Healthcare Services: Acute, Primary and Community
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I congratulate the noble Baroness, Lady Janke, on securing a very important debate. I am also grateful to all noble Lords for their contributions. I recognise many of the challenges raised, which is exactly why we are taking the action that we are. I am glad that the noble Lord, Lord Evans, in particular welcomed the direction of movement, as have so many noble Lords, including the noble Baroness, Lady Pidgeon.
It is important that we look at where we started, because I think it reminds us of the scale of the challenge. It was the noble Lord, Lord Darzi, who made the point that we inherited an NHS facing the worst crisis in its history. We all know of people stuck on waiting lists for many years, staff who have felt let down by bureaucracy and little support, and patients who have had to navigate a system that all too often felt complex, disjointed and fragmented—the noble Baroness, Lady Brinton, spoke about literal navigation, which I thought was a key point. Not only was that the situation but we recognise that, while we are making improvements, there is some way to go, and I want to set that out at the outset.
I am grateful to the noble Baroness, Lady Lane-Fox, for talking of her own personal experience, and I can say to her that, yes, the patient is at the centre of all the reforms that we are making.
The noble Lord, Lord Darzi, found that society is getting sicker. People are living longer but in poorer health and with more complex needs. I should emphasise that that burden is not shared equally. The gap in healthy life expectancy has grown between the richest and poorest areas, and the model of care that was in place, which we are still seeking to change, while making progress, is working least well for those with greatest disadvantage, who are most likely to have complex needs. I agree that the system we inherited and are changing has been too hospital-centric, too detached from communities and too organised into silos. To the noble Baroness, Lady Lane-Fox, I say, yes, modern technology has transformed everyday life, and the scale of change certainly had not reached the National Health Service. We had a stark choice, as noble Lords know, and our response is reform
We also heard from staff and patients that they do not want the status quo. To agree with the noble Lord, Lord Scriven, people said that they wanted radical reform, and we have embraced that. I believe that the 10-year health plan responds to that, setting out the three fundamental shifts—hospital to community, analogue to digital, and sickness to prevention—with neighbourhood health at its very core. Our neighbourhood health framework, which was published in March, gives partners the clarity to develop locally led plans.
What is at the core of this debate is how to make that shift real. For the first time, the medium-term planning framework sets a target to reduce long waits in community health services, with at least 80% of activity to take place within 18 weeks by 2028-29. We are restoring GP access; to some of the points made about the important role, which we acknowledge, of the GP, more than 76% of people are now saying that it is easy to contact their GP, which is up from 61% when we came into office.
The noble Baronesses, Lady Brinton and Lady Gerada, and the noble Lord, Lord Scriven, all spoke of the importance of GPs. We are training thousands more GPs, and we are boosting capacity. From July 2024 to April 2026, we had more than 2,000 additional GPs; in total, we now have over 30,000, which is the highest number since 2015. This has meant that we have delivered 12.7 million additional GP appointments this year compared with last year, and I am grateful to GPs.
We are investing directly in the services that will make neighbourhood health possible, which was raised, quite rightly, by the noble Baroness, Lady Cass. I totally agree with her about young people having that voice, and we ensure that that is the case, but I know where to come should we need further assistance.
We have invested an additional £601 million in general practice, taking total GP contract investment to nearly £14 billion in 2026-27. A number of noble Lords, including the noble Baronesses, Lady Janke and Lady Leaman, spoke about the importance of community pharmacy, which I totally align myself with. That is why, to recognise that key role, we have given a 10% uplift, which translates to £340 million. Further on funding, as a number of noble Lords have raised, including the noble Lord, Lord Scriven, over £9 billion is being invested through the better care fund, and there is a commitment to deliver 250 neighbourhood health centres, for which the first 27 sites have already been selected.
This is not just a vision, but vision is important: one of continuous, accessible and integrated care, centred around the patient, which prevents ill health, intervenes earlier and gives people more control, by 2035. I understand the wish for pace, and I share it, but we also have to be realistic. There is a reason it is a 10-year health plan: it is not so we wait but so we have a plan that will transform the model of elective care.
Many interactions will no longer take place in a hospital building, but they will be able to take place. The noble Baroness, Lady Lane-Fox, asked whether we are using technology to the best advantage; the NHS was certainly way behind where it should have been, but we are moving towards that, because interactions will be able to take place virtually or through neighbourhood services closer to home. We will see the first NHS online hospital, the development of the NHS app—which has already greatly improved, as many of us know, as patients access care, information and appointments more responsively through their phones—and, by 2035, two-thirds of out-patient care will take place digitally or in the community. Central to that will be the single patient record, which I look forward to coming to when we receive the Health Bill.
General practice will remain at the heart of neighbourhood health. I heard what the noble Baroness, Lady Gerada, said. We are introducing two new at-scale contracts—the single neighbourhood provider and the multi-neighbourhood provider—to support GPs and partners to work against larger geographies. I recognise the pressure on GPs. We are working with GPs to assist them in their effectiveness and in the way in which they serve patients. Integrated health organisations will take responsibility for local population budgets. They will support integration and move resources to where they have the greatest impact.
Key within this debate, and raised in particular by the noble Baronesses, Lady Pidgeon and Lady Gerada, the noble Lord, Lord Scriven, and other noble Lords, is funding. We know the importance of ensuring that investment supports the shift from hospitals to communities—and I say to the noble Lord, Lord Evans, that that will include mental health as well as primary care and neighbourhood care. The 10-year health plan sets out an operating model that shifts power from the centre to local commissioners and providers. As I mentioned, ICBs and providers are developing medium-term and multiyear plans through the medium-term planning framework to show how they will use funding in line with the priorities.
I assure noble Lords that ICB allocations give greater growth to community rather than acute services to support the community transformation that noble Lords and I seek and to support neighbourhood health. We will continue to set those national expectations, and we will support that by changes to system incentives, such as financial flows. I hear the call for ring-fences, which is often made. It is a legitimate challenge, but they do not by themselves guarantee better outcomes. Our approach is to set national priorities and accountability, as well as enabling ICBs to use funding flexibly, because they are best placed, as we know, to meet local need and secure best value.
Lord Scriven (LD)
My point was that flexibility is taken away when national directives come down, forcing ICBs to spend money on acute and emergency care.
Baroness Merron (Lab)
I always appreciate the expertise of the noble Lord, but I have set out our approach. We are focusing on outcomes and the best way to achieve them. We keep them constantly under review and discussion, so it is not top-down but how we are going to get to the place that all noble Lords want us to get to.
I know that I will be able to refer to only a limited number of questions, and I hope noble Lords will forgive me. The noble Baroness, Lady Walmsley, raised dental deserts. We are offering incentives to attract dentists under the golden hello scheme, which is what it says on the tin. Importantly, we are also increasing the supply of dentists. We have just announced the first sustained expansion of dental school places since 2007. The noble Baroness, Lady Walmsley, also asked about progress being made on publishing health food standards and the consultation. I acknowledge her particular interest and expertise. We will soon be consulting on the proposals for healthier foods targets and reporting. Importantly, we remain on track for delivering on this 10-year health plan commitment in this Parliament. If the noble Baroness would like further information, I would be very happy to obtain it for her.
The noble Lord, Lord Evans, asked about milestones that will be used to ensure that the shift from hospital to community is taking place, which is important. That is why we have published the Neighbourhood Health Framework, which will ensure that accountability. I am very alive to the points he made about mental health services, and I am sure that he welcomes the mental health strategy that will bring together all the points. I am very enthusiastic about the fact that we are piloting community-based mental health centres. I was glad to visit the one in Birmingham, which totally persuaded me of their value, but we must of course wait for the evidence.
I know that noble Lords know that the NHS that we inherited was under intolerable pressure. We have chosen reform, we have invested, we are rebuilding access, we are enhancing digital tools and we will deliver an NHS closer to home that is more preventive, joined-up and equal. That is the way we will take the NHS into the future.