- 11:59 am
- With permission, Madam Deputy Speaker, I shall make a statement to the House on “Fit for the Future”, the Government’s 10-year health plan for England.There are moments in our national story when our choices define who we are. In 1948, the Attlee Government made a choice founded on fairness: that everyone in our country deserves to receive the care they need, not just the care they can afford. It enshrined in law, and in the service itself, our collective conviction that healthcare is not a privilege to be bought and sold, but a right to be cherished and protected.Now it falls to our generation to make the same choice: to rebuild our national health service, and to protect in this century what Attlee’s Government built for the last. That is the driving mission of our 10-year plan.In September, Lord Darzi provided the diagnosis: the NHS was broken by 14 years of Conservative under-investment, and by their catastrophic top-down reorganisation. In the past year, Labour has put the NHS on the road to recovery. We promised 2 million extra appointments; we have delivered more than 4 million. We promised 1,000 new GPs on the frontline; we have recruited 1,900. We have taken almost a quarter of a million people off waiting lists, cutting them to their lowest level in two years. And we have launched an independent commission, chaired by Baroness Casey, to build a national consensus around a new national care service to meet the needs of older and disabled people into the 21st century.Today, the Prime Minister has set out our prescription to get the NHS back on its feet and make it fit for the future. Our plan will deliver three big shifts. The first is from hospital to community. We will turn our national health service into a neighbourhood health service. The principle is simple: care should happen as locally as it can—digitally by default, in a patient’s home if possible, in a neighbourhood health centre when needed, and in a hospital where necessary.We will put neighbourhood health centres in every community, so people can see a GP, nurse, physio, care worker, and therapist, and they can get a test, scan or treatment for minor injuries, all under one roof. The NHS will be organised around patients, rather than patients having to organise their lives around the NHS. It will be easier and faster to see a GP. We will train thousands more, end the 8 am scramble, provide same-day consultations, and bring back the family doctor. If you are someone with multiple conditions and complex needs, the NHS will co-create a personal care plan, so your care is done with you, not to you.Pharmacies will play an expanded role in the neighbourhood health service. They will manage long-term conditions, treat conditions such as obesity and high blood pressure, screen for disease and vaccinate against it. We will also reform the dental contract, to get more dentists doing NHS work, rebuilding NHS dentistry.Over the course of this plan, the majority of the 135 million out-patient appointments done each year will be moved out of hospitals. The funding will follow, so a greater share of NHS investment is spent in primary and community care.The second shift is from analogue to digital. No longer will NHS staff have to enter seven passwords to login to their computers, or spend hours writing notes and entering data. Our plan will liberate frontline staff from the parts of the job that they hate, so they can focus on the job that they love—caring for patients. For the first time ever, patients will be given real control over a single, secure and authoritative account of their data. The single patient record will mean that NHS staff can see medical records and know a patient’s medical history, so they can provide them with the best possible care.Wearable technology will feed in real-time health data, so patients’ health can be monitored while they stay in the comfort of their own home, with clinicians reaching out at the first signs of deterioration. The NHS app will become the front door to the health service, delivering power to the patient. You will be able to: book and rearrange appointments for you, your children or a loved one you care for; get instant advice from an AI doctor in your pocket; leave feedback on your care and see what feedback other patients have left; choose where you are treated; book appointments in urgent care so you do not wait for hours; and refer yourself to a specialist where clinically appropriate. Of course, patients can already do all that, but only if they can afford private healthcare. With Labour’s plan, every patient will receive a first-class service—whatever their background and whatever they earn.The third shift is from sickness to prevention. Working with the food industry, we will make the healthy choice the easy choice to cut calories. We will roll out obesity jabs on the NHS. We will get Britain moving with our new NHS points scheme, and we will update school foods standards so that kids are fed healthy, nutritious meals. We will tackle the mental health crisis with support in every school to catch problems early, 24/7 support with virtual therapists for those with moderate need, and dedicated emergency departments for patients for when they reach crisis point.The science is on our side. The revolution in artificial intelligence, machine learning and big data offers a golden opportunity to deliver better care at better value. New innovator passports and reform of the National Institute for Health and Care Excellence and the Medicines and Healthcare products Regulatory Agency will see medicines and technology rapidly adopted. Robotic surgery will become the norm in certain procedures, so patients recover from surgery at home rather than in hospital beds. The NHS will usher in a new age of medicine, leapfrogging disease so that we are predicting and preventing, rather than just diagnosing and treating. It is therefore the ambition of the plan to provide a genomic test for every newborn baby by 2035. Thanks to my right hon. Friend the Chancellor, this plan is backed by an extra £29 billion a year by the end of the spending review period, as well as the biggest capital investment in the history of the NHS.Alongside investment comes reform. This plan slashes unnecessary bureaucracy and devolves power and resource to the frontline. It abolishes more than 200 bodies, because listening to patients, guaranteeing safety and protecting whistleblowers is core business for the NHS and should never have been outsourced. The plan commits to publishing league tables to rank providers. We will intervene to turn around failing providers, and we will reinvent the foundation trust model in a new system of earned autonomy. Pay will be tied to performance, so that excellence is recognised and failure has consequences. Tariffs will be reduced to boost productivity. Block contracts will end, with funding tied to outcomes. The plan gives power to the patient, so hospitals are financially rewarded for better service. It closes health inequalities by investing more in working-class communities, and it establishes a national investigation into maternity and neonatal services to deliver the truth, justice and improvement that bereaved families deserve.I am sometimes told that NHS staff are resistant to change. On the contrary, they are crying out for it. They suffer the moral injury of seeing their patients treated in unfit conditions. They are ones driving innovation on the frontline, so their fingerprints are all over this plan. The public are desperate for change too. Each of us has our own story about the NHS and the difference it made to our lives. We also know the consequences of failure. To succeed, we need to defeat the cynicism that says that nothing ever changes.We know that the change in our plan is possible because it is already happening. We have toured the length and breadth of the country and scouted the world for the best examples of reform. If Australia can effectively serve communities living in the outback, we can surely meet the needs of rural England. If community health teams can go door to door to prevent illness in Brazil, we can certainly do the same in Bradford. We know that we can build the neighbourhood health service, because teams in Cornwall, Camden, Northumbria, and Stratford—where I was with the Prime Minister and Chancellor this morning—are already showing us how to do it. We will take the best of the NHS to the rest of the NHS. We will apply to best examples of innovation from around the world to benefit people here at home. Above all else, we will give power to the patient. This plan fulfils Nye Bevan’s commitment in 1948 to put a megaphone to the mouth of every patient. It will restore the founding promise of the NHS to be there for us when we need it.Of course, we know that there are those on the right who are willing us to fail. They will exploit the crisis in the NHS in order to dismantle it. The hon. Member for Clacton (Nigel Farage) and his cronies argue that universal healthcare could be afforded in the 20th century but not in the 21st. Labour rejects their declinist pessimism and so do the public. But that is the choice—it is change or bust, and we choose change.We know that the British people are counting on us. It falls to us to ensure that the NHS not only survives but thrives, and we will not let our country down. Of course, if we succeed, we will be able to say with pride that will echo down the decades of the 21st century that we were the generation who built an NHS fit for the future and a fairer Britain where everyone lives well for longer. I commend this statement to the House.
- I call the shadow Secretary of State.
- 12:11 pm
- I thank the Secretary of State for his typical courtesy in providing advance sight not only of his statement but of his plan. I am grateful, and others on the Government Front Bench might learn a thing or two from him. I am pleased to see the plan published. This Secretary of State is a rare thing these days: one whose announcements do tend to survive largely intact for more than a week. In the case of the plan, it is vital that it does stick.The Secretary of State is not known to be short on ambition, and to be fair that is reflected in his plan; it is ambitious. I believe that his long-term goals are right and that the reforms he has set out build on the reforms that the Conservatives set out and carried out. The desire to shift care from hospital to community, to better use technology and to move to prevention is not new at all, but it remains vital.The NHS undoubtedly needs reform, not just more cash—it is not fiscally sustainable in the long term to have 38% of day-to-day Government spending going on the NHS—so we need to focus on outcomes, not just inputs. But the plan, while welcome, is still sketchy on some of the details of delivery and how it will be paid for without the funds that the Secretary of State mentioned being eaten by pay rises and by inflation, as well as how that shift will be staffed. Greater use of the app is right, and builds on the amazing work done on the app by my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay) when he was Secretary of State. Greater use of technology and of genomics is right, and the Secretary of State’s big five tech bets are largely right, but, as he knows, tech alone will not deliver this; people will, so a workforce plan that is clearly aligned with his strategy is vital.Neighbourhood health centres are one of the measures at the heart of the Secretary of State’s plan. The concept is an interesting one, but it does throw up a number of questions that I hope he can answer in the spirit in which they are asked. Will the providers of those new centres be NHS public sector organisations, private sector organisations or a mixture? How will the centres fit with GP provision and other services without duplication or fishing in the same pool for staff? What assessment has he made of the cost of new buildings and technology to go in them? How many centres does he envisage, and by when? Crucially, how will he ensure that a public-private partnership model will avoid the downsides of the Blair- Brown private finance initiative model?
- I thank the shadow Secretary of State for his constructive approach to what does need to be a successful plan for the next decade, to get our NHS back on its feet, to make it fit for the future and to make sure we improve the health of the nation. Aside from the lines that he was no doubt given to trot out at the beginning—he almost said them with conviction—we know that we can count on him to be rather more serious and sensible than the display we saw from the Opposition yesterday.I turn to the shadow Secretary of State’s points. He was right to say that investment needs to go alongside reform. That is why the spending review only a matter of weeks ago set out the Chancellor’s commitment to the NHS and NHS reform. The Government are providing a £29 billion real-terms increase—a £53 billion cash increase—in annual NHS day-to-day spending by 2028-29. That funding will support the first steps towards delivering the reforms, the service improvements and the new technology set out in the plan.But investment alone is not enough. One of the reasons we are paying more and more for worse and poorer outcomes is that we have the wrong care in the wrong place at the wrong time. Contrary to what we read in some newspaper columns—on the radio this morning I heard the hon. Member for Clacton once again attacking the NHS’s equitable principles and funding model—the problem is not the model of funding; it is the model of care. That is why the shift to neighbourhood health is essential for delivering better outcomes for patients and better value for taxpayers.The technology coming down the track, and indeed the technology we already have, will drive the big productivity gains in the system that have eluded us. In recent years, the previous Government invested in more staff, but they put all those staff in hospitals to work in an undercapitalised NHS. If there are more inputs but not the enablers to deliver the service, we do not see the responding improvements in output and impact. That drives poorer productivity, poorer value for money and poor outcomes for patients, and that is the approach that we are changing.
- I call the Chair of the Health and Social Care Committee.
- As the acting Chair of the Health and Social Care Committee, I am delighted that the 10-year plan was finally launched today. I thank the Secretary of State for Health and Social Care for presenting it to the House.The plan represents a major opportunity for constructive reform of the health and social care system, and I am delighted that the Secretary of State will come to the Committee on 14 July to be scrutinised on it. Many organisations have waited patiently for the 10-year plan to be published. Will the Secretary of State explain how the plan will help restore the promise of a first-class service in the NHS?
- I thank my hon. Friend for her question and for the leadership she is showing to the Select Committee while the substantive Chair, the hon. Member for Oxford West and Abingdon (Layla Moran), is off on mat leave. What a delight it was to see the Committee Chair on the Terrace this week with her new baby. That was really delightful and we wish her well.One of the exciting things for me about today’s launch is just how widespread the support has been from across a range of different organisations that we will need to work with to deliver the plan. Whether it is the royal colleges and the trade unions, the organisations that represent patients, the wide range of healthcare charities or, crucially, frontline staff, everyone is up for this change and everyone is desperate for it to succeed.We will not get everything right and we will make mistakes along the way. We will listen and always learn and reflect. We know in the Government that we cannot do this without effective leadership from Ministers, but nor can Government do this alone. It is now our responsibility to mobilise the more than 1.5 million people who work in the NHS, the more than 1.5 million people who work in social care and our whole country behind a national mission to get our NHS back on its feet, to make sure it is fit for the future and to make sure, fundamentally, that we attack the injustices that lead to ill health, so that we have a fairer Britain where everyone lives well for longer.
- I call the Liberal Democrat spokesperson.
- I thank the Secretary of State for early sight of the plan this morning. After years of Conservative failure, a plan for the future of the NHS is welcome and Liberal Democrats support the Secretary of State in his vision to shift the NHS to a community-focused, preventive service. However, I seek his reassurance on some questions.In the 143 pages of the 10-year plan, there is only a passing reference to social care. Everyone knows that we cannot fix the NHS without fixing social care. With so many people unable to return home from hospital to get the care they need, solving the crisis in social care is a huge part of moving care out of hospital and into the community. Will the Secretary of State bring forward the Casey review, so that it reports in full this year, and reinstate the cross-party talks, so that consensus can be reached on the future of care?I welcome the idea of a neighbourhood health centre, but how does that interact with the plan for GPs? The 10-year plan implies that GP contracts will encourage them to cover a huge geographic area of 50,000 people. In North Shropshire, that would be two or three market towns combined and would span dozens of miles. Can the Secretary of State reassure me that there will still be a physical health centre, accessible to all, and that in areas with little public transport in particular, people will be able to access care when they need it?Finally, the plan hinges on the shift to digital solutions, and that is not without risk. The use of the NHS app is critical to what happens. How will the Secretary of State ensure that those without a smartphone—because they cannot afford one, do not feel confident using one or simply do not have adequate broadband or internet—can access the NHS? Many elderly and disabled people in particular who are digitally excluded will feel worried by today’s announcement.
- I welcome the Liberal Democrat support for the plan, and the constructive way in which Liberal Democrats have sought to work with us since the general election in pursuit of better health and social care services. I understand the point the hon. Member makes on social care. I will not repeat at length the points I made to the shadow Secretary of State, the right hon. Member for Melton and Syston (Edward Argar), but I hope the House is reassured by the action we are already taking on social care, whether through greater funding, the expansion of the carer’s allowance, increasing the disabled facilities grant, the fair pay agreements, and ensuring a partnership with social care to deliver better neighbourhood health services.Given what we have said about the importance of data, digital connections and better systems, I should say that in some parts of the country, the social care system is ahead of the NHS; it makes better use of data, and joins up systems in a more effective and efficient way. The NHS can learn lots from social care, as well as the other way round. I will take on board the representations of the Liberal Democrat and Conservative Front Benchers on speeding up the Casey commission—that is duly noted.I absolutely reassure the hon. Member for North Shropshire (Helen Morgan) on the point that she raises about neighbourhood health centres. One of the reasons we want to devolve so much power in the NHS is that I genuinely think that the closer decisions are made to the communities they serve, the better the outcomes and the provision. A one-size-fits-all approach to neighbourhood care simply will not work. My constituency is on the London-Essex border, and there are three hospitals within a 15-to-20 minute drive of where I live. In many rural towns, coastal communities and villages across the country, there is not even one hospital within that distance. In fact, people are driving huge distances across the country to get to a hospital. On our priority of rolling out neighbourhood health centres, I want to reassure Members on both sides of the House that we will start with the areas of greatest inequality and need, and communities where people have to travel far to their nearest hospital, so that people can genuinely receive care closer to home and, indeed, at home. Technology can play a big role in that.
- Several hon. Members rose—
- Order. Some 60 Members wish to participate. Clearly, the statement will likely impact every constituency in the country, so I understand why so many hon. Members wish to question the Secretary of State. It is our intention to try to call everybody, but there is important business later that has to be reached. May I urge brevity on all Members, and short answers on the Secretary of State? Health Committee member Jen Craft will now set an example.
- Thank you, Mr Deputy Speaker. The heart, soul and lifeblood of our NHS are the people who work in it. I doubt there is anyone in this House who does not owe a personal debt of gratitude to a health care worker. Can the Secretary of State reassure me that the fingerprints of NHS workers are all over this 10-year plan, and that it has been designed and produced with all their valuable inputs?
- I certainly can give my hon. Friend that reassurance. We launched the biggest consultation since the NHS began. We had over 270,000 contributions, 250,000 thousand responses and almost 2 million visits to the change.nhs.uk website, so I can absolutely give people the assurance that staff and patients’ fingerprints are all over the plan. That is why we have such a rich plan, in which people can have confidence.
- There is much to welcome in today’s plan, particularly the proposal to bring back family doctors, which I tried to do but frankly did not succeed in doing when I was Secretary of State, so we all wish him well with that, but does he agree that as we seek to transform out-of-hospital care, it is vital that we do not take our eye off the ball and allow another Mid Staffs inside hospitals? Does he also agree that it is essential that the CQC gives overall ratings and calls a spade a spade when it comes to the quality of care in hospitals, so that we know whether the care delivered by hospitals in our constituencies is outstanding or good, and if not—if it requires improvement or is inadequate—that action can be taken, and lives can be saved?
- I strongly agree with my predecessor on that. It is important that the CQC’s reports and judgments can be understood by the public and the people responsible for carrying out the improvements that it recommends. Via the NHS app, we will have much more transparency for patients about the range of providers, the quality of services and the views of other patients. That will give patients the freedom to choose, in a more data-driven way, where and when they are treated. There is also the importance of data-driven face-to-face inspections by experts. We can also have early warning systems that would alert people who hold his office and mine that something is going seriously wrong, so that we can intervene before more lives are lost unnecessarily.
- I call Select Committee member Josh Fenton-Glynn.