NHS 10-Year Plan

– in the House of Commons at 5:44 pm on 19 February 2019.

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Photo of Rosie Winterton Rosie Winterton Deputy Speaker (Second Deputy Chairman of Ways and Means) 5:44, 19 February 2019

We now come to the general debate on the NHS 10-year plan. Colleagues will notice that there is a bit of a time issue. I know that the Front-Bench spokespeople will be considerate in this regard, but it is only fair to warn colleagues that I will then impose an immediate three-minute time limit on Back-Bench speeches. I call the Minister, Stephen Barclay, to move the motion. [Interruption.] I am sorry. Let me do that again. I call the Minister, Stephen Hammond.

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care) 5:53, 19 February 2019

I beg to move,

That this House
has considered the NHS Ten Year Plan.

Thank you, Madam Deputy Speaker. You will understand that I am pleased not to have to follow my predecessor’s responsibilities.

As last year’s 70th anniversary celebrations proved, the NHS is one of this country’s proudest achievements. That is clear from the number of people who want to contribute to the debate this evening, so I shall be as brief as I possibly can. The Government’s top funding priority is the NHS. By 2023-24, the NHS budget will increase by £33.9 billion in cash terms, which is the equivalent of £20.5 billion in real terms. This means that in five years’ time the total NHS budget will be £148.5 billion.

In January this year, the NHS published the long-term plan, which sets out the priorities for the next 10 years of the service. The additional funding has given the NHS the stability and certainty it needs to make that plan for the decade ahead. The plan represents a historic moment for patients across the country. It was developed by NHS leaders and clinicians, in consultation with patients and the public, and Members can be assured that it focuses on the biggest priorities for patients in the next decade.

Photo of John Redwood John Redwood Conservative, Wokingham

Will the plan ensure that areas such as mine, which has fast growth and lots of new housing, will receive adequate resources to put in new surgeries and additional capacity, which has not happened in the past?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

My right hon. Friend will note that the plan includes the transformation that we will bring to primary care, which will look not only at how primary care will be developed and delivered, but at ensuring that there is enough money to deliver the changes.

The plan sets out a scheme that will provide the best support for patients throughout their lives—from getting the best start in life to being supported into old age. The plan sets out the transformation needed at every level of the health system to ensure that it can continue to provide world-class care. Part of that, as I have just said to my right hon. Friend, is a fundamental shift towards primary care and prevention. The plan will keep people healthy and out of hospital by boosting services closer to home.

Photo of Louise Haigh Louise Haigh Shadow Minister (Home Office) (Policing)

The long-term plan acknowledges that life expectancy continues to improve for the most affluent 10% but has either stalled or fallen for the most deprived 10%. In Sheffield, life expectancy for the most deprived women has fallen by four years over the nine years that this Government have been in power. Does the Minister have any analysis of why life expectancy has fallen for the most deprived women on his watch?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

I am sure that there will be a number of excellent questions and interventions, but it was a good question. The plan sets out that all local health systems will be expected to outline this year how they will reduce health inequalities by 2023-24, and the intention is that that process will consider exactly the health inequalities that Louise Haigh mentions.

Additional money for the primary sector will ensure that funding for primary medical and community health services, such as GPs, nurses and physiotherapists, increases by £4.5 billion in real terms in the next five years. That will mean up to 20,000 extra health professionals working in GP practices, with more trained social prescribing link workers within primary care networks. By 2021, all patients will be offered a digital-first option when accessing primary care. The plan also considers the future of the health system, and the new proposals for integration are the deepest and most sophisticated ever proposed by the NHS.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

The plan recognises that some proposals in the Health and Social Care Act 2012 were made in error when it comes to the transference of powers to public health bodies and local authorities. However, based on my reading of the plan, the omission from that list relates to addiction services. If we are serious about mental health and about improving care and reducing health inequalities in areas such as Sheffield, which was just mentioned, we need to get the commissioning of addiction services right and transfer that back to the NHS. Such services deal with some of the most vulnerable patients, but they are underfunded and failing to treat people, and the taxpayer is paying the price. Patients badly need those services, so will my hon. Friend take the matter up and give it a push?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

My hon. Friend makes a good point and urges me to take up the issue, which I will. He is obviously an expert in this field and will know that the Government have asked the NHS to come forward with proposals for legislative reform to support the long-term plan’s ambitions, and I will reflect on his comments in my thinking.

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. They will become the driving force for co-ordination and integration across primary and secondary care. Any claim that such reforms might lead to privatisation are misleading. In fact, the Chair of the Health and Social Care Committee said that the proposals

“will not extend the scope of NHS privatisation and may effectively do the opposite”.

The NHS will invest more in preventing ill health and stopping health problems getting worse. That includes offering tobacco treatment services to all in-patients and pregnant women who smoke, establishing new alcohol care teams, and offering preventive treatments to more people with high blood pressure and other risk factors for heart disease.

Photo of Paul Beresford Paul Beresford Chair, Administration Committee, Chair, Administration Committee

As my hon. Friend is probably aware, I have a part-time job in which I deal with a preventable disease: caries. In dentistry we spend £34 million to £38 million on this preventable disease. Will he consider looking seriously at how we could persuade local authorities to put fluoride in the water supply to prevent caries?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

My hon. Friend will know that the plan has much on prevention in primary care and public health. I offer to meet him, and I will listen carefully. He tempts me down a line that I would rather not go down tonight.

The long-term plan marks a huge step towards parity of esteem between mental and physical health. In the next five years, the budget for mental health services will increase by at least £2.3 billion in real terms. This additional funding will be used to fund a major expansion of mental health services for both children and adults. In addition to piloting four-week waits for children and young people, we will test waiting times for adult and older adult community mental health teams, and clear standards will then be set. Specific waiting times for emergency mental health services will take effect for the first time from 2020 and will be set to align with the equivalent targets for emergency physical health services.

Photo of Layla Moran Layla Moran Liberal Democrat Spokesperson (Education)

The mental health budget is 10.2% of the current NHS budget. If the overall budget increases, will there be an equivalent rise in the mental health budget? The mental health budget has risen because the overall budget has increased, but the proportion allocated to mental health has not risen. If we are serious about tackling mental health in this country, why is the proportion allocated to mental health not higher?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

The hon. Lady will know that, as I said a moment ago, the long-term plan, for the first time, sets a parity between mental health and physical health. The mental health budget will increase by £2.3 billion by 2023-24.

Of course, everything we have been talking about here needs to be supported by new innovations and new technology. Patients can expect a radical reshaping of how the NHS delivers its healthcare using technology, so that services and users can benefit from the opportunities of advances in digital technologies. That includes making care safer, enabling earlier diagnosis and giving more independence to those managing different health conditions.

Additionally, it is vital that we build a more innovative NHS, which will help patients to be among the first in the world to benefit from life-changing new technologies. Last year, the Secretary of State announced his ambition to sequence 5 million genomes in the next five years, making the NHS the first national healthcare system to offer whole genome sequencing as part of routine care.

Most importantly, none of that will be possible without dedicated staff who are properly trained and supported throughout their career. The long-term plan sets out a strategic framework to ensure that, over the next 10 years, the NHS will have the staff it needs to ensure that the detailed plan can be implemented. Baroness Harding is leading an inclusive programme of work to set out a detailed workforce implementation plan, which will be published in the spring, but the plan is not about numbers.

Photo of Vicky Ford Vicky Ford Conservative, Chelmsford

On the future workforce, I thank the Government for investing in our new medical schools. We are enormously proud of the new medical school in Chelmsford, which is training 100 doctors a year—I understand it is 12 times oversubscribed for next year. I am also pleased to hear that nursing numbers are up, but what will the Government do to target support at areas such as mental health nursing and adult nursing, where we have seen numbers drop?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

My hon. Friend is right that we need targeted support, which is why we have looked not only at increasing the recruitment of nurses but at the retention packages that might be offered, particularly for certain specialties—she mentioned mental health nurses. We have looked at the possibility of issuing golden hellos, and we have looked at targeted support for childcare and travel.

Photo of Philip Dunne Philip Dunne Conservative, Ludlow

My hon. Friend has been generous in giving way. I welcome the workforce implementation plan, and I welcome the fact that Baroness Harding, the chair of NHS Improvement, will be taking this work forward. Will my hon. Friend ensure that Baroness Harding looks at the retention of senior, experienced general practitioners under the general practice forward view? That issue has been raised in a number of areas. We are losing too many of them too early in their career, and the situation is similar with experienced consultants in our hospitals. A contributing factor is the annual allowance for pension contributions, where tax payments take away the extra gross income staff receive as they progress through their later years. Will my hon. Friend pick that up with the Treasury?

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

I have listened carefully to my right hon. Friend’s intervention, and he will be pleased to know that discussions with the Treasury are ongoing about certain potential incentives to senior serving staff.

The plan is not just about numbers; it focuses on getting the right people with the right skills in the right place, ensuring that our dedicated staff are supported, valued and empowered to do their best. It has clear commitments to tackle bullying, discrimination and violence, and a programme of work to sustain the physical and mental health of staff who work under pressure every day and every night.

Photo of Grahame Morris Grahame Morris Labour, Easington

All good policies should be evidence-based, so let me ask the Minister about the national cancer advisory group, which prepares an annual report detailing the progress of the cancer strategy each year. That report was expected in October/November but it has been delayed. When will it be published? It may well inform the work of the 10-year plan.

Photo of Stephen Hammond Stephen Hammond Minister of State (Department of Health and Social Care)

The publication date has not yet been finalised. I understand that it will be soon, but I will write to the hon. Gentleman to confirm the date of publication.

Through the long-term plan, we will ensure that the NHS continues to strive to be a world leader. It will continue to push the boundaries between health and social care, and between prevention and cure. It will be at the cutting edge of technology and innovation, while providing high-quality service for all patients. More importantly, it will always be there in our hour of need, free at the point of use and based on clinical need, not on the ability to pay. I commend the long-term plan to the House.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care 6:06, 19 February 2019

I thank the Minister for his brevity. I am sure the House will appreciate the way in which he both took a number of interventions and made his remarks speedily. I will endeavour to copy him. [Hon. Members: “Hear, hear”]

I start where the Minister almost concluded, by thanking NHS staff for the work they do day in, day out. He is a relatively new Minister to the post—so new that you gave him a different surname, Madam Deputy Speaker, but we will gloss over that. He inherits his portfolio after a time in which the NHS has suffered the most severe financial squeeze in its 70-year history. At one point under the Conservatives’ spending plans for national health services the money was set to fall on a head-for-head basis, although they have now revised the spending plans. Because of that financial squeeze over many years, he inherits a portfolio where 4.3 million people are on waiting lists and 2,237 people are waiting more than 12 months for treatment, more than 2.9 million people waited more than four hours in an accident and emergency department, and nearly 27,000 people wait two months for cancer treatment. The 18-week referral to treatment target has not been met since February 2016, the cancer target has not been met since December 2015, the diagnostic target has not been met since November 2013, and the A&E target has not been met since July 2015. Those targets are all enshrined in the NHS constitution and in statute, and they were routinely delivered under the last Labour Government. Under this Government, they have, in effect, been abandoned.

Photo of Gloria De Piero Gloria De Piero Shadow Minister (Justice)

People in my constituency have to wait longer than most people in the country for a GP appointment: 23% waited more than two weeks; and 15% waited more than three weeks. Does my hon. Friend agree that one of the many brilliant things the last Labour Government did was introduce the 48-hour target to see a GP?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care

The last Labour Government put record investment into the NHS, which was voted against every step of the way by the Conservatives. That Labour Government delivered some of the best waiting times on record and some of the highest satisfaction ratings, and they increased access to GPs in constituencies such as Ashfield.

The A&E standard is important not only for patients waiting in an overcrowded A&E but because it tells us much about flow through a hospital. Last week we had the worst A&E performance data since records began, with just 76.1% of those attending type 1 A&E seen, discharged or admitted to a ward in four hours. Behind the statistics are stories of patients left waiting in pain and distress and of the elderly languishing on trolleys. In fact, we have had 618,000 trolley waits in the past year. Patients have been waiting without dignity, at risk of cross-infection. There is no road map at all in the long-term plan to restoring access standards. Of course, the A&E standard is being revised in the long-term plan, even though the Royal College of Emergency Medicine has said:

“In our expert opinion scrapping the four-hour target will have a near catastrophic impact on patient safety in many Emergency Departments that are already struggling to deliver safe patient care in a wider system that is failing badly.”

I hope that when the review reports we can have a full debate in the House.

Photo of Daniel Poulter Daniel Poulter Conservative, Central Suffolk and North Ipswich

The hon. Gentleman is right to highlight the Blair Government’s injection of cash into the NHS and the meaningful difference that that made to many patients’ lives. On the waiting-time targets, if we are serious about parity for mental health and physical health, we should reflect on the fact that historically there have not been access targets for mental health of anywhere near the same standards that there are for physical health. Will the hon. Gentleman join me in urging a rethink of that and a much greater push for access targets for mental health services as a way to raise standards and improve the time within which patients get care?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care

The hon. Gentleman makes an important point. There are elements of the long-term plan that we welcome, including the access targets for mental health. We also welcome the commitment to save 400,000 lives, although there is no detail in the plan about how those lives are going to be saved. We welcome the rolling out of early cancer diagnostic and testing centres—after all, it is a policy that I announced in the 2017 general election campaign. We welcome the roll-out of alcohol care teams in hospitals—a policy that I announced at the Labour party conference last year. We welcome the commitments on perinatal mental health—again, a policy that we announced previously. We welcome the commitment for preferential funding allocated to mental health services—another policy that the Labour Opposition previously announced—but we will need to study the details carefully, as Layla Moran said.

The points about mental health from Dr Poulter were well made, because currently three in four children with a diagnosable mental health condition do not get access to the support they need. Child and adolescent mental health services are turning away more than a quarter of the children referred to them for treatment by parents, GPs, teachers and others. That is quite disgraceful, so I hope the extra investment in mental health services reaches the frontline quickly, and I hope that in summing up the debate the Minister will give us more details about when we can expect to see progress on that front.

Photo of Darren Jones Darren Jones Labour, Bristol North West

Does my hon. Friend agree that for hospitals such as Southmead Hospital in my constituency, which is one of the largest hospitals in Europe, frontline delivery requires a workforce that is able to meet the demand? Does he therefore agree with the comments from the King’s Fund, which says that the Government not only failed the test on the workforce but did not even turn up for the exam?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care

My hon. Friend makes a good point, and I will come on to discuss the workforce in a few moments. First, let me pick up the point made by my hon. Friend Louise Haigh.

There is recognition in the plan that widening health inequalities are becoming a more important issue, which we need to confront. There is much in the document about widening health inequalities. After years of austerity, with poverty rates increasing and child poverty at 4.1 million, we now see life expectancy in this country stalling for the first time in a hundred years, and actually going backward in the poorest parts of the country. Child mortality rates for children born into the most deprived of circumstances have increased. The truth is that poorer people get sick quicker and die earlier. For me, as a socialist and a Labour politician, that is shameful. We should be creating conditions in which people live longer, healthier, happier lives, which is why we need to end austerity across the board. The focus on health inequalities is therefore welcome, and that includes the stark recognition that inequalities are costing the NHS £4.8 billion a year in admissions—a remarkable figure.

Photo of Matt Rodda Matt Rodda Shadow Minister (Transport) (Buses)

I concur on the benefits of our Labour health policy and how the Government should do much more to fund healthcare in this country. Does my hon. Friend agree that there is a particular problem of retaining public sector workers in many high-cost areas? In areas such as Reading and Oxford—my hon. Friend Anneliese Dodds is sitting in front of me—there is severe pressure on the NHS because of the relatively low pay of many skilled staff.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care

Absolutely. I will come on to the workforce in a second.

Overall, there are welcome commitments in the long-term plan. We have counted up to 60 commitments to improve, expand or establish new services, but sadly there is no detail on how they will be delivered. There are commitments to expanding access to general practice, but where is the plan to recruit the workforce we need in the national health service?

When the previous Secretary of State came to the House last June, he said that there would be a full workforce plan—not an interim plan shared by Dido Harding, but a full workforce plan to coincide with this long-term plan.

Where is it?

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care

It has been delayed. There are no details about training budgets, because the Department has to wait for the spending review. We have 100,000 vacancies across the national health service, with think-tanks warning that we will have 250,000 vacancies unless we do something. We cannot wait for this workforce plan; we need action now.

Also missing from the long-term plan is any serious investment in public health services—this is picking up on another point that the hon. Member for Central Suffolk and North Ipswich made. Public health services are being cut again this financial year under this Government. When we take into account the cuts to public health services, the cuts to infrastructure, and the cuts to training, there is actually a £1 billion cut to health spending this year. The cuts to public health are equivalent to 1,600 fewer health visitors, 1,700 fewer school nurses, and 3,000 fewer drug workers. They mean that our constituents become sicker and demands on the wider NHS become greater. Drug and alcohol services will be cut by £34 million this year, even though the unmet need for treatment for alcohol problems has risen to 600,000 and admissions to hospital where alcohol is a primary factor have increased by 30%.

Also cut are smoking cessation services and obesity services. Cuts to health visitors and early years initiatives correlate with a fall in vaccination rates. Admissions to hospital for whooping cough are up by 59%. There have been deep cuts to sexual health services at a time when infections such as syphilis and gonorrhoea are increasing. These cuts to sexual health services are having an impact on women’s reproductive health, with experts expressing concerns that the use of long-acting reversible contraception is decreasing. Abortion rates among the over-30s are increasing and 8 million women live in areas where funding for contraception has decreased.

Let me read the House a quick extract from the Health Committee involving my friend—I will still call her my friend—Luciana Berger. I am desperately sad that she felt that she had to leave the Labour party. I hope that the Labour party will get on top of this antisemitism issue. At the Health Committee, she asked about the health consequences of delays in accessing sexual health services. In responding, Dr Olwen Williams from the British Association for Sexual Health and HIV said:

“We are seeing neonatal syphilis for the first time in decades and neonatal deaths due to syphilis in the UK…We are seeing an increase in women presenting with infectious syphilis in pregnancy, and that has dire outcomes.”

These public health cuts were endorsed, not reversed, in the long-term plan.

Photo of Paul Scully Paul Scully Chair, International Development Sub-Committee on the Work of the Independent Commission for Aid Impact, Chair, International Development Sub-Committee on the Work of the Independent Commission for Aid Impact

I am grateful to the hon. Gentleman for giving way. He talked about a few different topics, but I think that I heard him say that there was an overall cut in the health service—I think he did so when he was welcoming some of the Government’s measures. In the 2017 manifesto, Labour committed to a 2.2% increase, whereas this Government committed to a 3.4% increase, so I hope that he welcomes that increase as well.

Photo of Jon Ashworth Jon Ashworth Shadow Secretary of State for Health and Social Care

We committed more in our 2017 manifesto than the Tory party did in the manifesto on which the hon. Gentleman fought the election. The Tory party revised its spending plans because of pressure from the Labour Opposition. [Interruption.] Madam Deputy Speaker wants me to hurry up.

The final point that I want to make is this: the most intriguing part of the long-term plan is the remark that the Health and Social Care Act has created a complete mess, hindering integration; and it proposes scrapping the so-called section 75 provisions. We do not want to say, “We told you so,” but we did tell them so, and Tory MPs should apologise for voting to pass the Lansley Act. If they are going to support NHS England’s call to get rid of the section 75 arrangements, which put through a proposed privatisation, why do they not block the £128 million-worth of contracts that are currently out to tender? If they do not, it will be clear that the Tory party is still committed to privatisation in the national health service.

The truth is, the Tories have spent nearly nine years running down the NHS, refusing to give it the spending that it needs. They are privatising it still; there will be a £1 billion cut to the NHS this year. It is Labour who will rebuild the national health service.

Photo of Lucy Allan Lucy Allan Conservative, Telford 6:20, 19 February 2019

Thank you, Madam Deputy Speaker, for calling me to speak in this important debate. I welcome the 10-year plan, especially the emphasis on delivering care closer to home.

The future of the NHS is the greatest concern to my constituents in Telford because local health bosses have been deliberating for the past five years on whether to move our A&E and our women and children’s services out of the borough, in a project that they have named NHS Future Fit. On 29 January 2019, local health bosses announced that they will indeed remove those services and transfer them 19 miles away, to the other side of Shrewsbury, and that they plan to create in addition a new “super-hospital” on the same site. The project will cost a record £312 million.

My opposition to that project has been long-standing, because it does not meet local people’s needs. It does not improve health outcomes and it does not focus on narrowing health inequalities. I believe that if local hospital management understood the people of Telford better, they would not have come up with this plan. Telford is a rapidly growing new town—people are coming to live there all the time—and it has pockets of significant deprivation. By any measure, it fares significantly worse when it comes to health outcomes, life expectancy and the number of children living in low-income families than does Shropshire, which fares better than England’s average on measures of deprivation.

There are some very important points that we must consider when making a transfer of assets from an area of need to an area of affluence, because such an action is wholly inconsistent with the ethos and obligations of the NHS. Some have called my opposition parochial and territorial, and said that if I understood the plans, I might view them in a different light. But as a former non-executive director of a hospital trust, and as someone who has been working with constantly changing senior executives in the local hospital trust and engaging in the details of this plan since its inception in 2013, my opposition is based on an understanding of the healthcare landscape and local need.

We must ask these questions. Does this scheme meet the needs of local people? Is there any evidence that health outcomes will be improved? Is there any evidence that we will narrow health inequalities? Will out-of-hospital care make up for a reduction in planned medical beds and hospital staff? Put simply, the scheme may look good on paper, but will it work in Shropshire?

I have asked the Minister to call in the scheme for review, and I very much hope that he does.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care) 6:23, 19 February 2019

I welcome the principle of the long-term plan, as it certainly makes things easier for those who are running the health service, particularly after over eight years of real-terms cuts over the term of the last three Governments. It is trumpeted that there will be £20 billion extra by 2023-24, but that is still quite some time away, and on an annual basis that is 3.4% uplift. That is better than the real-terms cuts but less than what the NHS got in every year from its inception to 2010—and actually less than the 3.6% promised by the Prime Minister last August. It shows little recognition of growing demand and it should be considered per capita. In Scotland, we spend £163 per head more on health than is allocated in England. It is unfair to have just an overall figure and not recognise the growing demand on those services. It again focuses all the money on NHS England, basically to make it sound good, with cuts for public health and insufficient funding for training and for capital projects, and again insufficient funding for social care.

Social care will get a 2.9% increase, but it is estimated that the pressures are growing, at nearly 4%, and it cannot meet unmet need. Age UK estimates that 1.2 million people across the UK are not getting the care they need. In England, although need has almost doubled since 2010, the number of local authority-funded patients is down by over a quarter.

In Scotland, we have allocated £113 more per head for elderly care, which allows us to provide free personal care and keep people in their own homes for as long as possible. If they can stay in their own homes, rather than in hospitals or even in care homes, that is more cost-effective. We are still waiting for the Green Paper on adult social care—I seem to have been hearing about it almost since I was first elected.

The Secretary of State talks about the prevention agenda, and how prevention is better than cure, but public health funding will be cut by £200 million, and that comes on top of the £500 million cut it has already faced since 2014-15. Dr Poulter mentioned alcohol and addiction services, and we have heard about cuts to sexual health services. The long-term plan talks about reducing the burden of cancer, but it makes no mention of cuts to smoking cessation services, or of an obesity strategy that does something to stop junk food being advertised to children on television before 9 pm.

The Secretary of State has mentioned the “making every contact count” approach, which has been in place for most of my career. When I am dealing with a breast cancer patient, I always get them to promise me that they will come back, once we have got through the stress of their treatment, and that they and their partner will commit to giving up smoking, but I cannot deliver their smoking cessation; I still need a service that I can refer them to, such as Fresh Air-shire, where they will get support to achieve it.

As has been mentioned, the biggest challenge of all is workforce. It runs right through the long-term plan, which will not be deliverable unless the workforce challenge is dealt with. NHS England faces 100,000 vacancies, including 41,000 nursing vacancies, yet Health Education England is not facing an uplift in its funding and has previously faced a real-terms cut. The Minister talked about the move to community nursing, but there is a 50% cut in district nurses, and in 2021 none will graduate because the course is being lengthened. That will not support moving services into the community.

The nurse vacancy rate is 11.6% in England, which is more than twice the rate in Scotland. Indeed, Scotland has already reached what is supposedly the target for NHS England by 2028. In fact, the Royal College of Nursing estimates that in the next 10 years vacancies will grow to 48,000. That creates more stress on staff, encourages more people to leave, reduces quality of care and increases waiting times.

It is absolutely critical to tackle that, but what do we have? We have the removal of the nursing bursary and the introduction of tuition fees. We did not do that in Scotland, which is why we have a 14% increase in the number of students starting degree courses. In England the number is actually down by 4%. The Minister might well respond by talking about apprenticeships, but only 300 of those were taken up in 2017-18, instead of the thousands that were trailed, so they will not replace the drop of 900 in degree students. That means the Government are simply not producing enough nurses ever to fill the 41,000 vacancy rate. With a 90% drop in those coming from the EU, that will only get worse.

The Secretary of State loves to talk about digital. I have to say that I think he has a bit of an obsession with replacing GPs with apps. As a surgeon, I cannot promise that rubbing a mobile phone over the belly will diagnose appendicitis, so good luck with the app. But there are parts of the NHS where digital could really help. In Scotland, we have a system called PACS—the picture archiving and communications system—which allows radiologists elsewhere in the country to look at images. We have electronic prescribing, which saves time and effort as well as being a safety action, because we cannot prescribe a drug that the patient is allergic to, and it will pick up interactions. Electronic records make cancer pathways easier.

The Government’s response is integration and I have supported that on many occasions in the Chamber. However, it is important how it is done. The NHS in England has gone round and the round the loop of reorganisation. It is critical that those integrated care systems have a statutory body at the top and that section 75 of the Health and Social Care Act 2012 is repealed to stop forcing the outsourcing of contracts. Tariffs also need to be tackled. Tariffs reward hospitals for admitting, when it is important that people are treated in the community.

We will make a difference only when the Government take a “health in all policies” approach. Poverty is the biggest driver of ill health, so stopping the welfare cuts would be a good start.

Photo of Priti Patel Priti Patel Conservative, Witham 6:30, 19 February 2019

I welcome the Government’s commitment to the 10-year plan and I commend Ministers for the way in which they have presented it. I also welcome the way in which the additional funding will provide a strong foundation for transforming the NHS and healthcare services across our communities.

One of the key challenges the NHS faces is how better to deliver primary care and integrate services locally and at a community level. Of course, the NHS must also meet growing demand and changing demographics.

The Minister will know that in my constituency, there is considerable population growth. The town of Witham is set to grow by 20%, but our healthcare services are naturally unable to keep up with that growth and demand. Among the four practices in Witham town, the patient-GP ratio is a staggering 2,500:1, which is 50% more than the national average. In other, more rural parts of my constituency, the ratio is 3,400:1. We all know about the pressures of growing demand. All hon. Members will have constituents who contact them when they struggle to get local appointments.

It is therefore right that the plan looks to a rethink on how to deliver primary care, for example, through bringing new partners on board, integrating services, including mental health services and other aspects of local delivery, and providing more of a one-shop stop for assessments, minor treatments and community services. The Minister will know about my campaign in Witham town to secure a new healthcare centre.

Importantly, the plan describes how it will improve outcomes for patients. No Member should lose sight of that. The plan includes reducing pressure on acute hospitals, integrating health, social care, and mental health and wellbeing services.

For my constituents, the litmus test of the plan is naturally the delivery of a new facility in Witham town. We must also ensure that the money will encourage better collaboration and investment in services, and improve the NHS in all our communities.

Photo of Mike Hill Mike Hill Labour, Hartlepool 6:32, 19 February 2019

A couple of weeks ago in the train station café in Hartlepool, a constituent told me that her husband had stood outside their local GP practice for two hours to get her an emergency appointment, only to be told that there were none that day. That is not an uncommon occurrence in Hartlepool, where it is becoming increasingly difficult to access a GP. That is not the fault of GPs or practices, but a consequence of placing too great a burden on GPs over running clinical commissioning groups, and a fall in GP numbers.

The Government are calling for a major expansion of primary care and community services, saying that that is central to reducing the burden on hospitals and that they intend to introduce new 24/7 rapid response teams. Although we are making great strides in Hartlepool in tackling community and primary care needs, with ambitious projects such as creating a centre of excellence in the pipeline, improving access to GPs is vital.

I welcome the pledges in the plan to improve cancer care and diagnosis, and the greater focus on childbirth. In 2017, there were only three deliveries in the midwifery unit at Hartlepool hospital, putting it under threat. Now there are positive plans to bring about a return of full maternity services, including the creation of a maternity hub, guaranteeing the right for future citizens to be born and registered in our town. A lot of cross-party and multi-agency work has gone into this, and I hope that the Government, under their 10-year plan, will pledge to support these initiatives.

Finally, I welcome the admission that we need improvements to mental health, which for far too long has been considered the Cinderella service. Particularly for people in crisis, I would like improvements to emergency and urgent care, including the creation of local walk-in centres. There is a growing need to tackle mental health problems for children and young people. The announcement of a new NHS mental health workforce dedicated to supporting children in schools has been welcomed by many, including Barnardo’s. However, the charity has concerns about early intervention and waiting times for assessment and treatment. Its chief executive, Javed Khan, has said that the Government

“does not show enough action on how as a society we are going to stop sleepwalking into a children’s mental health crisis.”

I completely agree with him.

Photo of Henry Smith Henry Smith Conservative, Crawley 6:35, 19 February 2019

Thank you, Madam Deputy Speaker, for calling me to speak in this debate on the NHS long-term plan. I have the privilege of being the chair of the all-party group on heart and circulatory diseases—I took over chairing it last year—and I was very pleased to set up the all-party group on blood cancer in 2016. I would like to speak about both of those in turn.

There are over 130 types of blood cancer, each with its own unique symptoms, treatments and side effects. It is the fifth most common cancer in the UK and, sadly, the third biggest cancer killer, with about 40,000 people diagnosed with each year. The rate at which it affects people is far greater than for breast and prostate cancer combined. Indeed, one in 19 people will be diagnosed with a blood cancer in their lifetimes, and about 240,000 people currently live with blood cancer in the UK.

The NHS long-term plan sets out a number of areas that affect blood cancer. On early diagnosis, the ambition to have 75% of all cancers diagnosed by stage 1 or stage 2 by 2028 is welcome, as many blood cancers are very difficult to diagnose at an early stage. A recent parliamentary answer from the Under-Secretary of State for Health and Social Care, my hon. Friend Steve Brine, to Nic Dakin stated that there are 17 cancer sites for which no staging system exists and 67 cancer sites that are unstageable. Some blood cancers fall into these categories, and I would be grateful for clarification and assurances that these will be addressed.

I turn briefly to heart disease. Heart and circulatory disease still causes a quarter of all deaths in the UK. On average, it kills one person every three minutes or 420 people each day. The number of people living with heart and circulatory disease also remains high, at 5.9 million people across England, and there are over 42,000 premature deaths from cardiovascular disease each year in the UK.

I am delighted to see that the NHS long-term plan has a renewed focus on the prevention and early detection of the risk factors for heart and circulatory diseases. Four in 10 adults with high blood pressure remain undiagnosed, and it is estimated that one in five of those who have been diagnosed are not being optimally treated. By identifying more people who have these conditions, we can help to manage their risk and save more money and of course, crucially, lives.

I welcome the work that the voluntary sector does in supporting the NHS, and I am grateful to the Government for investing £20.5 billion more each year for the next five years in this very important service.

Photo of Grahame Morris Grahame Morris Labour, Easington 6:38, 19 February 2019

Thank you, Madam Deputy Speaker, for calling me in this debate. It is a pleasure to follow Henry Smith. I declare an interest as one of the vice-chairs of the all-party group on radiotherapy, and as a cancer survivor who was successfully treated with both chemotherapy and radiotherapy, thanks to an early diagnosis.

About one in four people receives some form of radiotherapy during their lives, and almost half of us in the UK will be diagnosed with cancer at some point in our lifetimes. These stark facts will I hope remind the Government of just how important it is that we invest in modern and accessible cancer diagnosis and treatments. In the brief time I have, I want to talk about chapter 3 of “The Long Term NHS Plan”, particularly section 3.62 on more precise treatments using advanced radiotherapy techniques.

On investment, the Government have promised to complete the £130 million investment in radiotherapy machines and to commission the proton beam machines at University College Hospital in London and the Christie Hospital in Manchester. However, I must respectfully point out to the Minister that that simply recycles announcements that have already been made, so this is not a comprehensive 10-year plan for radiotherapy.

As set out in the APPG’s “Manifesto for Radiotherapy”, far more is needed over the next 10 years. We need an initial investment of £250 million and then an ongoing investment of £100 million each year. Reannouncing previous expenditure commitments falls far short of what is required and will not meet the stated objective, mentioned by other Members, of improving cancer patient outcomes through improved survival rates.

Although it is needed in over 50% of cases, access to advanced radiotherapy in England is very patchy, varying from 25% to 49%, depending on the region. It is far worse in some regions—in the south-west and in the Westmorland and Lonsdale constituency, the average is about 38%. Ideally, patients should not have to travel more than 45 minutes to access this form of treatment. Considerable additional investment will be required to achieve that. At the moment, there is nothing specific in the plan to address that serious issue. The Government say they will increase the diagnosis of patients with stage 1 and stage 2 cancers. Again, we need more investment to do that.

I encourage all Members of the House, and indeed the Minister, to read the “Manifesto for Radiotherapy”, which highlights the importance and the important benefits of increasing the percentage spend on radiotherapy.

Several hon. Members:


Photo of Rosie Winterton Rosie Winterton Deputy Speaker (Second Deputy Chairman of Ways and Means)

Order. The winding-up speeches will start at 10 to seven. If people take less than three minutes, it will help others.

Photo of Nigel Huddleston Nigel Huddleston Conservative, Mid Worcestershire 6:41, 19 February 2019

If we are asking the NHS to be speedy and agile, I am sure we in the House can be.

I am glad to stand here today to talk about the great British institution that is the NHS and about how we can improve and protect it under this plan. Of course, we need to constantly transform and improve the NHS as our population grows and ages, and as treatment costs soar as we discover new but ever more expensive ways to treat previously untreatable diseases.

In Worcestershire, our acute hospitals are under immense pressure, with 10,500 A&E visits in January alone and an overnight bed occupancy rate of 93.7%. That fits into a wider national trend, with a 28% increase in hospital admissions over the past decade and an NHS in England that deals with 1.4 million patients every 24 hours.

That is where the 10-year plan really comes in, with a £20.5 million cash increase, funding for primary and community care increasing by £4.5 billion a year by 2023-24 and an ambitious target to make sure that, in 10 years’ time, 55,000 more people will survive cancer each year. My ask of the Minister is that, as we increase this funding, Worcestershire also gets its fair share.

Of course, it is not all about hospitals and it is not all about funding, so I welcome the renewed focus on prevention, which we all need to take some personal responsibility for, as do the food and drink manufacturers and the advertisers. I also welcome the renewed focus on mental health and the parity of mental health. The £2.3 billion in extra funding will give 350,000 more children and 370,000 more adults the support they so desperately need.

In contrast to Dr Whitford, I welcome all the changes we will have as a result of digital and technology investment, which is meant not to replace humans, but to enhance their productivity. That is a fantastic improvement, which we should all welcome.

I will keep my comments short. I have further comments to make, but I am sure I can write to the Minister. I am confident that, as always, he will respond. I really welcome these plans and the focus today.

Photo of Bambos Charalambous Bambos Charalambous Opposition Whip (Commons) 6:43, 19 February 2019

In May 2018, I introduced my private Member’s Bill on palliative care. Investment in palliative care will help save the NHS billions. While the long-term plan deals with some aspects of end-of- life care, it does not go far enough. There is still a postcode lottery when it comes to hospice funding, with some areas getting up to 50% of their funding from clinical commissioning groups, while other areas get as little as 1%.

We will all be living longer, so it is vital that we put in place proper funding for hospices and end-of-life care. I am very lucky to have North London Hospice’s health and wellbeing centre in my constituency. It provides excellent services for users, but I am still staggered that it has to constantly fundraise to keep them going. These services are vital and should not be dependent on people’s charity. I ask the Minister to commit to making all clinical commissioning groups assess the need for palliative care in their area and provide funds accordingly to meet that need.

Another area where we need additional investment is the NHS workforce. To address the anticipated rise in cancer, with the rise in life expectancy, the Government need to ensure that measures are in place to deal with training, recruitment and retention of staff. Macmillan Cancer Support states that currently 2.5 million people in the UK are living with cancer. That figure is expected to reach 4 million by 2030. That will put huge pressure on the NHS cancer workforce in the foreseeable future.

There is a particular concern about breast cancer specialists. For every three breast radiographers who retire over the next five years, only two are expected to replace them. Breast Cancer Now has called on the Government to invest £39 million in recruitment for the breast imaging and diagnostic workforce, as part of the plan to cover the cost of training to fill clinical radiologist vacancies and to address the current shortfall of radiographers. The problem is being compounded by the delay in the production of phase 2 of the cancer workforce plan, which should be an integral part of the long-term plan. Health Education England must produce phase 2 of the cancer workforce plan, which looks at how many staff are needed to meet growing patient demand. That can then be set out in the 10-year cancer workforce strategy.

Unless the Government get workforce planning right, I have serious concerns that patients will suffer. I urge the Minister to take action to deal with these matters urgently.

Photo of Will Quince Will Quince Conservative, Colchester 6:46, 19 February 2019

Colchester Hospital has always been a good hospital, with caring compassionate staff. It has not been without its difficulties—it was in special measures from 2013 to 2017—but I am pleased to report that our hospital has turned a corner. It took hard work, determination and passion to get Colchester Hospital out of special measures, and I must pay tribute to all those who made it happen: the doctors, nurses, healthcare assistants, porters, cleaners, administrators and managers. In particular, I would like to praise Nick Hulme, the chief executive, who displayed incredible leadership in helping to change the culture of the organisation, moving the emphasis away from getting out of special measures and instead simply concentrating on improving care.

The future of our hospital looks really bright. We have a merger with Ipswich Hospital creating resilience in the organisation, a world-class radiotherapy centre and a new imaging centre—the first of its kind in the country. It is now one of the best-performing hospitals for delivering the A&E four-hour standards. It is one of the best in the east of England for ambulance handovers and we have one of the lowest nurse vacancies for years. Staff want to come and work in Colchester, and that is fantastic.

As for the future, a new cancer centre is being built. I would like to thank all the kind donors and members of the public in Colchester and beyond who are helping to fund it. We still have about £200,000 to go, so I encourage people to support CoHoC, the Colchester Hospitals charity. The merger with Ipswich will create economies of scale and the potential for specialism and resilience. It will make our hospital trust more attractive to current staff as well as for recruitment. I thank the Minister for the £35 million of capital investment, the largest and most significant investment in decades. That will see an open, modern spacious entrance, and additional space in our A&E and urgent care centre. The key to the future of Colchester hospital is investment in primary care. We want fewer people having to go to our hospitals. Instead, we want them to be treated locally at super GP practices.

Finally, we want to see real and demonstrable improvements in primary care, not just richer GPs. We want to make sure that we are not taking staff from our hospitals and ambulance service, but bringing new people into our NHS. Otherwise, that will be counterproductive.

Photo of David Drew David Drew Shadow Minister (Environment, Food and Rural Affairs) 6:48, 19 February 2019

I shall be very brief and make one point.

I am pleased that this Government have seen the light. Whereas previous Governments made mistakes in going for large-scale reorganisations, this Government seem to have learned from them and I am very pleased about that. The problem is that trusts now seem to have turned their attention to community hospitals. I have two excellent community hospitals in Stroud and the Vale, but we are now facing the loss of radiography time. Minor injury units are not facing closure but they have restricted opening hours, and operating theatres are frequently left empty. That simply results in more pressure on acute hospitals, so it is counterproductive.

Will the Minister look at the impact on community hospitals, which are really important to rural areas? It is vital that we see them play an integral part in our NHS. Otherwise, we will just have A&Es snarling up and that is not acceptable in any way, so I hope the Government will invest time and effort and encourage trusts to reconsider the value of community hospitals.

Photo of Justin Madders Justin Madders Shadow Minister (Business, Energy and Industrial Strategy) (Labour), Shadow Minister (Health and Social Care) 6:50, 19 February 2019

With five and a half minutes of speaking time per year of the plan, I suspect that we have not quite done it justice tonight. However, we did manage to hear from nine Back Benchers during the debate. While I cannot refer to everyone in the time I have, I want to draw particular attention to certain contributions.

My hon. Friend Mike Hill spoke about the importance of improving GP access—something we can all relate to—and the importance of mental health, a big driver of the 10-year plan. My hon. Friend Dr Drew made important points about threats to services in his constituency, and we heard such points across the Chamber. I was particularly pleased to hear from my hon. Friend Grahame Morris, who, of course, speaks about cancer treatment from personal experience. He rightly pointed out the deficiencies in the 10-year plan in relation to that. My hon. Friend Bambos Charalambous was absolutely right to highlight the postcode lottery in palliative care. As with other areas such as neonatal care and IVF, it varies depending on where in the country someone lives. He also made a very important point about the cancer workforce.

I want to say a few words about the workforce. In recognising their invaluable work, which we thank them for, we also recognise—we on the Labour Benches do, at least—that without a fully staffed, respected and motivated workforce, the NHS would simply not be able to deliver the service that our constituents deserve. Last June, there was at last some Government recognition of the importance of the workforce, when the 10-year plan was announced. The then Health Secretary—now the Foreign Secretary—said:

“Alongside the 10-year plan, we will also publish a long-term workforce plan recognising that there can be no transformation without the right number of staff, in the right settings and with the right skills.”—[Official Report, 18 June 2018; Vol. 643, c. 52.]

We now know, however, that the workforce plan will not be with us until some time later this year, so is it not the case that without a workforce plan, we simply do not know how much of the 10-year plan is achievable?

As we know, the House of Lords Committee on the Long-term Sustainability of the NHS said that the lack of a workforce strategy

“represents the biggest internal threat to the sustainability of the NHS”.

Amazingly, the 10-year plan makes no reference to the actual numbers of staff expected to be employed during this period, so I put in a written question to the Minister about how many staff the NHS expects to employ by the end of the period covered by the 10-year plan. I was told in response:

“The Department does not hold the data requested.”

So there we have it in black and white: the Government do not have a clue.

Photo of Matt Western Matt Western Labour, Warwick and Leamington

Does that not just underline the fact this evening’s debate has been so ridiculously short on such an important subject? We need more time; we need another debate.

Photo of Justin Madders Justin Madders Shadow Minister (Business, Energy and Industrial Strategy) (Labour), Shadow Minister (Health and Social Care)

I thank my hon. Friend for his contribution. Of course, we were not actually meant to be here at all this week, but it is absolutely right that this debate took place tonight. We need another one and we will very shortly need a debate on the social care Green Paper, when that is published. We also need a debate on what we are going to do about some of the legislative changes that the Government have promised, because all these things need to take place in the public eye.

Photo of Anneliese Dodds Anneliese Dodds Shadow Minister (Treasury)

Does my hon. Friend agree that we also need a debate on privatisation, given that we are seeing no public consultation on very significant changes, such as what is purported to happen to the PET—positron emission tomography—scan centre at Oxford University Hospitals NHS Foundation Trust, causing a huge amount of local concern?

Photo of Justin Madders Justin Madders Shadow Minister (Business, Energy and Industrial Strategy) (Labour), Shadow Minister (Health and Social Care)

I thank my hon. Friend for her intervention. She is absolutely right. The Secretary of State has said on the record that he wants to stop privatisation, but we have identified a number of very important contracts lasting many years and costing millions of pounds that should be halted if the Government are going to stick to their word. It has not happened and it should.

The timetable for the publication of the plan has itself not gone to plan. Again, when the Foreign Secretary was Health Secretary, he said:

“we now intend to publish the social care Green Paper in the autumn around the same time as the NHS plan.”

I am not sure which autumn he was talking about for the social care Green Paper, but the intention was right, because, as he also said:

“It is not possible to have a plan for one sector without…a plan for the other”—[Official Report, 18 June 2018; Vol. 643, c. 52.]— but here we are.

In conclusion, whatever fine words, gimmicks and spin we have in the 10-year plan, we know that the reality is that the NHS is on its knees and that it cannot survive another decade of Tory Government. It is time for Labour to come to the rescue again.

Photo of Caroline Dinenage Caroline Dinenage Minister of State (Department of Health and Social Care) 6:54, 19 February 2019

I thank hon. Members from across the House for their contributions to this debate. It is clear there is agreement on the importance and value we place on our national health service. That is why the long-term plan is such a historic moment for the public, for patients and, of course, for the staff who work tirelessly to make our NHS one of the most enduring British success stories.

I will try to respond to as many of the speakers as possible, but I agree we need a much longer debate to fully do justice to this important subject. It has been quite a collegiate debate, with Back Benchers from across the House having welcomed many of the promises in the long-term plan, although not so much the shadow Front-Bench team, whose attitude I will quickly sum up: they do not like it unless they thought of it first, and we are not putting in enough money, although considerably more than they promised in their 2017 manifesto until they did a back-of-the-fag-packet recalculation. Why can they not celebrate our NHS? Why can they not celebrate the fact that the Government are making the single biggest cash investment in our NHS in its history? Some will question, of course, whether the funding is enough for the health service to implement this vital transformation, but I remind them that this is a fully costed plan developed by NHS leaders and clinicians within the budget agreed by the NHS and with the Government.

We must also remember that the future of the NHS is not just about the additional £33.9 billion cash injection by 2023-24; it is about spending every single penny of taxpayers’ money wisely—in five years’ time the NHS budget will be £148.5 billion—which is important because our NHS is under more pressure than ever before. As my hon. Friend Nigel Huddleston said, demand on A&E from type 1 attendances was 6.8% higher this January than last January—that is 2,700 more people through the doors every single day.

Of course, publishing one document will not translate all the long-term plan’s objectives into reality, which is why the NHS will develop a clear implementation framework by the spring to set out how the commitments should be delivered by local systems and ensure transparency for patients and the public. It is also why the Secretary of State has commissioned Baroness Harding, working closely with Sir David Behan, to lead a number of programmes to develop a detailed workforce implementation plan. The first stage of that will be revealed in the spring, and the rest will come forward in the autumn.

A key focus of the long-term plan is the importance of improving the patient experience, safety and flow through hospitals. The plan will support the reform of urgent and emergency care services to ensure that patients get the care they need quickly, relieve pressure on A&E departments and manage winter demands. Improving out-of-hospital care will ensure that people are treated in the most appropriate setting to avoid unnecessary visits to hospital and support quicker discharge.

Hon. Members spoke about the importance of local provision, community hospitals and local GP services. It is important that these services be decided and led by local NHS organisations that understand the local community healthcare needs, but of course we expect the NHS to work collaboratively to ensure that both urgent and routine care needs are met in a way that ensures the best possible use of NHS resources. Investment in primary and community services will increase by at least £4.5 billion, and spend on these services will grow faster than the rising NHS budget. Funding will be provided for an extra 20,000 other staff working in GP practices.

The long-term plan sets out how we will improve prevention, detection, treatment and recovery in respect of major diseases, including cancer, heart attacks and strokes—hon. Members have mentioned those today. Patients can expect the introduction of new screening programmes, faster access to diagnostic tests and new treatments and the use of technology, such as genomic testing. NHS England is already testing innovative ways of diagnosing cancer earlier, with sites piloting multidisciplinary diagnostic centres for patients with vague or non-specific symptoms, such as those common in blood cancers. The Government have pledged to roll out rapid diagnosis centres nationally to offer all patients a range of tests on the same day with rapid access to results.

Mental health has also been raised. The long-term plan renews the commitment to grow investment in mental health services faster than the NHS budget overall, with at least £2.3 billion in real terms.

The Government’s commitment to the health service is clear and undeniable. Our historic funding settlement has enabled the NHS to create a plan for the future of the system which will benefit patients now and generations to come. We will continue to support this system as it begins to put our plan into practice.

I thank the Members who have spoken this evening, and I will write to those to whose points I was not able to respond.

Question put and agreed to.


That this House
has considered the NHS Ten Year Plan.