Contribution
I thank the Secretary of State for his typical courtesy in providing advance sight not only of his statement but of his plan. I am grateful, and others on the Government Front Bench might learn a thing or two from him. I am pleased to see the plan published. This Secretary of State is a rare thing these days: one whose announcements do tend to survive largely intact for more than a week. In the case of the plan, it is vital that it does stick.
The Secretary of State is not known to be short on ambition, and to be fair that is reflected in his plan; it is ambitious. I believe that his long-term goals are right and that the reforms he has set out build on the reforms that the Conservatives set out and carried out. The desire to shift care from hospital to community, to better use technology and to move to prevention is not new at all, but it remains vital.
The NHS undoubtedly needs reform, not just more cash—it is not fiscally sustainable in the long term to have 38% of day-to-day Government spending going on the NHS—so we need to focus on outcomes, not just inputs. But the plan, while welcome, is still sketchy on some of the details of delivery and how it will be paid for without the funds that the Secretary of State mentioned being eaten by pay rises and by inflation, as well as how that shift will be staffed. Greater use of the app is right, and builds on the amazing work done on the app by my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay) when he was Secretary of State. Greater use of technology and of genomics is right, and the Secretary of State’s big five tech bets are largely right, but, as he knows, tech alone will not deliver this; people will, so a workforce plan that is clearly aligned with his strategy is vital.
Neighbourhood health centres are one of the measures at the heart of the Secretary of State’s plan. The concept is an interesting one, but it does throw up a number of questions that I hope he can answer in the spirit in which they are asked. Will the providers of those new centres be NHS public sector organisations, private sector organisations or a mixture? How will the centres fit with GP provision and other services without duplication or fishing in the same pool for staff? What assessment has he made of the cost of new buildings and technology to go in them? How many centres does he envisage, and by when? Crucially, how will he ensure that a public-private partnership model will avoid the downsides of the Blair- Brown private finance initiative model?
I ask those questions from a desire not to see this fail but to succeed, because it is in all our interests that the Secretary of State does succeed, but that will take time. Given that, on page 71 of his plan he talks about the need for “immediate opportunities” to be seized. Although there will be others, may I take the opportunity to suggest just one? He should deliver on the pre-election commitment for fracture liaison services to be delivered in all communities, as campaigned for by the Royal Osteoporosis Society, The Mail on Sunday, the Express and many others. That policy would deliver savings within the comprehensive spending review period. Similarly, Melton Mowbray in my constituency has a fantastic community hospital—there will be many up and down the country—and I hope that such hospitals will be a part of delivering more services in the community.
On maternity care, I welcome the Secretary of State’s commitment to a national investigation into maternity scandals, but I hope that will not stop him from delivering on the work done by the hon. Member for Canterbury (Rosie Duffield) and Theo Clarke, which included measures that can be implemented now to help improve maternity safety.
On systems reform, may I offer the Secretary of State a couple of words of caution? One is on folding the Health Services Safety Investigations Body into the Care Quality Commission, even as a discrete entity within it. HSSIB is not a regulator and is not designed as such, and it is important that those distinctions are not blurred in making that change. Similarly, may I urge him to be wary of further moving integrated care boards to larger geographies—they are at risk of becoming again the old regional health authorities—as that will move them further away from the local communities they serve and the entities providing social care in those communities with whom they must interact?
That brings me finally to a significant question hanging over the plan. Unless we move faster to adjust to the challenges of social care and put it on a sustainable footing, these reforms risk failing to seize the genuine opportunity presented. In the move from cross-party talks to an independent commission, we risk losing that opportunity. Crucially, I ask the Secretary of State again to consider bringing forward the end date of that commission so that we can go further and faster on social care.
I have often said to the Secretary of State that where he is wrong we will rightly hold him to account and challenge him, but where he is right we will offer constructive support. The plan, by and large, does say the right things. We must shift to outcomes and not focus continually on inputs, and we must do that through real and genuine reform. The challenges he faces will be in the detail, much of which is still to be confirmed, and crucially for the Government, in the actual delivery. He should not underestimate those challenges. I will work with him to improve the plan where it needs it, but I will support him where he pledges and brings genuine reform to our healthcare system. His plan will have a key test: will patients see the difference, and when will they see the difference? In all that we do, it is vital, as we reform our NHS, that patients are at the heart of our deliberations and our plans.