NHS Long-term Plan

Baroness Tyler of Enfield Excerpts

Monday 7th January 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I join the Minister in wishing the noble Lord, Lord O’Shaughnessy, well in his new position. I suspect this probably does not mean that he will be any less active on these issues.

I thank the noble Baroness for repeating the Statement. It would be churlish not to welcome additional funding for the NHS, but to suggest in some way, as the third sentence of the Statement does, that the noble Baroness’s party and Government were responsible for the establishment of the NHS is breathtakingly cheeky, to put it mildly. That is particularly so given that her party proceeded to oppose and vote against the establishment of the NHS by the post-war Labour Government.

What must we welcome in today’s Statement? We can welcome the use of genomics in developing care pathways and the commitment to early cancer diagnosis—after all, that was one of Labour’s policies in the most recent general election and in the ones before it. We should of course welcome the commitment to new CT and MRI scanners—again, a Labour policy. We welcome the greater focus on child and maternal health, including an expansion of perinatal mental health services—we welcome it because it has been our policy for some time. We welcome the rollout of alcohol teams in hospitals because, again, we have been urging the Government to do that for some time.

More generally, it is a shame that the noble Baroness started her Statement in the manner of making claims which are not borne out by actions. In many ways this symbolises the disingenuousness which lies at the heart of the Statement. The Government’s words about their conduct and behaviour towards the health and social care services in the UK are one thing, but their actions simply do not match their words.

There is much that one can agree with in the 123-page document launched today, especially given the involvement of doctors in creating it. However, many of the ideas, such as “prevention is better than cure”, seem to have come as a great revelation to our relatively new Secretary of State, if his recent performance in the media is anything to go by. That has, however, been the thinking on these Benches and across your Lordships’ House in many debates over many years, as it has been for decades in all the think tanks and health charities and, indeed, among almost everyone involved in the NHS.

Here is the rub, however—and let us look at prevention. How can prevention happen when, according to the Health Foundation, public health budgets have suffered a real-term funding reduction of £700 million to £1 billion in the past few years? Some 85% of councils plan to reduce their public health budgets in the next year, totalling almost £100 million of cuts. Smoking cessation, obesity and sexual health programmes—to name but three that the Minister mentioned—will all be cut, with a profound effect on a range of long-term illnesses and expensive conditions to the NHS. Will the Minister give a commitment today, as part of the long-term plan, to reverse these totally counterproductive public health cuts?

The long-term plan cannot be delivered if there are not the staff to deliver it, as was mentioned. The plan waxes lyrical about its intentions, but again the rub is in the action. Why is there a delay in setting out its ambitions for the NHS workforce today, when there are over 100,000 vacancies across the NHS, including 40,000 for nurses and 9,000 for doctors? According to recent estimates, by 2030 there will be 250,000 vacancies across the NHS. Experts and doctors’ leaders have warned that the Prime Minister’s vision, and that of Simon Stevens, risks being undermined and reduced to a set of “groundless aspirations” due to the NHS’s deepening staffing crisis, continued cuts to public health and limits to what the extra investment will achieve. Why does the long-term plan fail to address this mounting workforce crisis?

Turning to the suggestion of legislation, as a veteran of the Health and Social Care Act 2012, I read that the Government seek to:

“Remove the counterproductive effect that general competition rules and powers can have on the integration of NHS care”.


I have a mixture of reactions to that. We welcome the recognition that the Health and Social Care Act 2012 created a wasteful, fragmented mess, hindering the delivery of quality healthcare, but I cannot resist saying that that is what we predicted during the passage of the Bill. After billions of pounds wasted and the creation of a huge bureaucracy, are the Government now preparing to consign the whole of the Andrew Lansley Act to the dustbin of history? Will the Minister indicate when we will see draft legislation and the timetable for its consideration?

On social care and integration, if the care of the elderly, people with chronic conditions and co-morbidities and the disabled continues to be cut through successive local government settlements where billions of pounds have been lost, the aspirations on integration and joined-up services will be lost. The Government have set their face against tackling the social care elephant in the room and this plan, again, fails to address it. Where is the social care Green Paper? How can there be any empowerment if we do not have the staff or the expertise to deal with this?

What about the gaping holes in today’s announcement? We have waiting lists of 4.3 million with 540,000 waiting beyond 18 weeks for treatment. We have A&Es in crisis, trolley waits of over 600,000 and 2.5 million people waiting beyond four hours. Why is there no credible road map in this to restore the statutory standards of care that patients are entitled to, as outlined in the NHS constitution? Is that not a damning indictment of nearly nine years of desperate underfunding, cuts and failure to recruit the staff we need in the NHS? Will the Minister confirm that, once inflation is taken into account, the pay rise is factored in and the standard NHS working assumptions on activity are applied, there is actually a shortfall of £1 billion in the NHS England revenue budget for this coming financial year?

Briefly on Brexit, during the referendum campaign Vote Leave said that the money saved would bring £350 million a week to the NHS. When the Prime Minister announced the £20 billion extra in the summer, she said that it would partly be paid for by a Brexit dividend. Others have dismissed that suggestion. The Treasury has said that a combination of economic growth and perhaps even tax rises may be needed. Will the Minister comment on that and confirm which of those is correct and what will happen?

There are many welcome ambitions in this paper, but the reality is still that there is no plan to recruit the health staff we need, no plan for social care, no plan to restore waiting time standards, and no plan to reverse public health cuts. I am not convinced that the NHS is any safer in the Government’s hands now than it was before this Statement. We will certainly be monitoring this very carefully indeed.

[Baroness Tyler of Enfield (LD)]

My Lords, I associate these Benches with the very warm wishes sent in the direction of the noble Lord, Lord O’Shaughnessy, in his future endeavours.

We welcome the publication of the long-term plan today. It is a very important document. It will take time to absorb all its contents and we on these Benches would welcome an opportunity to debate it in more detail. Yes, there is a lot to welcome in the plan, particularly the focus on prevention. We welcome the focus on children and young people’s services and particularly the inclusion of issues relating to people with learning disabilities. But there are many concerns about how this plan will be put into effect. The workforce plan will have to work a lot better than any of the existing workforce plans, particularly if we are to be successful in retaining existing NHS staff as well as recruiting new staff and getting NHS staff to return, feeling that it is possible to work in more flexible ways. It will require a much more creative staff plan than we have at the moment.

Of course it is good news that we will focus on prevention rather than cure, but will the Minister clarify the precise funding mechanisms that would allow that to happen, particularly the role of NHS England, Public Health England, and local authorities in this new world? Will she also confirm the role that pharmacies will play in the public health agenda and the funding mechanism for that? Also, when will the Green Paper on social care be published? It is critical to the agenda that is being set out. I particularly welcome the £2.3 billion set aside for mental health services as part of the long-term plan. What is vital now is that everyone in the NHS, local authorities, schools and employers work together to deliver these plans and ensure that that money gets to the front line. Will that money be ring-fenced?

I take a particular interest in children and young people’s mental health. We are told, and it is welcome, that there will be a new emphasis on crisis care and a new single point of access or crisis hotline delivered through NHS 111 and with that, we are told, all children and young people experiencing mental health crises will be able to access age-appropriate crisis care 24 hours a day, seven days a week. That is to be welcomed. But will the Minister say whether that new crisis care service, which I wholeheartedly support, will be part of or separate from the adult 24/7 community-based mental health crisis response service, which is also contained in the plan? Will it also include 24/7 availability of CAMHS assessment in all A&E departments in hospitals up and down the country?

[Baroness Manzoor]

My Lords, I thank both noble Baronesses for their contributions to this Statement. I am very grateful for some of the positive comments that were made from both Benches. I am very proud that this Government are putting £20.5 billion into the NHS. That is an amazing achievement. We must recognise that this is a great achievement for the NHS. The NHS is working closely within itself and with the Government to ensure that we can deliver the outcomes we all want, which are improved care for those who use the NHS and to prevent people from getting ill in the first place. I welcome this. As someone who worked in the NHS in my early days I recognise the importance of this money. We are not being disingenuous in what we are trying to achieve—far from it. It is because we passionately care about the NHS that we are doing this.

A number of points were raised by both noble Baronesses. I hope that they will appreciate that I have only just got this brief, but I will endeavour to do my best to answer all the questions. However, if there are any that I have not responded to, I will of course write to the noble Baronesses and place a copy in the Library. The noble Baroness, Lady Thornton, quite rightly raised the issue of staff. We need staff in the NHS if we are to carry out any plans. They are very important to us. She asked what we were doing. There are record numbers of dedicated NHS staff and they work tirelessly to make sure that patients get excellent care. We support them by training 25% more doctors, nurses and midwives, giving a significant pay rise to over 1 million staff and listening to the issues that matter to them. We know that this is a complex area and we are listening and talking to staff to see how we can bring about greater improvements in workforce planning.

To put this into context, there are currently record numbers of doctors, paramedics and ambulance staff, and all HCHS staff. The monthly workforce statistics for September 2018 show that since May 2010, there are over 45,900 more professionally qualified clinical staff working in NHS trusts and CCGs, including 16,500 or 17.4% more doctors, over 6,500 or 2.2% more nurses, midwives and health visitors, and 13,400 or 8.3% more nurses on our wards. We recognise that it is a complicated issue and that there are staff shortages in some areas, and we are actively engaging with staff and looking at solutions as we move forward.

Other issues raised by the noble Baroness, Lady Thornton, related to Brexit and to scrapping the 2012 Act as part of the long-term plan. That was about legislation and I shall deal with legislation first. I think the basis of the noble Baroness’s question was whether we are going to scrap the Lansley reforms. In June the Government asked the NHS to come forward with proposals for legislative reform to support the ambitions of the long-term plan, which have now been set out clearly. NHS England will continue to engage nationally and locally to refine the proposals over coming months. The Government will consider updating legalisation where there is clear evidence that doing so would improve services for patients.

The noble Baroness, Lady Thornton, mentioned performance and the noble Baroness, Lady Tyler, also touched upon it. The Government have been clear that through the long-term plan the NHS must get back on the path of recovering performance. The plan is clear on proposals for updating urgent and emergency care and on expectations to reduce waits for planned operations. We must ensure that we have a health system which focusses on clinically appropriate targets. The ongoing clinical review of standards, which will report in the spring, will be followed by a period of testing and evaluating any new or refined standards. The review is considering standards for physical and mental health.

The public health grant was touched upon by the noble Baronesses. We are already giving local government more than £16 billion for public health services over the current spending review period. The Government recognise the important role played by local authorities in supporting people to live longer, happier lives and managing demand for health services. We have a clear commitment to ensure that public health services continue to do that. Future budgets for PHE and the public health plan, which is part of the financial settlement for local authorities, will be finalised at the upcoming spending review.