NHS Long Term Plan

Baroness Manzoor Excerpts

Thursday 31st January 2019 Lords Chamber

[Baroness Manzoor (Con)]

My Lords, I too thank the noble Lord, Lord Hunt, for raising this important debate and presenting the issues in his usual authoritative and well-informed way. I also thank all noble Lords for their valuable contributions; it has been a very well-informed debate and I am certainly learning fast.

I say humbly what a credit it has been to the House to hear about the NHS in a positive light. I understand that there are challenges and noble Lords have put many questions to me. Nevertheless, the support around the House for the NHS plan is very welcome.

It is fair to say that 2018 has been a remarkable year for the health service. As many noble Lords will appreciate, celebrating a 70th birthday is a time to reflect on what has been achieved and to look ahead with hope and optimism. As my noble friends Lord O’Shaughnessy and Lady Cumberlege said, the NHS has begun 2019 by publishing an unprecedented long-term plan for the next decade. The plan sets out a compelling vision of how the health service will provide a safer, more personalised service and more integrated care using technology and new ways of working to deliver more services in one’s own home or community.

To reassure my noble friend Lady Neville-Rolfe, the noble Lord, Lord Scriven, the noble Baronesses, Lady Donaghy and Lady Watkins of Tavistock, and the noble and gallant Lord, Lord Stirrup, I can say that the long-term plan is fully costed and has been developed within the spending settlement agreed with the NHS: an extra £33 billion in cash to reach a total of £148.5 billion in 2023-24. This is the equivalent of £20.5 billion extra in real terms. This increased spending, together with stretching but achievable ambition on efficiency, should ensure that the NHS will continue to deliver the world-class service we all want.

First, I recognise the importance of improving patient experience, safety and flow through hospitals. I agree with the right reverend Prelate the Bishop of Carlisle that spiritual care plays an important part in health outcomes. As the noble Lord, Lord Hunt, will be aware, NHS England is undertaking a clinical review of standards, considering the appropriateness of operational standards for physical and mental health relating to planned, unplanned, urgent or emergency care.

In 2018-19, the Government provided the NHS with an additional £1.6 billion to support and improve A&E and elective care performance. The NHS will use this investment to treat 250,000 more patients in A&E in 2018-19 and improve performance, with the four-hour standard to be achieved within 2019.

Many noble Lords, including the noble Baronesses, Lady Gale, Lady Wheeler and Lady Tyler of Enfield, and the noble Lord, Lord Hunt, inquired about the adult social care Green Paper. The Department of Health and Social Care is in the final stages of preparing it, and it will be published at the earliest opportunity. As noble Lords are aware, building a sustainable care and support system will require big decisions, and the upcoming Green Paper will place on record the extraordinarily difficult choices that we as a legislature and, more broadly, we as a country, must confront.

I understand the concerns raised by my noble friend Lord Hunt—he is a friend—regarding integration. As he indicated, the Green Paper will build on the proposals on integration in the long-term plan, which are the deepest and most sophisticated ever proposed by the NHS. We will invest in models of care that strengthen links between primary care networks and local care homes, as my noble friend Lord O’Shaughnessy laid out so clearly, alongside innovation. By 2021, every part of the country will be covered by integrated care systems, which will bring together local organisations, including local authorities, to redesign care and improve population health. I say to the noble Baronesses, Lady Massey of Darwen and Lady Pitkeathley, that this marks a significant change in how NHS organisations collaborate with one another and will support the health and care system to deliver a step change in how patient care is planned and delivered.

My noble friend Lord O’Shaughnessy raised the issue of primary legislation. He will be aware that the Government will consider updating legislation only where there is clear evidence that doing so would improve services for patients.

As noble Lords have noted, the spending review will have a profound impact on the prevention agenda. It will contain details of the local government funding settlement and the public health grant. As has been noted across the House, there is no time to waste in pushing forward this agenda. I say to the noble Lord, Lord Bird, that this is why prevention is a focus throughout the long-term plan. We will keep people healthy and out of hospital by focusing on the prevention of ill health and boosting services closer to home.

To address comments made by the noble Lords, Lord Rennard, Lord Turnberg and Lord Brooke of Alverthorpe, and the noble Baroness, Lady Walmsley, there is a push to improve upstream prevention of avoidable illness and its complications, such as offering NHS-funded tobacco treatment services and specialist weight management services to those with hypertension and a BMI over 30. A number of noble Lords mentioned smoking. The plan commits to offering all smokers admitted to hospital NHS-funded tobacco treatment services by 2023-24. I believe that this issue was raised by the noble Lords, Lord Rennard and Lord Turnberg, and my noble friend Lord Ribeiro.

I also note that my noble friend Lord Chadlington raised the issue of gambling and the noble Lord, Lord Brooke, mentioned gaming. We must look at those important issues in relation to health and health services. As a result of the long-term plan, within 10 years, 55,000 more people each year will survive cancer for at least five years and up to 150,000 heart attacks, strokes and dementia cases will have been prevented. In addition, we will take coherent cross-government action where required. This was demonstrated by the recent joint Defra and DHSC clean air strategy, as well as by the Government’s new world-leading plan on antimicrobial resistance, as noted by my noble friend Lady Neville-Rolfe.

The upcoming prevention Green Paper will be a major milestone in the prevention agenda this year. Our approach will also be underpinned by a focus on the reduction of health inequalities, both because it is unequivocally the right thing to do and because the potential health gains, especially in our most vulnerable communities, are significant. That was noted by the noble Baronesses, Lady Donaghy, Lady Tyler and Lady Massey. Of course, that focus will be very important.

I turn now to the plan’s commitment to improve access to primary and community healthcare services, with spending on these services increasing by £4.5 billion in five years’ time. This will allow all parts of the country to see an increase in both the capacity and the responsiveness of community and intermediate care services. As my noble friend Lady Redfern and the noble Baroness, Lady Thornton, noted, today NHS England and the British Medical Association launched the new primary care contract for GPs. The new contract framework marks some of the biggest general practice contract changes for over a decade and will be essential to delivering the ambitions set out in the NHS Long Term Plan through strong general practice services. It also includes funding for around 20,000 more health professionals in primary care networks by 2023-24. Expanding community-based multidisciplinary teams means thousands more clinical staff working in primary care and bigger teams of staff providing a wide range of care options for patients and freeing up time for GPs to focus on those with more complex needs.

My noble friend Lord Colwyn raised the important issue of dental care and NHS dentists. He is right to say that workforce planning is important in this key area. In addition, by 2023-24, every patient in England will be able to access a digital GP offer, improving access and convenience in primary care for all. Social care prescribing where appropriate, as mentioned by the noble Baroness, Lady Pitkeathley, will play a role in this.

That brings me to the important point on the safety of patient data. There are safeguards in place for this type of data, including legislation, scrutiny standards and toolkits, independent advisory bodies and a national data opt-out to ensure that data is used across the health and care system in a safe, secure and legal way. However, in response to the noble Lord, Lord Hunt, I recognise that we still have some way to go.

While I have already noted the importance of preventive care as a priority for this Government and the NHS, the plan also addresses important clinical areas and long-term conditions. Noble Lords have rightly identified that improving the early diagnosis of cancer is a priority. The new package of measures in the long-term plan include investment to support better screening services, provide new investment in state-of-the-art technology to transform the process of diagnosis and boost research and innovation. To that degree, the noble Baroness, Lady Thornton, is absolutely right.

As the noble Baronesses, Lady Masham of Ilton, Lady Gale and Lady Wheeler, identified, it is equally important that those with rare and complex conditions should receive the best support and treatment. I welcome the fact that over the next 10 years, the long-term plan will give patients better access to specialised services and offer more precise treatments. The department will continue to work with the NHS to ensure that we provide the very best service so that patient outcomes and quality of life are improved. As the NHS implements the plan, specialised services will remain a priority. That is why, every year, we invest more than £16 million in treating specialist conditions, as noted by the noble Baroness, Lady Wheeler.

I turn now to the provision of mental health services. Yesterday we had an excellent debate on this subject led by the noble Baroness, Lady Tyler of Enfield. As we know, more work days are lost to mental ill health in the form of anxiety, depression and stress than any other condition, so we have to get this right. I can reassure noble Lords that under the NHS Long Term Plan there will be a comprehensive expansion of mental health services. The plan renews the commitment to grow and invest in mental health services faster than the NHS budget overall for each of the next five years, with an additional £2.3 billion in real terms by 2023-24. This will provide a further 380,000 adults with access to psychological therapies and 345,000 more children will be able to access greater support. Crisis care will be expanded with a 24/7 community-based mental health crisis response for adults. We will ensure that that is available across England by 2020-21.

The NHS will test and roll out new waiting times to ensure rapid access to mental health services in the community over the next decade. We will reduce the number of people with learning disabilities or autism who are in-patients in mental health hospitals. It is absolutely right that we do so, and I totally support the comments made by my noble friend Lady Browning and the noble Baroness, Lady Jolly.

Specific waiting times for emergency mental health services will also take effect from 2020 for the first time, and will be set to align with the equivalent targets for emergency physical health services. This is the first time that this has happened and it is absolutely right.

I welcome the support of the noble Baroness, Lady Pitkeathley, for the NHS plan in relation to carers. Carers’ needs and views are important, and we acknowledge this.

The noble Lord, Lord Low of Dalston, raised the issue of eye care and the APPG report. I will write to the noble Lord to address this, because I am not familiar with the APPG report.

A large number of noble Lords—including my noble friend Lord Ribeiro, the noble Lords, Lord Turnberg and Lord Hunt, and the noble Baronesses, Lady Watkins and Lady Jolly—quite rightly raised workforce issues, and I want to acknowledge, as I am sure they do, the importance of our NHS workforce and all who work in it. We recognise that good leaders and leadership are essential to the provision of high-quality, sustainable services across the NHS. As part of the long-term plan, a group has been established to focus on how best to improve leadership culture and practice, talent management, leadership development and clinical leadership across the whole NHS. This work will inform the workforce implementation plan that the noble Baroness, Lady Harding, has been commissioned to produce, working closely with Sir David Behan. Initial recommendations will be presented to the department in spring 2019 and a final workforce implementation plan will follow later in the year, taking into account the outcomes of the spending review. We will go further not only to secure staff but to support the NHS in delivering its mission to become a world-class employer and to deliver the workforce the NHS needs.

A number of noble Lords raised the important issue of how we will ensure we have enough nurses, including Parkinson’s nurses. We are already taking steps, including increasing nurse training places by 25%—that is 5,000 additional training places from 2019-20. The NHS Improvement-led workforce group will agree action to improve the supply of nurses over the course of the long-term plan.

My noble friend Lord Ribeiro and the noble Lords, Lord Turnberg and Lord Rogan, will know that we have already made commitments through the next spending review period—for example, as my noble friend Lord Ribeiro said, medical training places—that acknowledge the importance of workforce training to underpin effective long-term NHS planning. At the forthcoming spending review, we will consider proposals from the NHS for a multi-year funding plan for clinical training places, based on workforce requirements in the NHS plan.

Health services are of course a devolved matter in Northern Ireland, but I will certainly convey the concerns raised by the noble Lord, Lord Rogan.

A number of noble Lords—my noble friends Lord Holmes of Richmond, Lady Neville-Rolfe and Lady Redfern, the noble Lords, Lord Hunt and Lord Scriven, and the noble Baroness, Lady Thornton—raised technology and artificial intelligence. As the Secretary of State has made clear in his vision for the future of healthcare, digital services and IT systems will need to comply with a modern technology architecture and meet a clear set of open standards so that they can talk to each other.

There have been many questions and I will shortly run out of time. However, I will write to noble Lords about the key themes that have come out in the debate and place a copy of my letter in the Library.

I did not get round to talking about technology and artificial intelligence. The Secretary of State considers this to be an important area, and I hear the concerns raised by the noble Lord, Lord Hunt.

I again place on record my thanks and appreciation for the quality and range of contributions from across the House. There is clearly much more to discuss and debate. The incoming Minister will have the opportunity to discuss these issues in greater depth with the House, including the many areas covered by the noble Baroness, Lady Thornton. We will keep the debate going.