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Future of Health and Care

Volume 689: debated on Thursday 11 February 2021

Mr Speaker, I come to the House today to set out our White Paper on the future of health and care. The past year has been the most challenging in the NHS’s proud 72-year history. The health and care system as a whole has risen in the face of great difficulties. Throughout, people have done incredible things and worked in novel and remarkable ways to deliver for patients, and we in this House salute them all—not just the nurse who may have had to care for two, three or four times as many patients as he would in normal times, and not just the surgeon who may have been called to treat patients beyond her normal specialism, but the managers across health and care who have come together in teams, as part of a health family, at local and national level; the public health experts, who have been needed more than ever before; and the local authority staff who have embraced change to deliver for their residents—and from all, a sense of teamwork that has been inspiring to see.

As a citizen, I care deeply for the whole health and care family, the values they stand for and the security they represent. They are there for us at the best of times, and they are there for us at the worst of times. As Health Secretary, I see it as my role sometimes to challenge but most of all to support the health and care family in their defining mission of improving the health of the nation and caring for those most in need.

I come before the House to present a White Paper based firmly on those values, which I believe are values that our whole nation holds dear. The White Paper is built on more than two years of work with the NHS, local councils and the public. At its heart, this White Paper enables greater integration, reduces bureaucracy and supports the way that the NHS and social care work when they work at their best—together. It strengthens accountability to this House and, crucially, it takes the lessons we have learned in this pandemic about how the system can rise to meet huge challenges and frames a legislative basis to support that effort. My job as Health Secretary is to make the system work for those who work in the system—to free up, to empower and to harness the mission-driven capability of team health and care. The goal of this White Paper is to allow that to happen.

Before turning to the core measures, I want to answer two questions that I know have been on people’s minds. First, are these changes needed? Even before the pandemic, it was clear that reform was needed to update the law, to improve how the NHS operates and to reduce bureaucracy. Local government and the NHS have told us that they want to work together to improve health outcomes for residents. Clinicians have told us that they want to do more than just treat conditions; they want to address the factors that determine people’s health and prevent illness in the first place. All parts of the system told us that they want to embrace modern technology, to innovate, to join up, to share data, to serve people and, ultimately, to be trusted to get on and do all that so that they can improve patient care and save lives. We have listened, and these changes reflect what our health and care family have been asking for, building on the NHS’s own long-term plan.

The second question is, why now, as we tackle the biggest public health emergency in modern history? The response to covid-19 has accelerated the pace of collaboration across health and social care, showing what we can do when we work together flexibly, adopting new technology focused on the needs of the patient and setting aside bureaucratic rules. The pandemic has also brought home the importance of preventing ill health in the first place by tackling obesity and taking steps such as fluoridation that will improve the health of the nation. The pandemic has made the changes in this White Paper more, not less, urgent, and it is our role in Parliament to make the legislative changes that are needed. There is no better time than now.

I turn to the measures in detail. The first set of measures promote integration between different parts of the health and care system and put the focus of health funding on the health of the population, not just the health of patients. Health and care have always been part of the same ecosystem. Given an ageing population with more complex needs, that has never been more true, and these proposals will make it easier for clinicians, carers and public health experts to achieve what they already work hard to do: operate seamlessly across health and care, without being split into artificial silos that keep them apart.

The new approach is based on the concept of population health. A statutory integrated care system will be responsible in each part of England for the funding to support the health of their area. They will not just provide for the treatments that are needed, but support people to stay healthy in the first place. In some parts of the country, ICSs are already showing the way, and they will be accountable for outcomes of the health of the population and be held to account by the Care Quality Commission. Our goal is to integrate decision-making at a local level between the NHS and local authorities as much as is practically possible, and ensure decisions about local health can be taken as locally as possible.

Next, we will use legislation to remove bureaucracy that makes sensible decision making harder, freeing up the system to innovate and to embrace technology as a better platform to support staff and patient care. Our proposals preserve the division between funding decisions and provision of care, which has been the cornerstone of efforts to ensure the best value for taxpayers for more than 30 years. However, we are setting out a more joined-up approach built on collaborative relationships, so that more strategic decisions can be taken to shape health and care for decades to come. At its heart, it is about population health, using the collective resources of the local system, the NHS, local authorities, the voluntary sector and others to improve the health of the area.

Finally, the White Paper will ensure a system that is accountable. Ministers have rightly always been accountable to this House for the performance of the NHS, and always will be. Clinical decisions should always be independent, but when the NHS is the public’s top domestic priority—over £140 billion of taxpayers’ money is spent on it each year—and when the quality of our healthcare matters to every single citizen and every one of our constituents, the NHS must be accountable to Ministers; Ministers accountable to Parliament; and Parliament accountable to the people we all serve. Medical matters are matters for Ministers. The White Paper provides a statutory basis for unified national leadership of the NHS, merging three bodies that legally oversee the NHS into one as NHS England. NHS England will have clinical and day-to-day operational independence, but the Secretary of State will be empowered to set direction for the NHS and intervene where necessary. This White Paper can give the public confidence that the system will truly work together to respond to their needs.

These legislative measures support reforms already under way in the NHS, and should be seen in the context of those broader reforms. They are by no means the full extent of our ambition for the nation’s health. As we continue to tackle this pandemic, we will also bring forward changes in social care, public health, and mental health services. We are committed to the reform of adult social care, and will bring forward proposals this year. The public health interventions outlined in this White Paper sit alongside our proposals to strengthen the public health system, including the creation of the National Institute for Health Protection, and last month we committed in our mental health White Paper to bringing forward legislation to update the Mental Health Act 1983 for the 21st century.

This landmark White Paper builds on what colleagues in health and care have told us, and we will continue that engagement in the weeks ahead, but it builds on more than that: it builds on this party’s commitment to the NHS from the very beginning. Eagle-eyed visitors to my office in Victoria Street will have noticed the portrait of Sir Henry Willink, who published from this Dispatch Box in 1944 the White Paper that set out plans for a National Health Service, which was later implemented by post-war Governments.

Throughout its proud 72-year history, successive Governments have believed in our health and social care system and strengthened it for their times. I believe the NHS is the finest health service in the world. I believe in the values that underpin it: that we all share responsibility for the health of one another. Its extraordinary feats this past year are unsurpassed even in its own proud history. Once again, we must support the NHS and the whole health and care system with a legislative framework that is fit for our times and fit for the future. We need a more integrated, more innovative and more responsive system, harnessing the best of modern technology and supporting the vocation and dedication of those who work in it. This White Paper is the next step in that noble endeavour, and I commend this statement to the House.

I thank the Secretary of State for advance sight of his statement. I suppose we should also thank Andy Cowper for advance sight of the White Paper.

We are in the middle of the biggest public health crisis that our NHS has ever faced: staff on the frontline are exhausted and underpaid; the Royal College of Nursing says that the NHS is on its knees; primary care and CCG staff are vaccinating and will be doing so for months ahead, including, possibly, delivering booster jabs in the autumn; and today, we learn that 224,000 people are waiting more than 12 months for treatment. This Secretary of State thinks that now is the right moment for a structural reorganisation of the NHS.

We will study the legislation carefully when it is published, but the test of the reorganisation will be whether it brings down waiting lists and times, widens access, especially for mental health care, drives up cancer survival rates, and improves population health. We are not surprised that the Secretary of State has ended up here. We warned Ministers not to go ahead with the Cameron-Lansley changes 10 years ago. It was a reorganisation so big that we could see it from space. It cost millions. It demoralised staff. It ushered in a decade of wasted opportunity and, of course, he voted for those changes and defended them in this Chamber, so, when he stands up, I hope that he will tell us that he was wrong to support them.

We have long argued for more integrated care, but how will these new structures be governed, how will they be accountable to local people, and how will financial priorities be set, because when something goes wrong, as tragically sometimes it does in the delivery of care, or when there are financial problems, such as the ones that we have seen at Leicester’s trust, where does the buck stop?

The Secretary of State is proposing an integrated care board tasked with commissioning, but without powers to direct foundation trusts, which spend around £80 billion and employ around 800,000 staff. He is suggesting a joint committee of the ICS and providers as well, but who controls the money, because it is from there that power flows? Both of those committees will overlap with a new third additional committee, the integrated care system health and care partnership, which includes local authorities, Healthwatch and even permits the private sector to sit on it. All these committees must have regard for the local health and wellbeing board plans as well. How will he avoid clashing agendas and lack of trust between partners, as we have seen at the ICS in Bedfordshire and Luton, for example? Nobody wants to see integrated care structures that cannot even integrate themselves. Legislation alone is not the answer to integration. We need a long-term funded workforce plan; we do not have one. We need a long-term, cross-governmental health inequalities plan; we do not have one. We need a sustainable social care plan; we were promised one on the steps of Downing Street and we still do not have one.

When the Secretary of State voted for the Cameron reorganisation 10 years ago, it was presumably because he wanted, in the words of the White Paper at the time, “to liberate the NHS”. Now he is proposing a power grab that was never consulted on by the NHS. It seems that he wants every dropped bedpan to reverberate around Whitehall again. He is announcing this just at the very moment when the NHS is successfully delivering vaccination, which is in striking contrast to the delivery of test and trace and of PPE early on where he was responsible. Again, we will look carefully at the legislation, but why is he so keen for these new powers? Why is he repealing his responsibility to set an annual mandate and bring it to Parliament?

The Secretary of State wants to intervene now in hospital reconfiguration plans, but why is he stripping local authorities of their power to refer controversial plans to him? With his new powers, will he reverse outsourcing? Will he end the transfer of staff to subcos? Will he bring contracts back in-house and block more outsourcing in the future? He is ditching the competition framework for the tendering of local services, while potentially replacing it with institutionalised cronyism at the top instead.

Fundamentally, how will this reorganisation and power grab improve patient care? The Secretary of State did not mention waiting times in his statement. It is mentioned once in the leaked White Paper. How will he bring waiting lists down? How will he improve cancer survival rates and widen access to mental healthcare, and by when? How will this reorganisation narrow widening health inequalities, and by when? Given that the Prime Minister insists that lessons cannot be learned from this pandemic until the crisis is over, why does the Secretary of State disagree with that and consider this reorganisation so urgent now?

I will take that as cautious support. I know that the hon. Gentleman sometimes has to say these things, but I am very glad that he leaves the door open for yet more enthusiastic support in the future, not least because of all the questions that he just asked. The proposals on the table—the proposals in the White Paper—are addressed directly to make the improvements that he calls for.

The hon. Gentleman raised an important point about the vaccination programme. The vaccination programme is one of the largest and also one of the most successful civilian operations that has happened in this country, and that is because of the teamwork among the NHS, local authorities, the Department and the brilliant civil servants who work in the vaccine taskforce. It is that combination, that teamwork and that integration which is making the programme the great success that it is.

The hon. Gentleman asked about timing, and I say to him: why argue for delay? Why stop work to integrate? Why stop work to ensure the NHS is more accountable? When people are working so hard in the NHS for us, why should we not work hard in this Parliament to give them the legislative support that they need and have asked for? That is the question he needs to answer if he wants to continue an argument for delay. If not now, when? There is no better time than immediately, so I hope that he will, on reflection and on reading the White Paper, come forward with enthusiastic support.

I absolutely look forward to debates about the details and the implementation. I look forward to the parliamentary passage of a significant piece of legislation in the future, and I look forward to the hon. Gentleman’s engagement on that, but the removal of bureaucratic barriers cannot wait. The increase in the integration of the system should not have to wait, and accountability for this enormous amount of taxpayers’ money to this House, and through this House to the citizens whom we serve, is something that should be welcomed right across this Parliament, and I hope that it will be.

May I start my comments by thanking the brilliant staff at the Royal Surrey County Hospital for the wonderful care they gave me—this morning, as it happens, when I unfortunately slipped over and broke my arm on a morning run. I have just come from the hospital.

It is a very big deal to do a structural reorganisation of the NHS, and I know from my time as Health Secretary how distracting it can be, but it is none the less the right thing to do and a brave thing to do, because NHS staff want nothing more than to be able to give joined-up care—joined up between hospitals, GP surgeries, the social care system and community care—and the current structures make that more difficult than it should be.

I also welcome the public health measures, particularly on obesity, given the high mortality rates that obese people have had during the pandemic. However, these integrated care systems are going to be very powerful, so my question to the Health Secretary is this: how will the public know in their area about the quality and safety of care, and whether waiting lists are being properly managed? How will they know how good all that is? Is he planning to ask the CQC to do Ofsted ratings, as it successfully does for hospitals and GP surgeries?

I pay tribute to my predecessor’s work setting up integrated care systems in the first place. In a way, this legislation builds on the foundations that he laid when he was in my job, and I look forward to working with the Health and Social Care Committee on the legislation as it proceeds. We have already had discussions, and I am grateful for the Select Committee’s work so far and the insights it has provided.

The question my right hon. Friend raises about the accountability of ICSs is absolutely central, not just to accountability for the use of taxpayers’ money, but to driving up both the quality of care for patients and the health of the population the ICSs serve. It is critical that we ensure the correct combination of high levels of transparency, the role of the CQC as inspector, and accountability up from the ICS, through NHS England, to Ministers and therefore Parliament, and through our democratic processes to taxpayers. The White Paper sets out at high levels how that accountability will work. The details will be a matter for the Bill. The combination of transparency and clear lines of accountability are vital to make sure that while we use the integration provided for in the Bill to empower frontline staff to deliver care better, they are held to account for the delivery of that care and, critically, the outcomes for the population as a whole whom we serve.

Health and social care staff always do their best for their patients and residents, regardless of legislative systems, but I welcome the Government’s recognition of the damage caused to the NHS in England by the Health and Social Care Act 2012, and the proposal to reverse some of its most obstructive and expensive aspects, particularly section 75, which forced the outsourcing of services, promoted competition instead of collaboration, and made pathways more disjointed and confusing for patients, especially those with complex conditions. The devil, however, will indeed be in the detail.

Which model of integrated care is the Secretary of State proposing? Will he merge organisations, including commissioning groups, or, as the NHS would prefer, create new public NHS bodies, similar to the health boards we have in Scotland? When sustainability and transformation partnerships were created, their transformation budgets were quickly used up in covering debts caused by the bureaucracy of the healthcare market, so what additional funding is he committing to bring about this reorganisation? Given the pressure of covid, the backlog of urgent cases, and extensive staff vacancies, how does he plan to create the capacity for staff to carry out such service change? Covid has highlighted the vulnerability of the care system, so what plans are there to integrate health and social care?

Finally, the Secretary of State has highlighted health inequalities, but poverty is the biggest driver of ill health. What discussions has he had with the Secretary of State for Work and Pensions and other Cabinet colleagues about promoting the prioritisation of health in all policy decisions?

Of course health is an important consideration in all policy decisions. The overall response to the pandemic has demonstrated that.

The hon. Lady is right to raise the issue of integration and to ask what plans there are for the integration of health and social care. Indeed, that is at the core of the proposals, as I set out clearly in my statement, and at the core of the White Paper. The integration of health and social care has improved significantly this year as a result of people having to work together in the pandemic. Fundamentally, social care is accountable to local authorities, which pay for it, and therefore to the local taxpayer, whereas the NHS is accountable to Ministers and central Government. The combination of these two vital public services is a challenge that I think can be addressed through the integrated care systems. We have been working very closely with the Local Government Association in England and the NHS to try to effect that integration as much as possible.

The hon. Lady raises the issue of funding. Of course, the NHS has record funding right now, and rightly so, but these reforms are about spending that money better to improve the health of the population, to allow new technology to be embraced, and to remove bureaucracy. It is not about having to spend more money on a reform; it is about reforming in order to spend money as well as possible.

When I was in the Army, I was badly hurt, and I was put under the care of the NHS. In turn, it sent me to a private practitioner, in Harley Street actually, who did me the world of good, and I paid nothing. Now, as an MP, I am frequently asked, “Are the Government intending to privatise the NHS?”. My reply is, “No, of course they aren’t, and very little of the NHS is privatised.” Could I ask my right hon. Friend to inform me how much of the NHS is privatised as a percentage and whether the plans are to increase it or not?

The NHS is not privatised at all. The NHS is delivered free at the point of care, or free at the point of use, according to need, not ability to pay. Of course, the NHS buys all sorts of things—it buys goods, technology, scalpels and services of different scales and sizes—and it employs people, and this combination is essentially what the NHS is made up of. It matters not the name of the provision; what matters is the care for the patients, and the quality of support for the population’s health. The pandemic has demonstrated that what matters is the outcomes, and the coming together of different types of provision has always contributed to the delivery of care for patients, as my hon. Friend set out. That will no doubt happen for the entire future of the NHS, which I have absolutely no doubt will go from strength to strength, not just now, after the last 72 years, but for the next 72 years, and after that.

I am fully in favour of a review of the NHS that brings it up to date and makes it the best healthcare centre in the world, but if he wants to make this a milestone, surely he should slow down a bit. Why not consult cross-party? At this unique time, when we have all been in this together, why can he not consult more? Why does he not to listen to the people, and consult those who work in the NHS, as well as the people who have benefited from it? Why rush this? Why not talk about it and get cross-party support? Politicians of all kinds have never ever got the NHS absolutely right. Why not work together across party lines, and consult the people who work in the NHS, and those who benefit from it? Slow down, Secretary of State, and you will get me on your side.

I very much hope to get the hon. Gentleman on side and supporting these reforms, not least because many of them were in not just the Conservative party manifesto, but the Labour party manifesto on which he stood. We have consulted extensively on the measures in this set of reforms over two years. I look forward to further work, consultation and discussions with parliamentarians on all sides before, during and no doubt after the passage of the Bill. It is an incredibly important piece of work. What I do not want to do is delay the improvements that people on the frontline have called for. The core measures of this Bill have been built on the asks of the NHS, working with local government, and I think we should get on and deliver that.

I give my overwhelming support to these proposals, particularly the drive for innovation and technology, which will improve not only access to care but care outcomes for patients. The Secretary of State will be aware that in Burnley General Hospital, we already have some advanced surgical robots that provide incredible care. Could I urge him to look, as part of these reforms, at how we can make sites such as Burnley Hospital regional centres of excellence in areas such as surgical robotics?

Yes. We care about technology in the NHS because we care about people and the improvements to people’s lives that it can generate. Surgical robots are just one example. I am very glad to hear that they are being used in such an innovative way in Burnley Hospital. I would love to come and see that for myself some time. This is exactly the sort of progress that the NHS should be making to free up the time of dedicated and highly skilled clinicians, and to enable the delivery of more high-quality surgery because of, for instance, the higher magnification that one can get in using a robot for surgery. That is just one example of the sort of thing that we can push further as a result of the measures in this White Paper.

When you go to Burnley, Secretary of State, I know you will also put Ribble Valley, Chorley and a few other places on your list.

The Secretary of State may be aware that before I returned to Parliament, I had some involvement with the establishment of the Greater Manchester model of health and social care. Can I offer him two insights from that? First, social care is clearly not yet funded in the way that is needed if we are to have proper integration. Secondly, it was possible to have a Greater Manchester strategic level for the nearly 3 million people of the conurbation, but to have integration and delivery at the district level. On the integrated care systems, will he guarantee that there will be nothing that prevents the very successful model that Greater Manchester is already pioneering?

Yes. The changes in Greater Manchester, in which the hon. Gentleman had an important role, are a good example of where we can drive this sort of integration. I can confirm that nothing I am proposing would get in the way of that. In fact, I hope that the changes in the White Paper will help areas that, like Greater Manchester, are already some way along this journey to go further, and will support them by ensuring there are fewer legislative barriers to the sorts of actions that they want to take. That includes both the measures across the NHS and the integration between health and social care.

Frontline health and social care providers have shown enormous flexibility, innovation and collaboration in dealing with this crisis. I welcome the Secretary of State’s proposals. I am particularly pleased that he suggests the need both for clear political accountability and strong local autonomy for the frontline. Will he assure me that, unlike Nye Bevan, the Secretary of State does not want to hear the sound of dropped bedpans in his office in Whitehall, and that, rather, we need a more local, more collaborative and more community-led approach to health and social care, as proposed by the Conservative Henry Willink—as he says, the original designer of the NHS?

Yes, that is absolutely right. In fact, my hon. Friend put it rather better than I did. Perhaps I will take up his rhetorical suggestions for how to make this case. Accountability is important, but the more local the decision making, the better. There should be local decision making across a whole range of partners—not just in the core NHS, but by providers of services, from whatever sector they come, including the voluntary sector, which, during this pandemic, has been embraced more. We need to build on that to make sure that we have a system that can truly serve local needs. Ultimately, all healthcare is locally delivered, because it is delivered to an individual to improve or save their life. Essentially, we need to make sure that the appropriate decisions are taken as locally as reasonably possible.

The pandemic has shone a light on massive health inequalities across the country. The Secretary of State announced the abolition of Public Health England in September, but there is still no clarity on where the vital health improvement function will sit in the future. Why are we hearing about new structures for the NHS today without also getting clarity on the arrangements for vital elements of public health and prevention?

There is a simple, clear reason for that, and I am very glad that the hon. Lady asks that question, because it is an incredibly important function. We will set out more details on the arrangements for health improvement functions, but the population health approach that is embedded within the integrated care systems set out in the White Paper will itself be at the fulcrum of delivery of health improvement and of narrowing health inequalities. If we think about it, around 20% of the impact on someone’s health is what happens in hospital; the rest is what happens outside hospital, the extra support that people can get and, of course, the choices that people make. Integrated care systems will be supported and funded in such a way that their goal is to improve the health of the local population, not just of the patient.

Health improvement is embedded in the structure and the design of the future of the NHS embedded in the White Paper, and the wider health improvement responsibilities will flow from that. We will set out the precise organisational structure of those shortly, but I needed to get the White Paper out first, because it is off this population health approach that the future of health improvement will be built.

I welcome the commitment to more joined-up care, which must include mental health. The Health and Social Care Act 2012 committed to parity of esteem between physical and mental health. Will the Secretary of State set out how, specifically, the White Paper builds on that? Will it require and measure parity of esteem in output, and particularly outcomes, for mental health? If not, why not?

I am grateful for my hon. Friend’s support. Parity of esteem between mental and physical health is critical, and of course it is embedded in a population health approach. It is critical that the new integrated care systems will of course have responsibilities for provision of mental health services as well as physical health services. The historical silos in the provision of mental health and physical health services need to be brought together; so often, the provision of both is critical in a world in which many people have multi-morbidities, including challenges with both their physical and their mental health.

I thank the Secretary of State for his statement and for announcing a progressive strategy, which we all welcome. Does he not agree that this pandemic has opened our eyes to the gaps in frontline service provision and that, if nothing else, we must ensure that nothing is able to prevent basic cancer treatment from taking place as we go forward? I spoke recently to someone in the midst of a cancer battle who said that they had been trying to fight with one hand tied behind their back. How will the Secretary of State ensure that patients awaiting scans and treatment plans are able to safely access them?

Yes, of course. The figures out today demonstrate the scale of the challenge when it comes to cancer treatment. Of course the pandemic has had a challenging impact on cancer treatment. We are supporting cancer alliances to improve outcomes as much as possible, and to work through the backlog that has inevitably built up because of the pandemic. Cancer alliances are a very important part of the future of the delivery of care. In many cases, they will be bigger geographically than an ICS. For them and for other specialist treatments, of course some cases will have to be at a larger scale than an ICS. Alongside putting these reforms in place, we are absolutely determined to do everything we can to ensure that people get the treatment for cancer that they need as soon as possible.

I very much welcome the White Paper. I urge my right hon. Friend to “think workforce” at every stage, but to ensure that prevention is the golden thread that runs through all future legislation and plans. Given that the last 12 months has very much laid bare the impact of inequalities on our public health outcomes, will we be truly bold and return to our prevention Green Paper, which the Secretary of State knows well, when it comes to facing the obesity crisis, smoking prevalence, alcoholism, diabetes and stroke prevention, to name just a few?

Yes. There are measures in this White Paper that precisely pick up the work of the prevention Green Paper that my hon. Friend did so much to shape when he was in the Department with me. In fact, many of the proposals in the White Paper are built from conversations that he and I shared. I want to put on the record my gratitude for the work that he did in shaping this agenda, because ultimately a population health agenda is an agenda about the prevention of ill health. Of course we must—and we will—treat those who become ill, but it is far better for everybody to support people to take a shared responsibility, including their own personal responsibility to stay healthy in the first place. The population health agenda that will be at the heart of the integrated care systems is ultimately a preventive agenda, and one that I am very glad to hear that he supports so wholeheartedly.

On this day eight years ago, the Government announced and then legislated for a new funding model for social care, which the Tories then scrapped two years later. Eight years on, we have yet another NHS reform announcement, but only yet another promise to reform social care. With 25,000 care home deaths during the pandemic, what will it take for the Prime Minister to make good on his promise to fix social care, and when will the Secretary of State start the long-promised cross-party talks to find a solution?

On the contrary—this White Paper covers health and care. It covers the integration of the NHS and social care at a local level. Of course there is further work on funding, as we have committed to in our manifesto, but the integration of those services, which has been so important during the pandemic, is one of the critical pieces of the forthcoming health and care Bill.

I congratulate the Secretary of State on this very important plan and announcement. As he knows, the Island is already piloting some ideas, so I thank his team of excellent advisers and the Secretary of State himself. May we have more pilot schemes to support his work? As he knows, the benefit of his approach may be felt more strongly on the Isle of Wight than anywhere else in Britain, due to our excellent but unavoidably small hospital at St Mary’s, the smallest county council in England, and our age profile. We want to help him and we want to be at the front of the queue. Will he also please consider the position of the 12 unavoidably small hospitals in England as part of the programme, of which St Mary’s is the most unique because it is on an island? I thank the Secretary of State and his team for their great work.

With an ask like that, it is hard to say anything other than yes, enthusiastically. I am keen to work with my hon. Friend, who is such an incredible voice for the Isle of Wight. The services on the Isle of Wight, by its island nature, are more closely aligned together than in many other parts of the country, but nevertheless suffer from some of the bureaucratic silo requirements in current legislation. I hope that these proposals will be received enthusiastically by all those involved in the provision of health, social care and public health on the Isle of Wight because they will remove the legislative barriers to closer integration and allow them to continue in the direction in which I know they are enthusiastically working with my hon. Friend’s support.

In the middle of a pandemic, when its implications for future healthcare are still not fully understood and when NHS staff are exhausted, with no respite on the horizon, there are real concerns that the Secretary of State is embarking on this reorganisation now. So how will these plans specifically address the lengthening backlog in cancer treatments in Halton and the north-west? How will replacing local decision making with large sub-regional health bodies allow greater local accountability and encourage local innovation?

The devolution of decision making to integrated care systems will help to join up care and deliver it more effectively. That is one reason why these proposals have been received so enthusiastically by the NHS itself and by NHS colleagues, including from local government, not least because the proposals originated from proposals from the NHS. I look forward to working with the hon. Gentleman and suggest that he works with his local NHS to make sure that this legislation goes through in the most high-quality way possible and that we have a high-quality debate on it, so that it can serve his constituents in exactly the way he sets out.

I know from conversations I have had with the Health Secretary in Mansfield that much of this change will be widely welcomed, and joining up our services is vital if we are to have the best possible healthcare system. I just have one concern: the announcement also talks about new public health measures, and there is an obesity strategy that I fear risks increasing inequality by raising the cost of the weekly shop. Surely education is the key to public health, by, for example, teaching people to cook fresh meals, as people need the skills to make healthier choices or they just end up paying more. So will the Health Secretary ensure that the public health elements of these reforms focus on that education and do not just end up hitting people in their pockets?

Yes, of course I am alive to that concern, and I look forward to further discussing these measures with my hon. Friend. The crisis has demonstrated how helping people achieve a healthy weight is important, and the Prime Minister has shown personal leadership on that in policy terms. Of course more information and education is an incredibly important part of this because it is about shared responsibility, including personal responsibility, to improve public health. I look forward to working with my hon. Friend on the details of it and making sure that we can get this into such a shape that it genuinely supports the tackling of obesity in a way that supports people, as he sets out.

A decade ago the Minister and his Conservative colleagues pushed through the Lansley reforms, even though NHS staff warned us that they would lead to fragmentation and waste. Why should we trust him now, given that he and his party got it so wrong then? How will he gain the trust and confidence of all NHS workers for his plans, and for the timing of these reforms?

The reforms that we have set out were themselves initiated and generated from the NHS, which may be one reason why I am so pleased to have seen such a strong, positive reaction from the NHS to these proposals. They are about what happens over the decade to come. Of course we always need to be improving the NHS, and each reform is a matter of the context of its times. These reforms are about more innovation, more integration and more accountability for the NHS, all with the goal of supporting those who work on the frontline to deliver better care.

Covid has changed the way we live and work. We have all had to adapt, and our NHS has been forced to find better ways of working. Can my right hon. Friend reassure me that our NHS will learn from our covid days, adopt some of the new measures in place and improve its performance over the coming years, while delivering on our commitment to recruit 50,000 more nurses and build 40 new hospitals?

Absolutely. We are on track to hire 50,000 more nurses over this Parliament and build 40 new hospitals over the decade. Those were core commitments in the manifesto that my hon. Friend and I both stood on with great enthusiasm, and I look forward to delivering on them. The White Paper will help towards that, but that is on track and under way already. He is quite right about learning from what has gone well in the pandemic, during which the NHS has had to work so incredibly hard, and the White Paper will help to do that.

Some of the culture and some of the ways of working have been more flexible, more dynamic and more joined-up within the NHS over the past year, embracing more modern technology than ever before. It is critical that we keep pushing that culture forward and supporting people in driving that culture forward and do not fall back to old ways of working. The White Paper will help us to do that, but it is only one part, because it is everybody working as a team and working together that is at the core of where things have gone well over the pandemic.

A year and a half ago, we halted the dangerous back-door privatisation of key services in Bradford’s hospitals while Ministers sat on their hands and ignored the outcry of NHS staff and local people. The proposals in the press confirm what I and many others have long said about the disaster and waste of privatisation in our NHS—[Inaudible.]

Imran, it is a very bad line, even on audio-only, but the Secretary of State is going to have a go at answering.

The irony is that the proposed changes that the hon. Gentleman was concerned about, which were halted, were ones that it is currently legally impossible for a Minister to stop without going through a whole process, which he knows about. The proposals in the White Paper will make it easier for us to work together collaboratively on the right outcome and remove some of the bureaucracy that, frankly, stops Ministers getting involved when a project is not going in the right direction. On that basis, I hope that he welcomes the White Paper.

Sorry about the gremlins, Imran, but the Secretary of State did very well in answering your question.

Can my right hon. Friend assure my constituents that bringing health and social care much closer together will help to provide a more efficient, higher-quality service? Can he specifically outline how an integrated care model may help to reduce demand for emergency services in Lincolnshire?

I very much hope so. This is about being able to deliver services according to local need and, crucially, not just looking at the patients who turn up—whether that is to an emergency service or through their GP for treatment in secondary care—but trying to get ahead of that and support people to stay healthy, bringing the budget of the NHS to bear on keeping people healthy in the first place. That preventive agenda is critical and can ensure not only that people stay more healthy but that we spend money more wisely.

Having been in Parliament in 2010, I voted against the Tory-Lib Dem coalition’s flawed reorganisation, the failure of which has led us to today’s announcement. As well as sharing concerns about having another reorganisation during a pandemic, what guarantees can the Secretary of State give that these changes will improve the health of my constituents when, under his plans, Hull will be lumped into an artificial hotch-potch of the Humber Coast and Vale ICS: an area of 1,500 square miles with cities, market towns and remote rural and coastal communities, with little transparency and no clear lines of accountability to local people in Hull, with our stark health inequalities?

Improving the accountability of ICSs is absolutely at the heart of the White Paper. I set out the three sections, and one of them is accountability to ensure that as ICSs get stronger powers and a statutory footing, there is the accountability that necessarily goes with that.

There is a perfectly reasonable debate to have about the geography of ICSs, making sure that they cover the right scale to be able to deliver services effectively and yet are local enough to deliver for local people. That has been an ongoing discussion. The aim is to implement the measures set out in the White Paper by April 2022 and by that time we will need to ensure that those geographies are right. In very large part they are already, but if there is further work to do in any area, I am happy to have a discussion about that.

The demands of the pandemic on Stockport Council, GP services and my constituency hospital, Stepping Hill, have shown the benefits of joint working and data sharing to improve care and health outcomes. I therefore welcome today’s announcement. We know that when bodies work together, people receive better care.

Stockport Together’s previous journey on this path highlighted the huge benefits of health and care working together as well as the challenges of addressing silo working and the pressures of pooled budgets. Will my right hon. Friend confirm that the proposals will deliver a more streamlined system that will give seamless care and healthier outcomes for my Cheadle residents?.

That is the goal, exactly as my hon. Friend sets out. In particular, I am glad that she raised data sharing as part of the integration. It is critical that we have high-quality data sharing, with data protected for the individual but shared among those who need it for the purpose of joining up care. If someone goes to hospital, they will not have to give all their details over and over again, and their GP will know about it. Care homes, GPs and hospitals, for instance, will be able to care better for an individual without having repeatedly to diagnose. This is a very important agenda for the NHS, which it should approach with confidence as a core part of joining up care.

In my constituency of Bedford and Kempston, patients are being left in unimaginable pain as they struggle to access even emergency dental treatment. Dental practices are struggling to stay open with the impact of covid on their businesses, and those who have survived are struggling to cope with the backlog. Imposing targets is not working, so will the Secretary of State include oral health in his future plans and agree a sustainable funding solution with NHS dentists to end the crisis in oral healthcare?

The crisis has been very tough on dentistry. By the nature of dentistry, the infection prevention and control systems in place are a challenge. I look forward to working with dentists to ensure that this sort of integration can help them appropriately. I am happy to arrange a meeting between the hon. Gentleman and the Minister responsible for dentistry to discuss these concerns.

I welcome the proposals for more integration and collaboration between the NHS and social care. However, it is vital that these important reforms do not get in the way of investment in NHS capacity and the commitment to recruit 50,000 more nurses. Will the Health Secretary assure the House that they will not and that the Government remain committed to the badly needed new urgent care centres at Stepping Hill Hospital and Tameside Hospital?

Yes, absolutely. Stepping Hill Hospital is obviously vital to my hon. Friend’s constituents. The urgent care centres are important too, especially in ensuring that people can have access to treatment closer to home for smaller, yet urgent problems. We have also introduced 111 First and people should call 111 before going to an urgent treatment centre or an A&E to let them know they are coming and to check that that is the right setting for them. That is an important part of our wider considerations, which the measures in the White Paper will help.

Shamefully, the poorer people are, the younger they will die. That link between economic deprivation and health outcomes means that Barnsley is suffering one of the highest covid mortality rates in England. Health inequality is an incredibly complex problem, but it is avoidable. Does the Secretary of State agree that a key test of the reforms is whether they will tackle that injustice?

I do. Tackling health inequalities is incredibly important and is a vital part of our levelling-up agenda. The hon. Gentleman is right to point out the gaps in life expectancy across the country. I hope that a move to a population health approach, whereby the focus of the whole local system is on improving the health of the population, not just those who ship up needing support, can help us as a society to tackle health inequalities.

A key element of the statement today is that it strengthens accountability to this House, which I very much welcome. Will my right hon. Friend confirm that this will mean that, as local Members of Parliament, we are better placed to represent our constituents in this place when it comes to communicating any concerns that they might have about unpopular local reorganisation of key services at their local hospital?

Yes, absolutely. It is important that, while the NHS continues to evolve and must evolve, it is there to serve our constituents. For a reform to take place, it needs to make the argument for why that is better for our constituents. Ultimately, when such a large amount of taxpayers’ money is spent on a public service, it is right that there is accountability to Ministers, and through Ministers to the House, for the services that are provided—that is the essence of a democracy—while preserving clinical independence, for instance, for individual decisions, and for the National Institute for Health and Care Excellence and decisions about appropriate advice on drugs. That is the settlement that the White Paper proposes and that I hope garners widespread support.

Integrated care systems have their roots in accountable care organisations, such as those used in America, in which individuals take out private health insurance. It is therefore hardly surprising that there is a great deal of concern about the introduction of integrated care systems here. Will the Secretary of State give a cast-iron guarantee that he will legislate to ensure that NHS patient data cannot be used to promote or sell private health insurance or services to patients?

I do not understand the logic of the hon. Lady’s question. I have not seen the sorts of concerns that she raises about integrated care systems, which, in the UK, have provided the joined-up care that people have been looking for for so long. I am happy to look at the details she raises on the provision of data, but the White Paper is about NHS provision, not the provision of healthcare through insurance, other than the national insurance that we come together as a society to pay in order to provide healthcare free at the point of use. That is a belief that I hold dear and is shared by the vast majority in the House and the country. I am happy to reaffirm that and reassure the hon. Lady.

As an officer of the all-party parliamentary group on obesity, I welcome this statement, particularly its promises relating to obesity policy, including limitations on unhealthy food advertising and new requirements for calorie information on food packaging. Will my right hon. Friend outline the likely timescales for the associated legislation and, in the interests of fairness and efficacy, will he ensure that there is a level playing field between advertising via British television broadcasters and advertising on often overseas online services, in terms of statutory extent and date of commencement?

Yes, these are very important measures and I am glad that they have my hon. Friend’s support, not least because of his extensive knowledge as a practising GP who has done so much during the crisis—the whole House is grateful for his commitment and work. On the timing of legislation, unfortunately I am not permitted to go into any further detail ahead of Her Majesty’s next visit to the other place, but the White Paper sets out the reforms that we hope to have in place by April 2022, and I hope that he can take from that some indication of our sense of pace.

With one of the highest covid death rates in the world, and with NHS workers under such incredible pressure, this is hardly the best time to be talking about yet another NHS reorganisation. In his response to me two weeks ago, the Prime Minister committed to addressing the key underlying causes of the high and unequal covid death toll: primarily, socioeconomic inequalities driven by 10 years of austerity. He said that he would be implementing Professor Sir Michael Marmot’s recommendations, to “build back fairer.” How do the White Paper proposals address those inequalities and their impact on our declining life expectancy and on the highest excess mortality rate in Europe?

I gently say that I disagree entirely with the hon. Lady’s pessimism about the ability of improvements in the health service to assist in the closing of health inequalities and the provision of care. As a Greater Manchester MP, she will understand better than most the benefits that come from that sort of integration. The idea that we should fail to act on what the NHS has itself asked for because of the challenges it is facing is completely the wrong way round. I see it entirely the other way round; it is incumbent on us to act in order to deliver the improvements that the NHS is calling for.

During the last Parliament, I sat on a joint Health and Housing, Communities and Local Government Committee, and I am pleased to be re-joining the latter Committee. That Committee commissioned a report on the future of adult care, which left open care insurance-type options to spread the financial burden, so as not to create an ever-larger NHS versus the critical local government role, and, crucially, with enhanced choice and flexibility for a 21st century care system. How will those aspirations fit into the plans that my right hon. Friend has described today?

The White Paper takes forward parts of those proposals relating to the integration between health and social care, and ensuring that it is those on the ground delivering health and social care who can decide the best way to provide that for their population. We are committed to taking forward funding reforms, as set out in our manifesto. Those funding reforms are not part of this Bill, but the Prime Minister has committed to bring those forward this calendar year.

I thank the Secretary of State for his statement, and for answering 30 questions in just under one hour and 10 minutes.