The Secretary of State for Health and Social Care ()
Mr Speaker, I come to the House today to set out our White Paper
on the future of health and care. The past year has been the most
challenging in the NHS’s proud 72-year history. The health and
care system as a whole has risen in the face of great
difficulties. Throughout, people have done incredible things and
worked in novel and remarkable ways to deliver for patients, and
we in this House salute them all—not just the nurse who may have
had to care for two, three or four times as many patients as he
would in normal times, and not just the surgeon who may have been
called to treat patients beyond her normal specialism, but the
managers across health and care who have come together in teams,
as part of a health family, at local and national level; the
public health experts, who have been needed more than ever
before; and the local authority staff who have embraced change to
deliver for their residents—and from all, a sense of teamwork
that has been inspiring to see.
As a citizen, I care deeply for the whole health and care family,
the values they stand for and the security they represent. They
are there for us at the best of times, and they are there for us
at the worst of times. As Health Secretary, I see it as my role
sometimes to challenge but most of all to support the health and
care family in their defining mission of improving the health of
the nation and caring for those most in need.
I come before the House to present a White Paper based firmly on
those values, which I believe are values that our whole nation
holds dear. The White Paper is built on more than two years of
work with the NHS, local councils and the public. At its heart,
this White Paper enables greater integration, reduces bureaucracy
and supports the way that the NHS and social care work when they
work at their best—together. It strengthens accountability to
this House and, crucially, it takes the lessons we have learned
in this pandemic about how the system can rise to meet huge
challenges and frames a legislative basis to support that effort.
My job as Health Secretary is to make the system work for those
who work in the system—to free up, to empower and to harness the
mission-driven capability of team health and care. The goal of
this White Paper is to allow that to happen.
Before turning to the core measures, I want to answer two
questions that I know have been on people’s minds. First, are
these changes needed? Even before the pandemic, it was clear that
reform was needed to update the law, to improve how the NHS
operates and to reduce bureaucracy. Local government and the NHS
have told us that they want to work together to improve health
outcomes for residents. Clinicians have told us that they want to
do more than just treat conditions; they want to address the
factors that determine people’s health and prevent illness in the
first place. All parts of the system told us that they want to
embrace modern technology, to innovate, to join up, to share
data, to serve people and, ultimately, to be trusted to get on
and do all that so that they can improve patient care and save
lives. We have listened, and these changes reflect what our
health and care family have been asking for, building on the
NHS’s own long-term plan.
The second question is, why now, as we tackle the biggest public
health emergency in modern history? The response to covid-19 has
accelerated the pace of collaboration across health and social
care, showing what we can do when we work together flexibly,
adopting new technology focused on the needs of the patient and
setting aside bureaucratic rules. The pandemic has also brought
home the importance of preventing ill health in the first place
by tackling obesity and taking steps such as fluoridation that
will improve the health of the nation. The pandemic has made the
changes in this White Paper more, not less, urgent, and it is our
role in Parliament to make the legislative changes that are
needed. There is no better time than now.
I turn to the measures in detail. The first set of measures
promote integration between different parts of the health and
care system and put the focus of health funding on the health of
the population, not just the health of patients.
Health and care have always been part of the same ecosystem.
Given an ageing population with more complex needs, that has
never been more true, and these proposals will make it easier for
clinicians, carers and public health experts to achieve what they
already work hard to do: operate seamlessly across health and
care, without being split into artificial silos that keep them
apart.
The new approach is based on the concept of population health. A
statutory integrated care system will be responsible in each part
of England for the funding to support the health of their area.
They will not just provide for the treatments that are needed,
but support people to stay healthy in the first place. In some
parts of the country, ICSs are already showing the way, and they
will be accountable for outcomes of the health of the population
and be held to account by the Care Quality Commission. Our goal
is to integrate decision-making at a local level between the NHS
and local authorities as much as is practically possible, and
ensure decisions about local health can be taken as locally as
possible.
Next, we will use legislation to remove bureaucracy that makes
sensible decision making harder, freeing up the system to
innovate and to embrace technology as a better platform to
support staff and patient care. Our proposals preserve the
division between funding decisions and provision of care, which
has been the cornerstone of efforts to ensure the best value for
taxpayers for more than 30 years. However, we are setting out a
more joined-up approach built on collaborative relationships, so
that more strategic decisions can be taken to shape health and
care for decades to come. At its heart, it is about population
health, using the collective resources of the local system, the
NHS, local authorities, the voluntary sector and others to
improve the health of the area.
Finally, the White Paper will ensure a system that is
accountable. Ministers have rightly always been accountable to
this House for the performance of the NHS, and always will be.
Clinical decisions should always be independent, but when the NHS
is the public’s top domestic priority—over £140 billion of
taxpayers’ money is spent on it each year—and when the quality of
our healthcare matters to every single citizen and every one of
our constituents, the NHS must be accountable to Ministers;
Ministers accountable to Parliament; and Parliament accountable
to the people we all serve. Medical matters are matters for
Ministers. The White Paper provides a statutory basis for unified
national leadership of the NHS, merging three bodies that legally
oversee the NHS into one as NHS England. NHS England will have
clinical and day-to-day operational independence, but the
Secretary of State will be empowered to set direction for the NHS
and intervene where necessary. This White Paper can give the
public confidence that the system will truly work together to
respond to their needs.
These legislative measures support reforms already under way in
the NHS, and should be seen in the context of those broader
reforms. They are by no means the full extent of our ambition for
the nation’s health. As we continue to tackle this pandemic, we
will also bring forward changes in social care, public health,
and mental health services. We are committed to the reform of
adult social care, and will bring forward proposals this year.
The public health interventions outlined in this White Paper sit
alongside our proposals to strengthen the public health system,
including the creation of the National Institute for Health
Protection, and last month we committed in our mental health
White Paper to bringing forward legislation to update the Mental
Health Act 1983 for the 21st century.
This landmark White Paper builds on what colleagues in health and
care have told us, and we will continue that engagement in the
weeks ahead, but it builds on more than that: it builds on this
party’s commitment to the NHS from the very beginning. Eagle-eyed
visitors to my office in Victoria Street will have noticed the
portrait of Sir Henry Willink, who published from this Dispatch
Box in 1944 the White Paper that set out plans for a National
Health Service, which was later implemented by post-war
Governments.
Throughout its proud 72-year history, successive Governments have
believed in our health and social care system and strengthened it
for their times. I believe the NHS is the finest health service
in the world. I believe in the values that underpin it: that we
all share responsibility for the health of one another. Its
extraordinary feats this past year are unsurpassed even in its
own proud history. Once again, we must support the NHS and the
whole health and care system with a legislative framework that is
fit for our times and fit for the future. We need a more
integrated, more innovative and more responsive system,
harnessing the best of modern technology and supporting the
vocation and dedication of those who work in it. This White Paper
is the next step in that noble endeavour, and I commend this
statement to the House.
11:50:00
(Leicester South) (Lab/Co-op)
I thank the Secretary of State for advance sight of his
statement. I suppose we should also thank Andy Cowper for advance
sight of the White Paper.
We are in the middle of the biggest public health crisis that our
NHS has ever faced:
staff on the frontline are exhausted and underpaid; the Royal
College of Nursing says that the NHS is on its knees; primary
care and CCG staff are vaccinating and will be doing so for
months ahead, including, possibly, delivering booster jabs in the
autumn; and today, we learn that 224,000 people are waiting more
than 12 months for treatment. This Secretary of State thinks that
now is the right moment for a structural reorganisation of the
NHS.
We will study the legislation carefully when it is published, but
the test of the reorganisation will be whether it brings down
waiting lists and times, widens access, especially for mental
health care, drives up cancer survival rates, and improves
population health. We are not surprised that the Secretary of
State has ended up here. We warned Ministers not to go ahead with
the Cameron-Lansley changes 10 years ago. It was a reorganisation
so big that we could see it from space. It cost millions. It
demoralised staff. It ushered in a decade of wasted opportunity
and, of course, he voted for those changes and defended them in
this Chamber, so, when he stands up, I hope that he will tell us
that he was wrong to support them.
We have long argued for more integrated care, but how will these
new structures be governed, how will they be accountable to local
people, and how will financial priorities be set, because when
something goes wrong, as tragically sometimes it does in the
delivery of care, or when there are financial problems, such as
the ones that we have seen at Leicester’s trust, where does the
buck stop?
The Secretary of State is proposing an integrated care board
tasked with commissioning, but without powers to direct
foundation trusts, which spend around £80 billion and employ
around 800,000 staff. He is suggesting a joint committee of the
ICS and providers as well, but who controls the money, because it
is from there that power flows? Both of those committees will
overlap with a new third additional committee, the integrated
care system health and care partnership, which includes local
authorities, Healthwatch and even permits the private sector to
sit on it. All these committees must have regard for the local
health and wellbeing board plans as well. How will he avoid
clashing agendas and lack of trust between partners, as we have
seen at the ICS in Bedfordshire and Luton, for example? Nobody
wants to see integrated care structures that cannot even
integrate themselves. Legislation alone is not the answer to
integration. We need a long-term funded workforce plan; we do not
have one. We need a long-term, cross-governmental health
inequalities plan; we do not have one. We need a sustainable
social care plan; we were promised one on the steps of Downing
Street and we still do not have one.
When the Secretary of State voted for the Cameron reorganisation
10 years ago, it was presumably because he wanted, in the words
of the White Paper at the time, “to liberate the NHS”. Now he is
proposing a power grab that was never consulted on by the NHS. It
seems that he wants every dropped bedpan to reverberate around
Whitehall again. He is announcing this just at the very moment
when the NHS is successfully delivering vaccination, which is in
striking contrast to the delivery of test and trace and of PPE
early on where he was responsible. Again, we will look carefully
at the legislation, but why is he so keen for these new powers?
Why is he repealing his responsibility to set an annual mandate
and bring it to Parliament?
The Secretary of State wants to intervene now in hospital
reconfiguration plans, but why is he stripping local authorities
of their power to refer controversial plans to him? With his new
powers, will he reverse outsourcing? Will he end the transfer of
staff to subcos? Will he bring contracts back in-house and block
more outsourcing in the future? He is ditching the competition
framework for the tendering of local services, while potentially
replacing it with institutionalised cronyism at the top instead.
Fundamentally, how will this reorganisation and power grab
improve patient care? The Secretary of State did not mention
waiting times in his statement. It is mentioned once in the
leaked White Paper. How will he bring waiting lists down? How
will he improve cancer survival rates and widen access to mental
healthcare, and by when? How will this reorganisation narrow
widening health inequalities, and by when? Given that the Prime
Minister insists that lessons cannot be learned from this
pandemic until the crisis is over, why does the Secretary of
State disagree with that and consider this reorganisation so
urgent now?
I will take that as cautious support. I know that the hon.
Gentleman sometimes has to say these things, but I am very glad
that he leaves the door open for yet more enthusiastic support in
the future, not least because of all the questions that he just
asked. The proposals on the table—the proposals in the White
Paper—are addressed directly to make the improvements that he
calls for.
The hon. Gentleman raised an important point about the
vaccination programme. The vaccination programme is one of the
largest and also one of the most successful civilian operations
that has happened in this country, and that is because of the
teamwork among the NHS, local authorities, the Department and the
brilliant civil servants who work in the vaccine taskforce. It is
that combination, that teamwork and that integration which is
making the programme the great success that it is.
The hon. Gentleman asked about timing, and I say to him: why
argue for delay? Why stop work to integrate? Why stop work to
ensure the NHS is more accountable? When people are working so
hard in the NHS for us, why should we not work hard in this
Parliament to give them the legislative support that they need
and have asked for? That is the question he needs to answer if he
wants to continue an argument for delay. If not now, when? There
is no better time than immediately, so I hope that he will, on
reflection and on reading the White Paper, come forward with
enthusiastic support.
I absolutely look forward to debates about the details and the
implementation. I look forward to the parliamentary passage of a
significant piece of legislation in the future, and I look
forward to the hon. Gentleman’s engagement on that, but the
removal of bureaucratic barriers cannot wait. The increase in the
integration of the system should not have to wait, and
accountability for this enormous amount of taxpayers’ money to
this House, and through this House to the citizens whom we serve,
is something that should be welcomed right across this
Parliament, and I hope that it will be.
(South West Surrey) (Con) [V]
May I start my comments by thanking the brilliant staff at the
Royal Surrey County Hospital for the wonderful care they gave
me—this morning, as it happens, when I unfortunately slipped over
and broke my arm on a morning run. I have just come from the
hospital.
It is a very big deal to do a structural reorganisation of the
NHS, and I know from my time as Health Secretary how distracting
it can be, but it is none the less the right thing to do and a
brave thing to do, because NHS staff want nothing more than to be
able to give joined-up care—joined up between hospitals, GP
surgeries, the social care system and community care—and the
current structures make that more difficult than it should be.
I also welcome the public health measures, particularly on
obesity, given the high mortality rates that obese people have
had during the pandemic. However, these integrated care systems
are going to be very powerful, so my question to the Health
Secretary is this: how will the public know in their area about
the quality and safety of care, and whether waiting lists are
being properly managed? How will they know how good all that is?
Is he planning to ask the CQC to do Ofsted ratings, as it
successfully does for hospitals and GP surgeries?
I pay tribute to my predecessor’s work setting up integrated care
systems in the first place. In a way, this legislation builds on
the foundations that he laid when he was in my job, and I look
forward to working with the Health and Social Care Committee on
the legislation as it proceeds. We have already had discussions,
and I am grateful for the Select Committee’s work so far and the
insights it has provided.
The question my right hon. Friend raises about the accountability
of ICSs is absolutely central, not just to accountability for the
use of taxpayers’ money, but to driving up both the quality of
care for patients and the health of the population the ICSs
serve. It is critical that we ensure the correct combination of
high levels of transparency, the role of the CQC as inspector,
and accountability up from the ICS, through NHS England, to
Ministers and therefore Parliament, and through our democratic
processes to taxpayers. The White Paper sets out at high levels
how that accountability will work. The details will be a matter
for the Bill. The combination of transparency and clear lines of
accountability are vital to make sure that while we use the
integration provided for in the Bill to empower frontline staff
to deliver care better, they are held to account for the delivery
of that care and, critically, the outcomes for the population as
a whole whom we serve.
(Central
Ayrshire) (SNP) [V]
Health and social care staff always do their best for their
patients and residents, regardless of legislative systems, but I
welcome the Government’s recognition of the damage caused to the
NHS in England by the Health and Social Care Act 2012, and the
proposal to reverse some of its most obstructive and expensive
aspects, particularly section 75, which forced the outsourcing of
services, promoted competition instead of collaboration, and made
pathways more disjointed and confusing for patients, especially
those with complex conditions. The devil, however, will indeed be
in the detail.
Which model of integrated care is the Secretary of State
proposing? Will he merge organisations, including commissioning
groups, or, as the NHS would prefer, create new public NHS
bodies, similar to the health boards we have in Scotland? When
sustainability and transformation partnerships were created,
their transformation budgets were quickly used up in covering
debts caused by the bureaucracy of the healthcare market, so what
additional funding is he committing to bring about this
reorganisation? Given the pressure of covid, the backlog of
urgent cases, and extensive staff vacancies, how does he plan to
create the capacity for staff to carry out such service change?
Covid has highlighted the vulnerability of the care system, so
what plans are there to integrate health and social care?
Finally, the Secretary of State has highlighted health
inequalities, but poverty is the biggest driver of ill health.
What discussions has he had with the Secretary of State for Work
and Pensions and other Cabinet colleagues about promoting the
prioritisation of health in all policy decisions?
Of course health is an important consideration in all policy
decisions. The overall response to the pandemic has demonstrated
that.
The hon. Lady is right to raise the issue of integration and to
ask what plans there are for the integration of health and social
care. Indeed, that is at the core of the proposals, as I set out
clearly in my statement, and at the core of the White Paper. The
integration of health and social care has improved significantly
this year as a result of people having to work together in the
pandemic. Fundamentally, social care is accountable to local
authorities, which pay for it, and therefore to the local
taxpayer, whereas the NHS is accountable to Ministers and central
Government. The combination of these two vital public services is
a challenge that I think can be addressed through the integrated
care systems. We have been working very closely with the Local
Government Association in England and the NHS to try to effect
that integration as much as possible.
The hon. Lady raises the issue of funding. Of course, the NHS has
record funding right now, and rightly so, but these reforms are
about spending that money better to improve the health of the
population, to allow new technology to be embraced, and to remove
bureaucracy. It is not about having to spend more money on a
reform; it is about reforming in order to spend money as well as
possible.
(Beckenham)
(Con)
When I was in the Army, I was badly hurt, and I was put under the
care of the NHS. In turn, it sent me to a private practitioner,
in Harley Street actually, who did me the world of good, and I
paid nothing. Now, as an MP, I am frequently asked, “Are the
Government intending to privatise the NHS?”. My reply is, “No, of
course they aren’t, and very little of the NHS is privatised.”
Could I ask my right hon. Friend to inform me how much of the NHS
is privatised as a percentage and whether the plans are to
increase it or not?
The NHS is not privatised at all. The NHS is delivered free at
the point of care, or free at the point of use, according to
need, not ability to pay. Of course, the NHS buys all sorts of
things—it buys goods, technology, scalpels and services of
different scales and sizes—and it employs people, and this
combination is essentially what the NHS is made up of. It matters
not the name of the provision; what matters is the care for the
patients, and the quality of support for the population’s health.
The pandemic has demonstrated that what matters is the outcomes,
and the coming together of different types of provision has
always contributed to the delivery of care for patients, as my
hon. Friend set out. That will no doubt happen for the entire
future of the NHS, which I have absolutely no doubt will go from
strength to strength, not just now, after the last 72 years, but
for the next 72 years, and after that.
(Huddersfield) (Lab/Co-op) [V]
I am fully in favour of a review of the NHS that brings it up to
date and makes it the best healthcare centre in the world, but if
he wants to make this a milestone, surely he should slow down a
bit. Why not consult cross-party? At this unique time, when we
have all been in this together, why can he not consult more? Why
does he not to listen to the people, and consult those who work
in the NHS, as well as the people who have benefited from it? Why
rush this? Why not talk about it and get cross-party support?
Politicians of all kinds have never ever got the NHS absolutely
right. Why not work together across party lines, and consult the
people who work in the NHS, and those who benefit from it? Slow
down, Secretary of State, and you will get me on your side.
I very much hope to get the hon. Gentleman on side and supporting
these reforms, not least because many of them were in not just
the Conservative party manifesto, but the Labour party manifesto
on which he stood. We have consulted extensively on the measures
in this set of reforms over two years. I look forward to further
work, consultation and discussions with parliamentarians on all
sides before, during and no doubt after the passage of the Bill.
It is an incredibly important piece of work. What I do not want
to do is delay the improvements that people on the frontline have
called for. The core measures of this Bill have been built on the
asks of the NHS, working with local government, and I think we
should get on and deliver that.
(Burnley) (Con)
I give my overwhelming support to these proposals, particularly
the drive for innovation and technology, which will improve not
only access to care but care outcomes for patients. The Secretary
of State will be aware that in Burnley General Hospital, we
already have some advanced surgical robots that provide
incredible care. Could I urge him to look, as part of these
reforms, at how we can make sites such as Burnley Hospital
regional centres of excellence in areas such as surgical
robotics?
Yes. We care about technology in the NHS because we care about
people and the improvements to people’s lives that it can
generate. Surgical robots are just one example. I am very glad to
hear that they are being used in such an innovative way in
Burnley Hospital. I would love to come and see that for myself
some time. This is exactly the sort of progress that the NHS
should be making to free up the time of dedicated and highly
skilled clinicians, and to enable the delivery of more
high-quality surgery because of, for instance, the higher
magnification that one can get in using a robot for surgery. That
is just one example of the sort of thing that we can push further
as a result of the measures in this White Paper.
Mr Deputy Speaker ( )
When you go to Burnley, Secretary of State, I know you will also
put Ribble Valley, Chorley and a few other places on your list.
(Rochdale) (Lab) [V]
The Secretary of State may be aware that before I returned to
Parliament, I had some involvement with the establishment of the
Greater Manchester model of health and social care. Can I offer
him two insights from that? First, social care is clearly not yet
funded in the way that is needed if we are to have proper
integration. Secondly, it was possible to have a Greater
Manchester strategic level for the nearly 3 million people of the
conurbation, but to have integration and delivery at the district
level. On the integrated care systems, will he guarantee that
there will be nothing that prevents the very successful model
that Greater Manchester is already pioneering?
Yes. The changes in Greater Manchester, in which the hon.
Gentleman had an important role, are a good example of where we
can drive this sort of integration. I can confirm that nothing I
am proposing would get in the way of that. In fact, I hope that
the changes in the White Paper will help areas that, like Greater
Manchester, are already some way along this journey to go
further, and will support them by ensuring there are fewer
legislative barriers to the sorts of actions that they want to
take. That includes both the measures across the NHS and the
integration between health and social care.
(Devizes) (Con) [V]
Frontline health and social care providers have shown enormous
flexibility, innovation and collaboration in dealing with this
crisis. I welcome the Secretary of State’s proposals. I am
particularly pleased that he suggests the need both for clear
political accountability and strong local autonomy for the
frontline. Will he assure me that, unlike Nye Bevan, the
Secretary of State does not want to hear the sound of dropped
bedpans in his office in Whitehall, and that, rather, we need a
more local, more collaborative and more community-led approach to
health and social care, as proposed by the Conservative Henry
Willink—as he says, the original designer of the NHS?
Yes, that is absolutely right. In fact, my hon. Friend put it
rather better than I did. Perhaps I will take up his rhetorical
suggestions for how to make this case. Accountability is
important, but the more local the decision making, the better.
There should be local decision making across a whole range of
partners—not just in the core NHS, but by providers of services,
from whatever sector they come, including the voluntary sector,
which, during this pandemic, has been embraced more. We need to
build on that to make sure that we have a system that can truly
serve local needs. Ultimately, all healthcare is locally
delivered, because it is delivered to an individual to improve or
save their life. Essentially, we need to make sure that the
appropriate decisions are taken as locally as reasonably
possible.
(Enfield North) (Lab) [V]
The pandemic has shone a light on massive health inequalities
across the country. The Secretary of State announced the
abolition of Public Health England in September, but there is
still no clarity on where the vital health improvement function
will sit in the future. Why are we hearing about new structures
for the NHS today without also getting clarity on the
arrangements for vital elements of public health and prevention?
There is a simple, clear reason for that, and I am very glad that
the hon. Lady asks that question, because it is an incredibly
important function. We will set out more details on the
arrangements for health improvement functions, but the population
health approach that is embedded within the integrated care
systems set out in the White Paper will itself be at the fulcrum
of delivery of health improvement and of narrowing health
inequalities. If we think about it, around 20% of the impact on
someone’s health is what happens in hospital; the rest is what
happens outside hospital, the extra support that people can get
and, of course, the choices that people make. Integrated care
systems will be supported and funded in such a way that their
goal is to improve the health of the local population, not just
of the patient.
Health improvement is embedded in the structure and the design of
the future of the NHS embedded in the White Paper, and the wider
health improvement responsibilities will flow from that. We will
set out the precise organisational structure of those shortly,
but I needed to get the White Paper out first, because it is off
this population health approach that the future of health
improvement will be built.
(Newton Abbot) (Con) [V]
I welcome the commitment to more joined-up care, which must
include mental health. The Health and Social Care Act 2012
committed to parity of esteem between physical and mental health.
Will the Secretary of State set out how, specifically, the White
Paper builds on that? Will it require and measure parity of
esteem in output, and particularly outcomes, for mental health?
If not, why not?
I am grateful for my hon. Friend’s support. Parity of esteem
between mental and physical health is critical, and of course it
is embedded in a population health approach. It is critical that
the new integrated care systems will of course have
responsibilities for provision of mental health services as well
as physical health services. The historical silos in the
provision of mental health and physical health services need to
be brought together; so often, the provision of both is critical
in a world in which many people have multi-morbidities, including
challenges with both their physical and their mental health.
(Strangford) (DUP)
I thank the Secretary of State for his statement and for
announcing a progressive strategy, which we all welcome. Does he
not agree that this pandemic has opened our eyes to the gaps in
frontline service provision and that, if nothing else, we must
ensure that nothing is able to prevent basic cancer treatment
from taking place as we go forward? I spoke recently to someone
in the midst of a cancer battle who said that they had been
trying to fight with one hand tied behind their back. How will
the Secretary of State ensure that patients awaiting scans and
treatment plans are able to safely access them?
Yes, of course. The figures out today demonstrate the scale of
the challenge when it comes to cancer treatment. Of course the
pandemic has had a challenging impact on cancer treatment. We are
supporting cancer alliances to improve outcomes as much as
possible, and to work through the backlog that has inevitably
built up because of the pandemic. Cancer alliances are a very
important part of the future of the delivery of care. In many
cases, they will be bigger geographically than an ICS. For them
and for other specialist treatments, of course some cases will
have to be at a larger scale than an ICS. Alongside putting these
reforms in place, we are absolutely determined to do everything
we can to ensure that people get the treatment for cancer that
they need as soon as possible.
(Winchester) (Con) [V]
I very much welcome the White Paper. I urge my right hon. Friend
to “think workforce” at every stage, but to ensure that
prevention is the golden thread that runs through all future
legislation and plans. Given that the last 12 months has very
much laid bare the impact of inequalities on our public health
outcomes, will we be truly bold and return to our prevention
Green Paper, which the Secretary of State knows well, when it
comes to facing the obesity crisis, smoking prevalence,
alcoholism, diabetes and stroke prevention, to name just a few?
Yes. There are measures in this White Paper that precisely pick
up the work of the prevention Green Paper that my hon. Friend did
so much to shape when he was in the Department with me. In fact,
many of the proposals in the White Paper are built from
conversations that he and I shared. I want to put on the record
my gratitude for the work that he did in shaping this agenda,
because ultimately a population health agenda is an agenda about
the prevention of ill health. Of course we must—and we will—treat
those who become ill, but it is far better for everybody to
support people to take a shared responsibility, including their
own personal responsibility to stay healthy in the first place.
The population health agenda that will be at the heart of the
integrated care systems is ultimately a preventive agenda, and
one that I am very glad to hear that he supports so
wholeheartedly.
(Twickenham) (LD) [V]
On this day eight years ago, the Government announced and then
legislated for a new funding model for social care, which the
Tories then scrapped two years later. Eight years on, we have yet
another NHS reform announcement, but only yet another promise to
reform social care. With 25,000 care home deaths during the
pandemic, what will it take for the Prime Minister to make good
on his promise to fix social care, and when will the Secretary of
State start the long-promised cross-party talks to find a
solution?
On the contrary—this White Paper covers health and care. It
covers the integration of the NHS and social care at a local
level. Of course there is further work on funding, as we have
committed to in our manifesto, but the integration of those
services, which has been so important during the pandemic, is one
of the critical pieces of the forthcoming health and care Bill.
(Isle of Wight) (Con) [V]
I congratulate the Secretary of State on this very important plan
and announcement. As he knows, the Island is already piloting
some ideas, so I thank his team of excellent advisers and the
Secretary of State himself. May we have more pilot schemes to
support his work? As he knows, the benefit of his approach may be
felt more strongly on the Isle of Wight than anywhere else in
Britain, due to our excellent but unavoidably small hospital at
St Mary’s, the smallest county council in England, and our age
profile. We want to help him and we want to be at the front of
the queue. Will he also please consider the position of the 12
unavoidably small hospitals in England as part of the programme,
of which St Mary’s is the most unique because it is on an island?
I thank the Secretary of State and his team for their great work.
With an ask like that, it is hard to say anything other than yes,
enthusiastically. I am keen to work with my hon. Friend, who is
such an incredible voice for the Isle of Wight. The services on
the Isle of Wight, by its island nature, are more closely aligned
together than in many other parts of the country, but
nevertheless suffer from some of the bureaucratic silo
requirements in current legislation. I hope that these proposals
will be received enthusiastically by all those involved in the
provision of health, social care and public health on the Isle of
Wight because they will remove the legislative barriers to closer
integration and allow them to continue in the direction in which
I know they are enthusiastically working with my hon. Friend’s
support.
(Halton) (Lab) [V]
In the middle of a pandemic, when its implications for future
healthcare are still not fully understood and when NHS staff are
exhausted, with no respite on the horizon, there are real
concerns that the Secretary of State is embarking on this
reorganisation now. So how will these plans specifically address
the lengthening backlog in cancer treatments in Halton and the
north-west? How will replacing local decision making with large
sub-regional health bodies allow greater local accountability and
encourage local innovation?
The devolution of decision making to integrated care systems will
help to join up care and deliver it more effectively. That is one
reason why these proposals have been received so enthusiastically
by the NHS itself and by NHS colleagues, including from local
government, not least because the proposals originated from
proposals from the NHS. I look forward to working with the hon.
Gentleman and suggest that he works with his local NHS to make
sure that this legislation goes through in the most high-quality
way possible and that we have a high-quality debate on it, so
that it can serve his constituents in exactly the way he sets
out.
(Mansfield)
(Con) [V]
I know from conversations I have had with the Health Secretary in
Mansfield that much of this change will be widely welcomed, and
joining up our services is vital if we are to have the best
possible healthcare system. I just have one concern: the
announcement also talks about new public health measures, and
there is an obesity strategy that I fear risks increasing
inequality by raising the cost of the weekly shop. Surely
education is the key to public health, by, for example, teaching
people to cook fresh meals, as people need the skills to make
healthier choices or they just end up paying more. So will the
Health Secretary ensure that the public health elements of these
reforms focus on that education and do not just end up hitting
people in their pockets?
Yes, of course I am alive to that concern, and I look forward to
further discussing these measures with my hon. Friend. The crisis
has demonstrated how helping people achieve a healthy weight is
important, and the Prime Minister has shown personal leadership
on that in policy terms. Of course more information and education
is an incredibly important part of this because it is about
shared responsibility, including personal responsibility, to
improve public health. I look forward to working with my hon.
Friend on the details of it and making sure that we can get this
into such a shape that it genuinely supports the tackling of
obesity in a way that supports people, as he sets out.
(Nottingham South) (Lab) [V]
A decade ago the Minister and his Conservative colleagues pushed
through the Lansley reforms, even though NHS staff warned us that
they would lead to fragmentation and waste. Why should we trust
him now, given that he and his party got it so wrong then? How
will he gain the trust and confidence of all NHS workers for his
plans, and for the timing of these reforms?
The reforms that we have set out were themselves initiated and
generated from the NHS, which may be one reason why I am so
pleased to have seen such a strong, positive reaction from the
NHS to these proposals. They are about what happens over the
decade to come. Of course we always need to be improving the NHS,
and each reform is a matter of the context of its times. These
reforms are about more innovation, more integration and more
accountability for the NHS, all with the goal of supporting those
who work on the frontline to deliver better care.
(Ashfield) (Con) [V]
Covid has changed the way we live and work. We have all had to
adapt, and our NHS has been forced to find better ways of
working. Can my right hon. Friend reassure me that our NHS will
learn from our covid days, adopt some of the new measures in
place and improve its performance over the coming years, while
delivering on our commitment to recruit 50,000 more nurses and
build 40 new hospitals?
Absolutely. We are on track to hire 50,000 more nurses over this
Parliament and build 40 new hospitals over the decade. Those were
core commitments in the manifesto that my hon. Friend and I both
stood on with great enthusiasm, and I look forward to delivering
on them. The White Paper will help towards that, but that is on
track and under way already. He is quite right about learning
from what has gone well in the pandemic, during which the NHS has
had to work so incredibly hard, and the White Paper will help to
do that.
Some of the culture and some of the ways of working have been
more flexible, more dynamic and more joined-up within the NHS
over the past year, embracing more modern technology than ever
before. It is critical that we keep pushing that culture forward
and supporting people in driving that culture forward and do not
fall back to old ways of working. The White Paper will help us to
do that, but it is only one part, because it is everybody working
as a team and working together that is at the core of where
things have gone well over the pandemic.
(Bradford East) (Lab) [V]
A year and a half ago, we halted the dangerous back-door
privatisation of key services in Bradford’s hospitals while
Ministers sat on their hands and ignored the outcry of NHS staff
and local people. The proposals in the press confirm what I and
many others have long said about the disaster and waste of
privatisation in our NHS—[Inaudible.]
Mr Deputy Speaker ( )
Imran, it is a very bad line, even on audio-only, but the
Secretary of State is going to have a go at answering.
The irony is that the proposed changes that the hon. Gentleman
was concerned about, which were halted, were ones that it is
currently legally impossible for a Minister to stop without going
through a whole process, which he knows about. The proposals in
the White Paper will make it easier for us to work together
collaboratively on the right outcome and remove some of the
bureaucracy that, frankly, stops Ministers getting involved when
a project is not going in the right direction. On that basis, I
hope that he welcomes the White Paper.
Mr Deputy Speaker
Sorry about the gremlins, Imran, but the Secretary of State did
very well in answering your question.
(Grantham and
Stamford) (Con) [V]
Can my right hon. Friend assure my constituents that bringing
health and social care much closer together will help to provide
a more efficient, higher-quality service? Can he specifically
outline how an integrated care model may help to reduce demand
for emergency services in Lincolnshire?
I very much hope so. This is about being able to deliver services
according to local need and, crucially, not just looking at the
patients who turn up—whether that is to an emergency service or
through their GP for treatment in secondary care—but trying to
get ahead of that and support people to stay healthy, bringing
the budget of the NHS to bear on keeping people healthy in the
first place. That preventive agenda is critical and can ensure
not only that people stay more healthy but that we spend money
more wisely.
(Kingston upon Hull North) (Lab) [V]
Having been in Parliament in 2010, I voted against the Tory-Lib
Dem coalition’s flawed reorganisation, the failure of which has
led us to today’s announcement. As well as sharing concerns about
having another reorganisation during a pandemic, what guarantees
can the Secretary of State give that these changes will improve
the health of my constituents when, under his plans, Hull will be
lumped into an artificial hotch-potch of the Humber Coast and
Vale ICS: an area of 1,500 square miles with cities, market towns
and remote rural and coastal communities, with little
transparency and no clear lines of accountability to local people
in Hull, with our stark health inequalities?
Improving the accountability of ICSs is absolutely at the heart
of the White Paper. I set out the three sections, and one of them
is accountability to ensure that as ICSs get stronger powers and
a statutory footing, there is the accountability that necessarily
goes with that.
There is a perfectly reasonable debate to have about the
geography of ICSs, making sure that they cover the right scale to
be able to deliver services effectively and yet are local enough
to deliver for local people. That has been an ongoing discussion.
The aim is to implement the measures set out in the White Paper
by April 2022 and by that time we will need to ensure that those
geographies are right. In very large part they are already, but
if there is further work to do in any area, I am happy to have a
discussion about that.
(Cheadle) (Con) [V]
The demands of the pandemic on Stockport Council, GP services and
my constituency hospital, Stepping Hill, have shown the benefits
of joint working and data sharing to improve care and health
outcomes. I therefore welcome today’s announcement. We know that
when bodies work together, people receive better care.
Stockport Together’s previous journey on this path highlighted
the huge benefits of health and care working together as well as
the challenges of addressing silo working and the pressures of
pooled budgets. Will my right hon. Friend confirm that the
proposals will deliver a more streamlined system that will give
seamless care and healthier outcomes for my Cheadle residents?.
That is the goal, exactly as my hon. Friend sets out. In
particular, I am glad that she raised data sharing as part of the
integration. It is critical that we have high-quality data
sharing, with data protected for the individual but shared among
those who need it for the purpose of joining up care. If someone
goes to hospital, they will not have to give all their details
over and over again, and their GP will know about it. Care homes,
GPs and hospitals, for instance, will be able to care better for
an individual without having repeatedly to diagnose. This is a
very important agenda for the NHS, which it should approach with
confidence as a core part of joining up care.
(Bedford)
(Lab) [V]
In my constituency of Bedford and Kempston, patients are being
left in unimaginable pain as they struggle to access even
emergency dental treatment. Dental practices are struggling to
stay open with the impact of covid on their businesses, and those
who have survived are struggling to cope with the backlog.
Imposing targets is not working, so will the Secretary of State
include oral health in his future plans and agree a sustainable
funding solution with NHS dentists to end the crisis in oral
healthcare?
The crisis has been very tough on dentistry. By the nature of
dentistry, the infection prevention and control systems in place
are a challenge. I look forward to working with dentists to
ensure that this sort of integration can help them appropriately.
I am happy to arrange a meeting between the hon. Gentleman and
the Minister responsible for dentistry to discuss these concerns.
(High Peak) (Con)
I welcome the proposals for more integration and collaboration
between the NHS and social care. However, it is vital that these
important reforms do not get in the way of investment in NHS
capacity and the commitment to recruit 50,000 more nurses. Will
the Health Secretary assure the House that they will not and that
the Government remain committed to the badly needed new urgent
care centres at Stepping Hill Hospital and Tameside Hospital?
Yes, absolutely. Stepping Hill Hospital is obviously vital to my
hon. Friend’s constituents. The urgent care centres are important
too, especially in ensuring that people can have access to
treatment closer to home for smaller, yet urgent problems. We
have also introduced 111 First and people should call 111 before
going to an urgent treatment centre or an A&E to let them
know they are coming and to check that that is the right setting
for them. That is an important part of our wider considerations,
which the measures in the White Paper will help.
(Barnsley Central) (Lab) [V]
Shamefully, the poorer people are, the younger they will die.
That link between economic deprivation and health outcomes means
that Barnsley is suffering one of the highest covid mortality
rates in England. Health inequality is an incredibly complex
problem, but it is avoidable. Does the Secretary of State agree
that a key test of the reforms is whether they will tackle that
injustice?
I do. Tackling health inequalities is incredibly important and is
a vital part of our levelling-up agenda. The hon. Gentleman is
right to point out the gaps in life expectancy across the
country. I hope that a move to a population health approach,
whereby the focus of the whole local system is on improving the
health of the population, not just those who ship up needing
support, can help us as a society to tackle health inequalities.
(Ipswich) (Con)
A key element of the statement today is that it strengthens
accountability to this House, which I very much welcome. Will my
right hon. Friend confirm that this will mean that, as local
Members of Parliament, we are better placed to represent our
constituents in this place when it comes to communicating any
concerns that they might have about unpopular local
reorganisation of key services at their local hospital?
Yes, absolutely. It is important that, while the NHS continues to
evolve and must evolve, it is there to serve our constituents.
For a reform to take place, it needs to make the argument for why
that is better for our constituents. Ultimately, when such a
large amount of taxpayers’ money is spent on a public service, it
is right that there is accountability to Ministers, and through
Ministers to the House, for the services that are provided—that
is the essence of a democracy—while preserving clinical
independence, for instance, for individual decisions, and for the
National Institute for Health and Care Excellence and decisions
about appropriate advice on drugs. That is the settlement that
the White Paper proposes and that I hope garners widespread
support.
(Wirral West) (Lab) [V]
Integrated care systems have their roots in accountable care
organisations, such as those used in America, in which
individuals take out private health insurance. It is therefore
hardly surprising that there is a great deal of concern about the
introduction of integrated care systems here. Will the Secretary
of State give a cast-iron guarantee that he will legislate to
ensure that NHS patient data cannot be used to promote or sell
private health insurance or services to patients?
I do not understand the logic of the hon. Lady’s question. I have
not seen the sorts of concerns that she raises about integrated
care systems, which, in the UK, have provided the joined-up care
that people have been looking for for so long. I am happy to look
at the details she raises on the provision of data, but the White
Paper is about NHS provision, not the provision of healthcare
through insurance, other than the national insurance that we come
together as a society to pay in order to provide healthcare free
at the point of use. That is a belief that I hold dear and is
shared by the vast majority in the House and the country. I am
happy to reaffirm that and reassure the hon. Lady.
(Vale of Clwyd) (Con) [V]
As an officer of the all-party parliamentary group on obesity, I
welcome this statement, particularly its promises relating to
obesity policy, including limitations on unhealthy food
advertising and new requirements for calorie information on food
packaging. Will my right hon. Friend outline the likely
timescales for the associated legislation and, in the interests
of fairness and efficacy, will he ensure that there is a level
playing field between advertising via British television
broadcasters and advertising on often overseas online services,
in terms of statutory extent and date of commencement?
Yes, these are very important measures and I am glad that they
have my hon. Friend’s support, not least because of his extensive
knowledge as a practising GP who has done so much during the
crisis—the whole House is grateful for his commitment and work.
On the timing of legislation, unfortunately I am not permitted to
go into any further detail ahead of Her Majesty’s next visit to
the other place, but the White Paper sets out the reforms that we
hope to have in place by April 2022, and I hope that he can take
from that some indication of our sense of pace.
(Oldham East and Saddleworth) (Lab) [V]
With one of the highest covid death rates in the world, and with
NHS workers under such incredible pressure, this is hardly the
best time to be talking about yet another NHS reorganisation. In
his response to me two weeks ago, the Prime Minister committed to
addressing the key underlying causes of the high and unequal
covid death toll: primarily, socioeconomic inequalities driven by
10 years of austerity. He said that he would be implementing
Professor Sir Michael Marmot’s recommendations, to “build back
fairer.” How do the White Paper proposals address those
inequalities and their impact on our declining life expectancy
and on the highest excess mortality rate in Europe?
I gently say that I disagree entirely with the hon. Lady’s
pessimism about the ability of improvements in the health service
to assist in the closing of health inequalities and the provision
of care. As a Greater Manchester MP, she will understand better
than most the benefits that come from that sort of integration.
The idea that we should fail to act on what the NHS has itself
asked for because of the challenges it is facing is completely
the wrong way round. I see it entirely the other way round; it is
incumbent on us to act in order to deliver the improvements that
the NHS is calling for.
(Northampton South) (Con) [V]
During the last Parliament, I sat on a joint Health and Housing,
Communities and Local Government Committee, and I am pleased to
be re-joining the latter Committee. That Committee commissioned a
report on the future of adult care, which left open care
insurance-type options to spread the financial burden, so as not
to create an ever-larger NHS versus the critical local government
role, and, crucially, with enhanced choice and flexibility for a
21st century care system. How will those aspirations fit into the
plans that my right hon. Friend has described today?
The White Paper takes forward parts of those proposals relating
to the integration between health and social care, and ensuring
that it is those on the ground delivering health and social care
who can decide the best way to provide that for their population.
We are committed to taking forward funding reforms, as set out in
our manifesto. Those funding reforms are not part of this Bill,
but the Prime Minister has committed to bring those forward this
calendar year.
