NHS Long-term Plan

Statement

My Lords, with the leave of the House, I shall now repeat a Statement given in the other place by the Secretary of State, Matt Hancock MP. Before I do so, I put on the record my appreciation and thanks to my noble friend Lord O’Shaughnessy. I am sure the House will agree that he has been an outstanding Minister and cares passionately about the NHS and the people who work in it. I wish him every success in his future endeavours. The Statement is as follows:

“Mr Speaker, with permission, I would like to make a Statement about the NHS long-term plan. The plan sets out how we will guarantee the NHS for the future. It describes how we will use the largest and longest funding settlement in the history of the NHS to strengthen it over the next decade, rising to the challenges of today and seizing the opportunities of the future.

It is worth taking a moment to reflect on when the NHS was first proposed from this Dispatch Box by Churchill’s Government in 1944—when, even after the perils of war, infant mortality was nearly 10 times what it is now; when two-thirds of men smoked and life expectancy was just 66; 10 years before we knew the structure of DNA; four decades before the first MRI.

The NHS has, throughout its history, led the world. But one constant has been that core principle set out by the national government—that the NHS should be available to all, free at the point of use according to need, not the ability to pay. As last year’s 70th anniversary celebrations proved, the NHS is one of our proudest achievements as a nation. We all have an emotional connection to it—it is part of our family history—and we all owe an enormous debt of gratitude to the people who make the NHS what it is and work so hard, especially during the winter months when the pressures are greatest.

Because we value the NHS so much, the new £20.5 billion funding settlement announced by the Prime Minister in June provides the NHS with funding growth of 3.4% a year in real terms over the next five years. This means the NHS’s budget will increase in cash terms by £33.9 billion, rising from £115 billion this year to £121 billion next year, £127 billion in 2020-21, £133 billion in 2021-22, £140 billion in 2022-23 and £148 billion in 2023-24. This rise, over £1 billion more in cash terms than proposed in June, delivers on our commitment to the NHS and will safeguard the NHS for the long term. This will help address today’s challenges. The NHS is facing unprecedented levels of demand. Every day, the NHS treats over 1 million people. Compared with 2010, NHS staff carried out 2 million more operations and saw 11.5 million more out-patients last year. Despite record demand, performance was better this December than last. So we will address today’s challenges, not least with the extra £6 billion coming on stream in under three months.

As well as addressing today’s challenges, the NHS long-term plan sets up the NHS to seize the opportunities of the future. At the heart of the plan is the principle that prevention is better than cure. In future, the NHS will do much more to support people to stay healthy, rather than just treat them when ill. So the biggest increase to any part of the NHS, at least £4.5 billion, will go to primary and community care, because GPs are the bedrock of the NHS. That means patients having improved access to their GPs and greater flexibility about how they contact them; better use of community pharmacists; better access to physiotherapists; and improved availability of fast and appropriate care to help communities keep people out of hospital altogether.

Organisations across the NHS, local councils, innovators and the voluntary sector will all work more closely together so that they can focus on what patients need. There will be a renewed clampdown on waste, so we can ensure that every penny of the extra money goes towards improving services and giving taxpayers the best possible return.

Ultimately, staff are at the heart of the NHS. The long-term plan commits to major reforms to improve working conditions for NHS staff, because morale matters. Staff will receive better training and more help with career progression. They will have greater flexibility in their work, be supported by the latest technology that works for them and be helped with their own mental health and well-being. This already happens in the best parts of the NHS, and I want to see it happen everywhere. We will bring in training, mentoring and support to develop better leadership in the NHS at all levels. We will build on work already going on to recruit, train and retain more staff so that we can address critical staff shortages.

The plan is the next step in our mission to make the NHS a world-class employer and deliver the workforce it needs. To deliver on these commitments, I have asked Baroness Dido Harding to chair a rapid programme of work, which will engage with staff, employers, professional organisations, trade unions, think tanks and others to build a workforce implementation plan that puts NHS people at the heart of NHS policy and delivery. Baroness Harding will provide interim recommendations to me by the end of March on how the challenges of supply, culture and leadership can be met, and final recommendations later in the year as part of the broader implementation plan that will be developed at all levels to make the NHS long-term plan a reality.

That is the approach we will be taking to support the NHS over the next decade, but what does it mean for patients and the wider public? It means patients receiving high-quality care closer to home; supporting our growing elderly population to stay healthy and independent for longer; more personalised care; more social prescribing; and empowering people to take greater control and responsibility over their own health through prevention and personal health budgets. It means access to new digital services to bring the NHS into the 21st century. It means more support for mothers by improving maternity services, and more support for parents and carers in the early years of a child’s life, so we can be the best place in the world in which to be born, in every sense. We will improve how the NHS cares for children and young people with learning disabilities and autism by ending inappropriate hospitalisation, reducing over-medicalisation and providing high-quality care in the community.

The NHS will tackle unacceptable health inequalities by targeting support towards the most vulnerable in areas of high deprivation. To help make a reality of the goal of parity between mental and physical health, we will increase mental health service budgets, not by £2 billion but by £2.3 billion a year. For the first time ever, we will introduce waiting time targets for community mental health, so that people get the treatment they need when they need it. We will also expand services for young people to include those up to the age of 25.

The long-term plan focuses on the most common causes of mortality, including cancer, heart disease, stroke and lung disease. The health service will take a more active role in helping people to cut their risk factors: stopping smoking, losing weight and reducing alcohol intake. The NHS will improve the quality and speed of diagnosis, and improve treatment and recovery, so we can help people live well and manage their conditions. We will upgrade urgent care, so people can get the right care more quickly.

The NHS long-term plan has been drawn up by the NHS, by over 2,500 doctors, clinicians, staff and patients. The plan will continue to be shaped and refined by staff and patients as it is implemented, with events and activities across the country to help people understand what it means for them and their local NHS services. The experts who wrote the plan say that it will lead to the prevention of 150,000 heart attack, stroke and dementia cases and to 55,000 more people surviving cancer each year. In all, half a million lives will be saved over the next 10 years, funded by the taxpayer, designed by doctors and delivered by this Government.

Today is an important moment in the history of the NHS. Our long-term plan will ensure the NHS continues to be there, free at the point of use, based on clinical need and not the ability to pay. But it will be better resourced, with more staff, newer technology and new priorities: a health service that is fit for the future, so it is always there for us in our hour of need. I am proud to commend this Statement to the House”.

My Lords, I join the Minister in wishing the noble Lord, Lord O’Shaughnessy, well in his new position. I suspect this probably does not mean that he will be any less active on these issues.

I thank the noble Baroness for repeating the Statement. It would be churlish not to welcome additional funding for the NHS, but to suggest in some way, as the third sentence of the Statement does, that the noble Baroness’s party and Government were responsible for the establishment of the NHS is breathtakingly cheeky, to put it mildly. That is particularly so given that her party proceeded to oppose and vote against the establishment of the NHS by the post-war Labour Government.

What must we welcome in today’s Statement? We can welcome the use of genomics in developing care pathways and the commitment to early cancer diagnosis—after all, that was one of Labour’s policies in the most recent general election and in the ones before it. We should of course welcome the commitment to new CT and MRI scanners—again, a Labour policy. We welcome the greater focus on child and maternal health, including an expansion of perinatal mental health services—we welcome it because it has been our policy for some time. We welcome the rollout of alcohol teams in hospitals because, again, we have been urging the Government to do that for some time.

More generally, it is a shame that the noble Baroness started her Statement in the manner of making claims which are not borne out by actions. In many ways this symbolises the disingenuousness which lies at the heart of the Statement. The Government’s words about their conduct and behaviour towards the health and social care services in the UK are one thing, but their actions simply do not match their words.

There is much that one can agree with in the 123-page document launched today, especially given the involvement of doctors in creating it. However, many of the ideas, such as “prevention is better than cure”, seem to have come as a great revelation to our relatively new Secretary of State, if his recent performance in the media is anything to go by. That has, however, been the thinking on these Benches and across your Lordships’ House in many debates over many years, as it has been for decades in all the think tanks and health charities and, indeed, among almost everyone involved in the NHS.

My Lords, I associate these Benches with the very warm wishes sent in the direction of the noble Lord, Lord O’Shaughnessy, in his future endeavours.

We welcome the publication of the long-term plan today. It is a very important document. It will take time to absorb all its contents and we on these Benches would welcome an opportunity to debate it in more detail. Yes, there is a lot to welcome in the plan, particularly the focus on prevention. We welcome the focus on children and young people’s services and particularly the inclusion of issues relating to people with learning disabilities. But there are many concerns about how this plan will be put into effect. The workforce plan will have to work a lot better than any of the existing workforce plans, particularly if we are to be successful in retaining existing NHS staff as well as recruiting new staff and getting NHS staff to return, feeling that it is possible to work in more flexible ways. It will require a much more creative staff plan than we have at the moment.

Of course it is good news that we will focus on prevention rather than cure, but will the Minister clarify the precise funding mechanisms that would allow that to happen, particularly the role of NHS England, Public Health England, and local authorities in this new world? Will she also confirm the role that pharmacies will play in the public health agenda and the funding mechanism for that? Also, when will the Green Paper on social care be published? It is critical to the agenda that is being set out. I particularly welcome the £2.3 billion set aside for mental health services as part of the long-term plan. What is vital now is that everyone in the NHS, local authorities, schools and employers work together to deliver these plans and ensure that that money gets to the front line. Will that money be ring-fenced?

I take a particular interest in children and young people’s mental health. We are told, and it is welcome, that there will be a new emphasis on crisis care and a new single point of access or crisis hotline delivered through NHS 111 and with that, we are told, all children and young people experiencing mental health crises will be able to access age-appropriate crisis care 24 hours a day, seven days a week. That is to be welcomed. But will the Minister say whether that new crisis care service, which I wholeheartedly support, will be part of or separate from the adult 24/7 community-based mental health crisis response service, which is also contained in the plan? Will it also include 24/7 availability of CAMHS assessment in all A&E departments in hospitals up and down the country?

My Lords, I thank both noble Baronesses for their contributions to this Statement. I am very grateful for some of the positive comments that were made from both Benches. I am very proud that this Government are putting £20.5 billion into the NHS. That is an amazing achievement. We must recognise that this is a great achievement for the NHS. The NHS is working closely within itself and with the Government to ensure that we can deliver the outcomes we all want, which are improved care for those who use the NHS and to prevent people from getting ill in the first place. I welcome this. As someone who worked in the NHS in my early days I recognise the importance of this money. We are not being disingenuous in what we are trying to achieve—far from it. It is because we passionately care about the NHS that we are doing this.

A number of points were raised by both noble Baronesses. I hope that they will appreciate that I have only just got this brief, but I will endeavour to do my best to answer all the questions. However, if there are any that I have not responded to, I will of course write to the noble Baronesses and place a copy in the Library. The noble Baroness, Lady Thornton, quite rightly raised the issue of staff. We need staff in the NHS if we are to carry out any plans. They are very important to us. She asked what we were doing. There are record numbers of dedicated NHS staff and they work tirelessly to make sure that patients get excellent care. We support them by training 25% more doctors, nurses and midwives, giving a significant pay rise to over 1 million staff and listening to the issues that matter to them. We know that this is a complex area and we are listening and talking to staff to see how we can bring about greater improvements in workforce planning.

To put this into context, there are currently record numbers of doctors, paramedics and ambulance staff, and all HCHS staff. The monthly workforce statistics for September 2018 show that since May 2010, there are over 45,900 more professionally qualified clinical staff working in NHS trusts and CCGs, including 16,500 or 17.4% more doctors, over 6,500 or 2.2% more nurses, midwives and health visitors, and 13,400 or 8.3% more nurses on our wards. We recognise that it is a complicated issue and that there are staff shortages in some areas, and we are actively engaging with staff and looking at solutions as we move forward.

My Lords—

I have a couple of minutes. On the adult social care Green Paper, it was recently announced that the Government will provide local authorities with £240 million this financial year, 2018-19, and £240 million next year for adult social care so that people can leave hospital when they are ready and go into a care setting that best meets their needs. This will help to free beds over the winter. There is a further £410 million for social care.

We recognise that the NHS and social care provision are two sides of the same coin and that we cannot have a plan for one side and not for the other. While the long-term funding profile of the social care system will not be settled until the spending review, we will publish the social care Green Paper soon, ahead of the spending review.

I am conscious that there were a couple of other issues, particularly in relation to the role of the NHS in relation to public health, which the noble Baroness, Lady Tyler, raised. I think I have highlighted it. On going forward and the implementation plan, as indicated in the Statement, the Secretary of State has asked my noble friend Lady Harding about how we move forward, particularly on workforce planning. An implementation plan will go to the Secretary of State by the spring and a more detailed implantation plan will be put in place once the spending review figures are available as part of the spending review framework. There will be a framework in terms of quality. I am conscious that my time is up, so I will write to the noble Baroness on the two other questions on adult social care and the differences in mental care for young people.

My Lords, I apologise to the noble Baroness for intervening. She paused, and I thought she had finished.

I refer noble Lords to the register and particularly to my advisory role with SweatCo.

I turn to public health issues. The plan makes a very bold statement about tackling some of our major public health problems. When it comes to specific government action, it is silent. I refer the Minister to the Chief Medical Officer’s annual report for 2018 which was published just before Christmas. It was very hard talking in some of the recommendations that the Government need to take. I shall cite just one of them. In relation to obesity the Chief Medical Officer recommended that the Government review the use of fiscal disincentives in relation to foods high in sugar and salt and of incentives to increase fruit and vegetable consumption. Why is the plan silent on these issues?

The plan is an overall strategy. The detail will be filled in over the coming months and years as we work closely with clinicians and people working in the NHS. That is why, looking at obesity, we introduced the sugar tax, which has been very successful. Noble Lords may say that we did not get as much money as we thought we would, but to my mind that is great; it means we have got preventive action because companies are now putting less sugar into drinks et cetera, which is a bonus. The noble Lord is right. That is why we are putting so much more money —£4.5 billion—into the preventive agenda so that we tackle the issues that he has just indicated.

My Lords, I declare my interest as professor of surgery at University College London and chairman of UCL Partners. I congratulate the noble Lord, Lord O’Shaughnessy, on the tremendous contribution he made to the work of your Lordships’ House as the Minister dealing with health and social care. He was greatly regarded and respected.

It is absolutely appropriate for Her Majesty’s Government to have focused on developing a strategy over 10 years to address the long-term sustainability of the National Health Service, which is something that your Lordships’ House elected to address through an ad hoc Select Committee two Sessions ago. There are many aspirations in this 10-year plan, but the important question is how Her Majesty’s Government propose to go about determining what is achieved, how it is to be implemented and how the outcomes are to be measured. There are important aspirations about, for instance, the adoption of personalised medicine, the adoption of genomics to drive diagnosis and the selection of care, the development of a workforce that is able to apply innovation and genomic medicine to the routine care of patients and the adoption of a digital strategy for patients and healthcare professionals to improve clinical outcomes. How are Her Majesty’s Government going to go about developing the metrics to determine how success should be measured? How will they go about providing a baseline picture of the current situation in different parts of the National Health Service so that the purpose and ambition of this plan can be properly measured? Which part of the NHS is going to be responsible for measurement and implementation: NHS England, NHS Improvement or, indeed, the Department of Health and Social Care?

That is almost all my brief. I echo the sentiments expressed by the noble Lord about my noble friend Lord O’Shaughnessy. The noble Lord is basically asking about next steps and who will be accountable for the plans. That is the question I asked: who is in charge? NHS Improvement and Health Education England are looking at workforce planning and clinical placements for nurses. They will relate to NHS England which is looking at the overall framework. The intention is that the work that my noble friend Lady Harding will be taking on will feed into workforce planning, and we will produce an overall framework in relation to clinical issues. A template will also be produced so that we know what best practice is, and this can then be filtered down to local areas through the integrated care system and clinical commissioning groups. NHS England will retain the overall strategy for all this. I hope that I have answered the noble Lord’s questions. As he knows, there are variations and a number of health inequalities around the country. It is imperative that we begin to address those and that is behind part of the framework.

My Lords, I thank my noble friend and other noble Lords for their kind words. It has been an absolute pleasure to work with them on health and social care issues over the last two years, as well as with the amazing staff in our health and social care system, who inspire us, treat us and look after us all the time. Like my noble friend, I am incredibly proud that in the 70th year of the NHS it is a Conservative Government who are making this historic funding settlement. However, I believe that this is an important document for another reason, which is that it marks a significant milestone in moving towards truly personal care that delivers precision medicine designed for individuals and better uses technology and the kinds of genomic medicines and innovations that the noble Lord, Lord Kakkar, talked about. It became clear to me during my time as a Minister that this can happen only if we complete the digitalisation and joining up of patients’ data so that, wherever patients land in the health system, any clinician has access to all the relevant information about them and can tailor treatments to them. Not only does that bring tremendous benefits for direct care but it has a huge positive impact on our life sciences industry, which is one of the great strengths of this country and one of our great hopes for the future. Can my noble friend confirm that the long-term plan involves the ambition of fully digitising the NHS and bringing that data together for the benefits that I have described?

I thank my noble friend Lord O’Shaughnessy for his comments. Of course, data and information are very important. It is very difficult for clinicians when they do not have good information and data, because they have to start again, asking questions and looking at the investigations that have been undertaken on a particular patient. Therefore, the future lies in the greater use of technology and data-sharing but, at the same time, this must be balanced with ensuring that safeguards regarding who accesses the data are put in place, as well as ensuring that the data is accessed with the patient’s consent.

My Lords, I echo the words of other noble Lords who have raised the extremely good work that the noble Lord, Lord O’Shaughnessy, did during his time as a Minister. I always found him helpful and diligent when I raised health issues with him. Therefore, I am sure that I speak on behalf of the House when I thank him and wish him well.

The plan talks about genomics, artificial intelligence and data, which are all about a new way of working for the NHS. However, if the rules and ethics do not keep up, there will be severe unintended consequences for both individuals and society as a whole. What specific work, undertaken by which specific body, will be carried out to ensure that the rules, laws and ethics of this new world mean that the new way of working takes place within a framework that is safe for individuals and society and does not lead to significant unintended consequences?

The noble Lord makes a very valid point. As I indicated in my previous answer, data-sharing, although important, must be balanced with ensuring that safeguards are in place for the patient. We work, and will continue to work, very closely with the Information Commissioner and the data protection guardian. I know that we recently passed legislation for those posts to be put on to a statutory footing, although I do not think that that has happened yet for the data protection guardian. I am sure that they will ensure that a very keen eye is kept on these matters, but of course NHS England, the CQC and other regulatory bodies will also have a duty of care to ensure that the safeguards are implemented effectively, as will local organisations that provide those services.

My Lords, I declare my health interests and associate myself with the remarks about the work of the noble Lord, Lord O’Shaughnessy. I welcome the priority for mental health in the long-term plan, particularly for children and vulnerable people who find themselves in the criminal justice system. However, currently approximately 85% of spending is on physical health and a mere 15% on mental health. As the additional funds are invested in mental health and learning disability services, will the noble Baroness please tell the House what the new balance between physical and mental health will be in 2023 to achieve parity of esteem?