PARLIAMENTARY DEBATE
National Insurance Contributions: Healthcare - 14 November 2024 (Commons/Commons Chamber)

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the impact of changes to employer national insurance contributions on primary care providers, hospices and care homes.

I am grateful to the hon. Member for asking this important question. It gives me the opportunity to say to GPs, dentists, hospices and every part of the health and care system that will be affected by changes to employer national insurance contributions that this Government understand the pressures they face and take their representations seriously. The Chancellor took into account the impact of changes to national insurance when she allocated an extra £26 billion to the Department of Health and Social Care. There are well-established processes for agreeing funding allocations across the system, and we are going through those processes now with this issue in mind.

This Government inherited a £22 billion black hole in the public finances, broken public services and a stagnant economy. Upon taking office we were told that the deficit the previous Government recklessly ran up in my Department alone would mean delivering 20,000 fewer appointments a week instead of the 40,000 more we promised. The Chancellor and my right hon. Friend the Secretary of State were not prepared to see further decline in our NHS. That is why we put in an extra £1.8 billion to stop the NHS going into reverse this year.

We built on that at the Budget, delivering the significant investment that the NHS needs to get back on its feet, backing staff with investment in modern technology, new scanners and new surgical hubs, and rebuilding our crumbling primary and secondary care estate. Alongside that, we delivered a real-terms increase in core local government spending power of around 3.2%, which will help to address the range of pressures facing the adult social care sector, including £600 million in new grant funding for social care. We are now working through exactly how that money will be allocated, as per normal processes. As the Secretary of State set out yesterday, we will ensure that every pound is invested wisely to deliver the Government’s priorities and provide value to taxpayers.

The Department will set out further details on the allocation of funding in due course, including through NHS planning guidance and the usual consultations, including on the general practice contract. As part of these processes, we will consider the impact of changes announced to employer national insurance contributions in a fair and open way over the next five months, before the changes come into force in April 2025.

I draw the House’s attention to my declaration of interests.

Many in the health sector will have been pleased to hear the announcement of the extra funding for the NHS, only for their joy to be struck down by the realisation that a manifesto promise not to raise national insurance contributions had been broken. That was compounded further by the discovery that a raft of frontline care providers—care homes, hospices, care charities, pharmacies and GPs, to name but a few—will not be exempt from the NI rise, leaving them with crippling staff bills and the threat of closures and redundancies. The hospice sector expects the cost to be £30 million—closures and redundancies. The initial assessment of the cost to GPs is £260 million—closures and redundancies, at the expense of 2.2 million appointments. For the care sector, the changes will cost £2.4 billion, dwarfing the £600 million in social care support that was announced. Does the Minister accept that it is inevitable that council tax will have to rise to support the increase in NICs?

For the first time, the National Pharmacy Association has announced collective action. Its chair said:

“The sense of anger among pharmacy owners has been intensified exponentially by the Budget, with its hike in national insurance employers’ contributions and the unfunded national living wage increase, which has tipped even more pharmacies to the brink.”

Will the Minister clarify who is exempt from NI? Will the Government admit that they got it wrong and make a change? The Prime Minister, Health Secretary and Chancellor have all said that allocations will be made “in the usual way”. Will the Minister clarify what the usual way is? Will mitigations be put in black and white to the House and the public? Is this part of the £20 billion, or new funding?

More importantly, will the Minister lay out a concrete timetable for hospices, care homes, GPs, pharmacists and all other allied health professionals, who are making decisions now? This seems to be another example of a big headline from the Labour party but no detail.

Well, really. I am quite dumbfounded by the hon. Gentleman’s response. I respect him for his professional practice, and he knows the state of the NHS that we inherited from the previous Government, as reported in Lord Darzi’s report. He talks about joy, but there was no joy when we inherited the mess they left back in July. He talks about people being tipped to the brink, and they absolutely were, as Lord Darzi made clear.

As I said, we will go through the allocation of additional funding in the normal process, which will be faster than under the previous Government because we are committed to giving the sector much more certainty. The normal process, as the hon. Gentleman should know from his time in government, is to go through the mandate and the planning guidance and to talk to the sector about the allocations due next April, as I said in my opening statement.

Does my hon. Friend join me in welcoming the Opposition’s new interest in social care? Does she further agree that the problems that social care faces owe more to the previous Government’s failure to do anything with Andrew Dilnot’s 2011 report than they do to anything that is happening now with national insurance?

My hon. Friend makes an excellent point. When I joined this House in 2015, I remember that the first act of the new, non-coalition Conservative Government was to take the legs from underneath that social care commitment by postponing the Care Act 2014. They cynically said at the time that they would bring it forward by 2020, which they thought would coincide with the next general election. We all saw how that went.

I call the Liberal Democrat spokesperson.

The increase in employer national insurance contributions will erode the very investment in the NHS that the Budget sought to prioritise. Katie, a GP from Lindfield in Mid Sussex, wrote to me saying that the NICs increases

“serve to directly undermine access and patient care.”

The Government have promised to recruit more GPs, but hiking national insurance puts that pledge in jeopardy. Surgeries are set to see eye-watering increases in staff costs, equivalent to 26,786 appointments in West Sussex alone. GPs will have no choice but to cut services and staff numbers, and patients will pay the price.

Does the Minister agree that stronger primary care, with faster appointments and fewer people having to go to hospital, is better for both the NHS and patients? If so, will she protect services and press the Chancellor to end this GP penalty?

The hon. Lady makes an excellent point about the importance of GPs and primary care to the wider sector. Immediately after taking office this summer, we freed up the system to employ 1,000 extra GPs through the additional roles reimbursement scheme—which the previous Government refused to implement—because we recognised the need for that extra capacity. We will be talking to general practice as part of the contract reforms over the next few months, following the normal process, to determine allocations for next year.

If this Government’s ambition, stemming from Lord Darzi’s report, is to be realised, significant investment is required not only in primary care but in third sector organisations. However, these organisations are concerned about the increased cost pressures on their services. Will the Minister ensure that there is sufficient support within the trickle-down approach, which the Department will now have to apply, to maintain current service levels and facilitate the urgently needed transition across health services?

I respect my hon. Friend’s expertise in this area. She is right, and we understand that the pressures are real, which is why we have committed to supporting the NHS and the social care system with the additional funding that my right hon. Friend the Secretary of State for Health and Social Care secured as part of the Budget settlement.

We are also working closely with the NHS, in a new relationship, to understand its needs. That is a dynamic conversation, because we want to understand what is happening in local systems as we continue to invest in them.

I call the Father of the House.

We all know that a lot of the debate on assisted dying revolves around the lack of hospice places to help people pass in the best way possible. Similarly, much of the debate on the NHS is about the lack of care home spaces. Leaving aside the cross-party name-calling, may I beg the Minister to consider exempting hospices and care homes from this national insurance increase?

I understand the right hon. Gentleman’s point. As I have said, we will continue our conversations with all affected providers in the normal way.

Does the Minister agree that the support that we will put in place for general practice and, in particular, the community health hubs that were recently announced, will be crucial to the improvement in the health service that we urgently need?

I respect my hon. Friend’s expertise and service to the national health service. He will understand the need to make the shift into neighbourhood health services. We have been clear that we will ensure the NHS spends all its allocations in the most effective way to enable that shift, as part of our 10-year plan.

A trustee of the Hamelin Trust, a not-for-profit provider of care and support across Essex, has contacted me because he is concerned about the £92,650 rise in national insurance that Hamelin will have to pay because of the measures introduced by the Government. He said:

“This will affect what they can do to support our communities and subsequently put more pressure on the NHS and local authorities. The impact on disabled people and older adults who rely on regular, consistent, high-quality care will be profound.”

I do not believe that the Government intended to hammer the disabled or older people who need care, so will the Minister prove me right and look at the policy again?

The right hon. Gentleman was part of the last Government—I am pleased to note that he is talking to his new constituents. The £22 billion black hole and the report from Lord Darzi indicate the fragility of the system we have inherited. We are ensuring that vulnerable groups are supported through the allocations provided to both the Department for Health and Social Care and the Department for Work and Pensions.

When Labour came into government in July, every element of our health service was in crisis. Since, then, we have announced record investment in our national health service, but I am yet to hear whether the Conservative party supports that record investment. Does the Minister agree that the Government are listening to health professionals, taking tough decisions and not simply playing politics?

My hon. Friend makes an excellent point. We have still not heard from the Opposition whether they agree with the extra investment that has gone into the sector or with Lord Darzi’s report that diagnosed their legacy, including why they left that legacy and the serious issues we now have to address.

Shooting Star children’s hospice in Hampton serves children with life-limiting conditions and supports their families not just in my constituency but across south-west London and Surrey. With the national insurance hike, it faces a bill of £200,000, on top of all the inflationary costs that it has had to absorb. It is also waiting for confirmation as to whether the children’s hospice grant, which this year provided it with £1.8 million, will continue beyond April 2025. Will the Minister commit to making hospices exempt from the NI rise, not just for nursing staff but for all staff, and when will she be able to give Shooting Star and other children’s hospices confirmation on whether the children’s hospice grant will continue? They need to plan now.

I commend the hon. Lady for raising the great work done by hospices. We understand the pressures and the precarious situation that many have been left in after 14 years of the last Government. We are willing and keen to talk to representatives from all types of hospice, and others. We are going through the process of the allocations and we will be able to get back to them as soon as possible.

Hundreds of my constituents in Leeds South West and Morley are stuck on record long waiting lists, thanks to the Conservative party. It is essential that we get those waiting lists down, because they have profound effects on our economy and on the health of those waiting. Will the Minister confirm that the measures that we set out in the Budget will provide the additional appointments needed to get those waiting lists down?

My hon. Friend makes an excellent point. As I said in my response to the hon. Member for Hinckley and Bosworth (Dr Evans), we faced a situation where we were told that we would have to reduce appointments by 20,000 a week. We have taken serious steps, and my right hon. Friend the Secretary of State fought hard for our Budget allocation so that we can have 40,000 extra appointments as promised in our manifesto, which was overwhelmingly endorsed by the British public. We are determined that we will bring change to the system and tackle the waiting lists.

Increased taxes for hospices, care homes, GPs and pharmacies. Is that a deliberate decision by the Labour Government or just a cock-up?

We understand the precarious situation that hospices are in—the precarious situation that they found themselves in before we came to power— and we are committed to talking to them and other affected providers. We will be going through the normal process of allocations in the next few months.

Many of my constituents continue to wait on record-long waiting lists. Does the Minister agree that, before the Opposition throw stones, we should remind the House that their spending plans would have cut £15 billion from the NHS, which would have completely shattered an already broken NHS?

Those Conservative Members who have held on to their seats—I have been in that situation as well—know that the public, staff and patients understand exactly what state they left the NHS in. That is why they had such a disastrous election result. We are determined to change the NHS and to make it fit for the 21st century. Part of what we have done in this Budget through that extra allocation, our conversations with those in the health and social care system and our 10-year plan will do just that.

While Scotland’s public sector is facing a £500 million bill for the Chancellor’s reckless national insurance hike, Scotland’s charities, including hospices, face a £75 million price tag under these changes. The Budget simply cannot be balanced on the back of Scotland’s charities and hospices. This is a disgraceful decision for which the Labour Government are rightly being hounded. There is still time for them to do the right thing and cover these costs—I agree with what the Father of the House said. Will the Minister tell us whether they will do so?

The SNP has been in charge in Scotland for something like 20 years now—I forget exactly how long, but it seems like a very long time. Again, the Scottish people gave us an excellent result at the general election, and I am delighted to have so many Scottish colleagues here with me now. However, the SNP has the opportunity to make decisions in Scotland around health and social care as well, so I suggest that they do a better job.

It is disappointing to put it mildly that the Opposition spokesperson was unable to mention the record funding committed in the Budget.

It was in my opening line—

Order! The shadow Minister has been granted an urgent question. He asks the questions; he does not answer them from the Front Bench.

Does the Minister agree that it is also disappointing that the Opposition ignore the fact that they completely disregarded and ignored social care when they were in office?

The Government have no responsibility for that.

Well, I do agree with my hon. Friend. As I have said, when I became a Member of Parliament in 2015, I remember very clearly the absolute shock that I felt when the Conservatives immediately announced that they were not going to meet the commitment that they had made to implement the Care Act 2014 at that time, and we are still playing catch-up on that issue.

Doctors from Duns, Galashiels, Selkirk, Kelso and across the Scottish Borders have contacted me about the impact that this national insurance hike will have on their practices. They tell me that the decision will be a huge retrograde step for primary care, will have a huge financial impact on their practices, and will undermine access to primary and patient care. Why have the Labour Government made this choice to hammer local doctors?

As I have said, we have made a commitment to general practice and primary care by releasing extra GPs into the system. We recognise the situation in which GPs find themselves. I know this because I worked with GP practices in my previous career. We need those practices to be the foundation of our neighbourhood services, which is why we will talk in the normal process about the allocations over the next few months as part of the contract.

If we are to reform the NHS, we need to move resources over time into primary care. The reality is that GPs see at first instance 90% of patients, but receive only 8% of NHS funding. Will my hon. Friend ensure that, in the settlement that is agreed with NHS providers, particular attention is given to supporting GPs?

On the social care sector, when we help the hospices and social care providers, which are charities and small organisations in particular, can perhaps do so without subsidising some of the hedge funds that are now investing heavily in social care? We do not want to add to their profits while supporting the small charities involved.

My hon. Friend has led fantastic work in previous Parliaments on the health and social care system, which he understands very well. He makes an excellent point about ensuring that additional funding goes where we want it to, which is towards supporting our constituents, particularly with social care. We have all seen the situation over the last decade over so. Improving that is critical to the urgent and emergency care system, and to the dignity of those people who need the service. We will continue to talk to them, and to local systems, about the impact of any changes.

I hear what the Minister says about the Government wanting to stop the NHS going into reverse, but that is exactly what risks happening to GP practices in my constituency. I met with one on Friday that told me that, as a consequence of having to find extra funds for national insurance contributions, it will no longer be able to make permanent a temporary support post, or proceed with the recruitment of the extra GP that it wanted to take on. There is a contradiction at the heart of the rules: GPs are treated as private contractors, but if they were private contractors, they would be eligible for employment allowance. Because their work is entirely in the public sector, they cannot get it. Surely something has to give.

The right hon. Gentleman tempts me to go into my previous career working with GPs and their employment and contractual status, but I will not do that now, Mr Speaker, as you would rightly curtail me. GPs have a complicated contractual status that has been long in the process. We understand the precariousness of primary care. GPs are crucial to our plans for developing the health service, and we will discuss with them, in the normal process, the allocations for the following year.

Last month’s Budget finally gave my constituents hope that there will be an NHS that works for them. Will my hon. Friend assure me that this Government will avoid the sticking-plaster, piecemeal approach of the last Government, and bring forward a long-term plan to fix the NHS for the future?

My hon. Friend is right: getting away from short-term fixes and sticking plasters is exactly what we are attempting to do. That is why we put in the extra security of extra GPs over the summer, committed to extra funding in the Budget, and launched our 10-year plan. I encourage all hon. Members and their constituents to submit their views to that exercise at change.nhs.uk.

Dr Aleksandra Fox of the Ash surgery in my constituency is one of a number of GPs who have pointed out to me the deleterious effects of an ill-thought-through Budget. In addition, charities such as Shooting Star and Demelza children’s hospices are facing problems now. They cannot wait for discussions through the normal channels while this cock-up is put right. When will something be done about it, please?

The right hon. Gentleman says that it is an ill-thought-through Budget. I do not know whether he agrees or disagrees with the extra funding that the Government have committed to the NHS after the disaster of the last 14 years.

This morning, we learned that the Scottish Government have wasted £28 million of taxpayers’ money on the flawed, ill-conceived National Care Service (Scotland) Bill, which did not command the support of almost any of the stakeholders needed to pass it. Does my hon. Friend agree that the additional funding for the NHS that has been committed to in our Labour Budget should be used to come up with a proper plan for social care across the UK that does not follow the flawed approach in Scotland?

I am so pleased to see my hon. Friend in her place. As I said to the hon. Member for Aberdeenshire North and Moray East (Seamus Logan), the SNP has been in charge of Scotland for a very long time. We have certainly missed having a Scottish Labour voice in this place. She makes an excellent point and shines some sunlight in this place on the actions that have been taken up in Holyrood.

Julia’s House hospice does amazing work across Wiltshire and Dorset, but its chief executive Martin Edwards came to Parliament on Tuesday to tell me that the additional national insurance contributions will cost the hospice £250,000 a year. For that hospice, and Naomi House, which does similar good work, the changes are a significant concern. I know that the people of Wiltshire and Dorset will do as much as they can to raise additional funds, but will the Minister reflect on that unexpected gap and offer some reassurance?

I agree with the right hon. Gentleman that his hospice, and the hospices in many of our constituencies, do great work. We are aware of the precarious situation that they have been in for a number of years, and we want to ensure that they are fully part of end of life care. He will know from his time in the Treasury that there are complicated processes, both in the Treasury and in the Department of Health and Social Care. When I talk about the normal processes for allocating money, I think he understands that well. We are mindful of hospices’ concerns, and we will continue to talk with them.

Between 2013 and 2023, during the Conservatives’ time in government, the number of general practices fell from 8,044 to 6,419. Does my hon. Friend agree that it is a bit rich for the Conservatives to pretend now that they care so much about general practice, given that 1,600 practices closed on their watch?

My hon. Friend brings a great deal of expertise to the House from her work in social care, so she knows and understands the precarious nature of the sector, which we cannot stress enough. I do not know whether the Conservatives have actually read the report by Lord Darzi, but that report and its appendices give a really clear idea and diagnosis of the state in which the NHS and social care system was left. It will take a long time to rebuild it, and the sustainability of general practice and primary care is particularly problematic. That is why we took those actions in the summer, and why we will continue to support them and build up a neighbourhood health service.

The Minister will understand that GPs are private contractors to the health service, as are pharmacists, hospices and many wonderful charities. The Government have decided to ensure that the public sector is protected from the national insurance increase. All that the Minister—or her Secretary of State—needs to do is agree that all the suppliers to the national health service are also protected, which would safeguard their position. Otherwise, care homes will close down, pharmacies will close down, and hospices will not be able to provide their services. My constituency has the wonderful St Luke’s hospice, which does brilliant work—I helped to found it back in the 1980s—and which has told me that it will have to reduce services drastically as a result of the changes. Whenever nurses and other medical practitioners get a pay rise, those suppliers have had to cope without being given the money to fund that pay rise. They need to be protected from that as well.

I thank the hon. Gentleman for his comments and for supporting his local hospice. He is an experienced parliamentarian; he knows that this is not simple and that the provider landscape is complicated. As we heard from my hon. Friend the Member for Sheffield South East (Mr Betts), large private equity companies own many social care providers. We want to ensure that any additional funding from the Budget goes exactly where it needs to be: supporting patients—our constituents—where they live and need care. That is why, over the next few months, we will continue to talk to providers in the usual way about the allocation of those funds.

Since the Budget, I have been contacted by GPs, care providers and charities in my constituency, all expressing concern about the impact of the rise in employer NICs on their ability to serve the most vulnerable in our community. Will the Minister reconsider the change by finding a way to exempt the charitable sector in the same way as the public sector? I have written to Ministers and tabled early-day motions on this issue. Will she take this opportunity to assure the charitable sector that it will not be impacted by the measure?

The hon. Lady tempts me to make specific commitments, which I am not prepared to do, as I am sure she understands. She is right that people are expressing concerns about some of these decisions. That is because they are in such a precarious situation as a result of what we have inherited from the past 14 years. As the Prime Minister and the rest of the Government have been clear throughout the election and afterwards, we have a 10-year plan because it will take a long time to fix the foundations and build up the sector to make it more resilient and sustain it for the future. We want to fix those foundations, and we will talk closely with everyone affected over the coming months, but this will take a long time. Those providers are precarious because of the mess that we inherited.

Earlier this week, I received a letter from the Lincolnshire and Nottinghamshire air ambulance, a charitable healthcare provider. The national insurance changes will add £70,000 a year to its costs, and if it is forced to close, lives will be lost. May I urge the Minister—I know she will want to protect this service—to do all she can to ensure that that air ambulance and others across the country are not hit by this tax?

I assure the hon. Gentleman that since we were elected, the Government have already taken action to secure extra investment in the health and social care system, and we are committed to building a thriving health and social care system for the rest of the 21st century.

A rural pharmacy—one of the few remaining in my constituency—derives 90% of its turnover from providing NHS services. Will the Minister consider giving pharmacists for whom NHS services account for such a large proportion of their work an exemption from the NICs rises? What assessment have the Government made of the impact on the continuing delivery of programmes such as Pharmacy First if pharmacists have to shut their doors?

The hon. Gentleman makes an excellent point about pharmacies. We absolutely understand their importance, both in urban constituencies such as mine and in rural areas. I remember from when I became an MP in 2015 the changes that the previous Government made to the pharmacy contract, and I am aware of the precarious situation that pharmacists have been in. We will continue to talk to them as part of the normal process, but we understand how important they are to building a neighbourhood service and to the future of the NHS.

Acorns children’s hospice, St Richard’s hospice and GPs, care homes and pharmacies across West Worcestershire have all been in touch with concerns about the extra cost burden that the Government have imposed on them. Can the Minister explain how it fits in with her strategic plans to slap extra cost on the community sector while rebating the NHS trust sector?

I am sure that all those hospices, which do great work, were also in touch with the hon. Lady when she was part of the previous Government. She will know from her time on the Treasury Committee that following the Budget, we go through the planning guidance and have conversations with all core contracted sectors. That is part of the normal process. We are absolutely committed to building back the foundations of the NHS and social care system, making it fit for the 21st century and creating a 10-year plan to which we want everyone to contribute. Community and neighbourhood systems are a fundamental part of that.

GPs, pharmacies and social care homes from across Ceredigion Preseli have contacted me to express their concerns about the impact of the policy changes surrounding employer national insurance contributions. It is essential that they are supported with the cost that comes from this policy. The Minister has suggested that there might be additional support for some of them through the usual systems. Will she clarify whether that will mean funding being found from the Department’s budget, or whether there will be additional new money from the Treasury? That would have certain ramifications for the Welsh Government and whether they get additional Barnett formula funding.

I understand the concerns of the providers that have come to the hon. Gentleman, and he is right to raise them in this place. As he knows, health and social care is devolved to the Welsh Government, and there has been much benefit already from the Barnett consequentials of the Budget. We will continue to talk to the devolved regions—in, may I say, a much more co-operative way than the previous Government did—to ensure that we have a good system across the entire United Kingdom.

In a tweet to the Health Secretary, Caroline Rayment, who is the clinical lead for the Wharfedale and Silsden community partnership, said,

“you came to our practice in June and told us you wanted to support the family Dr. Costs for the NMW and NI will come to approx £50k—we are a small practice of 7000 patients—how is this helping us?”

Can the Minister answer Caroline’s question?

I am not abreast of all the Health Secretary’s tweets and the responses to them, but Caroline makes a point that has been made by many people in the Chamber today, as well as a number of providers. As I said in my opening statement, we understand the precarious situation that those providers have been put in because of the failures of the past 14 years and the £22 billion black hole that the Government have inherited. As my hon. Friend the Member for Shipley (Anna Dixon) said, general practice has been put in a precarious situation over the past 14 years, with thousands of practices going bust and giving back their contracts. That is a situation that we promised the British public we would change, and we will do so.

The hon. Gentleman may or may not think that this is political knockabout, but I was very clear in my opening statement that we understand the pressures that the sector is under. We understand the mess that we inherited, and we are fixing it. We are working with social care, GPs, providers and hospices that are affected by any changes in the Budget, and we will continue to talk to them in the usual way. We are committed to doing this faster than the last Government did it. Under the last Government, planning guidance and commitments to the NHS were always running late—they were always playing catch-up. We are committed to making sure that the sector is much more sustainable, so that it can do the important job we are asking it to do.

I call Jim Shannon.

Thank you, Madam Deputy Speaker. As Members know, I am the last person —when I am called, the debate is almost over.

Will the Minister confirm whether consideration has been given to the fact that the rise in national insurance contributions will not affect the NHS as a whole, as the block grant for us in Northern Ireland will cover it? However, GP practices in my constituency of Strangford will suffer, and unlike high street businesses or manufacturing, they cannot increase prices to cover that impending rise, leaving practices with no option other than to reduce hours in order to stay solvent. Does the Minister agree that this is the last thing already overstretched GP practices need, and will she commit to take this issue back to the Treasury for reconsideration as it relates to healthcare businesses such as GPs, dentists and pharmacies?

As the hon. Gentleman knows, health and social care is a devolved issue. We will continue to work closely with all the devolved areas, because we think that that is important, unlike the last Labour Government—the last Conservative Government. [Laughter.] I slipped there—I almost got through.

We absolutely understand the precarious nature of general practice and, in particular, I understand the really serious issues around health and social care in Northern Ireland. The hon. Gentleman knows that, and he makes a good case for the sector. We want to ensure that it supports people in Northern Ireland with the good primary and community care they deserve.