NHS Mandate

Statement

My Lords, with the leave of the House, I shall now repeat in the form of a Statement the Answer given to an Urgent Question in another place. The Statement is as follows:

“I am grateful for the opportunity to set out the Government’s approach to setting a mandate for NHS England for 2019-20. The Government’s annual mandate to NHS England for 2019-20 will, for the first time, be a joint document with the annual NHS Improvement remit letter, signalling the importance of these two arm’s-length bodies working increasingly closely to maximise their collective impact.

It will set one-year transitional objectives to allow the NHS time to plan to implement the long-term plan it has developed to allow it to meet the needs of patients, families and staff as it heads towards its 80th anniversary, as well as continuing to set expectations on planning for EU exit. We are committed to the NHS and are funding its long-term plan to ensure it is fit for the future for patients, their families and NHS staff. The accountability framework sets the expectations that will make the plan a reality as we look ahead to the 80th birthday of the NHS.

The Government have continued to prioritise funding the NHS with a five-year budget settlement for the NHS announced in summer 2018, which will see its budget rise by £33.9 billion a year in cash terms by 2023-24. The funding settlement and implementation of the NHS long-term plan are not affected in any way by the short delay in publication of the accountability framework. We are all engaged to ensure that the accountability framework is published and laid as soon as possible. I and my ministerial colleagues and officials are working closely with NHS England and Healthwatch, as statutory consultees, to ensure accountability, improvement and progress to deliver world-class care for patients”.

My Lords, I thank the Minister for repeating the Answer to the Urgent Question asked by my honourable friend Jonathan Ashworth in the Commons earlier today. Why was it necessary to ask that question at all? I hope the Minister may be slightly embarrassed by the lack of courtesy in not informing Parliament of the delay in laying the mandate for NHS England before Parliament in a timely fashion. That is the first time that has happened since the Health and Social Care Act 2012 came into operation. She must also recognise that this is a very important matter. The Secretary of State appears to have ignored the statutory obligation which was much debated and discussed in your Lordships’ House before that Act was passed. Your Lordships placed huge importance on the mandate and the fact that this was how the NHS would be held to account.

Why was this deadline missed? The answer—that the NHS was busy doing the plan and such things—is not adequate. This is about accountability to Parliament. We need to discuss why targets in last year’s mandate have not been met. This is a serious omission for the mandate because it sets the objectives that the Government expect NHS England to achieve, as well as its budget. I absolutely accept that the Government are committed to the budget and the plan, but they do need to address, with some apology, the lack of accountability that this omission means.

I thank the noble Baroness for her question. I refer to the comments by Simon Stevens in the PAC yesterday, when he laid out how he sees the situation for the NHS:

“We have an agreed direction in the long-term plan … We have the budget set for the next year, and we have the NHS annual planning process … wrapped up. 2019-20 is … a transition year into stepping into the new five-year long-term plan”.

As the noble Baroness knows, planning guidance for 2019-20 was updated in January when the long-term plan was published. For all practical purposes, this document sets the decision-making for local NHS decision-makers during this year. The national implementation programme for the long-term plan, which will set the longer-term milestones for delivery of the plan until 2023-24, will be published at the end of this year. The mandate and its accountability framework is an important accountability mechanism and strategy document for the NHS. It is taking longer partly because of the close working of NHSE and NHSI and the transitional nature of this year.

It is important that this document does come out, for the purposes of strategy and accountability, but it is most important that it is got right. That is why it is taking slightly longer. I look forward to the debate this House will have when it is published. I am sure that the noble Baroness will hold us to account in the usual manner.

My Lords, I am very sorry that the Minister has been forced to give such an innocuous Answer on such a very important issue. We are awaiting not only the mandate but the workforce plan, and we have long awaited the social care Green Paper. Is the department still busy recruiting around the world to replace positions that are being vacated by staff from the EU—who are either going home or not coming here in the first place—or is there some other reason? I would have been much more reassured if the Answer had told us that the department is discussing with other departments across government the social determinants of health and how addressing those will help make the NHS much more sustainable in the near future. Can the Minister rescue this innocuous Answer by assuring the House that those discussions are taking place?

The noble Baroness is absolutely right that there is cross-departmental relevance to both the social care Green Paper and the workforce strategy. She will know that the long-term plan and the forthcoming Green Paper on social care have been developed in tandem. A number of reforms were already set out in the long-term plan, including the enhanced health and care homes model, which will of course involve MHCLG; the comprehensive model for personalised care, which will involve the personalised health budgets; and of course local health and care plans, which will simplify healthcare systems. We are looking forward to the Green Paper being published in full and I am sure that she will want to hold me to account on that in this Chamber. I look forward to that moment with great anticipation.

Of course, the workforce plan and HEE’s budget are also a matter for cross-departmental debate, as is the spending review, which is another reason why a lot of work is going into this. Again, it is important that this work is done to get it exactly right. The principles on which that work must be done are to consider multi-year funding plans for clinical training places based on the workforce requirements of the NHS going forward.

My Lords, I want to raise not the timeliness of the mandate but its content. The noble Baroness will be aware of the problems of undercapacity in eye care services—which were documented by the report entitled See the Light: Improving Capacity in NHS Eye Care in England, produced by the All-Party Parliamentary Group on Eye Health and Visual Impairment, of which I am co-chair—and that undercapacity is putting the sight of patients at risk. The first recommendation of that report, addressed to the Secretary of State for Health and Social Care, was that eye health should be specifically included in the Government’s mandate for the NHS, to ensure that it is accorded a higher priority than it appears to enjoy at the moment. Will the Minister give me an assurance that this recommendation will be fully addressed when the new NHS mandate is finally published?

I thank the noble Lord for his question. I can tell him that, while the accountability framework has not yet been published, it has been decided that it will be a high-level framework that will set two objectives: to ensure the effective delivery of the NHS long-term plan, and to support the Government in managing the effects of EU exit on health and care. Of course, the long-term plan includes improvements to a number of services and this will be followed by the national implementation programme for the long-term plan, which will have milestones for delivery of that plan up to 2023-24. I hope he will be reassured that eye health is included in that. If he would like to follow up specific points with me regarding the concerns his group has raised, I would be very happy to meet him later.

My Lords, can the Minister give an assurance that people who want to do so can come to work in the UK and be paid less than £30,000? Otherwise, this will stop many people coming: care homes and people who are disabled and living in their own homes cannot afford £30,000.

The noble Baroness raises a very important point. This, of course, will not be part of the accountability framework but it is a very important question of concern for Higher Education England and the workforce strategy which is going forward. It has been a question of close discussion and debate between the Department of Health and Social Care and the Home Office and will continue to be so.

The 2014 Act stated clearly that we were looking for safe staffing. The cry at the moment is an urgent plea for a safe staffing formula that will satisfy the needs of the whole population. As far as I can see, five years after the law was passed, we are now looking at another two or three years. We are really in a situation in which safe staffing is the top priority.

I thank the noble Baroness for her question. As I have said, the Government set out six principles underpinning the long-term plan to meet the expectations that the NHS has for the future. One of those principles is to ensure that the NHS is building the workforce that we need for the future, so that we have the right numbers and the right types of doctors, nurses and other expert professionals, with more of them being trained here in the UK. As part of the spending review period, we will be working to understand how we can get the funding necessary to recruit and train new staff as part of the HEE process for the workforce strategy.