, it must be seen as everyone’s responsibility, with everyone being accountable for extending fairness and equal opportunities at work.
Thirdly, the review recommends a single set of unified leadership and management standards for NHS managers. These standards will apply to everyone, including those who work part time and flexibly, with a curriculum of training and development to help people meet them. This modernisation is well overdue, and completing the training should be a prerequisite for advancing to more senior roles.
Fourthly, the review recommends a more simplified, standardised appraisal system for the NHS, moving away from variation in how performance and career aspirations are managed towards a more consistent system that takes into account how people have behaved, not just what they have achieved.
Fifthly, the review identifies a lack of structure around careers in NHS management. It proposes a new career and talent management function for managers at a regional level, to oversee and support careers in NHS management and to provide clear routes to promotion, along with training and development.
Sixthly, the review recommends that the recruitment and development of non-executive directors needs to be given greater priority due to their vital role in providing scrutiny and assurance. It proposes an expanded specialist appointments team in the NHS, tasked with encouraging a diverse pipeline of talent.
Finally, there is currently little or no incentive for leaders and managers to move into the most challenging roles, as the barriers are often seen as simply too high. I want leaders in the NHS to seek out those roles, not shy away from them. It is essential that we address that and get great leaders into areas that feel left behind. The review proposes an improved offer, with stronger support and incentives to recruit top talent into those positions.
We will be accepting these comprehensive, common-sense recommendations in full. The recommendations have been welcomed by groups representing people who work throughout the NHS, including by the NHS Confederation and NHS Providers. By taking the review forward, we can finally bring how we do health and care leadership into the 21st century, so that we have the kind of leadership that patients and staff deserve, right across the country, and so that we make sure that some of our country’s most cherished institutions can thrive in the years ahead.
I commend this statement to the House.
The Secretary of State has picked quite the week to talk about standards in leadership.
I give a huge thanks to NHS staff and leaders for the work they are doing against the most extraordinarily difficult backdrop. I also thank General Sir Gordon Messenger and Dame Linda Pollard for carrying out the review. Its seven recommendations are sensible, and I am pleased the Secretary of State has already committed to implementing them.
As this is a rare example of decisiveness from the Health Secretary, can he tell us when he intends to publish his implementation plan? All too often, the senior leadership of the NHS still does not represent the diversity of the population it serves. Instead of throwing red meat to his Back Benchers, for reasons that will probably be obvious to everyone, I would like to hear how, in particular, he intends to ensure that equality, diversity and inclusion will be improved, so that the best leaders are incentivised into the most challenging roles and are able to provide inclusive healthcare for the breadth of diversity in our great country. Can he explain why the review has not covered leadership in primary care or social care in any detail? Surely this is a missed opportunity. Let us face it: although he is trying to dress this up as the biggest shake-up in history, I am not sure that giving staff an induction on joining the NHS is a revolutionary development, and it hardly meets the scale of the challenge.
The NHS faces the biggest crisis in its history. NHS staff are in a system under pressure like never before, and there are simply not enough of them. There are currently 106,000 vacancies across the NHS, and staff are leaving in droves. In some specialties, such as midwifery, they are leaving faster than we can recruit them. I do not know how the Health Secretary expects NHS managers to demonstrate good leadership and deliver the best outcomes for patients when there are no staff to lead. For an organisation the size of the NHS, one of the biggest employers in the world, not to have a plan for its workforce is unbelievably negligent. What is the NHS meant to do until he eventually delivers his long-term workforce strategy, which he has been promising for some time? How are managers meant to lead effectively when instead of thinking about patient care as their primary driver, they have become buildings and facilities managers, because the ceilings are falling in? The only place where more than 40 new hospitals really exist is in the Prime Minister’s imagination.
The Health Secretary said that we should accept only the highest standards in NHS management, so let me ask him not about the generalities, but about the specifics. Last month, it was reported that North East Ambulance Service bosses oversaw cover-ups of negligence, leaving about 90 families not knowing how their loved ones died. He said yesterday that he is still considering whether to launch a review. Is he seriously considering protecting managers who cover up bad practice, instead of standing up for grieving families? Staff in that service were reportedly paid to sign gagging clauses, and I understand that attempts to get them to sign such clauses are still under way. In a written question, I asked how many non-disclosure agreements had been signed in the NHS since the Government said that they would be banned in 2014. He does not know and he is refusing to investigate the use of gaging clauses in the NHS. So how can he claim to be shaking up NHS culture and dealing with bullying when he has no interest in what is going on under his nose?
Of course the NHS needs good leaders, but when it comes to examples of poor leadership in the NHS, the Health Secretary did not need the Messenger review; he just needed to look in the mirror. This is the man who described the NHS as Blockbuster Video
“in the age of Netflix”,
as if it was the greatest revelation since Moses received the 10 commandments. Who has been in government for the past 12 years? On his watch, on this Government’s watch, we have the highest waiting times in the NHS’s history; the lowest patient satisfaction since 1997; longer waiting times for cancer in every year since 2010; heart attack and stroke victims left waiting for about an hour, on average, for ambulances; and patients at risk of serious injury because the hospital is crumbling around them. He kicked off his own Health Week expecting applause for the fact that, despite his best efforts, there are still 9,000 people waiting for more than two years for treatment. He knows, I know, NHS staff know and the public know that with this Government, NHS staff are lions led by donkeys, wanting and inadequate.
I am not surprised by the typical response from the hon. Gentleman: not really engaging with the real issues and showing once again that he is more interested in theatrics than in the real issues facing our NHS. He started his comments by trying to make some kind of joke about the leadership news this week, but we all know that he is only interested in one leadership review in a political party in this House, and it is not the Conservative party’s.
Let us look at the issues that the hon. Gentleman raised. He rightly talked about the importance of the workforce overall and how we need more doctors and nurses. He should know that we have more doctors and nurses than ever before and that we are recruiting at a faster rate than ever before, with 10,000 more nurses and over 4,000 more doctors in the past year, and more in training than ever before. However, he will know that dealing with the challenges of getting more workers and building those hospitals, all of which are on track, requires proper funding, yet he and his party voted against the funding that the NHS needed to achieve that.
The hon. Gentleman is right to talk about when things go wrong in the NHS. Of course they need to be properly investigated, as they were in Telford and Shropshire, when we learned about the terrible things that had been going on under successive Governments in that trust. When there is a need for other investigations to take place, including independent ones, such as the one I have just asked for in Nottingham, that will be done. But the hon. Gentleman should understand that the best thing, which is far better than doing a review when things go wrong, is not having things go wrong in the first place. That is why he should have welcomed this report.
This is an important review. There have been regular radical changes in the management of the NHS throughout my 25 years in this House, so may I suggest that my right hon. Friend proceeds with care? He rightly says that good leadership of the NHS is important, for example, to ensure that we can deal with the covid backlogs, and that includes consultants. Too many experienced consultants are leaving the NHS because of problems with their pensions, so will he now commit to an urgent review of this issue, including looking at the change in the abatement scheme?
I thank my right hon. Friend for her comments. I always listen carefully to what she has to say, given her important experience. On the pension issue, she will know that in the 2020 Budget, I believe it was, significant changes were made, especially to where the taper rate kicks in—it went from £110,000 to £200,000. That benefited the top 5% of earners in this country, but it was the right thing to do to encourage and incentivise doctors, in particular, to work more. She is right to talk about what more we can do. We are looking precisely at what further flexibilities we can offer on pension arrangements.
The Health and Social Care Secretary talks about strong leadership and culture change. I point out to him his Government’s and his Department’s dismal record in meeting the pledge to close the in-patient units that are being used to trap more than 2,000 autistic people and people with learning disabilities rather than support them in their own homes. We have just passed the 11-year anniversary of the scandal at Winterbourne View. Not only has his Government failed in their pledge to close down these units, which was the original promise made after that scandal, but 560 people in those in-patient units do not need to be there at all, a quarter of them are more than 50 km from their own home, people are spending longer in units now than they were seven years ago, and more people have been admitted to the units year on year from 2015-16. This is one of the biggest scandals and the worst failures of his Department and Government. When is he going to act on it?
The hon. Lady is right to highlight the importance of this issue and she will know that my predecessor had asked for a review on it. It was done and we have accepted its outcome, and it is being implemented. I hope she will understand that in implementing the outcome of that review it is important that we listen to clinical advice from within the NHS and make sure that we put the interests of each patient first.
I call the Chair of the Select Committee, Jeremy Hunt.
I thank the Health Secretary for this excellent report and commend Sir Gordon Messenger and Dame Linda Pollard for all their work in putting it together. It has some very important recommendations. People who run hospitals are doing one of the most difficult jobs in Britain today, and anything we can do to give them better support in their careers will help all of us.
Does my right hon. Friend agree that the elephant in the room is that one thing that makes their job most difficult: we have more national targets in the NHS than any other health system anywhere in the world? That means not only that there is a risk of patients turning into numbers, but that we remove the autonomy from managers to show the leadership that Sir Gordon is advocating in this report. So as my right hon. Friend implements the recommendations, will he look at the role of national targets in the NHS and whether we need to simplify and reduce them?
I thank my right hon. Friend for his support of the report. Of course he speaks with incredible experience. He is right to raise the issue of the importance of targets, and sometimes targets can have unintended consequences. The report does talk a bit about the importance of that issue. I can assure him that as we make changes and work with our colleagues in the NHS to make reforms, we will certainly be taking that into account.
As the Secretary of State will have seen over his years as an MP and a Minister, there are managers and leaders who are excellent and outstanding and there are others who are not so good. Is not part of the problem, as Mrs May mentioned, the continual structural changes, which add to instability, the massive recruitment and retention problems and the record numbers of people using the hospitals? No matter what he does to improve leadership, it will not solve all those problems. Part of the problem is that we do not have enough people coming forward to take up leadership roles. At what point in the next five to 10 years does he expect to have solved the leadership crisis in the NHS?
The hon. Gentleman is right to talk about the importance of recruitment in the NHS—bringing in the right people in the first place and then retaining them—but I hope that he will also recognise that good leadership plays an important part in that. This morning, I went to Chelsea and Westminster Hospital, which is an outstanding and incredibly well run hospital, and heard from the leadership team about the important role that they play in attracting and retaining talent. I hope that he recognises that point as well.
The reason why the Department keeps that under review is that, although the pass has stopped and there is absolutely no prospect that I can see of its ever coming back into place, it is right that, as we wind things down and work on the digital resources, all things are looked at appropriately.
There is a big gap—an omission—around this leadership issue in social care. We have big retention issues. There are more than 9,000 vacancies. Does the Secretary of State have a plan to address that big omission in health and social care, including retaining the people we need on the frontline?
The short answer is that, yes, the hon. Lady is right to talk about the importance of retaining and recruiting more nurses. When it comes to nurses’ pay, she will know that we gave a 3% rise last year when there was a freeze for the public sector workforce generally. This year, we will be listening carefully to what the independent recommendation is.
How many directors and chief executives of health bodies are there in the NHS, and what performance requirements are built into their contracts? We want them to deliver high-quality care with falling waiting times.
I cannot give my right hon. Friend the exact number that he is asking for, but I can answer the latter part of his question. I agree that we want to see a massive improvement in appraisal and performance standards; I am sure that, when he gets to see the report in detail today, he will be pleased by what he reads.
The Secretary of State said that we must accept only the highest standards and act where standards fall short. My constituent, Paul Calvert, bravely exposed the management failures of the North East Ambulance Service and, indeed, the criminal negligence of cover-ups of patient deaths.
Mr Calvert, who gave me his permission to raise this case—I met him in person last week—is being bullied, harassed and blackmailed, but he still refuses to sign a non-disclosure agreement. He was offered £41,000 conditional on his silence and on destroying the evidence that he has of wrongdoing. Tomorrow, we anticipate his employment being terminated. Mr Calvert and grieving families want a public inquiry into the North East Ambulance Service. Does the Health and Social Care Secretary agree, and will he outline how the Messenger review will protect NHS whistleblowers such as my constituent, Mr Calvert?
I thank the hon. Gentleman for bringing Mr Calvert’s case to my attention. The Under-Secretary of State for Health and Social Care, my hon. Friend Maria Caulfield, has listened to that carefully. She is meeting some of the families affected by that case very shortly, and Mr Calvert is someone to whom she can reach out directly.
Like the hon. Gentleman and, I am sure, the whole House, I am very concerned about what I have heard about this ambulance service. I am not satisfied with the review that has already been done. We need a much broader and more powerful review. I will have more to say on the matter very shortly.
I welcome this review and thank my right hon. Friend for bringing his statement to the House. Good leadership is important because it drives the culture within an organisation. It was terrible to hear what Grahame Morris had to say just now. We can see that bullying and harassment in an organisation often come down to how the leadership and the processes are operating.
Whistleblowers need to know that they can rely on the processes within organisations, but who do they go to as well? The National Guardian’s Office would be one, as would the local guardians in the hospitals. I recently introduced a whistleblowing Bill to ensure that people are able to go to another body, because they cannot be constricted within their organisation. We need to be able to benefit from whistleblowers who speak out and expose wrongdoing so that we can close down these cultures that we have seen operating in our organisations.
My hon. Friend is right: it is important that, where people who are working within the NHS or social care see wrongdoing or things that concern them, they have a safe space to report that and to make sure that their concerns are properly addressed. She will know that the Health and Social Care Act 2022 contains new provisions, including one for the Health Services Safety Investigations Body, but I have listened carefully to what she has said and I will consider what more we can do.
The Secretary of State might recall that, as a member of the all-party group for management, I have had a long interest in management and good management. I congratulate him on having this review, because the NHS is a complex organisation.
The Topol review that was carried out only two or three years ago showed a world of technology and change that is almost beyond belief for such a massive human organisation. I have not had the time to read the report yet, but is the Secretary of State sure that we have high-quality training for our managers? Many of the business schools and many of the people providing the training in our universities are not training for that kind of environment. We do need first-rate, high-quality management schools with a health bias.
I agree with the hon. Gentleman. I know that he has a long-standing, valuable interest in this issue. I appreciate that he has not had time to look at the report, but I think he will be pleased when he reads our recommendations around a modern training plan.
The most important thing that happened in Westminster this week was yesterday’s reception for Harry’s Pledge. Harry is a young boy who needs a lot of care. Harry’s Pledge campaigns for the needs of carers and those who are cared for. I am introducing a private Member’s Bill to give guidance for that. Will the Secretary of State look at that Bill to see whether the Government could support it? Leaders in care need to have the guidance to judge whether they are succeeding.
NHS staff are exhausted and demoralised, and now we are asking them to deal with the growing waiting lists. We still have a huge vacancy problem within our NHS. Where is the plan to deal with that issue? If we are to improve our NHS going forward and have anything there for these managers to manage, we need to deal with that problem within the workforce.
I thank the Secretary of State for his statement and congratulate him on the work he has been doing in this important area. Does he agree that for too long there has been a culture of a lack of accountability among NHS senior management, and too often a blame culture, where things go wrong but are not transparently acknowledged? Does he agree how awful that is for the patients concerned? Will he do everything possible to ensure that we tackle the blame culture and the lack of accountability to the public, who the NHS is there to serve?
I agree very much with my hon. Friend. She will know from her own NHS trust, particularly the maternity problems there and the terrible cases set out in the Donna Ockenden report, just where that kind of culture can lead. Of course there are fantastic examples day in, day out of great culture and great leadership in the NHS, but there are also poor outcomes. She is absolutely right that we need to tackle those. That is exactly what is in this report.
I cannot really understand why yet another restructure of the NHS is the answer to the crisis we face. The last one diverted billions of pounds from patient care, and millions of people are suffering as a result. Instead of yet another costly restructure, why does the Secretary of State not just get on with building the new hospitals we need, such as the one at North Tees in Stockton, and tackling the health inequalities that blight our communities?
I warmly welcome my right hon. Friend’s statement on the review and his strong support for inspirational leadership, which is key for our NHS. Does he agree that relevant training and career development are vital for all staff working in the NHS, to allow them to gain career advancement?
I hope the Secretary of State will agree that it is key that managers in the NHS and local authorities can work together effectively. I give great credit to the leaders in the clinical commissioning group, the hospital trust, the director of public health, the social care directors and the city council, who worked really well together in Sheffield during the pandemic to deliver a joined-up service and have kept us as MPs thoroughly involved.
As we move on to the slightly wider integrated care system and integrated care board, will he give a commitment that the place-based working that has been so effective in the past will be allowed to continue at local authority level?
The place-based working that the hon. Gentleman talks about is also at the heart of the integration White Paper that the Government presented recently.
I welcome Gordon Messenger’s review, but does the Secretary of State not agree that in the history of the national health service, reorganising senior management has often been a distraction? Will he prioritise the area that would make a real change to health and care—the interface between the two—and focus on career progression and development for care workers in particular, who hold the key to unblocking the awful problems that we have in both sectors?
I know my right hon. Friend speaks with experience, and I appreciate that he will not have had time to look at the report in detail yet, but I think when he does read it he will find that it is precisely what he has just asked for. This is not a reorganisation; it is all about strengthening management, and the report sets out in quite some detail how that can work.
I agree with Mrs May on NHS reorganisations. I once met a very senior and very able NHS manager who said they had been through 14 restructures of the NHS and they quite liked number five. How will this review better integrate ambulance services with their local hospitals to improve performance standards for local patients?
When it comes to ambulance services, an important part of the NHS, this review is just as important. We all want to see good leadership in ambulance services, but if we get better leadership across the board we will see better collaboration and co-ordination—something heavily referred to in the report.
I welcome this statement; leadership is vital and it is something we do not talk enough about in this country, whether in the private or public sector. My right hon. Friend referred to recommendation 6 on non-executive directors. Does he agree that we need to attract a more diverse set of non-executive directors, with regard to their skillset as much as anything else?
I thank the Secretary of State for his statement and for the commitment to quality leadership within the NHS. As he said himself, that is so important. The review findings and recommendations are a method to deliver that improvement. Retention of staff—the consultants, the GPs, the doctors and the nurses—is core to any improvement, so what is being done to retain staff and not lose them? Is it the Secretary of State’s intention to share the findings with regional Administrations, particularly the Northern Ireland Assembly, to provide betterment across all the United Kingdom of Great Britain and Northern Ireland?
The hon. Gentleman will know that the review specifically looked at the NHS and care in England, but there are important lessons here that can be drawn on by, for example, the health service in Northern Ireland. On the issue of retaining staff, the NHS is undertaking many initiatives to improve that, but I hope he will agree with me that one key way to retain staff is to ensure we have good leadership and good managers.
The review underlines how vital leadership is to driving change and improvements in care. I put on record my thanks to the chief executive and board of the Queen Elizabeth Hospital Kings Lynn NHS Foundation Trust, who have taken that hospital out of special measures, thanks to the hard work of the staff. As my right hon. Friend knows, to continue to improve care and to retain and recruit staff there is a pressing need for a new hospital for the QEH. I urge him to make an announcement on the new hospitals programme and to back QEH’s bid.
My hon. Friend rightly never misses an opportunity to make the case for his local hospital. I have heard him carefully and I am happy to meet him to discuss it.
I thank my right hon. Friend for his statement and for the report. Recommendation 4 talks about a standardisation of appraisal. Does he agree that cutting out variation in performance is key, and will he therefore confirm that the recommendations from Tim Briggs’s “Getting It Right First Time” report will be embedded in that standardisation procedure?
I agree with my hon. Friend: that recommendation for a standard appraisal system, which, remarkably, does not exist at the moment, is of particular importance, like all of the recommendations. I agree with the emphasis he puts on that.
The focus that the Health Secretary is giving to leadership management training must be right. We all know that in a Care Quality Commission report on a hospital or an Ofsted report on a school, one of the key differences between adequate and outstanding is the quality of leadership. All credit to the report for focusing on that; I think we would all benefit from understanding that it is one of the key characteristics of hospitals whose internal staff surveys show strongly positive morale—often a key leading indicator.
Will the Secretary of State say a word or two about the point raised by Grahame Morris? The report and what has come out of the North East Ambulance Service are truly shocking and highlight what I think Sir Gordon Messenger called a need for a change of culture. How can we encourage all our NHS trusts to be open and transparent about what has gone wrong, so that we do not have future scandals like that?
My hon. Friend will see when he has had the opportunity to read the report in full that it does rightly talk about the importance of that particular issue: ensuring that people within the NHS and care feel comfortable coming forward when they see wrongdoing, so that we can act much more quickly. That is why we will be implementing all the recommendations. Regarding the North East Ambulance Service, I hope he heard what I said earlier about the need to look at that again very carefully.
As a former chair of the all-party parliamentary group on cancer for 10 years, I welcome this review. However, I put it to my right hon. Friend that at least part of the problem with waiting times and lists is the fact that only around half of all NHS staff are clinically trained. There is an imbalance there. Following my amendment during the passage of the Health and Care Act 2022, which he accepted, I suggest that one thing that could really help would be to get the NHS to focus more on outcomes such as one-year cancer survival rates, as a means of encouraging earlier diagnosis, and less on processes, which are very management-heavy.
I thank the Health Secretary for this vitally important report at this critical time. Is he aware of reports circulating in the media that some NHS health information pages appear to have been de-sexed in their language about conditions affecting women? Is he, like me, very concerned about this, and will he look into it?
My hon. Friend will not be surprised to learn, I hope, that as Health Secretary I think an individual’s biological sex is incredibly important when trying to meet their health needs. I have seen the reports. In fact, I do not think they are just reports. With regard to the NHS website on ovarian cancer, I think it is actually has been, as she puts it, de-sexed. That is not something that I agree with. Of course, issues of gender, rather than sex—I distinguish the two—should be approached with compassion and sensitivity, but it is right that when it comes to healthcare, where there are health issues that impact only people of a particular biological sex, such as ovarian cancer and prostate cancer, the health service recognises that.
I am very concerned that the review found evidence of a blame culture and responsibility avoidance. We have to be clear that this culture is not just damaging but actually kills patients, because lessons are not learned from mistakes that are actively hidden. What can we learn from the airline industry, which adopted a no-blame culture and, through that, dramatically reduced airline-related deaths?
I recognise the importance of leadership and reform of the NHS. Can we now show some leadership and reform in the area of NHS dentistry? The Labour Government wrecked NHS dentistry when they brought in the contracts that have led to dentists leaving the profession in droves. When people up and down the country, including my constituents in North Norfolk, cannot see an NHS dentist, is it not about time that we reformed the rotten contracts that Labour brought in?
My hon. Friend is right. It is well known how the Labour Government came up with contracts with the British Dental Association that are leading to poor outcomes for millions of people across the country. We have already made some short-term changes, and we are in the process, right now, of making some longer- term strategic changes that will create all the right incentives.