NHS Sustainability and Transformation Plans

Philip Dunne Excerpts

Wednesday 14th September 2016 Commons Chamber

[The Minister of State, Department of Health (Mr Philip Dunne)]

It is a pleasure to be here today, and I welcome the hon. Member for Hackney North and Stoke Newington (Ms Abbott) to her post. I think this is the first time she has opened a debate in her present position, and I am pleased to be doing so for the first time myself. I believe that she was appointed about three weeks before me, and I think it would be fair to say that we are both on a steep learning curve.

I am also pleased that the hon. Lady has chosen the sustainability and transformation plans as the subject of the debate, because that gives me an opportunity to correct some of the misconceptions that she has just revealed, and, more importantly, to inform the whole House of the status of the NHS’s plans. Let me begin by reminding the House of their origins. The NHS’s own plans for the future, set out in the “Five Year Forward View” and endorsed by the Government—but not, as it happens, by the Labour party— recognised three great challenges facing the NHS: health and wellbeing, care and quality, and finance and efficiency.

[Bill Wiggin (North Herefordshire) (Con)]

May I congratulate my hon. Friend, and say how delighted I am to see him at the Dispatch Box fulfilling such a crucial brief? While he is on his steep learning curve, will he visit Hereford County hospital, so that he can understand the difficulties faced by rural patients and see what he can do to help us?

[Mr Dunne]

I am delighted to accept that invitation from my neighbour and friend, not least because many of my constituents look to Hereford County hospital for their acute care, but also because it is one of the hospital trusts that are in special measures, which is my specific responsibility. I look forward to seeing my hon. Friend there, perhaps even during the coming recess.

[Norman Lamb]

I wish the Minister all the best in his new role. Does he share my concern about the evidence from around the country that in many areas mental health is peripheral to the STP process? Will he ensure that no STP plan will be accepted unless mental health is central to it?

[Mr Dunne]

I am grateful for that intervention from the right hon. Gentleman, who has taken such a personal interest in this subject. I can confirm that mental health is one of the issues that will be addressed in each of the plans that will be taken forward. I hope that reassurance helps.

[Several hon. Members rose—]

[Mr Dunne]

I am going to make a little progress, as I have only just started.

The “Five Year Forward View” also recognised that the challenges facing different areas of the country differ, so the issues facing Hackney are not the same as the issues facing Ludlow, and a single national plan would not be effective or appropriate. Indeed, the Labour party recognised that in its 2015 general election manifesto, which most Labour Members present stood on. It said:

“To reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides.”

[Sir Simon Burns]

Will my hon. Friend give way?

--- Later in debate ---

[Mr Dunne]

I give way to the hon. Lady.

[Catherine West]

I thank the Minister for giving way and hope he does well in his first performance here in the House. What percentage of acute trusts are in deficit, and what proportion of clinical commissioning groups are in special measures?

[Mr Dunne]

Many trusts were in deficit in the last financial year, and those deficits were funded by the Department of Health. Looking forward, we are using the financial discipline of control totals not to instigate cuts, as the hon. Member for Hackney North and Stoke Newington suggested, but to hold the accountable managers to account for delivering within the financial envelope that those control totals represent. That is what a responsible Government do—we give money to public services and expect them to live within those means. This year the NHS has received one of the largest cash settlements it has ever had, three times more than the rate of inflation.

[Dr Murrison]

I am very grateful to my hon. Friend for giving way, a courtesy not extended by the Opposition Front Bencher.

May I ask my hon. Friend to look very closely at STP footprints? The experience of those of us who represent rural areas is that aligning our areas with more urban centres can often mean that our constituents get a raw deal, and since my footprint includes urban areas in Bath and Swindon I am slightly concerned that the same thing may happen again.

[Mr Dunne]

If I manage to get there, I am going to come on to the footprints and how it was that 44 areas were identified, but in rural areas in Wiltshire and Shropshire we do look to urban areas to provide the acute care for all our local residents, so it is appropriate that the footprint areas encompass both the acute and the full range of primary sectors.

[Mr Jim Cunningham (Coventry South) (Lab)]

I welcome the Minister to his new job. What is happening in relation to bed-blocking, and what are the Government and the national health service doing to deal with care in the community in particular?

[Mr Dunne]

The hon. Gentleman raises a critical point and one of the real challenges facing the NHS at present, which is how to make discharge out of the acute setting, and movement right the way through the patient flow, more effective. As I will come on to say—if I get there—that is precisely why we are looking at bringing local authorities into the footprints for these STPs, so that the entire patient pathway can be taken into account.

[Several hon. Members rose—]

[Mr Dunne]

I will give way to my right hon. Friend the Member for Chelmsford (Sir Simon Burns), who has been most persistent in trying to participate in this debate but has not so far been allowed.

[Sir Simon Burns]

I am very grateful to my hon. Friend. So that there can be no misunderstanding, because the shadow Secretary of State does not seem to have fully grasped the brief, will my hon. Friend, with his superior knowledge, explain categorically to the House about transparency in the health service with regard to not only STPs but other reconfigurations? There automatically always has to be a public consultation with local communities before any decisions are made— something that the shadow Secretary of State seems to be totally oblivious of.

[Mr Dunne]

I am grateful to my right hon. Friend, who has a great deal of experience in this area, having served in the Department for many years. He has pre-empted what I am about to say, which is that all the STPs will be subject to full and appropriate public consultation once we are in a position to do that.

[Several hon. Members rose—]

[Mr Dunne]

I am going to continue my remarks, as I have already been quite generous in taking interventions.

As part of its annual planning round in 2015, NHS England published planning guidance last December—nine months ago—calling for clinical commissioning groups to come together with their providers across entire health economies to develop a collective strategy for addressing the challenges in their area. Those are the sustainability and transformation plans. There are 44 areas, which were agreed six months ago in March. They cover the whole of England, bringing together multiple commissioners and providers in a unique exercise in collaboration. Their geographies have been determined not by central diktat but by what commissioners and providers felt made the most sense locally.

Each area has also identified a strong senior leader who has agreed to chair and lead the STP process on behalf of their peers. They are well respected, credible figures in their local health economies, and we and NHS England are committed to supporting them to bring people together to agree a shared plan for how best to improve and sustain health services for their local populations. Local authorities, too, are fully engaged in the development of the plans. In some cases, local NHS organisations have agreed with local authorities that a senior council leader will lead the STP for their area. I think that is happening in Birmingham—I see a number of Birmingham Members present.

[Maria Eagle]

It is clear from the leaked document that Merseyside and Cheshire are looking to save £1 billion by 2021. In that context, does the Minister not agree that there will be an outcry when the secret proposals—which have now been leaked—to merge much-loved hospitals and cut services in Liverpool, for example, are finally consulted on? Does he acknowledge that they will have no chance of receiving any support?

[Mr Dunne]

The hon. Lady is leaping much too far ahead. There are no proposals at this point—[Interruption.] I will explain the exact state of the STPs shortly. There are a number of draft ideas to try to improve the services that are delivered to patients. Looking to the future and the efficiencies that need to be provided, as part of the five-year forward view the NHS leadership asked the Government to fund £8 billion of additional cash for the NHS. We provided £10 billion; the Labour party refused to provide anything like it. In return, the NHS agreed to look for £22 billion of efficiencies up to 2020. We have assisted it through the efforts of Lord Carter, whom we asked to undertake a review of efficiencies across the NHS. He has identified 10 work streams in which clear efficiencies can be found—many of which, incidentally, have been identified by Opposition Members. The hon. Member for Hackney North and Stoke Newington herself has referred in the past to areas of the NHS in which there is waste, and a newspaper article this week by the former Chair of the Public Accounts Committee, the right hon. Member for Barking (Dame Margaret Hodge), referred to “absurdities” in the spending practices in the NHS. We are trying to put right some of the practices that have been swept under the carpet for too long.

[Heidi Alexander (Lewisham East) (Lab)]

rose—

[Mr Dunne]

I am going to make some progress.

I turn now to the timetable and the progress that has been made so far. Each area was asked to work together over the first six months to draw up its initial thinking into a first draft plan by the end of June. Those plans were individually reviewed by senior leaders from NHS England and NHS Improvement during July and August. Each area is now in the process of developing its STP, with a view to submitting a worked-up plan to NHS England in October. The plans, as one would expect, will vary in their proposals, but all are expected to demonstrate a shared understanding of where an area is in relation to the three challenges set out in the five year forward view and where they need to be by 2020-21.

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I am grateful to the Minister for giving way. He was very generous the last time I had an opportunity to intervene on him.

Part of the concern in my constituency about the north-west London STP relates to the fact that Harrow receives less NHS funding per patient than any other part of London. For some months we have sought a meeting with a Health Minister to discuss that issue. Is the Minister prepared to receive a delegation from our clinical commissioning group?

[Mr Dunne]

I am grateful to the hon. Gentleman for his kind words about my willingness to take interventions from both sides of the House.

I am interested that the hon. Gentleman should mention funding allocations. Across the NHS, the allocations are a legacy of the formulas that were set in place by the Labour Government, of which he was a member. People across the country, not least in rural areas such as Shropshire, cannot understand why the funding per capita is much less generous in some parts of the country than in others. I am taking an interest in that and would be willing to sit down with him and other colleagues to understand the particular circumstances in north-west London, which we will have to do after the coming recess.

Returning to the progress that is being made, all the plans are expected to present an overall strategy for their area and to identify the top three to five priorities required. In the most advanced plans, we are also expecting areas to set out how they will deliver a number of national priorities, including on mental health and diabetes. Some will build on the early work of vanguard or Success Regime joint working, which has been developing better co-ordinated care models over the past year or so.

[Sue Hayman (Workington) (Lab)]

Will the Minister give way?

[Mr Dunne]

Shortly. I must make some progress.

The plans offer the NHS a unique opportunity to think strategically. For the first time, the NHS is planning across multiple organisations—both commissioners and providers—with local authorities to address the whole health needs of an area and the people it serves. Also for the first time, the NHS is producing multi-year plans showing clearly how local services will develop over the next five years to deliver real improvements in patient care and better efficiency to ensure that the NHS continues to be able to cope with rising demand from our ageing population. That is leading some STPs to face up to tough choices about the future of some services. Such choices have often been postponed again and again because they were too hard or relied on individual organisations operating on their own to shoulder the responsibility rather than it being shared across the geography or the whole healthcare economy.

[Antoinette Sandbach (Eddisbury) (Con)]

Does the Minister recognise the concerns in constituencies such as mine that have a border with Wales? The numerous closures of hospitals in Wales by the Labour Welsh Government are placing pressure on NHS trusts in Cheshire and Merseyside.

[Mr Dunne]

My constituency also shares a border with Wales, so I am acutely aware that Welsh patients regrettably have to wait longer and have worse access to treatment than those in England. Many of them look to English hospitals for services that are unfortunately not available in Wales, in part due to a conscious political decision of the Welsh Government to allocate less funding to the health service in Wales.

[Alex Cunningham]

I met a young surgeon at my north-east hospital in a personal capacity last week. She was excellent and caring and was clear in what she had to explain to me. She was so dedicated that it made me proud that she worked for the NHS. I was not proud, however, to hear about the facilities with which she has to work following the cancellation of our new hospital project in 2010 by the Tory-Lib Dem Government. Does the Minister agree that we can have as many plans as we like, but if we do not have the infrastructure, we cannot deliver the care required by some of our neediest communities?

[Mr Dunne]

There is undoubted pressure on infrastructure, as there is on technology. As technology improves and becomes available to the NHS, it provides opportunity—for example, for much more care to be undertaken closer to the patient. In many cases, this can be done increasingly in or near their home. That will have consequences for our existing infrastructure estate, and some of that will lead to a reconfiguration of existing hospital services. There is a programme of renovation across our hospitals, but of course that cannot get to everywhere at the same time. I apologise to the hon. Gentleman that he does not have the shiny new hospital that he would like, but there is a building programme, which will continue in the future.

[Sue Hayman]

rose—

[Mr Dunne]

I will now give way to the hon. Lady, who has been very patient.

[Sue Hayman]

I appreciate that. As the Minister is aware, we face particular issues in Cumbria, which has led to our having the Success regime. We are about to go into consultation on that, in key areas such as maternity, accident and emergency and the community hospital’s future. My constituents are concerned about how the STPs are going to fit in with the Success regime, what the fit will be and whether all that will be challenging and confusing.

[Mr Dunne]

As I have said, and as the hon. Lady knows, the Success regime in her area will become subsumed within the STP, but the advantages for areas in the Success regime is that it means the organisations have been working together for much longer than in the pure STP areas, and that will bring benefit in terms of the maturity of their plan and their willingness and ability to implement it.

[Several hon. Members rose—]

[Mr Dunne]

I am not going to take any more interventions, as I am going to have to wind up shortly.

The hon. Member for Hackney North and Stoke Newington has raised concerns in her remarks today and outside this place, and I would like to address a few of them before I finish. She has said that the STPs will result in significant cuts and changes to front-line services. I wish to make it absolutely clear to the House that, for all her protestations, these plans are not about cuts; they are about local areas, including commissioners, providers and local authorities, coming together and deciding how to improve services in the medium and long term. Some areas are taking difficult decisions, often looking to tackle long-standing problems, but this will be subject to rigorous local and national scrutiny. I can categorically assure her and this House that no changes will occur without local consultation and the normal process in the event of any proposed reconfiguration.

The hon. Lady has also accused the STP process of lacking transparency, being undertaken in secret and lacking time. Planning within the NHS is not new; an annual planning round culminates in December each year. As I have said, NHS England announced STPs publicly in its planning guidance published in December last year, and since then local STPs’ leads have been engaging locally, as they deem appropriate—there has been no secret. What is new is that for the first time in years different NHS bodies, with local authorities, have been working collaboratively together to develop these plans. The 44 local areas are submitting their worked-up plans to NHS England for consideration in October. The NHS will scrutinise these plans and make recommendations over which to take forward and prioritise for discussions with Ministers and for formal public consultation, which will follow. Implementation will take place once the feedback from consultation has been assessed, so that this implementation will begin from early next year, with timings dependent on each individual area’s specific proposals.

The hon. Lady has claimed that the process does not allow for adequate public or parliamentary engagement. These proposals remain at a draft stage, but we have made it clear to local leaders that they are responsible for ensuring that plans engage with all local stakeholders when they are ready, and proposed changes will be subject to local consultation. Many have already engaged with groups of clinicians and other stakeholders in their area in preparing draft plans. I have also indicated that local areas will be launching public consultations shortly, once their updated plans have been scrutinised by NHS England, and we welcome involvement from the public and from MPs. I have no doubt that there will be opportunities in the coming months for us to continue these discussions in this House and in the Department, and I will be willing to talk to MPs who are concerned about activities in their area.

The hon. Lady has called on the Government to publish the plans. As I have said, these plans are being prepared by local areas within the NHS, and they will be published and subject to further consultation in due course. She has also raised concerns about the use of private sector advisers in developing the STPs. I just point out gently to her the irony that 38 Degrees, which she prayed in aid for much of her advice in preparing for this debate, relied itself on a private sector advisory group, whose report I happen to have here—Incisive Health, a recognised private sector adviser within the NHS and elsewhere. It is a bit rich of her to come to this House arguing against the use of the private sector when she does so herself.