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Government Mandate for the NHS

Volume 658: debated on Thursday 25 April 2019

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the Government’s failure to lay before Parliament the NHS mandate for the current financial year.

I am grateful to have 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, called an accountability framework. This signals 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 implement the long-term plan, and it has been developed to meet the needs of patients, families and staff.

We are committed to the NHS and are funding its long-term plan to ensure that it is fit for the future for patients, their families and NHS staff. The accountability framework sets the expectations that will make that long-term plan a reality. The Government have continued to prioritise funding the NHS, with a five-year budget settlement for the NHS announced in summer 2018 that will see the NHS budget rise by £33.9 billion a year by 2023-24.

The funding settlement and the implementation of the long-term plan are not affected in any way by the short delay in the publication of the accountability framework. We are all engaged to ensure that the accountability framework is published and laid as soon as possible, and I and my ministerial colleagues and officials are working closely with NHS England and Healthwatch England, as statutory consultees, to ensure accountability, improvement and progress to deliver world- class care for patients.

It is a pleasure to see the Minister of State, as always, but the Secretary of State should be here to defend his failure to produce the NHS mandate. In every previous year, in accordance with section 23 of the Health and Social Care Act 2012—an Act that he supported and voted for despite everyone telling the Government not to support it—the Government have published the NHS mandate before the beginning of the financial year. This mandate outlines the Secretary of State’s priorities for the NHS given the financial settlement, yet this is the first time a Secretary of State has failed to lay before Parliament the Government’s mandate to the NHS for the forthcoming financial year. Is this a failure of leadership or the latest piece of stealth dismantling of the Health and Social Care Act? If it is the latter, why not just take our advice and bin the whole thing and so end the wasteful contracting, tendering and marketisation it ushered in?

The Minister talks of the 10-year long-term plan, but it is no good his telling us he endorses Simon Steven’s vision of the NHS in a decade’s time, when Ministers cannot even tell us what they expect the NHS to achieve in a year’s time. He boasts of the new revenue funding settlement for the NHS but seemingly has not got a clue what he wants the NHS to spend it on in the next 12 months, and at the same time he does not talk about the cuts to public health budgets, training budgets and capital investment.

Will the new accountability framework deliver for patients in the next 12 months? Last year’s mandate pledged that A&E aggregate performance in England would hit 95% in 2018. That pledge was broken, so can the Minister tell us whether, for those A&E departments not trialling the new access standard, the four-hour A&E standard will be met this year, or will the target not be met for the fourth year running?

Or how about the 18-week referral to treatment target? More than half a million people are now waiting more than 18 weeks for treatment. The target that 92% of people on the waiting list should be waiting less than 18 weeks has not been met since 2016. Will that target be met in the next 12 months, or has it also been abandoned? What about cancer waits? Some 28,000 patients are now waiting beyond two months for treatment. The target for 85% of cancer patients to be seen within two months for their first cancer treatment after an urgent referral has been missed in every month but one since April 2014. Will that target be met this year, or will cancer patients be expected to wait longer and longer?

On staffing and pay, will funding be made available in the next 12 months, as it was last year, for a pay rise for health staff employed on agenda for change terms and conditions working in the public health sector for local authorities and social enterprises?

We have no NHS mandate, even though it is mandatory. We have no social care Green Paper, even though it has been promised five times. The big issue has been ducked again. We have no workforce plan, even though we have 100,000 vacancies across the NHS, and the interim plan, which should have been published today, has been delayed again. The Secretary of State parades his leadership credentials around right-wing think-tanks, yet on this record he could not run a whelk stall, never mind the Tory party. It is clearer than ever that only Labour will fully fund our NHS and deliver the quality of care patients deserve.

Anyone listening to that will have realised that the hon. Gentleman is more concerned with political points scoring and process than with the substance and funding of the NHS. [Interruption.] The hon. Member for Dewsbury (Paula Sherriff) shouts at me, but she will want to remember that the shadow Secretary of State welcomed the long-term plan—or much of it—back in January.

It is absolutely clear—evidence was provided to the Public Accounts Select Committee yesterday by the permanent secretary and the chief executive of NHS England—that while obviously it would be better to publish by the deadline, it is more important that the mandate be right than published on a particular day. It is more important that we get this document on the long-term strategy of the NHS correct. As Simon Stevens, the chief executive of the NHS, said, there is no problem with this short delay to the mandate. It is an important document, but it is causing him no problems. It is causing no problems.

The hon. Gentleman mentioned access to treatment and treatment times. This winter, more than 7 million patients were seen in under four hours. That is an increase of nearly 6% in attendances. I would have hoped that the Opposition Front Bench might have praised the NHS and its hard-working staff—

Rather than shouting political points across the Dispatch Box.

The hon. Gentleman says there are no targets. He is of course wrong.

No, the hon. Gentleman said there were no targets likely to be set for the NHS this year. The accountability framework will include detailed and specific annual deliverables and set out in detail a process for delivering future implementation as well as some of the early delivery goals for 2019-20. He is wrong therefore to say that the framework will not have deliverables attached to it. It will. He also mentioned the Green Paper—

I have said, as the hon. Gentleman has heard many times, that we are finalising that. Again, it is more important to get it right. On the long-term plan for workforce implementation, a draft plan is being produced and I expect that plan to be published in the very near future—[Interruption.]

Order. The shadow Secretary of State exceeded his time on his feet. He must not now chunter in borderline delinquent fashion from his seat.

There are all sorts of lines I could follow that with, Mr Speaker.

It is clear that it is this side of the House that is putting in the funding to make sure that the NHS can deliver for the patients, staff and families.

Most of us will remember that the NHS Confederation said four years ago that it wanted

“a manageable number of objectives, which…focus on long-term outcomes for patients and populations rather than measures of how services are delivered”—


“encourage collective responsibility for patient outcomes rather than silo working – particularly the expected outcomes from integrated care”.

Most people in the NHS will welcome the short delay if the result is that it makes it more possible for them to achieve the objective of the NHS, which is serving patients together.

My hon. Friend will have noted, as I said in my opening remarks, that this is an accountability framework because it brings together both the mandate for NHS England and the remit letter to NHS Improvement. It is a sign of more collaborative working which, as he says, almost everybody in the NHS and the healthcare arena would welcome.

The Minister will know the funding pressures that the NHS has been under, despite the 10-year plan: we still await the actual money being delivered, even though it has been announced. In the Wirral, a great deal of inefficiency is caused by the chronic underfunding of social care, for which the Government are responsible, which puts enormous pressure on health services. When it finally arrives, will the plan for the next year offer some proper relief in that area?

The hon. Lady will know that the Government have committed £33.9 billion up to 2023-24, and the first element of that has arrived this year. There will be, as I said earlier, publication of a Green Paper on social care and, combined with the comprehensive spending review, that will ensure that the Government will provide for the social care funding that is necessary.

Will the Minister recognise that the commitment under the long-term plan to ambulatory care, which is supported by the Royal College of Physicians, is helping patients receive the best form of care service in their own homes?

My hon. Friend is right. At the heart of the long-term plan is the emphasis on primary care and prevention. Providing care for people in their own homes undoubtedly achieves better outcomes for patients and he is right to welcome it.

The Minister will know that NHS England is currently consulting on proposals to change the law to remove mandatory competition, but billions of pounds’-worth of NHS services are currently out to tender. Has he considered, as part of the mandate, issuing clear guidance to CCGs that while the consultation is taking place they do not need to put many services out to the market? Or is he happy for that privatisation to continue on his watch?

The hon. Gentleman is right to point out that a consultation is being undertaken on various aspects of the long-term plan and the legal framework that needs to be put in place. It is entirely up to local CCGs to make decisions on their procurement policy.

Record investment is going into Kettering General Hospital and a record number of patients are being treated, but the best way that the Minister can deliver the NHS mandate and long-term plan for the people of Kettering is by providing the funding for a new urgent care hub, the site of which he has visited at Kettering General Hospital, and by working with the Ministry of Housing, Communities and Local Government to take advantage of local government reorganisation in Northamptonshire to create a health and social care pilot. Will he commit to both?

My hon. Friend and I have sometimes disagreed on certain things, but one thing we agree on is his advocacy for his constituents, and he is right that I have been to see for myself the issues in Kettering in terms of the current configuration of the accident and emergency department. He is right to press for that urgent care centre, and he knows that he has impressed the case on my mind.

Everybody in Kettering must be aware of the hon. Member for Kettering (Mr Hollobone). It is beyond my vivid imagination to suppose that there is any resident of the area who is not aware of him.

The truth is that it is very difficult for the NHS to make plans without knowing what the Government’s plans are for social care. We know, following a response to a question in yesterday’s debate, that the Green Paper has actually been written. There is simply no excuse for the continued delay in its publication which would allow the House to scrutinise it and the NHS to be able to provide a truly integrated approach to health and social care. Just saying that it will be published soon is no longer acceptable. Will the Minister set out when we can expect to see this vital document, so that we can scrutinise the Government’s plans?

The hon. Lady knows that the House and her Committee will have the fullest opportunity to scrutinise the document as and when it is published. She also knows that there is a commitment to publish it soon. She also rightly points out that it will deliver on the need to ensure that health and social care are integrated.

For most of my professional life, I was an NHS planner. I assure the Minister that the great expectation and anticipation of NHS planners for planning guidance in the mandate is very real. They are public servants who expect to be held accountable and do what the Government ask them to do. It is unacceptable to leave them in the dark. It is an insult to patients—taxpayers who pay for services and expect to know what they can receive locally. The delay is inexcusable.

The Minister says he has a plan and the Government say they have the money, so why cannot they publish it? What are they trying to hide?

The Government are not trying to hide anything. The hon. Lady is right that it is an important document, and it is important therefore that we get it absolutely correct. I refer her to what the chief executive of NHS England said yesterday. He said:

“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…stepping into the new five-year long-term plan.”

The chief executive of the NHS thinks that the process is working acceptably.

I am really not following the Minister on why this mandate has not been published. I wonder whether it is because of the paralysis in Government caused by the Brexit shambles or because, as the Health Service Journal reports, the Secretary of State is focused on an anticipated leadership race and his thoughts are elsewhere.

In the hon. Lady’s fantasy world, that may be true, but my right hon. Friend is in fact addressing a conference in Manchester, talking about the gender pay gap and how this side will close it in the NHS. I would have thought she would welcome that, rather than shouting at me.

On a point of order, Mr Speaker. When the Secretary of State comes to the Dispatch Box and makes a clear commitment that the publication date of the Green Paper will be before Christmas, and we know that the document has been written, what are the consequences of an absolute failure to honour such a commitment made at the Dispatch Box by a Secretary of State?

The consequences are political more than anything else. Quite what form that political consequence takes, if there is to be any, very much depends upon the view of the House of Commons; so the matter is the property of the House. I do not wish to incite strong feeling on this matter and the Minister has answered questions fully—whether to the hon. Lady’s satisfaction or not is another matter—and courteously. There are proceedings that can be brought to the House, but those are rarely brought and they would require a written communication with me. If, for example, a Member thought that the behaviour were contemptuous of the House, it is perfectly proper to bring that to my attention and I would have to consider it very carefully. But my instinctive reaction is that the consequence is a political consequence in terms of what might be considered a negative opinion of the failure to honour an earlier commitment. We shall leave it there for now.