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?
Can the Secretary of State also confirm that despite his rhetoric about prevention, the public health budget is set to be cut again in the next financial year as part of a wider £1 billion of cuts to broader health spending, and that when those cuts are taken into account, spending will rise not by 3.4%, as he says, but by 2.7%? That will mean deeper cuts again to smoking cessation services, deeper cuts again to drug and alcohol addiction services and deeper cuts again to sexual health services when infections such as gonorrhoea and syphilis are on the rise. By the way, why is HIV/AIDS not even mentioned in the long-term plan? What was the Secretary of State’s answer when asked about public health cuts in his weekend interviews? Targeted Facebook advertising. Given that life expectancy is going backwards, health inequalities are widening and infant mortality is increasing, the public health cuts should have been reversed today, not endorsed.
The NHS long-term plan admits that
“the extra costs to the NHS of socioeconomic inequality have been calculated as £4.8 billion a year in greater hospitalisations alone.”
Does that not confirm that, for all the rhetoric on prevention, the reality is that the Government’s austerity and cuts are making people sicker and increasing the burden on the NHS? Nowhere have we seen greater austerity than in the deep cuts to social care, but where are the Government’s proposals today? They still do not have any.
With respect to social care, surely the Secretary of State agrees that:
“It is not possible to have a plan for one sector without having a plan for the other.”—[Official Report, 18 June 2018; Vol. 643, c. 53.]
Those are not my words, but the words of the Foreign Secretary when he stood at the Dispatch Box last June as the Secretary of State for Health and Social Care. I agree with him; it is a shame that the current Secretary of State does not.
By the way, the Foreign Secretary also promised that:
“Alongside the 10-year plan, we will also publish a long-term workforce plan”.—[Official Report, 18 June 2018; Vol. 643, c. 52.]
Where is it? The Secretary of State has not done it. We all want to know where the staff are coming from to deliver the ambitions that have been outlined today. We are short of 100,000 staff. We are short of 40,000 nurses. The Secretary of State talks of doing more for mental health services; we are down 5,000 nurses in mental health. He talks of doing more for primary and community care; GP numbers are down by 1,000 and district nursing numbers are down by 50%. Now, the Home Secretary wants to impose a £30,000 salary cap on those coming from abroad to work in our NHS, ruling out nurses, care assistants and paramedics. The Secretary of State should do his job and tell the Home Secretary to put the future sustainability of the NHS first, instead of his Tory leadership ambitions, and ditch that salary cap for the NHS.
There are certainly many welcome ambitions from NHS England today, but the reality is that those ambitions will be hindered by a Government who have no plan to recruit the staff we need, who have no plan for social care and who are pushing forward with deep cuts to public health services. Patients have been let down as the Government have run down the NHS for nearly nine years. We do not need 10 more years of the Tories. The NHS needs a Labour Government.
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.
The hon. Gentleman argued about various budgets. The budgets in the NHS are going up because we care about the future of the NHS. The Labour party called for an increase of 2.2% a year; we are delivering an increase of 3.4% a year. Labour has nothing to say on health, as it has nothing to say on any other area of domestic business. We will make sure that we are the party of the NHS for the long term.
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?
My right hon. Friend is absolutely right. Throughout this statement, Opposition Members have been murmuring from a sedentary position about the public health budget. Let me address that directly. The public health budget, which was devolved five years ago with widespread acclamation across the House, has been set and will be set in the spending review. We are putting an extra £20 billion into the NHS—the scale far dwarfs individual budgets—and the whole long-term plan is about prevention being better than cure. The public health budget is important, and it is being delivered well because it is being delivered by councils in concert and tied to other subjects. The truth is that we are having the whole NHS focus on the prevention strategy, not just one individual budget; those who concentrate on just one budget are missing the point.
A very large number of right hon. and hon. Members are seeking to catch my eye. The Secretary of State is attending to the questions put to him in his usual courteous fashion, and I think that is respected. However, I gently point out to the House that this is the first of three ministerial statements today and that there is then further substantive business with which we want to make progress, so I gently encourage colleagues to be economical.
I am heartened that Baroness Harding is looking at the staffing side of things, but she does have a mountain to climb. Let me remind the Secretary of State that the last time the NHS went out to recruit GPs, it ended up with fewer GPs at the end of the year than it had had before. That is not to mention the pension cap put in place by his former mentor—or maybe his current mentor—the former Chancellor, which now means that there is a problem with the retention of senior clinical staff. We can add to that list the immigration rules and pay ceiling. Is the Secretary of State lobbying the Home Office and the Treasury, particularly to deal with the £30,000 cap and the pension cap?
I welcome much of the tone of the hon. Lady’s remarks. The truth is that it is critical to ensure that we have the workforce and the people to deliver the plan. There is a whole section of this plan, as well as ongoing work, to deliver that. I want to clear up this point: in the immigration White Paper published by the Home Secretary before Christmas, as now, there is no cap on recruitment numbers for nurses and doctors. The proposal is that the cap will not necessarily apply within a shortage occupation. We will be recruiting people from around the world to work in our NHS.
I very much congratulate my right hon. Friend on the 10-year plan and on his announcement of the Harding review. Will Baroness Harding look particularly at the way in which pay and pensions are structured for general practitioners and pinch-point specialists within the NHS, since they are retiring or going part time at the moment—a full 10 years before the time they had anticipated when they went to medical school?
We are already looking at that subject. It is very complicated because of the nature of assets owned by GPs—their value having risen sharply over the last generation. However, we have record numbers of GPs in training. Although we need to ensure that we retain more GPs and encourage as many as possible to be full time, we have successfully breached our target; we are training more GPs than we had planned to, and that is a good thing.
I welcome the focus in the long-term plan on the most common causes of mortality—cancer, heart disease, stroke and lung disease—and on cutting the risk factors. However, will the Secretary of State just explain to me how cuts to public health budgets and the fact that the comprehensive spending review is much later in determining the money that will be made available for public health can be part of a joined-up plan to start dealing with some of these diseases?
There is £16 billion ring-fenced for public health in this spending review. Crucially, we want the whole NHS to be focused on keeping people healthy as well as curing them when they are ill. Yes, of course it is a matter for that one budget in the spending review process, but it is also a matter of the whole £148 billion a year that will be going into the NHS.
I welcome the Secretary of State’s plan. He will be aware that our constituents value receiving treatment as locally as possible. Will he give an assurance that he will do all he can to ensure that district general hospitals are there to provide most of these crucial services?
Yes. I am a strong supporter of district general hospitals and community hospitals. So often, local matters because it matters to patients and their families. If someone is having a highly complicated procedure, they will want to be in the very best place in the country—or, indeed, in the world—but often they will want to be close to home as well. That matters for small hospitals and district general hospitals such as the one on which my hon. Friend’s constituents rely so much.
The Secretary of State has waxed lyrical today about the NHS becoming a learning organisation, being transparent and admitting its mistakes. Will he therefore set the trend and lead by getting up at the Dispatch Box and apologising to this House for the fragmentation and chaos caused by the Lansley Act?
We will listen to and learn from what clinicians say about what legislative changes are needed now. This document is all about concentrating on what is the right thing for the future, rather than the blame culture that we are trying to get rid of in the NHS.
I very much welcome my right hon. Friend’s statement and the fact that he has been able to announce future spending so that hopefully the planning for how those resources are spent can be done properly. Will he also bear in mind that, during the period of the national health service, some 60% of the time there has been a Conservative Secretary of State, which shows very much the support and commitment of the Conservative party to the health service? Regarding the money that he is talking about, what will he do to ensure that people see and understand what is being spent locally?
I want to concentrate on cancer services. I have tried to be very positive and to engage with Ministers through the all-party parliamentary group on cancer, but I must express my disappointment at chapter 3. The Secretary of State referred to paragraph 3.51 on cancer, particularly in relation to some of the new investments. Practicalities and resources must be linked to the ambition to improve outcomes, so we need early diagnosis and cost-effective treatment. For example, this country has the second worst survival rate in Europe for lung cancer; only Bulgaria is any worse. The “Manifesto for Radiography” by professionals, oncologists and so on set out some specific asks, including a one-off investment of £250 million in advanced radiotherapy and an additional £100 million a year to support that investment with trained staff. I am afraid that the Government’s plans set out in the 10-year plan fall far short of that, so I do hope that the Secretary of State will look at that again.
We very much agree with the thrust and purpose of the hon. Gentleman’s remarks. In fact, paragraph 3.56 sets out how we are learning from what has happened in Liverpool and elsewhere in the country to make sure that we get early diagnosis right because, as he says, early diagnosis is absolutely critical. I will take away his specific points, but the whole thrust of the plan with regards to cancer is about increasing early diagnosis.
In a local community survey that I am doing right now, mental health is particularly flagged up by people as a priority for them, as well, so I very much welcome the Secretary of State’s continued focus on that in this 10-year plan. I also very much welcome the fact that as part of the work with the Department for Education, the trailblazer area in south-west London will enable us to really see some of the more joined-up working that he talked about. Will he set out what the additional services available for young people up to the age of 25 will mean practically? I represent a very young constituency, and that will be a key change that could benefit us.
At the moment, as somebody transitions from children’s mental health services to adult mental health services, there is often a gap in provision as they register for the adult services. The purpose of having the new care plans up to the age of 25—similar to those, for instance, for care leavers that we have brought in in other legislation—is to make sure that there is a seamless transition from children’s mental health services to adult mental health services and not a gap that many, many people fall through.
Let me bring the Secretary of State back to the issue of public health. He seems to be saying that this is only a small grant and therefore not really very important compared with spending on the NHS as a whole. May I draw his attention to the wording in the long-term plan where it says that action by the NHS
“is a complement to, but cannot be a substitute for, the important role of local government”?
That role has been undermined by £700 million of cuts to public health grants in the past five years. Will he now recognise that if we are going to get a proper joined-up approach to ill-health prevention, he needs to give a commitment that in future the public health grant will increase, in real terms, at least by the same amount as NHS funding as a whole?
I certainly did not say that the public health grant was small—I said that it was £16 billion over the last spending review period. But NHS spending as a whole, by the end of this five-year funding settlement, will be £148 billion every year. Therefore, turning the firepower of the whole NHS to keeping people healthy in the first place will play a huge role in this. Of course, the public health grant has to be settled as part of the spending review, but the idea that that is the whole of everything with regard to preventing ill-health is missing the point.
In the week before Christmas, when we mere mortals were just looking forward to a holiday, the Secretary of State did an all-night shift in Milton Keynes University Hospital and then travelled to Chelmsford, where he visited my brand new medical school and did a “Dragons’ Den” with medical entrepreneurs who are finding new ways to use technology to treat their patients. May I thank him for his super-energy, and does he agree that supporting staff and embracing innovation is also key to our NHS?
Yes, it was a joy to make that visit. We found ourselves in a new medical school in a room where the students were enjoying a dissection—my goodness, after a night without sleep it was quite a thing. It was a joy to go there with my hon. Friend and I agree with both the points she made.
I, too, congratulate the Secretary of State on the NHS 10-year long-term plan. There are between 6,000 and 8,000 rare diseases. One in 17 people, or 6% of the population, will be affected by a rare disease in their lifetime—that is 3.5 million people in the United Kingdom. Will he confirm a commitment to assisting those with rare diseases, and can the NICE process for new life-saving drugs be urgently speeded up so that more lives can be lightened and saved?
I strongly agree with the hon. Gentleman. For those who have rare diseases, diagnosis takes seven years, on average, and genomics can bring that down to a matter of seven days, in the best cases. We are the world leaders in genomics and we are going to stay that way. We have reached the 100,000 genome sequence and we are going to take it to 1 million, with 500,000 from the NHS and 500,000 from the UK Biobank. He is absolutely right. This is one of the bright shining stars of the future of healthcare, and Britain is going to lead the way.
As a former Health Minister, I congratulate the Secretary of State and the Government on this statement. I particularly pay tribute to his work on mental health—I am proud that under this Government it looks as though we are finally beginning to close the gap and stop mental health being the Cinderella service—and on early diagnosis of cancer. I also welcome his espousal of the work on genomics, which I, as a former Minister for life sciences and health technology, and others were involved in setting up. Does he agree that if we are really going to drive the revolution of accountability, productivity and local engagement, the accountable care pilots offer us the chance to really measure and drive digital communities of healthcare where we reward communities that promote health and wellbeing?
Yes, I do. I pay tribute to the work that my hon. Friend did in putting together the areas of the NHS where this is already working. We want to spread that success more broadly across the NHS to make sure that we seize these very exciting opportunities as well as deal with the important day-to-day challenges that the NHS faces.
On 29 December, two young people, one of them aged only 24, committed suicide by jumping from the Humber bridge in my constituency. Since I first commented on this, I have been inundated with comments from local residents detailing the inadequate mental health support that they have. Unfortunately, the Humber bridge is becoming a place that people choose to visit when they are feeling desperate and as though there are no other options. Partly for this reason, can I ask the Secretary of State to commit—not in 10 years, or even in one year or six months, but right now—to providing more money for the Humber NHS Foundation Trust so that we can help to support people when they are feeling so very desperate?
I will absolutely look into the request that the hon. Lady makes. The example that she gives locally in Hull is actually reflected across the country in terms of the need for greater access. For the first time, we are going to have access targets for community mental health, because it is critical to make sure that we have accountability and understand what is happening in mental health trusts in terms of access so that we can then drive policy to meet it. But I appreciate that that is a medium-term goal: in the short term, she has made a specific request for a specific organisation, and I will absolutely look into it and write to her.
Mental health issues are often part of the very complex causes of rough sleeping. They are also a barrier to getting rough sleepers off the streets. Will my right hon. Friend say more about how his plan fits in with the Government’s plan to eradicate rough sleeping?
Yes, my hon. Friend is absolutely right about this. I pay tribute to the work that he did as a Minister in this area. We have put forward £30 million to support mental health services for rough sleepers. It is about so much more than just the money, though—it is about co-ordinating care and co-ordinating different agencies. There is a lot of work going on on this inside Government that he was very much involved with.
My clinical commissioning group has to make more than £40 million of cuts in the next 15 months and is proposing to cut GP and urgent care centre opening hours. It also has an £11 million risk thanks to the predatory private “GP at hand” scheme, of which the Secretary of State is a member. We have had GP practices suspended, palliative care beds closed, and our major hospital under threat of demolition for seven years. Will he accept that the self-regarding statement he has just made will be unrecognisable to people who work in and use the NHS, which is reeling from the crisis that his Government have caused?
I will take advice and consideration from many people, but not from the hon. Gentleman, who for seven years has run a frankly outrageous campaign based on scare stories about hospital closures that are totally unreasonable, unrealistic and wrong. He will never be somebody I listen to, because I care about improving the future, not political point-scoring.
Last Friday, it was a pleasure to meet the chief executive and chair of my local hospital trust to discuss the new A&E department and the new mental health ward that will be built on the site of Torbay Hospital over the next year. Does the Secretary of State agree that it also vital that we have the local services around mental health, in particular, because in the past we have seen far too many people from Devon being sent elsewhere, across the country, and that this investment will now bring that to an end?
Yes, absolutely. My hon. Friend is a brilliant advocate for Torbay and for the English Riviera, and has made the case so strongly for his local hospital. I was delighted that we could recently find the funding to support the case that he and local clinicians have made, and I look forward to working with him to make it a reality.
Before coming to this place, I was a senior manager in Bristol’s primary care trust and then the CCG. I want to pay tribute to the NHS managers who have kept the ship afloat since the Lansley reforms. Today’s plan is clear in its commitment to triple integration and seeking to free commissioners from the barriers to integration in the 2012 procurement rules, but tomorrow the CCG in Bristol will embark on a huge re-procurement process for some community services for the next 10 years based on those old rules. In the light of his plan, will the Secretary of State intervene locally and support my call to pause that divisive community services re-procurement?
I will raise the hon. Lady’s point with NHS Improvement, which considers these things. Local provision of services should, rightly, be decided by local clinical priorities, but she makes a cogent point that I will raise with NHSI, and I will ask its chief executive, Ian Dalton, to write to her.
I declare an interest, as chair of the all-party parliamentary group on blood cancer and the APPG on heart and circulatory diseases. I very much welcome this plan’s focus on those areas. In tribute to my caseworker, Susan Lester, who sadly passed away last week from pancreatic cancer, can I have an assurance from the Secretary of State that he will continue to work with voluntary sector organisations such as Bloodwise, the British Heart Foundation and Pancreatic Cancer UK?
Yes, of course. I am sure the whole House will join me in passing on our condolences to the family, friends and colleagues of my hon. Friend’s caseworker. He is doing right by her in raising that issue in the House. Of course we will keep working with those organisations, which do brilliant work. In fact, there is an event in the Commons tomorrow with Bloodwise, which the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Winchester (Steve Brine), will attend.
Before Christmas, I attended the inaugural event of the Addie Brady Foundation, in memory of 16-year-old Addie, who died a year ago from a brain tumour—her second primary cancer. She was affected by a rare genetic condition called Li-Fraumeni syndrome, a feature of which is a high risk of cancer and repeat cancers. Her family, other families and an international panel of experts have been campaigning for a national screening programme for people suffering from Li-Fraumeni syndrome. Can the Secretary of State confirm whether his announcement today includes much needed Li-Fraumeni syndrome screening on the NHS, particularly for children, which would extend and save lives?
I am delighted to hear my right hon. Friend talk at length about prevention. In that vein, what role does he see for initiatives such as the daily mile in schools, which allows young people to get into the thrust of getting involved in sporting activity and sets them up for life?
My hon. Friend makes an important point. Things like the daily mile, which I have participated in, are an incredibly important part of this. Prevention is about public health and the whole NHS, but it is also about more than that. We talk a lot in the House about the rights that the NHS gives us—the right to care that is free at the point of use, according to need—but we also need to talk about the responsibilities that we have, including the responsibility to use the service wisely and the responsibility to ourselves and our communities to keep ourselves healthy. That part of the debate needs to continue and be strengthened, at the same time as ensuring that the NHS is always there for us.
Under the Government’s public health proposals, County Durham will lose 38% of its budget—or £19 million. The Secretary of State said that we should be listening to clinicians. Clinicians in County Durham are clear that they want that budget protected. Can he tell me what those clinicians are missing? Is it not a fact that this Government are quite clearly going to remove money from deprived areas such as County Durham, while more leafy areas, including Surrey, have an increase in their budgets?
I very much welcome this plan, its ambitions and the Government’s commitment to it. Does my right hon. Friend agree that one of the biggest obstacles to a fully functioning health service is the fact that information cannot be easily shared between many centres? There are myriad systems, which means that data cannot be accessed from one centre to another. When it comes to care, the professionals are brilliant and must be praised, but this situation is causing distress, and it slows diagnosis and wastes patients’ time. I speak from a great deal of personal experience, unfortunately, having spent too long in the NHS with family members. Can he give an assurance that that will be addressed by the plan?
Yes. I feel strongly about this. Chapter 5 of the plan is all about digitally enabled care. The interoperability of data between systems in different parts of the NHS is mission-critical. Over Christmas we published proposals for the interoperability of primary care systems, and we will roll that out in the hospital sector as well, so that people can access their own patient record and the clinicians who need to see it can access the whole record. Instead of having to phone each other up to find out what is going on with a patient they once had, they should be able to look at the record.
I welcome the Secretary of State’s recognition that the staff are at the heart of the NHS and join him in thanking them for their excellent work, but there are 40,000 nursing vacancies today. How many nursing vacancies will there be at the end of 2019, and how many will there be at the end of 2020?
I know that the hon. Gentleman takes a close interest in that, as chair of the all-party group. Obviously we need more nurses. The vacancies are, in many cases, filled by temporary staff, but that is not the best way to manage things. We need more nurses and more doctors. I am glad that we have a record number of GPs in training. In the plan, we have made provision for a 50% increase in the number of clinical placements. We have a whole programme, including the Harding review, to take this forward and ensure that it happens, because the NHS is, at its heart, delivered by its people.
I welcome the Secretary of State’s statement and in particular the continued commitment to increase funding for mental health and build on the work already done through the five year forward view. Does he agree that one of the challenges in implementing those changes is ensuring that funding gets to the frontline through commissioning decisions? That has been one of the obstacles to generating real change on the ground and achieving the goal of parity of esteem between mental and physical health.
My hon. Friend is absolutely right. We need not only more funding for mental health, which is in the plan, but more joined-up delivery of mental health services. Since the birth of the NHS, mental health services have been separate from physical health services, but treatment needs to be for the whole person—their physical, mental and social health. We need not only the money but the join-up, and my hon. Friend the Member for Thurrock (Jackie Doyle-Price), the Mental Health, Inequalities and Suicide Prevention Minister, is working closely on that.
I agree with the shadow Secretary of State completely. I do not feel satisfied that the Secretary of State recognises the urgent need to reverse cuts to social care budgets alongside this plan. Does he see that savings made by reducing avoidable admissions and delayed transfers of care could go towards delivering a more ambitious 10-year plan for our NHS?
I congratulate the Secretary of State on this announcement and particularly on the increase in spending, which is more than the Labour party promised at the last general election. The vital point of today’s announcement is the publication of the plan, which has been decided by clinicians, so that they can tell politicians what is right for the NHS. Will he thank the clinicians for that work? We want to take party politics out of the NHS.
My hon. Friend is quite right: we must focus on the substance of what is needed to deliver an NHS that will be there for us all in our hour of greatest need. That is what we should be concentrating on. I have heard some Members say, “Whatever the Government promise, we will just promise more.” That is no way to have a discussion about the future of the country and our most valued institution. Instead, we should back the NHS’s plan, deliver on it and keep the economy strong so that we can keep putting in the money that the NHS needs.
Paragraph 4.17 of the plan states:
“Mature students are more likely to have family and other commitments that make it harder to retrain without financial support.”
Will the Secretary of State therefore now admit that his Government made a huge mistake when they abolished bursaries for nurses and allied health professionals?
My constituency is one of the 25 trailblazer areas that will have new mental health support teams working in and around schools. Will the Secretary of State give further details on what this plan will do to deliver improved mental health services on the ground, particularly for young people in schools?
Supporting children with mental ill health is an incredibly important part of the plan, from early intervention on anxiety and depression through to support for those with more serious mental health conditions. It means that there will be dedicated support that can link with schools’ mental health services and help signpost in what is often a complicated system. The Mental Health Minister, my hon. Friend the Member for Thurrock, has already agreed to meet my hon. Friend to discuss this further. It is an important and welcome intervention.
When our local sustainability and transformation plan was submitted in October 2017, it projected an annual deficit in health and social care in Staffordshire and Stoke-on-Trent of £542 million by 2020-21, which is more than double the £250 million projected at the time of the 2015 general election. That shows the scale of the problem, because there are more than 40 STPs across England. Will the Secretary of State write to me with some numbers to show how this long-term plan will help our local STP with the extra revenue and investment needed to transform services so that we do not face a litany of unsustainable cuts, notwithstanding those in the years immediately to come?
Of course we are putting more money in, and in the coming days we will announce the local provision increases for the first year—there is a £6 billion cash uplift in year 1. We will be working with local areas in the months ahead on the plans for years 2 to 5.
In the past few weeks I have visited Witney Community Hospital, the Windrush surgery, the Nuffield health centre and the associated nearby pharmacies, and I have seen not only their brilliant winter preparedness but how they form a hub for care close to home. Does my right hon. Friend agree that ensuring that people are treated in the community and improving public health is the way to ensure that we have free, high-quality care for everybody?
My hon. Friend is absolutely right. The community hubs being developed in many different parts of the country are critical in bringing together support and enabling early intervention. The adage that a stitch in time saves nine is almost as old as “prevention is better than cure,” but both are equal in their wisdom.
Money might not be everything, but transforming a service against a background of real-terms cuts is almost impossible. The Central London clinical commissioning group is in the middle of a 13% real-terms cut, the West London clinical commissioning group is having an 8% real-terms cut, real-terms cuts are being made in mental health services, and Westminster City Council has cut 31% of its funding for social care. Can the Secretary of State indicate whether inner-London residents will see any benefit as a result of this plan?
One of the most effective ways of reducing avoidable deaths is to stop people smoking in the first place, and to encourage those who do smoke to give up as fast as possible. How will this plan encourage pregnant mothers, 11% of whom still smoke, to give up smoking and get their partners to give up, and how will it encourage young people not to start in the first place?
My hon. Friend is absolutely right. When people are in hospital, there will now be much more aggressive provision of counselling and support to stop them smoking. It is also about targeting support, rather than treating everyone the same and giving them the same messages. It is absolutely right to include micro-targeting and to use social media to communicate with people. There are luddites who say that we should not use these modern approaches, but we on the Government Benches believe in the future.
I am pleased that the Secretary of State is keen to improve public health and reduce health inequalities, and I assume that he will therefore support my new clause 5 to the Finance (No. 3) Bill, which is specifically about ensuring that the Government’s economic policies reduce health inequalities. On social care, is he aware that in 2017 alone 50,000 people with dementia had an emergency hospital admission because there was not adequate social care? What will he do to ensure that his plan, which we are still waiting for, will avoid such emergency admissions in 2019? Please do not say that more has been given in the Budget, because that is a sticking plaster compared with all the cuts that the Government have made in social care.
Page 32 of the document sets out details on the integration with social care that the hon. Lady rightly calls for. Clearly, ensuring better integration in cases of dementia is absolutely vital. Some parts of the country are doing that brilliantly with integrated commissioning, but we need to ensure that is spread across the whole country.
I welcome this plan and the Secretary of State’s energy. When he visited Pilgrim Hospital in my constituency, he saw that this is not solely about money, because a huge chunk of the challenge that the NHS faces is about the workforce. Within the workforce plans in this 10-year plan, will he pay particular attention to under-doctored areas such as Lincolnshire, where it is a huge challenge to produce the same outcomes that we see in other parts of the country?
My hon. Friend is dead right. It was a real pleasure to visit Pilgrim Hospital in Boston, where my grandmother worked as a nurse for 30 years, and to meet the staff. He is absolutely right about the recruitment challenges that they face, which is why a whole chapter of the report, and ongoing work, is dedicated to improving recruitment. When we put £20 billion into a public service, of course we will need more people to deliver it.
At this very moment, Derriford Hospital in Plymouth is on OPEL 4 alert—the new name for black alert. The real shame is that that is now so commonplace that it no longer always makes the news. Will the Secretary of State, who I know visited the hospital recently, explain whether the new NHS plan will address the structural inequalities in funding for the regions, especially the far south-west? Those inequalities often contribute to the underfunding of services, which is why our hospital is on OPEL 4.
I enjoyed my visit to Derriford Hospital’s night shift and learned an awful lot from it. One of the consequences of seeing what is happening on the ground is that we are providing it with a new A&E facility. We are putting tens of millions of pounds into the hospital, so it would be a bit better if the hon. Gentleman mentioned that as well as rightly raising concerns about performance. That funding was the result of the campaigning of the hon. Member for Plymouth, Devonport, who is an absolutely brilliant campaigner for his local community—[Interruption.] Yes, the Members for Devonport and for Moor View. I am a big supporter of Derriford Hospital and think it does a brilliant job, and in challenging conditions, but it is going to get a better A&E because we have provided the funding to allow it to do that.
I welcome the commitment to mental health in the NHS long-term plan, particularly the badly needed new care model for young adults, the commitment to more care for people with severe mental illnesses and the further expansion of mental health liaison services in A&E. I also welcome the commitment to more performance standards for adults with mental illnesses. Will my right hon. Friend make sure that those mental health standards are introduced sooner rather than later, so that we do not have to wait too long for the waiting time standards? Transparency is so important for the parity of esteem between mental health and physical health.
The Bedfordshire mental health trust told me today that the need for in-patient beds for men has increased. Will the Secretary of State urgently reinstate the in-patient mental health facilities in Bedford, which his Government removed, so that my constituents no longer have to travel at least 20 miles to access care?
Of course the provision of services locally is a matter for local clinicians, and it must be led by local clinicians. I am always happy to look at individual cases and, as with the other example, I will ask the NHS to write back to the hon. Gentleman with an explanation.
Upgrading the NHS’s technology is key to its productivity and its future, and it should include rolling out a new NHS app; phasing out outdated technologies such as fax machines; and adopting new fourth industrial revolution technologies. What progress has the Department made in those areas?
My hon. Friend is dead right. There is a whole chapter in the plan on using new technologies not only to improve care but to make care more convenient. He has been a doughty campaigner for the use of technology in health services. His trip to my local hospital to understand these issues went down incredibly well locally, and I hope he keeps pushing us to do the best we can.
How can it possibly make sense that, when the Health Secretary is targeting much needed support towards areas of high deprivation, the Secretary of State for Housing, Communities and Local Government is cutting funding for social care and public health, and cutting deepest in cities such as Nottingham with high levels of poverty? Is that not actively undermining the Health Secretary’s stated ambition to improve health and reduce inequality?
Adult social care is not working properly in Northamptonshire, with far too many delayed transfers of care for elderly people. With the root-and-branch reform of local government in Northamptonshire, there is a wonderful, unique opportunity to create successful integrated health and social care pilots. Will the Secretary of State seize this opportunity and get the 10-year NHS long-term plan off to a wonderful start in Northamptonshire?
Yes. I have discussed the proposals made by my hon. Friend and his Northamptonshire colleagues with the Secretary of State for Housing, Communities and Local Government. We are both enthusiastic to see what can be done, and I invite my hon. Friend into the Department to speak to my officials about how this could be done. His proposals are, by design, entirely consistent with the proposals in paragraph 1.58 of the long-term plan, and I very much look forward to working with him and his Northamptonshire colleagues on making it happen.
Health visitors are vital to delivering early intervention and prevention, yet their numbers are in freefall—falling by 23.5%, or 2,425 health visitors, since October 2015. Health visitors are now working with dangerous caseloads, so when will the Secretary of State ensure that we have safe delivery of health visiting services?
The hon. Lady is dead right. Of course, health visitor numbers went up very sharply between 2010 and 2015. In fact there is a proposal in the plan, and the NHS will be discussing with Government the best way to commission health visitors. Health visitors are clearly a health service but, at the moment, they are commissioned by local authorities. We look forward to working with the NHS and with the Ministry of Housing, Communities and Local Government on how best we can commission health visitors in future, because they are a critical part of maternity services.
Over the holiday period, another young woman tragically died of cervical cancer, which she contracted before the age of 25; therefore, she was not able to have a smear test. Will the Secretary of State, as part of this review, remove that ridiculous and utterly arbitrary age limit so that, where a GP believes a female patient needs a cervical smear, they can have one irrespective of their age?
I entirely understand the hon. Gentleman’s argument. He is a reasonable man who makes reasonable arguments, and I will take it up with Mike Richards, who is running the screening review. I will ask Mike to write to him specifically on that point and to take it into account.
As the chair of the all-party parliamentary group on infant feeding and inequalities, I am glad that the long-term plan has a commitment to improving maternity services in England. The announcement on 30 December said that the UK Government are
“asking all maternity services to deliver an accredited, evidence-based infant feeding programme in 2019 to 2020, such as the UNICEF Baby Friendly initiative”.
What does the Secretary of State mean by “such as”? UNICEF Baby Friendly is the gold standard, as recognised by Scotland and Northern Ireland, which have 100% accreditation, but England has only 60% accreditation. Does he also acknowledge the need for community-based infant feeding support, such as peer supporters and health visitors, because it cannot just stop at the hospital door?
I pay tribute to the hon. Lady’s work as chair of the all-party parliamentary group on infant feeding and inequalities. She makes a strong and passionate case for breast feeding. I do not want to let the best be the enemy of the good. The proposal she cites is a proposal from the NHS. Of course, if other such services come forward, why should we be against it? I want to be clinically led in this area, but I very much support the thrust of her argument.
The people of Hartlepool lost their A&E several years ago, and there is a powerful argument for the return of those services. On the subject of urgent care, what measures does the Secretary of State intend to take to help our overstretched ambulance services?
There is extra support for ambulance services in the plan, which is incredibly important. The targets and accountability measures for ambulances were reviewed this time last year, and we now need to make sure that the whole ambulance service gets the support it needs.
Will the Secretary of State update the House on the review of the tariff process in relation to his statement? Specifically, what will be the impact on NHS trusts in London of changes to the market forces factor? I am concerned that those changes will mean that London loses out when it comes to the funding to be allocated in his plan.
Of course we want to make sure that the funding is allocated fairly, and we want to make sure that all the different factors that count towards and cause different costs in different parts of the country are properly taken into account, whether it is rurality or the market forces factor, so called because of the differences in relative costs. I will write to the hon. Gentleman with the full details in the coming days, but what matters here is to make sure that we are clearly led by the evidence.