Skip to main content

NHS Long-Term Plan: Implementation

Volume 662: debated on Monday 1 July 2019

Mr Speaker, I would like to update the House on the implementation of the NHS long-term plan and the delivery of improvements to the health service. Today marks the 100th anniversary of the Ministry of Health, founded under the Liberal and Conservative coalition of Lloyd George, and the Department has been staffed by brilliant, impartial civil servants ever since, and is today.

I can tell the House that on Thursday last the boards of NHS England and NHS Improvement agreed the long-term plan implementation framework. Alongside the clinical review of standards, and the interim workforce plan, published last month, this framework is a critical step in delivering on our 10-year vision for the NHS, and in transforming our health service with the record funding that this Government are putting in. The document sets out the framework within which each of the 300 commitments in the long-term plan will be delivered, and it also sets out the 20 headline commitments and how we will monitor the delivery of the plan. In the past, there have been criticisms that NHS plans have not led to full delivery. We are determined to ensure that the long-term plan fulfils its potential to transform the health service for the better, and I am placing a copy of the implementation framework in the Libraries of both Houses.

I wish to draw attention to three particular areas, the first of which is cancer care. I thank my hon. Friend the Member for Basildon and Billericay (Mr Baron) for his efforts to ensure that we focus on the vital indicator of cancer survival. The Prime Minister set out the ambition that by 2028 three quarters of all stageable cancers are detected at stage 1 or stage 2. Early detection and diagnosis are essential to the enhancement of people’s chances of surviving cancer.

Since 2010, rates of cancer survival have increased year on year. However, historically our survival rates in the UK have lagged behind the best-performing countries in Europe. The implementation framework sets out our goal of measuring the one-year cancer survival rates as one of the core metrics for the long-term plan. The one-year survival rate is how we measure our progress in achieving the ambitions set out in the plan. To realise those ambitions and ensure that we do everything we can to give people diagnosed with cancer the best chance of survival, the framework sets out first, a radical overhaul of screening programmes; secondly, new state-of-the-art technology to make diagnosis faster and more accurate; and thirdly, more investment in research and innovation.

From this year, we will start the roll-out of rapid diagnostic centres throughout the country, building on the success of a pilot with Cancer Research UK, so that we can catch cancer much earlier. NHS England is further extending lung health checks, targeting areas with the lowest survival rates, and Health Education England is increasing the cancer workforce, which will lead to 400 more clinical endoscopists and 300 more reporting radiographers by 2021. With these steps, our ambition is that 55,000 more people will survive cancer for five years, each year from 2028. Improving the one-year survival rate is how we ensure that the NHS remains at the forefront of cancer diagnosis and treatment and continues to deliver world-class care.

The second area is mental health. The Prime Minister and her predecessor rightly prioritised the treatment of mental health so that we can ensure that mental health finally gets parity with physical health. The £33.9 billion cash-terms settlement, which is the longest and largest cash settlement in the history of the NHS, includes a record £2.3 billion extra in real terms for the expansion of mental health services. The framework sets out how 380,000 more adults and 345,000 more children and young people will get access to mental health support. I pay tribute to the mental health Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price), who has done so much work to put the issue on the agenda.

We are introducing four-week waiting-time targets for children and young people and testing four-week community mental health targets for adults. The implementation framework refers specifically to the vital improvements to community mental health services that we all know are needed. Those improvements include services for adults living with serious mental disorders, including eating disorders, and for those coping with substance misuse. The framework also sets out how we will create a new workforce of mental health support teams to work with schools and colleges to help to identify young people who need help and reach them faster. In all, it is a fundamental shift in how we treat mental illness and how the NHS will prioritise mental health services.

The third area that I wish to touch on is people. Three quarters of the NHS budget goes on staff, because people are the most valuable resource that we have in the NHS. We need not only the right numbers but to ensure that staff have the right support. The long-term plan sets out our ambition to recruit, train and retrain the right numbers of staff over the next decade. Last month, Baroness Dido Harding set out the interim people plan, which sets out how we will build the workforce we need and create the right culture, so that doctors, nurses and other NHS staff have the time to care for patients and for themselves.

Last week, the British Medical Association accepted in a referendum the new agreement with junior doctors that will improve both pay and working conditions. Thanks to the hard work of my predecessor, we are already taking steps to increase the number of clinical training places by opening five new medical schools and increasing the number of routes into nursing through apprenticeships and nursing associates. Last year, more than 5,000 nursing associates started training through apprenticeships. This year, it will be up to 7,500.

Those are just three of the most vital areas from the 10-year vision for the NHS set out in the long-term plan. Across England, based on the implementation framework, local strategic plans are now being developed and will be brought together as part of a national implementation plan by the end of the year, and all of this will be underpinned by technology. Today sees the official opening of NHSX, the new part of the NHS, which will drive digital transformation to give citizens and clinicians the technology they need and save and improve lives. I am delighted that NHSX has received such a warm welcome across the NHS because it has so much potential to transform every part of health and social care for patients and staff.

The forthcoming spending review will settle budgets for health education, public health and NHS capital investment, and the settlements will feed into the final implementation of this plan. As part of the spending review, we will also review the current functioning and structure of the better care fund, which is rising in line with NHS revenue growth.

On this the 100th anniversary of the foundation of the Ministry of Health, this framework sets out how we will go about securing the foundations of the national health service into the next century and the creation of an NHS that delivers world-class care for generations to come. I commend this statement to the House.

I am grateful to the Secretary of State for an advance copy of his statement. I had hoped for a greater sense of urgency from him. He talks about the 100-year anniversary of the Ministry of Health, but this year is the first time in 100 years that the advances in life expectancy have begun to stall, and even go backwards in the poorest areas. Just the other week, we saw that infant mortality rates have risen now for the third year in a row. As this is the first time that they have risen since the second world war, I would have hoped for a greater focus on health inequalities in his statement today, not least because public health services—the services that, in many ways, lead the charge against health inequalities—are being cut by £700 million. Now he says that we should wait for the spending review for the future of public health services, but we do not know when the spending review is. The Chief Secretary to the Treasury has said that it will be delayed, so it could be next year.

In the past, the Secretary of State has talked about a prevention Green Paper. Will that prevention Green Paper be before the spending review or after the spending review? Will he also tell us whether it is still the intention of the Department to insist that local authorities fund their public health obligations through the business rates?

At the time of the publication of the long-term plan last year, the then Secretary of State for Health said that we cannot have one plan for the NHS without a plan for social care, yet we still have no plan for social care. We have been promised a social care Green Paper umpteen times. We are more likely to see the Secretary of State riding Shergar at Newmarket than see the social care Green Paper. Where is it?

The Secretary of State talks about the better care fund revenue increase. May I press him further on that? Is he saying that the clinical commissioning group allocations to the better care fund, which tend to be the bulk of the better care fund, will increase in line with the NHS revenue increase, or is he saying that there will be new money available for the better care fund? Adult social care has been cut by £7 billion since 2010 under this Tory Government, which is why hundreds of thousands of elderly and vulnerable people are going without the social care support that they need. Presumably, we will have to wait for the spending review for proposals on social care.

The Secretary of State talks about the workforce. We have 100,000 vacancies across the NHS. We have heard about the interim people plan, but of course we have seen the bursary cut, the pay restraint, and the continuing professional development cut. That plan is all good and fine, but when will it be backed up by actual cash?

The Secretary of State talks about IT systems and apps—we know that he is very fond of that—but again he gives us no certainty on capital investment. Hospitals are facing a £6 billion repair bill—ceilings are falling in and pipes are bursting. The repair bill designated as serious risk has doubled to £3 billion. When will we have clarity on NHS capital?

We broadly welcome what the Secretary of State said about mental health, but 100,000 children are currently denied mental health treatment each year because their problems are not designated as serious enough, and over 500 children and young people wait more than a year for specialist mental health treatment. He talks of a fundamental shift, so can he guarantee that clinical commissioning groups will no longer be allowed to raid their child and adolescent mental health services budgets in order to fill wider gaps in health expenditure? On mental health resilience and prevention, only 1.6% of public health budgets is currently spent on mental health, so will he mandate local authorities, when setting their public health budgets, to increase the money they spend on mental health?

On cancer, we broadly welcome what the Secretary of State has said, but patients are waiting longer for treatment because of vacancies and out-of-date equipment. Today we learned that consultant oncologists with shares in private hospitals are referring growing numbers of patients to those hospitals. Is that not a conflict of interest? When will we see tougher regulation of the private healthcare sector?

The Secretary of State talked about the clinical review of standards that is being piloted in 14 hospitals, yet those hospitals are not publishing the data. If he wants to abandon the four-hour A&E target, will he insist that those pilot hospitals publish all the data? He did not mention waiting lists. We have seen CCGs rationing treatment because of the finances. We have seen 3,000 elderly people refused cataract removals. We have seen CCGs refusing applications for hip and knee replacements. We have even seen a hospital that until last week was inviting patients to pay up to £18,000 for a hip or knee replacement—procedures that used to be available on the NHS. When is he going to intervene to stop that rationing of treatment, which we are seeing expand across the country because of the finances?

Finally, there are many laudable things in the long-term plan that we welcome. Alcohol care teams were a Labour idea. Perinatal mental health services were a Labour idea. Gambling addiction clinics, which the Secretary of State announced last year, were a Labour idea. Today he is talking about bringing catering back in-house, which is also a Labour idea. Why does he not just let me be Heath Secretary, and then he could carry on being the press secretary for the right hon. Member for Uxbridge and South Ruislip (Boris Johnson)?

Well, it is great that by the end of his questions the hon. Gentleman finally got to the future of the NHS, which is what we are here to discuss. However, what I did not hear—unless I missed it—was a welcome for the extra £33.9 billion that we are putting into the NHS. I did not hear him welcome the fact that life expectancies are rising, or our plan to drive up healthy life expectancy still further. I did not hear him say whether the Labour party supports our efforts to ensure that the NHS is properly funded and supported not only now but into the future, because that is what this Government are delivering.

I will go through some of the questions that the hon. Gentleman did raise. He asked about the prevention Green Paper. Indeed, he will know that preventing people getting ill in the first place is a central objective of mine, and it will be forthcoming shortly. He mentioned the better care fund. I was very precise in what I said about the better care fund, because its funding is rising in line with NHS revenue growth. In fact, the overall funding available to deliver social care in this country has risen by 11% over the past three years. Of course there is more to do to ensure that we have a social care system that is properly funded and structured to ensure that everybody can have the dignity of the care they need in older age, and that people of working age get the social care they need, but the Labour party ought to welcome the increase in funding, as well as the aim of ensuring that we get the best possible value for every pound.

The hon. Gentleman mentioned the clinical review of standards, which he welcomed when it was announced recently. The pilots that he mentioned started just four weeks ago, and of course we will be assessing the results and ensuring that we get the right structures in place in future. I am glad that he welcomed it, but in relation to publishing data, after just four weeks it is unsurprising that we are still in the early stages.

The hon. Gentleman asked me to ensure that the increase in funding for mental health will happen and that CCGs will be required to see that increase flowing through to make sure that patients get better service. I can confirm that NHS England is already intervening. The £2.3 billion increase that we have set out in the long-term plan will be required to flow through to the frontline. This implementation framework is part of the system that we are putting in place to make sure that that happens.

I very much welcome the Secretary of State’s announcement on putting the one-year cancer metric at the very heart of cancer services as a means of encouraging earlier diagnosis. You will be well aware, Mr Speaker, that the all-party parliamentary group on cancer has long championed the need to put this metric at the very heart of our services in order to encourage earlier diagnosis. The inconvenient truth is that despite the best will of those on both sides of this debate on the need to focus on process targets, we have failed to close the gap on international averages in our cancer survival rates. I chaired the APPG for 10 years, and I know that the current chair, the hon. Member for Scunthorpe (Nic Dakin), is waiting to speak as well. Will the Secretary of State ensure that sufficient funds are allocated to the one-year metric, because history would suggest that this metric has been there, or thereabouts, in the mix before, but because the money has been attached to the process targets, local NHS systems have ignored it?

I pay tribute to the work that the APPG, so ably led, has done in putting the measurement of improvements of cancer services at the forefront of the debate. I particularly acknowledge the point about early diagnosis. Here in the UK, we are one of the best countries in the world at treating cancer once it is diagnosed, but we are behind the curve on early diagnosis. Putting a one-year cancer diagnosis metric at the heart of the implementation of the long-term plan is a critical step in making that happen. What is going to happen now is that each of the local systems will feed into the framework in terms of how they will be putting this into action. The full implementation plan, which will be published shortly after the spending review, will take that into account, as well as all the budgets that need to be settled in the spending review. I would recommend to my right hon. Friend—my hon. Friend—[Interruption.] Just for now. I recommend that he keep up this campaign, because we have made significant progress in the implementation framework but there is still more to do.

The hon. Gentleman was temporarily elevated to the Privy Council by his right hon. Friend on the Treasury Bench. He might—who knows?—regard that as an earnest of what is to come.

There is no reference to GPs in the statement—I have just been looking through it. This comes at a time when my constituents are telling me that they are having to wait three weeks to get a GP appointment. Faith House GP surgery on Beverley Road, which I have raised with the Secretary of State directly, is now due to close. It is all very well training doctors for the future, but what is he going to do about the crisis in primary care now?

I picked out three of the 20 areas that we are particularly focused on in this implementation framework, one of which is the number of GPs and the broader primary care workforce, because it is not just about GPs but about all those who also support primary care across the board. We have a clear target of 5,000 more GPs, based on the 2015 baseline. We have a record number of GPs in training. Last month, the Minister for Health, my hon. Friend the Member for Wimbledon (Stephen Hammond), announced the consultation on changes to the pension to remove some of the unintended consequences of pension tax changes for GPs to ensure that we retain our highly trained, highly qualified GPs. There is a whole load of work in the people plan being led by Baroness Dido Harding to make sure that we have the number of GPs that we need and the wider primary care health workforce that is necessary.

As my right hon. Friend said, the first Minister of Health was Christopher Addison, then a Liberal, who abolished his position as President of the Local Government Board to succeed himself as the first Minister of Health in 1919, but the first Secretary of State to hold up a White Paper saying “national health service” was the Conservative Sir Henry Willink in 1944. We must give credit to the Labour party for bringing in the health service, agreed by the coalition Government, in 1948, although we have to recognise that Aneurin Bevan decided to nationalise the hospitals and not the GPs, when most people expected it to be the other way round.

In the experience of my wife, who did five years as Minister for Health and Secretary of State for Health, we should be praising all those who support the clinicians—the support workers, administrators and others who help doctors, nurses and other professionals—to look after us at all stages of our lives. We must have the extra money. I am glad that we have gone beyond the Labour party’s ambitious targets to meet our own ambitious targets, and that we can look forward to doing more, because we have to recognise that health will require a greater proportion of our wealth as we live longer and want better services.

I wholeheartedly agree with the entirety of what my hon. Friend said. It is true that for the majority of its 71-year history—71 this week—the NHS has been run by Conservative Secretaries of State, and the largest cash injections have come from this party. It is a truly national institution that we should all support, and we have to support not only the doctors, who lead many parts of the NHS, and the nurses, but all the health service staff, because it is a true team effort.

The Secretary of State may remember that I brought a group of mental health reformers to see him, to make the case for culture change in mental health services to address clear human rights abuses such as locking people up when they do not need to be locked up, often for a long period, shunting people around the country in ways that would never happen with physical health and the endemic use of force in mental health services. We argued that ending inappropriate institutional care would free up money for better prevention and early intervention. He said he loved that approach. Is he doing anything to actually implement it?

Yes. First, in terms of the review led by Simon Wessely of the legal powers set by the Mental Health Act 1983, there will be a Government response and then legislation in due course. We want to get that legislation right and bring it forward on an open basis, to ensure that we get a consensus behind it before introducing it formally to the House. On the administrative side, a programme of work is under way to deliver exactly what the right hon. Gentleman mentioned. In my statement, I specifically referenced the expansion in community mental health services that must happen, which will be good value for money and, of course, much better for many patients.

I felt that my right hon. Friend’s announcement deserved a more enthusiastic response than the uncharacteristically churlish one it received from the shadow Health Secretary. In terms of mental health, I particularly welcome the introduction of four-week waiting time targets for children and young people, because I know how much distress has been caused to many of my constituents by undue delays in the assessment and treatment of young people with mental health problems. Can he tell the House when he plans to implement those new waiting time targets and how he will keep pressure on CCGs, so that the benefits are seen on the ground as soon as possible?

I thank my right hon. Friend for his question. The shadow Secretary of State is so nice behind the scenes that he sometimes has to get a bit spiky in public, just to prove to his masters in the Leader of the Opposition’s office that he is on their side.

Over the rest of this year, we will deliver the plan to ensure that these targets are put in place. The truth is that we can only manage what we measure, and having a target for access to mental health services and pilots on how we do that for children’s health services is an incredibly important part of ensuring that the system lines up behind the rapid availability of mental health services, which, as I imagine every Member knows from constituency casework, is critical.

I very much welcome the ambition of this plan, the recognition that it will need appropriate resources—it very much needs appropriate staffing, because the human resource is most important—and the emphasis on cancer and early diagnosis. May I ask the Secretary of State how he will ensure that improvements in early diagnosis for less survivable cancers are central to the target to diagnose 75% of cancers at stage 1 and stage 2? There is a concern that the less survivable cancers will get neglected, given the nature of the plan at the moment.

I am grateful to the hon. Gentleman for the tone that he takes, and he is absolutely right in his analysis. I know he met the cancer Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for South Ribble (Seema Kennedy), last week on this point. We absolutely will address it, and we will not miss the less survivable cancers. Indeed, the focus on early diagnosis will of course help survivability, but it is also a focus across all cancers equally, rather than just on those where survivability has improved so much.

This long-term plan for the NHS has been developed by the NHS, not imposed by Government. Does my right hon. Friend agree that this sets the plan apart and means it is much more likely to work for staff and patients alike?

Yes, my hon. Friend is absolutely right. The plan is of the NHS by the NHS for the NHS. We in Government will absolutely facilitate it and support it, and of course we are putting in the money, but the NHS as a whole should be very proud of what this plan proposes and the way the implementation is being done in such a rigorous fashion.

May I press the Secretary of State a little further on the section of the plan that relates to prevention and early intervention? We are all waiting still for the prevention Green Paper. In particular, there are some diseases and illnesses, such as stroke, where apparently four out of five cases could be prevented by such early action, whether it is diagnosis of atrial fibrillation, or blood pressure and cholesterol testing devices. What more can be done for this Government to show they are serious about preventing ill health, such as stroke?

I completely agree with the hon. Gentleman. The whole plan—the whole NHS long-term plan—is about prevention as well as cure. The focus of the NHS needs to switch more towards prevention as well as, of course, helping people get better when they get ill. Taking the example of stroke, there is a lot on the prevention of stroke in the draft prevention Green Paper—just to give him a bit of a teaser for that. At the core of improving prevention of stroke is both behaviour change but also better use of data, because being able to spot people who have symptoms that are likely to lead to stroke can then help much more targeted interventions. I find it striking that with the big stroke charities, as with the big heart charities, their big ask is for better and more access to data.

May I thank my right hon. Friend for his statement and his commitment to this implementation plan, alongside the commitment to increase clinical standards? That is not a criticism of the medical professions; it is just a determination to make sure that the NHS is an infinite learning organisation and can learn from its mistakes. In that respect, will he recommit to HSIB—the healthcare safety investigation branch of his Department—which is devoted to doing clinical investigations without finding blame, so that these problems can be surfaced and the learning can be implemented across the NHS? In particular, will he recommit to the legislation, which has been through prelegislative scrutiny and is still waiting to be introduced?

Yes, I am looking forward to that legislation being introduced. The work that my hon. Friend’s Select Committee—the Joint Committee on the Draft Health Service Safety Investigations Bill—did in the prelegislative scrutiny was incredibly important. The HSIB Bill promises to improve patient safety, which is an important part of the agenda, and I look forward to its being brought forward to the House.

I have recently become the vice-chair of the all-party parliamentary group on sickle cell and thalassaemia. Sickle cell is very much a hidden disability which is lifelong. Some people take up to five medications a day, which is very costly. If they have a relapse, they can be hospitalised, but it is more cost-effective and preventive to have free prescriptions than to end up in hospital. Will the Secretary of State review the matter and do what is both best for those patients and in the public interest?

I will certainly look at the matter. When I was on a night shift with a London ambulance crew, we attended a patient who suffered from sickle cell, and it was horrific to see the degree of pain that they were in. I have therefore seen at first hand exactly how horrific the condition can be and I will look into the hon. Lady’s suggestion.

I was delighted to be able to show the Secretary of State the health and wellbeing hub in Budleigh Salterton and the opportunities at Ottery St Mary community hospital, and that he confirmed that both places had a role to play in the future of health provision in East Devon. However, last week, the National Audit Office found that community hospitals and GP surgeries were struggling to pay the rents charged by NHS Property Services and that, nationally, outstanding debt has almost tripled since 2014 to £576 million. If my right hon. Friend is interested in securing a legacy before he moves on to even higher political office, will he please look at that, particularly in advance of the review planned for 2021?

I certainly will. I also draw my right hon. Friend’s attention to an announcement, which we made last month, to allow local hospital trusts to request property from NHS Property Services so that it can be transferred to the trusts if it can be used better and more flexibly locally, in the way that the hub I saw at Budleigh Salterton absolutely delivers. I can also see such an opportunity for the potential hub at Ottery St Mary, which was a community hospital and has enormous promise for delivering services closer to the community.

I thank the Secretary of State for the statement and the substantial moneys that the Government have committed to the NHS long-term plan, particularly given the need for the cancer strategy to be fully implemented. On rare diseases, will he confirm that drugs such as Orkambi, Spinraza and medicinal cannabis will be simple to apply for and accessible for those who desperately need them now, when time is not on their side?

I understand the importance of those drugs. Each one is in a slightly different part of the process. We have opened up availability of medicinal cannabis. Indeed, I was talking this morning to the head of NHS England to ensure that our plans to normalise access to medicinal cannabis for those with a clinical need for it can be brought forward. The hon. Gentleman should expect to hear more news soon on the progress that NHS England and the National Institute for Health and Care Excellence have made. On Orkambi, we are still engaged with the company, Vertex, to try to bring that to patients in a cost-effective way. I greatly hope that Vertex will make some progress.

It has been great to hear my right hon. Friend mentioning the new medical schools. The one in Chelmsford is fantastic. It is 12 times oversubscribed for next year—we would love an increase in places. It was lovely to meet three of the medical students last week, when they raced across the high street to have selfies taken with my right hon. Friend’s predecessor.

We are also doing well on nurse apprenticeships, but there is an issue, especially with mature students coming in to study adult nursing. Will my right hon. Friend look again at how to give them financial assistance?

I thoroughly enjoyed visiting my hon. Friend’s local medical school and seeing the expansion that has taken place. The two of us walked into a room occupied almost entirely by dead bodies, which was quite an experience. [Interruption.] It was nothing like this place. On the specific and substantive questions she asks, we are looking at both the funding for the expansion of medical schools and how we ensure that we get the nurses we need into the profession. That will be part of the spending review process with the settlement of the budget for Health Education England.

Having been diagnosed earlier this year with a stage 3B melanoma, I always get a bit sweaty when people start talking about how important it is to have early diagnosis to ensure survival rates, but of course they are absolutely right. The number of people, in particular men, with melanoma is rising and people are still dying. I have heard horrific tales of people going to GPs five, six or seven times before a GP was able to send them on to see a dermatologist. I have heard about dermatologists saying, “I’ll look at this mole here, but I’m not going to look at that one because you haven’t been referred for that one. That will have to be a separate referral.” I have heard of people waiting six or seven weeks for histopathology to come back. All those things delay the process. Do we not need to have a wholesale approach to melanoma to ensure that we save more people’s lives?

Yes, the hon. Gentleman is absolutely right. I agree with what he says. There is a need for the whole medical profession to be constantly up to date with the latest treatment and diagnostic science. I am determined that part of the drive for early diagnosis is about not just diagnosis once referred, but better referral. We all have a part to play in that—wider society, as well as primary care.

Many people in my constituency find it difficult to obtain NHS dentistry. While that is part of the short-term plan, on the ambitions outlined in the plan for long-term improvements to oral health, what assurance can the Secretary of State give that NHS dentists will be in place to deliver them?

NHS dentistry is incredibly important. Ultimately, dentistry is part of prevention; it prevents oral ill health. We are doing a lot of work on what further we can do to support oral health. In fact, I had a meeting with the Minister with responsibility for public health on that subject this morning. I would love to meet my hon. Friend to discuss it further.

The Secretary of State clearly identified three critical areas for improvement to cancer survival rates. He is absolutely right about early diagnosis. I do not want to make my hon. Friend the Member for Rhondda (Chris Bryant) any more sweaty than he already is, but it cannot be repeated enough times that spotting these issues early on is critical to improving survival rates. The Secretary of State is also right about the importance of mental health. The third point he touched on was that the workforce is key to underpinning all this. In that regard, does he know how many specialist mental health and specialist cancer nurses we will have at the end of the 10-year period?

The answer to that question is being worked on as part of the people plan, which Baroness Dido Harding is putting together. We published the interim plan last month. The full people plan will be available after we have settled, in the spending review, the budget of Health Education England. The hon. Gentleman raises an incredibly important point.

I very much welcome the plan, with £33.9 billion being committed by 2022-23. My slight concern is where the money is going to come from. I wonder whether my right hon. Friend has had assurances from the Treasury that that will indeed be the case. With all the other pressures on spending and revenues in the coming years, that might be a little difficult. We have to find ways to ensure that the revenue is there because this money must be spent.

Yes, it will in all circumstances. This is a firm commitment, supported right across this House and right across our party, and it will be delivered. There is absolutely no question about that.

We know that areas of greater deprivation have greater health needs than other areas. Will the Secretary of State tell us what more there is in the long-term plan specifically about increasing the resources for GP practices that serve areas of greater deprivation? They have longer waiting times and greater vacancy lists and we need specific action to support those practices.

Making sure that we have the right allocations for CCGs across the country that reflect the needs of the local population is a very important responsibility for NHS England—as the commissioner of those services—to make sure that the money follows need. After all, the principle of the NHS is that it is available to everybody according to need, not ability to pay.

We all know that the Secretary of State is a great fan of technology and of improving the mental health of young people, and all people across the country. In my constituency, a man called Richard Lucas has set up a new online system called govox, which is a revolutionary, technologically enabled way of improving mental health among young people. Will the Secretary of State advise the House how innovative new technological solutions at a local level can best get into CCGs and the local NHS, so that we can improve mental health for everybody?

My hon. Friend has raised with me before the new technology developed by Mr Lucas. A new technology such as this can be picked up by all sorts of different parts of the NHS—by different CCGs or mental health trusts—which can then use it. One of the reasons that we have brought in NHSX, which opens today, is to make sure that there is a central place to which people with a good idea for how to improve the health of the nation by using technology can go to find a way into the NHS, so that great practice and good technology can be promulgated across the NHS as quickly as possible.

Speaking of revenue, what is the Secretary of State’s attitude to NHS trusts that set up subsidiary companies, if one of the main motives is clearly seen to be VAT avoidance, as in the case of Bradford trusts where nearly half the extra revenue of setting up a company in the first five years would be VAT-related?

If the hon. Gentleman writes to me with the specifics of the case, I will be very happy to look into it. The use of subsidiaries in the way that he described in principle has been available to NHS organisations for some time, and I am very happy to take up the case that he asked about.

I strongly welcome the 10-year plan and particularly what the Secretary of State said about apprenticeships, and I urge him to push more degree apprenticeships in the NHS. If it is right to have a 10-year long-term plan for the NHS in England, does he agree that we also need a long-term NHS plan for my constituency of Harlow? The only way that we can achieve that is by having a new hospital health campus. He has visited our hospital and realises that it is not fit for purpose.

Few people make the case for their constituencies better than my right hon. Friend, and nobody makes the case for Harlow better than him. He invited me around Harlow hospital. I went into the basement to see some of the work that is needed, and the basement of Harlow hospital is in a worse state of disrepair than the basement of this building. That means that it needs work, so I am considering his proposal. The future NHS capital budget will be settled in the spending review, so I suggest that he has a conversation with Treasury Ministers as well. I look forward to seeing the case progress.

My right hon. Friend is also right about how important degree apprenticeships are. Both of us are former Skills Ministers and have heralded the arrival of degree apprenticeships as a route for people into high-paid, high-quality jobs without them having to go to university.

Delayed discharge has a knock-on effect on the whole NHS. The fact that the Secretary of State has said today that all he will do is review the better care fund and that he will not publish a White Paper on social care shows what a low priority this is. When will we see the White Paper on social care for which we have been waiting not just months, but years?

The statement was about the implementation of the NHS long-term plan, to which of course the future of social care is vital, which is one reason why the spending power available within social care has risen by more than 10% over the past three years. We continue to work on the long-term future of social care. We will have to wait for a new Prime Minister before publishing the Green Paper—I think that is fairly obvious—but it would also be good to get a bit of cross-party collaboration. When my right hon. Friend the Member for Ashford (Damian Green) made some proposals that were in line with the cross-party work of two Select Committees of this House, within half an hour the shadow Secretary of State’s friend, the shadow Chancellor, had rubbished the idea—I do not think he took the time even to read it. We could do with a bit of cross-party work on the future of social care in this country.

Thanks to the record funding boost for the NHS, Cheltenham General Hospital can plan for the future with confidence, but local trust managers consistently cite difficulties with recruiting emergency medicine doctors as a reason for not being able to expand A&E provision. Does the Secretary of State agree that some of the additional resources must go into training additional A&E doctors so that we can give Cheltenham General Hospital the resources it requires?

Yes, I agree very strongly with that. When I said that my right hon. Friend the Member for Harlow (Robert Halfon) was one of the best constituency advocates, I forgot my hon. Friend the Member for Cheltenham (Alex Chalk), who is also one of the best, and certainly the best advocate for Cheltenham, that the House has ever seen. He is absolutely right in the substance of his question, which is that we must have the support for the workforce we need, including in emergency medicine, to ensure high-quality emergency facilities near to people—where they are needed—and he makes that case with respect to the expansion of services at Cheltenham Hospital, which he supports incredibly strongly.

Is the privatisation of the urgent care centre in the Runcorn-Halton part of my constituency part of the Secretary of State’s NHS plan?

I am not sure what specific case the hon. Gentleman is referring to, but I will tell him this about privatisation: I support the NHS being free at the point of delivery so that everybody can use it, and the most important principle at stake is how to deliver the best possible services for our constituents. That is what I will keep doing.

The success of the NHS long-term plan in Northamptonshire will depend on urgent short-term reform of the combined health and social care system in the county. There are 1,400 hospital beds in the two hospitals in Northamptonshire; 900 are occupied today by stranded and super-stranded patients as a result of delayed transfers of care. This is the worst situation in the country. The number of patients staying more than seven days in a hospital bed is twice the national average. Northamptonshire’s over-65 population is the fastest growing in the county. We need to take advantage of local government reform to establish an integrated health and social care pilot, but this requires the personal attention of the Secretary of State. Without that, we will not make any progress. Will he meet Members of Parliament from the county this month to get this under way?

Yes, and I suggest we meet also with the Secretary of State for Communities and Local Government. I have met the Northants MPs to progress this, and I have also meet the Communities Secretary about it. My hon. Friend is dead right. There is a serious problem, but there is also an opportunity for much more integrated health and social care. If Northants MPs, the Communities Secretary and I can find an opportunity to meet, perhaps we will be able to crack through this one.

I thank the Secretary of State for his announcement. I have two questions. First, do he and his Department accept that there are additional costs in providing healthcare on an Island that is of an equal standard to that provided elsewhere? Secondly, will he and his officials agree to meet Island officials to discuss plans for a pilot scheme to help integrate healthcare, adult social care and other local government services to ensure maximum efficiency in the delivery of services, as my hon. Friend the Member for Kettering (Mr Hollobone) just talked about, and to ensure that as much money as possible goes to frontline services?

Yes, I shall be happy to ensure that that meeting happens. As for Island healthcare costs, my hon. Friend is right to say that the Isle of Wight is unique in its health geography, and that there are places in this country—almost certainly including the Isle of Wight—where healthcare costs are higher because of the geography. There is a programme for smaller hospitals that are necessarily smaller because of the local geography, as they need special attention.

As I have said, I shall be happy to ensure that the meeting goes ahead, and I shall continue to talk to my hon. Friend, who makes the case for the Isle of Wight better than any other.

Tomorrow I shall attend the funeral of my Auntie Bib, who has just died of cancer. It was discovered at quite a late stage. May I press my right hon. Friend to ensure that rapid access diagnosis centres are rolled out as quickly as humanly possible, and to give the House more details? May I also—as is my job—remind him that he is, of course, the Secretary of State for Health and Social Care for this entire United Kingdom, and ask him how he intends to engage with devolved authorities when targets are being missed to ensure that standards are maintained across the island? Our constituents are all British citizens, and they all require and deserve the same level of support.

I am sure that the whole House will want to pass our condolences to my hon. Friend, to his family, and to friends of his aunt. In a way, it is fitting to end this session with a very personal example of why early diagnosis matters.

As for my hon. Friend’s second point, ensuring that we have high-quality health services throughout the UK is, of course, vital. It is true that there has been a smaller increase in funding for the NHS in Scotland, and a consequent smaller increase in the number of healthcare professionals there. We need an improvement right across this country. We are delivering that in England, and I am sure that my hon. Friend will continue to make the case for better health services in Scotland from the Scottish National party Government, who receive the money from the UK Treasury but do not put all of it towards the NHS.

Order. I will come to points of order in a moment. We now come to—or we will come to, after the points of order, so I should more accurately say that we shall shortly come to—the motion on the estimate for the Department for International Development. The debate will led by Mr Laurence Robertson. I inform the House that I have not selected the amendment in the name of Margaret Beckett. It may also be helpful if I inform the House that I have not selected either of the amendments to the second motion. After the points of order, I will call the Minister to move the motion, but first we will treat of points of order.