Government Mandate for the NHS

Jonathan Ashworth Excerpts

Thursday 25th April 2019 Commons Chamber

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the Government’s failure to lay before Parliament the NHS mandate for the current financial year.

[The Minister for Health (Stephen Hammond)]

I am grateful to have the opportunity to set out the Government’s approach to setting a mandate for NHS England for 2019-20. The Government’s annual mandate to NHS England for 2019-20 will, for the first time, be a joint document with the annual NHS Improvement remit letter, called an accountability framework. This signals the importance of these two arm’s-length bodies working increasingly closely to maximise their collective impact. It will set one-year transitional objectives to allow the NHS time to implement the long-term plan, and it has been developed to meet the needs of patients, families and staff.

We are committed to the NHS and are funding its long-term plan to ensure that it is fit for the future for patients, their families and NHS staff. The accountability framework sets the expectations that will make that long-term plan a reality. The Government have continued to prioritise funding the NHS, with a five-year budget settlement for the NHS announced in summer 2018 that will see the NHS budget rise by £33.9 billion a year by 2023-24.

The funding settlement and the implementation of the long-term plan are not affected in any way by the short delay in the publication of the accountability framework. We are all engaged to ensure that the accountability framework is published and laid as soon as possible, and I and my ministerial colleagues and officials are working closely with NHS England and Healthwatch England, as statutory consultees, to ensure accountability, improvement and progress to deliver world- class care for patients.

[Jonathan Ashworth]

It is a pleasure to see the Minister of State, as always, but the Secretary of State should be here to defend his failure to produce the NHS mandate. In every previous year, in accordance with section 23 of the Health and Social Care Act 2012—an Act that he supported and voted for despite everyone telling the Government not to support it—the Government have published the NHS mandate before the beginning of the financial year. This mandate outlines the Secretary of State’s priorities for the NHS given the financial settlement, yet this is the first time a Secretary of State has failed to lay before Parliament the Government’s mandate to the NHS for the forthcoming financial year. Is this a failure of leadership or the latest piece of stealth dismantling of the Health and Social Care Act? If it is the latter, why not just take our advice and bin the whole thing and so end the wasteful contracting, tendering and marketisation it ushered in?

The Minister talks of the 10-year long-term plan, but it is no good his telling us he endorses Simon Steven’s vision of the NHS in a decade’s time, when Ministers cannot even tell us what they expect the NHS to achieve in a year’s time. He boasts of the new revenue funding settlement for the NHS but seemingly has not got a clue what he wants the NHS to spend it on in the next 12 months, and at the same time he does not talk about the cuts to public health budgets, training budgets and capital investment.

Will the new accountability framework deliver for patients in the next 12 months? Last year’s mandate pledged that A&E aggregate performance in England would hit 95% in 2018. That pledge was broken, so can the Minister tell us whether, for those A&E departments not trialling the new access standard, the four-hour A&E standard will be met this year, or will the target not be met for the fourth year running?

Or how about the 18-week referral to treatment target? More than half a million people are now waiting more than 18 weeks for treatment. The target that 92% of people on the waiting list should be waiting less than 18 weeks has not been met since 2016. Will that target be met in the next 12 months, or has it also been abandoned? What about cancer waits? Some 28,000 patients are now waiting beyond two months for treatment. The target for 85% of cancer patients to be seen within two months for their first cancer treatment after an urgent referral has been missed in every month but one since April 2014. Will that target be met this year, or will cancer patients be expected to wait longer and longer?

On staffing and pay, will funding be made available in the next 12 months, as it was last year, for a pay rise for health staff employed on agenda for change terms and conditions working in the public health sector for local authorities and social enterprises?

We have no NHS mandate, even though it is mandatory. We have no social care Green Paper, even though it has been promised five times. The big issue has been ducked again. We have no workforce plan, even though we have 100,000 vacancies across the NHS, and the interim plan, which should have been published today, has been delayed again. The Secretary of State parades his leadership credentials around right-wing think-tanks, yet on this record he could not run a whelk stall, never mind the Tory party. It is clearer than ever that only Labour will fully fund our NHS and deliver the quality of care patients deserve.

[Stephen Hammond]

Anyone listening to that will have realised that the hon. Gentleman is more concerned with political points scoring and process than with the substance and funding of the NHS. [Interruption.] The hon. Member for Dewsbury (Paula Sherriff) shouts at me, but she will want to remember that the shadow Secretary of State welcomed the long-term plan—or much of it—back in January.

It is absolutely clear—evidence was provided to the Public Accounts Select Committee yesterday by the permanent secretary and the chief executive of NHS England—that while obviously it would be better to publish by the deadline, it is more important that the mandate be right than published on a particular day. It is more important that we get this document on the long-term strategy of the NHS correct. As Simon Stevens, the chief executive of the NHS, said, there is no problem with this short delay to the mandate. It is an important document, but it is causing him no problems. It is causing no problems.

The hon. Gentleman mentioned access to treatment and treatment times. This winter, more than 7 million patients were seen in under four hours. That is an increase of nearly 6% in attendances. I would have hoped that the Opposition Front Bench might have praised the NHS and its hard-working staff—

[Stephen Hammond]

Rather than shouting political points across the Dispatch Box.

The hon. Gentleman says there are no targets. He is of course wrong.

[Jonathan Ashworth]

I said you were not meeting them.

[Stephen Hammond]

No, the hon. Gentleman said there were no targets likely to be set for the NHS this year. The accountability framework will include detailed and specific annual deliverables and set out in detail a process for delivering future implementation as well as some of the early delivery goals for 2019-20. He is wrong therefore to say that the framework will not have deliverables attached to it. It will. He also mentioned the Green Paper—

[Jonathan Ashworth]

Where is it?

[Stephen Hammond]

I have said, as the hon. Gentleman has heard many times, that we are finalising that. Again, it is more important to get it right. On the long-term plan for workforce implementation, a draft plan is being produced and I expect that plan to be published in the very near future—[Interruption.]