North-east London STP

Baroness Blackwood of North Oxford Excerpts

Friday 16th December 2016 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I congratulate the hon. Member for Ilford South (Mike Gapes) on securing this important debate. He is rightly known as a fierce defender of his local NHS services, and his constituents should be proud of his record.

As both a patient with a chronic and complex illness and a daughter of a cardiologist and a nurse, I know from both sides exactly how much heart and soul our NHS workforce put into their day jobs. It is easy in debates such as this about structures and processes to lose sight of that, so I wish to begin by paying tribute to all of those who work at Barking, Havering, and Redbridge University Hospitals NHS Trust in the constituencies of the hon. Gentleman and the hon. Member for Walthamstow (Stella Creasy) for their dedication, determination and commitment to providing first-class services to all those in their care. We should just take a moment to note that.

The NHS’s own plans for the future, set out in the five-year forward view, recognise three great challenges facing the NHS: health and well-being; care and quality; and finance and efficiency. The five-year forward view also recognised that challenges facing different areas of the country will inevitably be buried. The problems facing Ilford will, by definition, not be the same as those facing Ipswich, and a single national plan would not be effective or appropriate. That is why NHS England’s 2015 planning guidance called for local commissioners to come together with their providers across entire health economies to develop a collective strategy for addressing those challenges in their own areas. In much the same way, in fact, Labour’s 2015 general election manifesto on health, “A Better Plan for NHS Health and Care”, said that to reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides. The hon. Gentleman mentioned the King’s Fund, which has been clear that we need to strengthen parts of the STP process. It will be of interest to him that Chris Ham, the chief executive, has also been clear that STPs are the only chance the NHS has to improve health and care services. We have to drive this through and we have to get it right.

All local STPs are now published and, as the hon. Gentleman said, local areas should be having conversations with local people and stakeholders including Members of Parliament to discuss and shape the proposals, understanding what matters to them and explaining how services might be improved. These conversations will inevitably gain pace over coming months and we should all want and encourage as many people as possible to get involved. Where relevant, areas should build on existing engagement through health and wellbeing boards and other existing local arrangements. They should also look for innovative ways to reach beyond those existing relationships and into local communities.

There are 44 STP areas, as the hon. Gentleman will know. They cover the whole of England, bringing together multiple commissioners and providers in a unique exercise in collaboration. That is why this is quite a challenge.

[Stella Creasy]

It is good to hear the Minister say that she wants to see local people involved in these plans. Will she therefore commit not just to a conversation but a consultation with teeth to give people confidence that the very difficult decisions that we all know have to be made about changing the NHS can be done with their consent, and not simply given to them as a fait accompli?

[Nicola Blackwood]

Perhaps if the hon. Lady lets me continue with my speech, she will hear a little more about how the process will go forward.

The geographies have been determined not by central bodies, but by what local areas have decided makes the most sense to them. In the case of the constituency of the hon. Member for Ilford South, that has involved five providers, seven CCGs and eight local authorities covering the whole of north-east London. Each area has also identified a senior leader, who has agreed to chair and lead the STP process on behalf of their peers. In north-east London it is Jane Milligan, the chief officer of Tower Hamlets CCG, who is co-ordinating the development of the plan.

I was concerned to hear what the hon. Gentleman said about local authorities not feeling as involved as they should. It is important to emphasise that local authorities must play a role in developing these plans. Reflecting the social care needs of an area, which councils are obviously best placed to represent, will be key to the success of the NHS in the coming years, so they must be closely involved.

The plans offer the NHS an opportunity to think strategically and open up the public discussion about how we will meet the challenges facing the NHS in terms of demand and rising costs. It is inevitable that debate will become heated; it is simply a reflection of how important local NHS services are for us all. By planning across multiple organisations—both commissioners and providers—STP footprints can seek to address in an holistic way the health needs of an area and all the people within it in a way that we have never had the opportunity to have before.

We all know that the NHS faces tough choices about how we will design future services to meet rising demand, rising costs, and more chronic and complex illnesses. Choices have often previously been postponed again and again because they were too hard and because the discussions are too uncomfortable. I do not think anyone in the Chamber would think it is fair or safe for our local populations for us to keep putting them off in this way.

In north-east London, as elsewhere, that has meant having an honest conversation about the best way forward for services that are unsustainable as well as how to integrate services to give patients a clearer route through the system. All those conversations will help ensure that patients maintain access to high-quality care.

As I understand it, the north-east London October STP draft looks at these challenges in a number of different ways. The hon. Gentleman has described some of them. It also proposes embracing integrated services, from urgent and emergency care to mental health care and support as well as public health, which is important to me as the Minister for Public Health. The STP is also exploring how to improve patient outcomes through community-based care and preventive measures, which must be important if we are to manage demand. For example, the proposals include utilising initiatives to provide adequate housing in the area, and using new models of care to give health education. It also highlights three enablers for change for the area—workforce, digital enablement and infrastructure—and investigates how to improve its position with each.

I share the view of the hon. Gentleman and the hon. Lady that the public, key stakeholders and elected representatives should be closely involved in the development of STPs. With the plans now published, preparation for STP implementation must begin in the new year. Now is the time for STP leaders to reach out actively and engage patients and the wider public, and I expect nothing less. That means having frank, engaging and iterative conversations across areas, as well as some potentially difficult conversations about what the NHS could and should look like. Simon Stevens and Jim Mackey—the heads of NHS England and NHS Improvement—have written an open letter to STP leaders making that expectation absolutely clear. The letter reiterated that now is the time for local engagement to help develop the proposals and for those involved to make it clear that these plans must have a real benefit to patients.

I should also be clear that, nationally, all reconfigurations must meet the four tests mandated by the Government to NHS England in 2010, which require all local reconfiguration plans to demonstrate support from GP commissioners, strong public and patient engagement, clarity on the clinical evidence base, and support for patient choice. We would not expect any proposal to move forward that has not met all four tests. Patients must be at the heart of the NHS, and no plan can be successful unless they are fully engaged.

I close by saying that the hon. Gentleman has raised some very serious questions around details of his local STP plan and the quality of public consultation. I will ask the Minister responsible for community health—the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat)—to meet him and the hon. Lady to discuss the details to ensure that they are properly ironed out and that the public consultation and discussion are of the highest possible quality.

Question put and agreed to.