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Sir Keir Starmer will warn the NHS must “reform or die”, as the government publishes an independent investigation into the state of the health service.

The report – ordered by Health Secretary Wes Streeting days after he took on the role – was carried out by peer and surgeon Lord Darzi.

Politics live: Starmer and Sunak face off again over winter fuel

It will conclude the NHS is in a “critical condition”, with record waiting lists and too much of its budget spent in hospitals, as well as saying the nation’s health had significantly deteriorated over the past 15 years.

However, Lord Darzi will also say the service’s vital signs “remain strong”, as the sector is filled with staff who “shared passion and determination to make the NHS better for our patients”.

In a speech on Thursday, the prime minister will point to the probe’s findings and lay the blame at the Conservatives’ door – especially the impact of their 2012 Health and Social Care Act, which the report described as a “calamity” that had “proved disastrous”, as well as claims there has been a decade of underinvestment.

But he will offer his own solutions, with a 10-year plan from Labour that promises to have “the fingerprints of NHS staff and patients all over it”.

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Sir Keir will say: “Our NHS went into the pandemic in a much more fragile state. We had higher bed occupancy rates, fewer doctors, fewer nurses and fewer beds than most other high income health systems in the world.

“And let’s be clear about what caused that… a ‘scorched earth’ approach to health reform, the effects of which are still felt to this day.

“The 2010s were a lost decade for our NHS… which left the NHS unable to be there for patients today, and totally unprepared for the challenges and opportunities of tomorrow.”

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Minister’s plan to cut NHS waiting list

The prime minister will say there is a “profound responsibility” on the government to address the issues, for both health and economic reasons, promising three “big shifts” in its approach:

• Using more technology to create a “digital NHS”
• Shifting more care out of hospitals and into communities
• Moving from treating sickness to focusing on prevention

Sir Keir will warn that what he calls “the biggest reimagining of our NHS since its birth” will not be “easy or quick”.

But he will add: “What we need is the courage to deliver long-term reform – major surgery not sticking plaster solutions.

“The NHS is at a fork in the road, and we have a choice about how it should meet these rising demands – raise taxes on working people to meet the ever-higher costs of aging population, or reform to secure its future.

“We know working people can’t afford to pay more, so it’s reform or die.”

Report gives Starmer mandate for change

Lord Darzi’s damning report coincides with the publication of the NHS monthly performance data.

The figures will reinforce what the former health minister has laid bare in his blistering assessment of the health service. From A&E to children’s services, mental health to cancer treatment, his conclusion is that patients are being failed.

It is in this state because the NHS has suffered from consecutive body blows – years of chronic underfunding, a growing population with complex health needs and the impact of the pandemic. This should come as no surprise.

The slow, steady decline of the NHS has been evident for some time. The challenge facing the government is its response.

What does it do now? Lord Darzi recommends three key areas for urgent action: NHS reform that will see a shift away from hospitals towards primary care and community-based services, tackling the NHS estate, and utilising developing technology to improve patient care.

The government has already said it is going to prioritise the longest waits on the elective register. But should it do that while ignoring the root causes as outlined in the report?

There is the danger then that targets will continue to be missed in the mid to longer term.

The challenge facing the government is it does not have time to waste or money to spare. It is evident that fixing the NHS will need both.

Lord Darzi says there is no quick fix and it is likely the prime minister knows already what action must be taken first.

He knows too, that this report gives him a mandate for transformative and desperately needed change.

Shadow health secretary Victoria Atkins said the Tories would “review this report carefully”, but claimed Labour had appeared to have “missed an opportunity to put together meaningful plans for reform”.

She added: “We Conservatives recognise that investment has to be married with reform. This is why we brought forward long-term plans for productivity, tech, ‘Pharmacy First’, virtual wards, attracting pharmaceutical research and training and retaining staff. We did this whilst boosting investment in the NHS in real terms every single year.

“The Labour government will be judged on its actions. It has stopped new hospitals from being built, scrapped our social care reforms and taken money from pensioners to fund unsustainable pay rises with no gains in productivity. They need to move from rhetoric to action.”

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Liberal Democrat leader Sir Ed Davey, who campaigned heavily on health and social care during the last election, said the report’s findings showed the NHS was “on its knees after years of the Conservatives driving local health services into the ground”.

He said fixing the problem was “this country’s greatest challenge”, as he called for the government to “make it their top priority”, adding: “That must include recruiting more GPs, fixing our crumbling hospitals and crucially tackling the social care crisis that has been ignored for far too long.”

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Budget 2025: Raft of tax hikes expected today – as more policies confirmed

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Budget 2025: Raft of tax hikes expected today - as more policies confirmed

A raft of tax rises is expected in the budget this lunchtime – with the chancellor acknowledging that voters are “angry at the unfairness in our economy”.

In a newly released video, Rachel Reeves said the public is “frustrated at the pace of change” – but vowed to “take the fair and necessary choices” to tackle the cost of living crisis.

And in a dig at the Conservatives – especially former prime minister Liz Truss – she pledged not to impose austerity, lose control of public spending, or engage in more reckless borrowing.

Budget 2025: Follow the latest in the Money blog and Politics Hub

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10 times Labour promised not to hike taxes

Tax rises: What we know so far

Taxation will be a dominant part of the budget as Ms Reeves tries to plug an estimated £30bn black hole in the public finances.

A headline measure is expected to be an extension of the freeze on income tax thresholds for another two years beyond 2028, which should raise about £8bn.

But given the chancellor had ruled out such a measure last year – because it would “hurt working people” and “take more money out of their payslips” – this will attract criticism from opposition parties.

The chancellor has backed away from raising income tax rates outright, a move that would have breached Labour’s manifesto, but she still needs to find the cash to pay for her public spending plans.

Watch our special programme for Budget 2025 live on Sky News from 11am
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Watch our special programme for Budget 2025 live on Sky News from 11am

Some measures already confirmed by the government include:

• Allowing local authorities to impose a levy on tourists staying in their areas

• Expanding the sugar tax levy to packaged milkshakes and lattes

• Imposing extra taxes on higher-value properties

It is being reported that the chancellor will also put a cap on the tax-free allowance for salary sacrifice schemes, raise taxes on gambling firms, and bring in a pay-per-mile scheme for electric vehicles.

Setting the scene ahead of the budget at 12.30pm, Ms Reeves said she will “push ahead with the biggest drive for growth in a generation”, promising investment in infrastructure, housing, security, defence, education, and skills.

Although she has vowed not to “duck challenges” nor “accept that our past must define our future”, she admitted that “the damage done from austerity, a chaotic Brexit, and the pandemic were worse than we thought”.

What are the key timings for the budget?

11am – Sky News special programme starts.

About 11.15am – Chancellor Rachel Reeves leaves Downing Street and holds up her red box.

12pm – Sir Keir Starmer faces PMQs.

12.30pm – The chancellor delivers the budget.

About 1.30pm – Leader of the Opposition Kemi Badenoch delivers the budget response.

2.30pm – The independent Office for Budget Responsibility (OBR) holds a news conference on the UK economy.

4.30pm – Sky News holds a Q&A on what the budget means for you.

7pm – The Politics Hub special programme on the budget.

The fiscal black hole is down to several factors – including a downgrade in the productivity growth forecast, U-turns on cuts to benefits and the winter fuel allowance, as well as “heightened global uncertainty”.

Nonetheless, the chancellor has promised more investment to cut NHS waiting lists, deal with “waste in the public sector”, and reduce the national debt.

“This budget is for you, the British people. So that together we can build a fairer, stronger, and more secure Britain,” she said.

Conservative shadow chancellor Sir Mel Stride has said Ms Reeves is “trying to pull the wool over your eyes” – having promised last year that she would not need to raise taxes again.

Meanwhile, Liberal Democrat deputy leader Daisy Cooper has accused her and the prime minister of “yet more betrayals”.

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What is the ‘milkshake tax’?

What could her key spending announcements be?

As well as filling the black hole in the public finances, these measures could allow the chancellor to spend money on a key demand of Labour MPs – partially or fully lifting the two-child benefits cap, which they say will have an immediate impact on reducing child poverty.

Benefits more broadly will be uprated in line with inflation, at a cost of £6bn, The Times reports.

In an attempt to help households with the cost of the living, the paper also reports that the chancellor will seek to cut energy bills by removing some green levies, which could see funding for some energy efficiency measures reduced.

Other measures The Times says she will announce include retaining the 5p cut in fuel duty, and extending the Electric Car Grant by an extra year, which gives consumers a £3,750 discount at purchase.

The government has already confirmed several key announcements, including:

• An above-inflation £550 a year increase in the state pension for 13 million eligible pensioners

• A freeze in prescription prices and rail fares

• £5m to refresh libraries in secondary schools

Extra funding for the NHS will also be announced in a bid to slash waiting lists, including the expansion of the “Neighbourhood Health Service” across the country to bring together GP, nursing, dentistry and pharmacy services – as well as £300m of investment into upgrading technology in the health service.

And although the cost of this is borne by businesses, the chancellor will confirm a 4.1% rise to the national living wage – taking it to £12.71 an hour for eligible workers aged 21 and over.

For a full-time worker over the age of 21, that means a pay increase of £900 a year.

Read more from Sky News:
Will expected ‘stealth tax’ announcement affect you?
Are we set for another astoundingly complex budget?

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What the budget will mean for you

Britons facing ‘cost of living permacrisis’

However, the Tories have hit out at the chancellor for the impending tax rises, with shadow chancellor Sir Mel Stride saying in a statement: “Having already raised taxes by £40bn, Reeves said she had wiped the slate clean, she wouldn’t be coming back for more, and it was now on her. A year later and she is set to break that promise.”

He described her choices as “political weakness” – choosing “higher welfare and higher taxes”, and “hardworking families are being handed the bill”.

The Liberal Democrat deputy leader Daisy Cooper is also not impressed, and warned last night: “The economy is at a standstill. Despite years of promises from the Conservatives and now Labour to kickstart growth and clamp down on crushing household bills, the British people are facing a cost-of-living permacrisis and yet more betrayals from those in charge.”

She called on the government to negotiate a new customs union with the EU, which she argues would “grow our economy and bring in tens of billions for the Exchequer”.

Green Party leader Zack Polanski has demanded “bold policies and bold choices that make a real difference to ordinary people”.

The SNP is calling on the chancellor to “help families” rather than “hammer them with billions of pounds of cuts and damaging tax hikes that destroy jobs and hurt economic growth”.

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Budget 2025: What is a freeze on income tax thresholds – and will you pay more?

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Budget 2025: What is a freeze on income tax thresholds - and will you pay more?

A headline tax-raising measure expected in today’s budget is an extension of the freeze on income tax thresholds for another two years beyond 2028, which should raise about £8bn.

The amount people pay is dependent on how much they earn, with different tax bands kicking in at different income levels.

Read more: Chancellor to announce tax rises in budget

In the past, these thresholds have been increased in line with inflation. But more recently they have been frozen, leaving people paying more to the exchequer even if actual tax rates stay the same.

The Conservative government began the thresholds freeze in 2021. At last year’s budget, Rachel Reeves said the Labour government would extend the freeze though not beyond 2028, as to do so would “hurt working people”.

Sky News looks at what the thresholds are, the implications of freezing them, and how that causes “fiscal drag”.

Income tax thresholds

England, Northern Ireland and Wales all have the same income tax rates, set by the British government.

Scotland’s income tax bands are set by the Scottish government, so Westminster budget announcements on income tax do not affect workers in Scotland.

For England, Northern Ireland and Wales, there is a “personal allowance” of £12,570, under which no income tax is paid.

For those earning above £100,000, the personal allowance goes down by £1 for every £2 of income, and can go down to zero, so a person can end up paying income tax on all of their income.

What does freezing thresholds do?

Thresholds were previously increased annually by consumer price index (CPI) inflation – the estimate of the level of prices of goods and services bought by households.

But, because income tax thresholds have been frozen while wages continue to rise, more people are being brought into higher bands and having to pay more income tax.

A worker whose earnings just keep up with inflation is paying a larger proportion of their salary in tax due to the freeze.

This means more money for the government – a lot more.

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The budget vs your wallet: How the chancellor could raise billions

The Office for Budget Responsibility (OBR) estimates a continuing freeze in thresholds would raise about £42.9bn annually by the 2027/28 tax year.

And the Institute for Fiscal Studies (IFS) has projected that freezes to the basic and higher rates of income tax alone would raise £39bn a year by 2029-30.

That is roughly similar to the amount of revenue that would be raised by increasing all income tax rates by 3.5 percentage points.

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Sky News goes inside the room where the budget is decided

Fiscal drag

Freezing income tax thresholds without tax rates increasing has been branded a “stealth tax”, as the government collects more revenue without having to pass a law to raise tax rates.

It is also known as fiscal drag, as more people are pulled into paying tax, or into paying tax at a higher rate.

The OBR estimates the freeze will bring nearly four million more people into paying income tax, three million more people into the higher rate (40%) and 400,000 more into the additional rate (45%) by 2028-29.

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Army pauses use of Ajax armoured fighting vehicles after dozens of soldiers fall ill

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Army pauses use of Ajax armoured fighting vehicles after dozens of soldiers fall ill

The British Army has paused the use of its new Ajax armoured fighting vehicles after “around 30” soldiers suffered vibration and hearing problems following a training exercise at the weekend.

A Ministry of Defence (MoD) spokesperson said on Tuesday the two-week pause comes after “a small number of soldiers reported symptoms of noise and vibration” in the exercise, which was “immediately stopped”.

The spokesperson said “around 30 personnel presented noise and vibration symptoms” after tests were carried out, but the “vast majority of these have now been medically cleared and are continuing on duty”.

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Is the army’s new fighting vehicle any good?

A small number “continue to receive expert medical care”, they said.

“Out of an abundance of caution, the minister for defence readiness and industry [Luke Pollard] has asked the army to pause all use of Ajax for training and exercising for two weeks, while a safety investigation is carried out into the events this weekend.

“A small amount of testing of the vehicle will continue, in order to ensure that any issues can to identified and resolved.”

The MoD said the decision “underlines our absolute commitment to the safety of our personnel. As with any major equipment programme, we continue to test and refine the vehicle to ensure safety and performance”.

More on Ministry Of Defence

“The safety of our personnel is our top priority,” the spokesperson said.

The Ajax, which costs nearly £10m and weighs more than 40 tonnes, is being billed by the ministry as a “next generation” fighting machine.

The Ajax has a 40mm gun
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The Ajax has a 40mm gun

As heavy as a Russian tank, the vehicle is equipped with cameras, protective armour and a 40mm gun, with bullets that can rip through concrete.

Soldiers were taken to hospital this summer after suffering hearing and other injuries because of loud noise and vibrations coming from the vehicles.

Earlier this month, the MoD confirmed that a “small number” of troops had reported noise and vibration concerns following trials on three variants of the tracked vehicle.

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Ajax military vehicles. Pic: MoD
Image:
Ajax military vehicles. Pic: MoD

A spokesperson said an investigation was carried out and “no systemic issues were found”.

An internal review published in 2021 found that senior soldiers and MoD officials had known for up to two years that earlier faults with the Ajax vehicle had been putting troops at risk of harm.

The health and safety report revealed that issues such as potential hearing damage had first been raised in December 2018, but trials were not suspended until November 2020.

At that time, more than 300 soldiers were offered hearing tests, with 17 still under specialist care as of December 2021.

A total of 589 of the various Ajax models have been ordered by the army, which it expects to receive by 2030.

The Ajax could be deployed to Ukraine to support any possible peace deal, the MoD has indicated.

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