NHS Long-term Plan

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 the time when the NHS was first proposed from this Dispatch Box, under the Churchill Government in 1944. Even after the perils of war, infant mortality was nearly 10 times what it is now, two thirds of men smoked and life expectancy was just 66. It came 10 years before we knew the structure of DNA and four decades before the first MRI. The NHS has led the world throughout its history, but one constant has been the core principle set out by the Conservatives in that national Government: the NHS should be available to all and free at the point of use according to need, not 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—our own family story—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. That means that 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 then £148 billion in 2023-24.

That rise of £33.9 billion, which is actually over £1 billion more in cash terms than was proposed in June, delivers on our commitment to the NHS and will safeguard the NHS for the long term and help to address today’s challenges. The NHS is facing unprecedented levels of demand. Every day, it treats over 1 million people. Compared with 2010, the NHS 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 December. So we will address today’s challenges, not least with the £6 billion extra coming on stream in under three months.

As well as addressing current 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 the future, the NHS will do much more to support people to stay healthy, rather than just treating them when they are 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 that patients will have improved access to their GPs and greater flexibility about how they contact them, as well as better use of community pharmacists and better access to physiotherapists. Improving the availability of fast and appropriate care will help communities to keep people out of hospital altogether.

The next principle is that 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 also be a renewed clampdown on waste so that we can ensure that every penny of the extra money goes towards improving services and giving taxpayers the best possible return.

Ultimately, staff—the people who work in the NHS—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 more with their own mental health and wellbeing. That already happens in the best parts of the NHS, and there has been a huge amount of work to support the people who work in the NHS, but I want to see it happen everywhere. We will bring in better training, mentoring and support to develop better leadership in the NHS at all levels. We will build on the work that is already going on to recruit, train and retain more staff so that we can address critical staff shortages.

The plan published today is the next step in our mission to make the NHS a world-class employer and deliver the workforce it needs. To deliver on the workforce 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. She will make her 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 that 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. It means supporting our growing elderly population to stay healthy and independent for longer. It means more personalised care and more social prescribing. It means empowering people to take greater control of, and responsibility for, their own health through prevention and personal health budgets. It means accessing new digital services to bring the NHS into the 21st century. It means more support for mothers by improving maternity services. It means providing more support for parents and carers in the early years of a child’s life so that this country 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 to make a reality of the goal of parity between mental and physical health, we are going to 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 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—something that never happened under the previous Labour Government.

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 by stopping smoking, losing weight and reducing alcohol intake. The NHS will improve the quality and speed of diagnosis and improve treatment and recovery, so that we can help people to live well and manage their conditions. We will upgrade urgent care so people can get the right care more quickly.

All in all, the NHS long-term plan has been drawn up by the NHS—by more than 2,500 doctors, clinicians, staff and patients. It 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 to 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 attacks, strokes and dementia cases, and to 55,000 more people surviving cancer each year—in all, half a million lives saved over the next 10 years. It is funded by taxpayers, designed by doctors and delivered by this Government.

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

I welcome the advance copy of the Secretary of State’s statement, but may I quickly say at the outset that Churchill’s Tory party voted against Labour’s NHS 22 times?

We welcome many of the ambitions outlined today by NHS England. We welcome the greater use of genomics in developing care pathways. We welcome the commitment to early cancer diagnosis; after all, it was a Labour policy announced at the general election. We welcome the commitment to new CT and MRI scanners; it is a Labour policy. We welcome the greater focus on child and maternal health, including the expansion of perinatal mental health services; again, it is a Labour policy. We welcome the roll-out of alcohol teams in hospitals, because, yes, it is another Labour policy.

The Secretary of State did not mention this, but we will study carefully the details of any new proposed legislation, because we welcome the recognition that the Health and Social Care Act 2012 has created a wasteful, fragmented mess, hindering the delivery of quality healthcare. Healthcare should never be left to market forces, which is why scrapping the competition regime and scrapping the Act’s section 75 procurement regulations, as proposed today by NHS England, are long-standing Labour policies. The Government should be apologising for the Health and Social Care Act. But why stop halfway? Why not commit to fully ending the purchaser-provider split? Why not commit to democratic accountability when planning care? Why not commit to consigning the whole Lansley Act to the dustbin of history?

What about the other holes in today’s announcement? Waiting lists are at 4.3 million, with 540,000 waiting beyond 18 weeks for treatment. A&Es are in crisis, with 618,000 trolley waits and 2.5 million waiting beyond four hours in A&E. So why is there no credible road map today to restoring the statutory standards of care that patients are entitled to, as outlined in the NHS constitution? They were routinely delivered under a Labour Government. Is it not a damning indictment of nearly nine years of desperate underfunding, cuts and failure to recruit the staff we need that those constitutional standards will not be met as part of this 10-year plan?

The Secretary of State boasts of the new budget for the NHS. Will he confirm that once inflation is taken into account, once the pay rise is factored in and once the standard NHS England assumption about activity is applied, there is actually a £1 billion shortfall in the NHS England revenue budget for this coming financial year? When he answers, will he tell the House—I will be listening carefully to what he says—whether he has seen or is aware of any internal analysis from the Department, NHS England or NHS Improvement that confirms that £1 billion shortfall figure?

Well, I think we discovered from that that Labour has absolutely nothing to say about the future health of the nation. The hon. Gentleman did not even deign to thank the people who work in the NHS for their incredible work. Did we hear any acknowledgement of the million more people who are seen by the NHS, of the record levels of activity going on in the NHS and of the fact that we have more nurses and doctors in the NHS than we had in 2010? He had nothing to say. He talked about the workforce. Chapter 4 of the document is all about the workforce plan. He gives me the impression that, like his leader on Brexit, he has not even read the document he is talking about.

The hon. Gentleman asked about targets and legislation. On legislation, when clinicians make proposals on what legislation needs to change to improve the NHS, we listen. We do not then come forward with further ideological ideas. We listen. So we will listen to what they have said. The clinicians have come forward with legislative proposals and we will listen and study them closely.

On the money that the hon. Gentleman talked about, it was a bit like a broken record. He asked about a £1 billion shortfall in the NHS budget. I will tell him what we are doing with NHS budgets: we are putting them up by £20.5 billion. There is an error in the analysis by the Nuffield Trust, because it does not take into account an improvement in the efficiency of the NHS. Is it true that every year we can improve the way the NHS delivers value for taxpayers’ money? Absolutely. We can and we must, because we on the Government Benches care about the NHS and about getting the right amount of money into the NHS, but we also care about making sure that that money is spent wisely. The hon. Gentleman would do well to heed the views of the NHS itself, which says that yes, the NHS is probably the most efficient health service in the world, but there is always more to do.

First, I congratulate my right hon. Friend on his paying tribute to the work of the late Sir Henry Willink, who served in Churchill’s Conservative Government. I met him once or twice when he became master of a Cambridge college. The Conservatives have shown respect for the NHS ever since, as he foreshadowed.

I also congratulate my right hon. Friend on the large increases in funding that are almost as big as some of the funding increases that I received when I was a Health Minister and then Secretary of State. Ever since it was founded, all Governments have increased spending on the NHS—they are bound to—and whichever party is in opposition we always have these knockabout exchanges about whether it is enough. As my right hon. Friend rightly says, what matters is how effectively the money is spent to produce the right patient outcomes. The plan appears to reflect that very well.

Does my right hon. Friend agree that the biggest pressure facing the health service is the extraordinary growth in demand, and the change in the nature of that demand, which is being caused by the ageing population, with chronic conditions playing such a large part? Does he also accept that his most urgent priority is to build further links between the hospital service, the GPs, the community services and local authority social services, so that we have people working no longer in silos, but together to produce the best package for the patient? We have achieved something, but not very much. I hope that when we produce our adult social care policy, which I hope is soon, my right hon. Friend will begin to think about some reforms to make sure that all elements of the service work together properly to produce the proper and most cost-effective personalised treatment for each individual patient.

I pay tribute to my right hon. and learned Friend, who of course did so much to set in train the modern health service that we know and whose reforms were kept and, indeed, enhanced during the period when Labour was in government. He is right about the need to run the NHS so that it can be the best that it possibly can be. Yes, we need the money, but we also need to run it well. It is no good just to argue about the money. On that he may have a surprising ally, because the shadow Secretary of State, who is currently looking at his mobile phone—well, he is not any more—said a couple of months ago:

“we need to augment the debate beyond the current mantra of ‘we can spend the most’”.

However, it appears that the Labour party only has a mantra of “We can spend the most.” We care about the money, but we care about the NHS being the best that it possibly can be, too.

I note that the Secretary of State referred to the Churchill Government in 1944, but had he looked at Hansard he might have seen that Churchill cited the Highlands and Islands Medical Service, which was the first national health service in 1913.

I welcome the long-term plan, but the integration to which it aspires is going to be frustrated if there is no reform of the internal market and the fragmentation continues. The Secretary of State cites the funding, which he describes as 3.4% per year. That is actually just back to what the NHS received prior to 2010. He talks about a million extra patients. With this enormous increased demand, does he not think that it would be more honest to describe funding per head, rather than just a total? Scotland spends £163 more per head. Perhaps he should aspire to spend the money on the patients and then perhaps the NHS would keep up.

Again, like the previous funding agreement, the funding is focused only on the NHS, with cuts to public health, no extra money for health education and still no Green Paper on social care. I totally agree that prevention is better than cure, so will the Secretary of State reverse the cuts to public health? In his own letter, which was circulated, he emphasised reducing cancer deaths, yet there was no mention of prevention at all. That is the best way to reduce cancer deaths. Public health is crucial, smoking cessation is crucial and tackling childhood obesity is crucial, so will he liaise with his colleagues in the Department for Digital, Culture, Media and Sport and set a nine o’clock watershed on advertising rubbish foods?

I agree with the aim of improving screening. Last year, the Government agreed that they would reduce the bowel cancer screening age from 60 to 50. Can the Secretary of State tell us when that will actually happen? Does he recognise that it will mean a bigger need for endoscopists and radiologists? So will he fund Health Education England to provide them and to provide the other doctors, nurses and staff that the NHS will need to deliver this long-term plan?

My response is yes on the cancer screening—it is in paragraph 3.53. I want to return to the point that was made by the hon. Lady and by my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) about the link to social care. Of course that is critical. The plan has a section on the link to social care and the social care Green Paper will then tie into the plan. Of course, the two come together and the Green Paper on social care will be provided soon.

I warmly welcome this ambitious and wide-ranging long-term plan for the NHS. I agree with the hon. Member for Central Ayrshire (Dr Whitford) that so much is dependent on social care, on public health and on the workforce through Health Education England budgets, but may I add to that the situation for capital budgets within the forthcoming spending review? So much of the success of transforming services depends on the upfront funding to get things going and sometimes double running so that we can get a new service up and running before an existing service closes down. Will the Secretary of State go further in talking about the role and importance of capital budgets?

I also really welcome the triple integration—not only between health and social care, but between mental and physical health and between primary and hospital services. Could the Secretary of State confirm and support the proposal in the long-term plan that the legislative tweaks that will support that much needed integration will come from the NHS itself? I confirm that the Health and Social Care Committee remains committed to subjecting those proposals to pre-legislative scrutiny. Will he meet me to see how we can take that forward?

Yes, I would be very happy to meet my hon. Friend to discuss the legislative changes. These changes have been proposed by the NHS. The NHS wants the changes set out at a high level in the plan. Of course there is a lot of consequential work to do to turn them into a full legislative proposal. The NHS is working on that. If it does that alongside and working with the Select Committee, I would be very happy to meet with her to discuss how that might happen. This is very much the NHS’s proposed legislation and I look forward to discussing it with her.

I am glad that the Secretary of State says that he will listen to clinicians if they want to change primary legislation. I just think that many of those clinicians and many Labour Members wish that he and his colleagues had listened to us when we warned about the problems with the Lansley legislation six years ago. But let us put that to one side. The biggest challenge facing the NHS is indeed the increase in the number of older people with two, three or more long-term chronic conditions. They need more joined-up services in the community and at home. The local NHS has been asked to put forward its plans for these new services by April. It cannot do so without proper long-term funding for social care. So will we hear about that in the Green Paper before April—yes or no?

When I answered a previous question on the timing of the social care Green Paper, I said it would be provided “soon.” I certainly intend that to happen before April. My previous commitment was to do it before Christmas, so it is well advanced. But the hon. Lady is right on the legislative proposals. There is a broad consensus on the need for more integration, as my hon. Friend the Chair of the Select Committee said. The proposals that are made by the NHS in the paper are what it thinks is needed in order to deliver this integration, which I very strongly support.

No doubt my right hon. Friend is gratified, as would be the Churchill-led National Government of 1944, by how truly remarkable and amazing the national health service, the baby of that Government, has turned out to be. Will he assure me that this money does not come without strings and that he will enforce a much better system of lessons learned and, in particular, of disseminating best practice more widely through the NHS? Finally, will he please kick the work of the sustainability and transformation partnerships into some form of prompt result?

When I referenced Churchill, I did not realise that it would be in front of his family. My right hon. Friend is quite right about the need for a just culture—a need for understanding the lessons that are learned when things go wrong—in what is a high-risk business of providing medicine and medical care. Those lessons should be properly learned and there should be transparency and openness and a culture of constantly improving the way that things are done, whether that is medically, logistically or organisationally in hospitals. That is a critical part of the review that Baroness Dido Harding will take forward. It is something that she cares deeply about, making sure that we get the culture right within the workforce not only to tackle the high levels of bullying and harassment, which are completely unacceptable in the national health service, but to make sure that there is a spirit and a culture of continuous improvement and of learning from errors that everyone makes. All of us make errors, and we should learn from them and that culture should be inculcated right across the NHS.

The Secretary of State was absolutely right to commit in his statement to ending the inappropriate hospitalisation of people with learning disability and autism, but the long-term plan itself postpones for five years the ambition of reducing by 50% the number of people who are in institutions. Mencap has described that as disgraceful. It amounts to abandoning the current plan to reduce the number by 50% by this March and it effectively tells the system to take its foot off the brake and will result in people continuing to be treated as second-class citizens, and continuing to have their human rights abused. I urge him to rethink this outrageous long postponement of an absolute imperative to get people out of institutions and to give them a better life.

I have a lot of sympathy with the right hon. Gentleman’s argument. The target for this March, which I inherited, was for a reduction of a third to a half. We are at a reduction of over 20%. The challenge has been that, while the number of people who are being moved into community settings has proceeded as per the plan, more people have been put into secure settings. This is an area that I care deeply about getting right, and I very much take on board the response of Mencap and the right hon. Gentleman to the proposals.

I congratulate the Secretary of State on his plan. As a former Minister of public health, let me say how delighted I am and how much I agree with him that prevention is better than cure. As Governments of all shades have said for a long time, the reality is that people must take more responsibility for their own health—notably to keep their weight down and to take more exercise. This is all good messaging, but the problem is that obesity and being over-weight is an increasing problem, especially among the young. What new messages—what new approach—will we have to public health if he is really going to make the sort of progress that we need to make?