NHS Long Term Plan

Baroness Wheeler Excerpts

Thursday 31st January 2019 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I, too, congratulate my noble friend on securing this debate and on his excellent speech. There is much to commend and welcome in the NHS Long Term Plan. However, the key questions on how it is to be delivered in the light of the realities of the huge injection of cash the NHS needs on top of what has been pledged by the Government, how integrated care is to be achieved without addressing the funding crisis in social care and, without any indication in the plan, how the chronic shortage of staff in key professions is to be addressed all remain to be answered.

My contribution today is on specialised health services. These typically cover small patient populations, collectively treat hundreds of thousands of patients every year and cannot sensibly be planned, procured and provided at a local level. One in 17 people will be affected by a rare or complex condition at some point in their life. I declare an interest as a voluntary vice-chair of the cross-party Specialised Healthcare Alliance, which comprises charities and voluntary organisations, large and small, representing and campaigning for people with rare diseases and complex health conditions, and corporate supporters.

Many specialised services provide for people with rare genetic conditions, while anyone might need to call upon others, such as spinal injuries and serious burns. Under the Health and Social Care Act 2012, NHS England is the sole direct commissioner of all specialised services. It has a current annual budget of £16.6 billion of the NHS total spend. Before the Act, services were planned at either local or regional level, but in effect much of NHS England’s approach almost from the beginning of its existence has been to shift the balance back towards local decision-making. Indeed, the NHS Long Term Plan and last year’s supporting planning guidance represent the latest in a long line of attempts to get the balance right between national and local responsibility for planning specialised services. There are now to be planning boards across areas, with alternative collaborative arrangements in some circumstances.

Guidance so far is vague on structures, processes, procedures and timescales, so I have some key questions for the Minister and I ask her to write to me if she is unable to respond today. First, we are told that 70 services might benefit from local collaboration, with mental health, cancer and learning difficulties prioritised in the first instance. When will further details of the changes and processes for moving to the new structures and of the decisions on which services are to be provided locally be announced? What forms of alternative arrangements will be permitted?

My second question relates to the key issue of consultation with local services, patients, carers and representatives of patient organisations. NHS England seems to have learned from past experience of seeking to drive through changes without sufficient consultation and involvement. Can the Minister reassure the House that the new specialised planning boards will embrace the provisions and spirit of patient involvement in the 2012 Act and include patients and public representatives, who will be meaningfully involved in decisions about the way their care will be delivered?

Finally, there must be clear and transparent accountability and oversight when service planning is delegated to local level. Can the Minister confirm that NHS England will retain overall accountability for all specialised services, and can he also confirm when formal accountability arrangements will be published? NHS England’s vision for specialised services presents important opportunities to improve patients’ experience of care. If it is to be realised, NHS England must take a transparent and collaborative approach to working with the public and patient organisations.