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Funding Settlement for the health service in England

Part of NHS Funding Bill – in the House of Commons at 5:00 pm on 4th February 2020.

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Photo of Edward Argar Edward Argar Minister of State (Department of Health and Social Care) 5:00 pm, 4th February 2020

As has been very clear throughout the progression of this Bill so far, there are Barnett consequentials, which will be dealt with in the usual and appropriate manner.

I will turn to the detail of the amendments in a moment, but before I do, let me say that my hon. Friend Lucy Allan addressed the debate in Westminster Hall just before the general election. In that, I said that if her constituents wanted a strong voice in this place, they should vote for her. I am very pleased that they did exactly that. Her speech shows exactly why.

This legislation is a simple Bill of two clauses. The substantive clause—clause 1—puts a double-lock duty on the Secretary of State and Her Majesty’s Treasury to ensure that NHS England will receive, as a minimum, £33.9 billion extra a year by 2024, enshrining in law the NHS England revenue budget rise in line with the Government’s manifesto commitment. The Bill has deliberately been drawn narrowly to focus on that core commitment.

New clauses 4, 5 and 11 focus on whether the allocations are sufficient. At their heart is the question of whether the quantum is appropriate and will meet the needs of the NHS. Although I understand the sentiment behind these new clauses, they are unnecessary. The chief executive of the NHS said in 2018, after the announcement of the settlement:

“As the NHS turns 70, we can now face the next five years with renewed certainty. This multi-year settlement provides the funding we need to shape a long-term plan for key improvements in cancer, mental health and other critical services.”

We are giving the NHS the funding that it believes it needs.

There is already a clear duty on the Secretary of State for Health to lay before Parliament and publish an annual mandate to NHS England. The mandate sets objectives that NHSE must seek to meet in the year ahead, and its budget for doing so. That budget includes funding to meet all of NHSE’s statutory duties, including duties under the NHS constitution. The Secretary of State has a further duty to keep performance against the mandate under review, and must also publish his annual assessment of this performance in Parliament, with Parliament entitled to table debates and questions on the matter as it so wishes. Therefore, although I appreciate the purpose behind these new clauses, they would serve no useful additional purpose. Parliament already has ample opportunity to review NHSE’s budget, to consider whether it is sufficient to deliver on the objectives that the Government have set and to hold the Government to account. I will touch a little more on this when addressing new clauses 9 and 2 later.

I turn to new clause 5 and the concerns that the Bill enshrines the NHS budget in cash terms—a point that the shadow Minister has reasonably put to me and to the Secretary of State on previous occasions. Like Government departmental settlements, the NHS budget is set in cash terms. This is essential to deliver certainty and predictability. However, responding to changes or fluctuations in expected inflation rates is part of the normal course of business, and would be addressed and scrutinised as necessary through fiscal events such as Budgets. We do not need to legislate for that separately. Furthermore, the House should remember that what we are proposing is a floor, not a ceiling. We are retaining the flexibility for an increase in funding in a range of scenarios. Nothing in the Bill prevents that at any future point.