PARLIAMENTARY DEBATE
Public Service Reform - 24 April 2025 (Commons/Commons Chamber)

This Government believe in the power of good public services to provide security and opportunity, but we are clear that the way in which the state works has to change. That is why we are reforming the planning system to get more houses built, why we have introduced free breakfast clubs to give children the best start to their day, why we have launched the AI action plan to drive the adoption of new tech in public services, and why a combination of investment and reform has helped us to cut NHS waiting lists for months in a row.

Labour was elected to get the NHS back on its feet, and that is exactly what we have been doing. At Sandwell and West Birmingham hospitals NHS trust in my area, the waiting list has fallen by 10% since the election, which means that patients are finally getting the treatment they need. One of the key things we have been doing is to look at things such as ambient AI to automate doctors’ notes and ensure that we have modern technology in the NHS. Will the Minister set out what we are doing to ensure that the NHS adopts all technology and reform to ensure that patients are being seen as quickly as possible?

My hon. Friend is absolutely right. There is huge potential to increase NHS productivity through the adoption of new technology and AI. As I have said, the combination of investment and reform has helped us meet our election pledge to deliver 2 million extra NHS appointments in England in the first year seven months early, but we want to go further. We want to adopt the technology to which my hon. Friend has referred to get maximum productivity and better outcomes for patients.

I thank the Minister for his response. I have been contacted by a constituent who is concerned for his poorly elderly father, who requires cryotherapy. That service used to be offered at his local GP, avoiding a difficult trip to our local hospital, which would have a deleterious impact on his father’s already poor health. Given the Government’s focus on moving more health services into the community and people’s homes as part of our public service reform agenda, does my right hon. Friend agree that cryotherapy services should be considered as part of that welcome shift?

The Health Secretary has talked about three big shifts that are part of the 10-year NHS plan. One of those shifts is from hospital to the community, which will require more services to be available locally. We have agreed a new GP contract, which will see a large boost to general practitioner funding, alongside reforms to improve digital access. If we are going to make this shift, it is important that services are available in the local community.

The Government’s laudable mission-led approach has seen NHS waiting lists fall for five months in a row. Like many public services, our NHS has been plagued by over-specified guidance and unnecessary targets for many years, so will the Minister assure the House that the mission-led approach will mean a focus on core non-negotiables to deliver for the British people?

The missions set out the Government’s long-term targets, and the plan for change sets out the key targets for the next few years. I do believe that targets can play a key role in driving behaviour, and that the focus on getting waiting lists and waiting times down set out in our plan for change can make a real difference over the coming few years.

I thank the Minister for that answer. I know from my time as a councillor outside this place that under the last Government, policy was made in Westminster, with very little thought given to how it could hit frontline services more locally. However, examples such as test and trace during the pandemic show that local services can deliver national priorities effectively, so what can the Minister do to ensure that civil servants down here work better with frontline workers up there to make sure that this Government’s priorities are being delivered?

The hon. Member makes a very good point. It is really important that we change the way in which policy is made—that we listen more to the frontline and work with the test-and-learn approach that was referred to by the Minister for the Cabinet Office in answer to the previous question. That can help drive better outcomes for the public.

Over recent years, the public have seen the state get bigger and taxes go up, but they have not always felt that they are getting the right outcome from those changes. To deliver our plan for change, we need to reform the state to make it more efficient and more effective. We have started to deliver those reforms through stronger performance management, accelerating AI adoption, a focus on the frontline, and reforming rules around recruitment and secondments. Those plans will help empower our excellent civil services to work better, reduce bureaucracy and focus on what really matters, which is better outcomes for the public.

I commend the ministerial team, both on the innovation fund and—more importantly—the test-and-learn culture that has been referred to, which embraces a willingness to take risks and iterate. Does the Minister agree that in order for this work to be truly successful and transform our public services, we must also reform our governance and approval processes in parallel, so that they do not inadvertently stifle this welcome method of innovation?

The right hon. Member obviously has hugely important experience in this regard. He will know from that experience that the traditional system can be risk-averse, and that it can seek to resolve too much and try to cover every base before launching a policy. The test-and-learn approach is different by intention. It intends to start small and to build from there. What is absolutely certain is that whether it is his party or my party in power, there is a duty on any Government today to pursue reform of the state to improve outcomes for the public, so in that regard I agree with him.

A number of months ago, the Chancellor of the Duchy of Lancaster announced the plan for change and the pillars, missions and various other things that come with it. When will he update the House on how that is going and how the Government are meeting those targets?

Well, I have good news for the right hon. Gentleman. [Laughter.] This is parliamentary accountability in action. One of the key targets in the plan for change was to get waiting lists and waiting times down. I am pleased to report to him that they have fallen for five months in a row and that we have met our first step on 2 million extra appointments early, and I look forward to more progress in the future.

With 2,100 jobs set to go at the Cabinet Office by 2028, please can the Minister confirm what impact those cuts will have on his Department? What responsibilities might be transferred out of it?

The Cabinet Office has tripled in size in the past decade or so. I think it is right, after growth like that, that we look at productivity and how to get the best outcomes for the public. We have introduced a mutually agreed exit scheme. Some of the headcount reduction will be by transferring functions to other places, but I believe that the Cabinet Office can absorb a headcount reduction after, as I said, tripling in size over the past decade or so.

Can the Minister outline Government plans to reform the funding of fire authorities? That is especially important in Somerset, where changes to employer national insurance contributions, the ending of the rural support grant, the removal of the services grant and the reduction of the pension grant will cost Devon and Somerset Fire Authority nearly £2 million a year, at a time of rising costs.

I do not want to interrupt the collegiate mood we have had this morning by pointing out that we had to take those decisions after the inheritance we received. I cannot speak for every local authority settlement around the country, but the local authority settlements announced after the Budget were on the whole better than they have been for many years. They will not make up for the past 14 years, but they are better settlements than many local authorities have seen for some time.

I thank the Minister very much for his answers to those questions. The reform of public services is important, and I welcome the ideas he has put forward. I know he has a deep interest in Northern Ireland. Is it possible on his journeys to Northern Ireland—I understand that he goes regularly —for him to discuss the reform of public services with the Northern Ireland Assembly and the relevant Minister to ensure that we can have the same benefits that come from what he is putting forward today, thereby improving services and saving money at the same time?

It is important that we have good dialogue between all the devolved Governments and the UK Government. I believe that we do have that good dialogue in place at the moment. There are always different political parties represented around the table, and people will come at things from a particular angle, but when it comes to this kind of agenda, the questions are: how do we get the best value for money for people, how do we get waiting lists down, and how do we make sure that the taxes that people pay get the best possible public sector productivity? There is a common agenda there, and I see no reason why we cannot keep working productively together on that.