PARLIAMENTARY DEBATE
NHS Long-Term Plan - 18 June 2018 (Commons/Commons Chamber)

With permission Mr Speaker, I will make a statement about the Prime Minister’s announcement yesterday of a new long-term funding plan for the NHS. The NHS was built on the principle that good healthcare should be available for everyone, whatever their background and whatever their needs. Seventy years on, it remains this country’s most valued public service: an institution that is there for every family, everywhere, at the best of times and at the worst, so no one in this House underestimates the importance of putting the NHS on a steady financial footing, not just for the sake of their constituents but also for their own families and loved ones. That is why I am proud today that this Government have announced their commitment to a long-term funding settlement for the NHS.

From vaccinations to IVF, to radiotherapy and to next-generation immunotherapies, the NHS has always been at the forefront of excellence in medicine, but as only the sixth universal healthcare system in the world, it has also come to symbolise equity both at home and abroad. Despite pressures in recent years, the Commonwealth Fund rates the NHS as the best healthcare system in the world, cancer survival rates are at a record high, stroke mortality is improving faster than almost anywhere else in the OECD and heart disease mortality rates continue to fall. All this is thanks to NHS staff who continue to work tirelessly, day in, day out to make it the world-class service it truly is.

But alongside advances in medicine, demographic pressures pose a potentially existential threat to the NHS as we know it. With the number of over-75s expected to increase by 1.5 million in the next 10 years, these pressures, far from reducing, will intensify. So in March the Prime Minister made the bold decision to commit to a 10-year plan for the NHS backed up by a multi-year funding settlement. Since then I have been working closely with the Prime Minister and the Chancellor, and I can today announce that the NHS will receive an increase of £20.5 billion a year in real terms by 2023-24—an average of 3.4% per year growth over the next five years. The funding will be front-loaded with increases of 3.6% in the first two years, which means £4 billion extra next year in real terms, with an additional £1.25 billion cash to cope with specific pension pressures. Others talk about their commitment to the NHS, but this settlement makes it clear that it is this Government that delivers, and the details will shortly be placed in the Library of the House.

This intervention is only possible due to difficult decisions taken by the Government—opposed by many—to get our nation’s finances back in order and our national debt falling. Some of the new investment in the NHS will be paid for by our no longer having to send annual membership subscriptions to the EU after we have left, but the commitment that the Government are making goes further, and we will all need to make a greater contribution through the tax system in a way that is fair and balanced. My right hon. Friend the Prime Minister said that we will listen to views about how we do that and, my right hon. Friend the Chancellor will set out the detail in due course. I want to pay particular tribute to the Chancellor, whose careful stewardship of the economy—alongside that of George Osborne before him—is what makes today’s announcement possible.

The British public also, rightly, want to know that every pound in the NHS budget is spent wisely. It is therefore critical to the success of the plan that the whole NHS improves productivity and efficiency, eliminates provider deficits, reduces unwarranted variation in the system so that people get the consistently high standards of care wherever they live, gets better at managing demand effectively, and makes more effective use of capital investment. We have set the NHS five key financial tests to show how it will play its part in putting the service onto a more sustainable footing, and I will expect the NHS to give this work the utmost priority. The tests will be a key part of the long-term plan.

However, this is more than just a plan to get finances back on track. In its 70th year, we also want our NHS to make strides towards being the safest, highest-quality healthcare system in the world. That means making a number of improvements to the treatment and care currently offered, including getting back on track to delivering agreed performance standards, locking in and further building on the recent progress made in the safety and quality of care, and transforming the care offered to our most frail and vulnerable patients, so that we prioritise prevention as much as cure. It also means transforming our cancer care, where we still lag behind France and Germany despite record survival rates. There is no family in this country that has not been touched by cancer, so the whole House will want to know how the NHS intends to make our cancer treatment and care among the best in Europe.

Many of our constituents worry about the mental health of their loved ones, families and friends. Again, I am proud of this Government’s record here: investing more in mental health than ever before and legislating for true parity as part of one of the biggest expansions in mental health provision in Europe. A critical part of the plan will be to decide what next steps will enable us to claim not just that we aspire to parity of provision with mental health, but that we are actually delivering it.

For our most vulnerable citizens with both health and care needs, we also recognise that NHS and social care provision are two sides of the same coin. It is not possible to have a plan for one sector without having a plan for the other. Indeed, we have been clear with the NHS that a key plank of its plan must be the full integration of the two services. As part of the NHS plan, we will review the current functioning and structure of the Better Care Fund to make sure that it supports that. While the long-term funding profile of the social care system will not be settled until the spending review, we will publish the social care Green Paper ahead of that. However, because we want to integrate plans for social care with the new NHS plan, it does not make sense to publish it before the NHS plan has even been drafted, so we now intend to publish the social care Green Paper in the autumn around the same time as the NHS plan.

Finally, there are two further elements crucial to putting the NHS on a sustainable footing. 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. This applies to both new and existing staff. As part of this, we will consider a multi-year funding plan for clinical training to support this aim. Similarly, we know that capital funding is critical for building the NHS services of the future and, again, we will consider proposals from the NHS for a multi-year capital plan to support the transformation plans outlined in the long-term plan.

Given the national economic situation, yesterday’s announcement is bold and ambitious. For the first time, national leaders of the NHS will develop a plan for the next decade that is clinically led, that listens to the views of patients and the public and that is backed by five years of core funding. We want to give the NHS the space, the certainty and the funds to deliver a comprehensive long-term plan to transform health and care and to ensure that our children and grandchildren benefit from the same groundbreaking health service in the next 70 years as we all have done in the first 70.

That is the Government’s commitment to our NHS, and I commend this statement to the House.

I thank the Secretary of State for an advance copy of his statement.

Today’s announcement is the clearest admission that eight years of cuts, of the tightest financial squeeze in its history and of privatisation have pushed the NHS to the brink. Is not the announcement of new potential legislation the clearest admission that the Health and Social Care Act 2012 has been a wasteful mess and should never have been introduced in the first place?

With waiting lists at 4 million, with winters in our NHS so severe that they were branded a “humanitarian crisis” and with 26,000 cancer patients waiting more than 60 days for treatment, Tory MPs should not be boasting today but should be apologising for what they have done to the NHS.

We have long called for a sustainable funding plan for the NHS, and I note that the Secretary of State did not use the words “Brexit dividend.” Is that because he knows—I say this for the benefit of his own Back Benchers—there is no such thing as a Brexit dividend? That is why the Institute for Fiscal Studies said with respect to the Brexit dividend that

“over the period, there is literally zero available”.

If the Secretary of State disagrees with the IFS, will he confirm the Government’s own Office for Budget Responsibility forecasts that there is no Brexit dividend initially for the public finances? Is it not the truth that this package will be paid for by extra borrowing and higher taxation? The Prime Minister should level with the British public and not take them for fools.

The Secretary of State is graceful enough to concede that higher taxation is on the way, but do the British public not deserve to know how much extra tax they will be paying? Will VAT go up under the Tories? Will the basic rate of income tax go up under the Tories? It is not good enough for him to say that these are matters for the Chancellor, because they are matters for the Cabinet of which he is a member.

Given that the Secretary of State is putting up tax and borrowing, and of course every £1 should be spent wisely, can he guarantee that not a further penny piece will be siphoned off into poor-quality, poor-value privatisation? Three years ago, he told us that the NHS would find £22 billion-worth of efficiency savings. How much of those efficiency savings came to fruition?

How much will the NHS be spending on agency workers and locums in the coming years? The NHS already spends £3 billion a year. Staffing gaps have led to clinical negligence claims of £1.7 billion a year, twice the rate of 2010. How much of this new money will go to further claims? The NHS spends £389 million a year on consultancy costs. Will consultancy costs increase, or will the Secretary of State cap them? With hospital trusts in deficit by £1 billion, can he guarantee that trusts will break even next year?

Is it not the truth, as expert after expert has said, that this settlement is not good enough to deliver the needed improvements in care? Indeed that is why the Prime Minister could not even confirm, when asked a basic question today, whether this funding will deliver the NHS’s constitutional standards on treatment waits, A&E waits and cancer waits.

Can the Secretary of State tell us whether, this time next year, the waiting list for NHS treatment will be higher or lower than the 4 million it is today? This time next year, will there be more or fewer patients waiting more than 60 days for cancer treatment? This time next year, will there be more than 2.5 million people waiting beyond four hours in accident and emergency or fewer? If he cannot give us basic answers to these fundamental performance target questions, that exposes the inadequacy of this settlement.

Why does the Secretary of State not tell us what was left out of this settlement? We have a childhood obesity crisis; we have seen cuts to sexual health services and to addiction services; and health visitor numbers are falling. Yet there is no new money for public health in this announcement—instead we are told to wait until next year. We have a £5 billion repair bill facing the NHS and outdated equipment, yet there is no new money for capital in this settlement—instead we are told to wait until next year.

On social care, we have had £7 billion in cuts and we have had 400,000 people losing care support. The social care Green Paper is delayed again. Is it not a total abdication of responsibility to have left social care out of this settlement? This is not a credible long-term funding plan for our NHS; it is a standstill settlement for the NHS. The reality is that under this plan the NHS will remain understaffed, under-equipped and underfunded—it needs to be under new management.

It was a valiant effort, but the hon. Gentleman could not get away from the truth in British politics: when it comes to the NHS, Labour writes the speeches, Conservatives write the cheques. He gamely managed to avoid smiling when he said that this settlement was not enough. He said the same thing on “Sunday Politics” yesterday. Let me remind him that at the last election his party was promising not the 3.4% annual increases that we are offering today, but 2.2%. What today he says was not enough he said in the election was enough to

“'restore the NHS to be the envy of the world”.

His leader said that it would

“give our NHS the resources it needs”.

What we are offering today is not 10% or 20% more than that, but 50% more. In five years’ time this Conservative Government will be giving the NHS £7 billion more every year than Labour was prepared to give. [Interruption.] It is funny, isn’t it, that Labour Members talk about funding the NHS but when we talk about it they try to talk it down? They do not want to hear the fact that under a Conservative Government there will be £7 billion more funding every year—that is 225,000 more nurses’ salaries under a Conservative Government. [Interruption.]

Order. There is far too much noise in this Chamber. As is my usual practice, I was addressing Education Centre students via Skype this morning. They were from a primary school from Wythenshawe and Sale East. One of the youngsters said to me, “Is it not the case, Mr Speaker, that often Members speak very rudely to and at each other?” I could not dissent from that proposition. I think it would be helpful if Members calmed themselves. The Secretary of State is accustomed to delivering statements and responding to urgent questions in this place, and he knows, and will expect, that there will be plenty of opportunity for people to question him. As he gives his answers, it is only right that he be heard, as I want then to hear every Member.

Thank you, Mr Speaker. The hon. Gentleman said just now that there is

“no such thing as a Brexit dividend”.

I have heard lots of other people say that from a sedentary position. But what did their leader say on 26 February? These were his exact words:

“and we will use the funds returned from Brussels after Brexit to invest in our public services and the jobs of the future”.

So who is right: is it the hon. Gentleman or his leader?

After paying the Brexit divorce bill this Conservative Government will use the contributions that would have gone to Brussels to fund our NHS—that is what the British people voted for. But the main reason we are able to announce today’s rise, one of the biggest ever single rises in the history of the NHS, is not the Brexit dividend but the deficit reduction dividend, the jobs dividend, the “putting the economy back on its feet” dividend, after the wreck left behind by the Labour party. Every measure we have taken to put the economy back on its feet has been opposed by the Labour party, but without those measures there would be no NHS dividend today; with the Conservatives you don’t just get a strong NHS, you get the strong economy to pay for it.

In the next few weeks, as Labour scrabbles around to raise its offer on the NHS, we will no doubt hear that it is offering more for the NHS, but when the Labour party comes forward with that offer, the British people will know that the only reason it has done so is that a Conservative Government shamed it into doing so with an offer far more generous than anything Labour was prepared to contemplate.

Another thing I have heard said about NHS funding is, “Whatever the Conservatives offer, we’ll match and do more,” but the trouble is that the opposite is true, because under this Government NHS spending in England is up 20% in the past five-year period, but in Wales it is up just 14%. That is to say that for every extra pound per head invested in England, in Wales it is just 84p, which is why people are 70% more likely to wait too long in A&Es in Wales. The right response to this statement would be for Labour to say that every additional penny though the Barnett formula will go into the NHS in Wales, but we did not hear that pledge.

The hon. Gentleman also talked about social care, and this matters. I fully agree with him that we need to have a strong plan for social care and that it needs to go side by side with the NHS plan, and we have made some important commitments to the social care sector today. But if he is going to criticise social care cuts, he might at least ask why austerity happened. It was not, as he continually suggests, because of an ideological mission to shrink the state, but to save our economy and create jobs so that we could reinvest in public services. The evidence for that is shown today, with the first ever five-year NHS funding plan, to go alongside a 10-year plan. This is a Conservative Government putting the NHS first and shooting to pieces his phoney arguments about Conservative values.

I recognise and thank the Secretary of State for his tireless efforts in making the case for this funding uplift and for a long-term plan. Will he now go further and set out whether, as a result of the extra funding, we will see an end to capital-to-revenue transfers? Will he also set out the role of transformation funding, because we all know that that is essential to get the best from the resources that we are going to add?

My hon. Friend asks two important questions. As she knows, we have committed to phase out capital-to-revenue funding, because if we are to make the NHS sustainable in the long run, we urgently need to make capital investment in estates, technology and a whole range of new machinery, including cancer-diagnostic machinery and so on, and we will not be able to do that if we continually have to raid capital funds for day-to-day running costs. That was one of the main reasons why we decided that we had to put revenue funding on a more sustainable footing. My hon. Friend is absolutely right about that.

Transformation funding is also important, because when the five year forward view was published, pressures in secondary care and the acute sector meant that a lot of transformation funding was sucked into the hospital sector and we were not able to focus on the really important prevention work that can transform services in the long run. I am very sympathetic to the idea that we need, if not a formal ring fence, a pretty strong ring fence for transformation funding, so that the really exciting progress that we see in some parts of the country can start to spread everywhere.

I echo the comments made about the approach of the NHS’s 70-year anniversary across the four countries of the UK, having myself spent a fair chunk of those 70 years—perhaps slightly longer than I care to admit—working in the NHS.

Like most people present, I imagine, I absolutely welcome the additional funding, which has been described as bringing the UK to the same level of spending as France by 2023. In that description is, though, the admission that we do not spend the equivalent of what France spends right now. Indeed, we saw a deficit of almost £1 billion in 2017-18, despite transformation funding being sucked in to try to clear that deficit.

I echo what the hon. Member for Totnes (Dr Wollaston) said: is transformation funding on top of this funding? If it is just revenue funding, will there be a separate announcement about transformation funding? The Secretary of State also mentioned the need for prevention, yet we do not see any mention of money for public health. That is where we need to be doing prevention.

It is said that we need a 3.9% increase in social care spending, but that is not identified in the statement. If the Green Paper is to come only in the autumn, social care may not get real funding until next year. With the demographic challenge that the Secretary of State mentioned, that is just too far away. The NHS has faced, on average, an uplift of 1.2% over the past eight years, according to the King’s Fund. Taking it up to 3.4% brings it more in line with the traditional uplifts that we have seen, and yet, in actual fact, with an ageing population, the pressure is even higher. Hopefully, this will stop the slide of the NHS, but the NHS Confederation says that it is not possible to transform on this kind of money. It is, therefore, important that these other projects are looked at separately and are funded separately.

As for where that money is to come from, I do not know how the Prime Minister kept a straight face when she talked about the Brexit dividend. The Institute for Fiscal Studies says that there will not be a dividend. The Office for Budget Responsibility talks about a £15 billion drop in public service and finances. I want to know how the rise will be funded. Will it all be just borrowing and tax rises? The Government should be honest about how they will fund this rise.

First, may I thank the hon. Lady for doing something that the shadow Health Secretary did not do, which is to welcome this £20 billion annual rise in the NHS budget? I completely agree with her about the importance of prevention, the importance of social care and the importance of making sure that we sustainably invest in transformation funding. The think tanks do disagree on what level of rise is necessary. Lord Darzi and the Institute for Public Policy Research said 3.5%; we are on 3.4%, which is not far off that. The IPPR went a little higher, but, like the hon. Lady, Paul Johnson said that this will stop the NHS going backwards.

With respect to overall funding levels for the NHS, the United Kingdom currently funds the NHS at the western European average as a percentage of GDP. That is not as high as France or Germany and it is true that, by the end of this five-year period, our funding will end up at broadly similar levels to those of France today, although of course it may change them over the five-year period.

I gently say to the hon. Lady that if that is a worry for her, she needs to explain to NHS users in Scotland why, when NHS spending has increased by 20% in England over the past five years, it has increased by only 14% in Scotland because of choices made by the Scottish National party. For every additional pound per head invested in the NHS in England only 85p has been invested in the NHS in Scotland. I hope that she makes a pledge, as I hope Labour does with its responsibility for Wales, that every extra penny that she gets through the Barnett formula will go to the NHS, because that is what the voters in Scotland want.

As soon as we are fully out of the EU, there will indeed be a very big Brexit dividend, which a lot of us want to get on and enjoy here at home. Will the Secretary of State confirm that some of that money will be spent on training and educating and recruiting people already settled here into full-time NHS jobs to cut down on very expensive agency staff and to stop denuding the health services often of poorer countries around the world?

My right hon. Friend is absolutely right. One thing that we have historically got wrong in the NHS is not having a long-term workforce plan. Whatever Members’ views on the Brexit debate, it was always a false economy to say that we could get away with not training enough people because we could import them from other EU countries. The truth is that we are not the only country with an ageing population: France, Spain and Portugal need their doctors and nurses as well, as indeed, as he rightly says, do poorer countries.

For the sake of the record, is the Minister aware that, when John Major’s Government fell and Labour came into office, £33 billion was being spent on the national health service? By the time the Labour Government left office, they had trebled the amount of money in real terms to an average of 5.9%. People like me are proud of that achievement. The reason why the people will not listen to him and his 10-year plan is that he is the same man who, only two years ago, was calling on the junior hospital doctors to work seven days a week. He caused chaos in the national health service and he is not fit to run it.

May I gently say to the hon. Gentleman—

There’s no need to be gentle with me.

Okay, may I decisively say to the hon. Gentleman, if he was so proud of what the last Labour Government did, why did he say nothing when, at the last election, his party was only offering a 2.2% increase? If he thinks it is important to be generous, he should be welcoming what we are saying today.

I warmly welcome this new money for the NHS in its 70th anniversary year. Does the Secretary of State agree that it should devote some of these new resources to more staff dealing with early diagnosis of cancer, to help more people beat this condition in accordance with the “Shoulder to Shoulder” campaign being run by Cancer Research UK?

I absolutely agree. In fact, the critical thing that we need to improve in our cancer care is diagnosing more people at stages 1 and 2, rather than at stages 3 and 4. That means more staff and more diagnostic machinery. One of the most encouraging points about Simon Stevens’s response to the new settlement was that he said that it will allow us to accelerate the improvements that we are making in cancer care.

I welcome this as a step in the right direction, but there is a complete absence of any clarity about how this will be funded. Given that, given—as he knows—the lack of any Brexit dividend and given that there has been nothing of detail at all on social care despite the Secretary of State recognising the need to bring health and social care together, can I tempt him again to engage in genuine cross-party discussions to reach a proper, long-term settlement, including consideration of a dedicated NHS and care tax?

With respect, this is a huge increase in NHS funding, the like of which I am not aware that the Liberal Democrats were proposing at the last election. Although I am grateful to the right hon. Gentleman for welcoming the settlement, for him to stand up and say that it is not enough is not a satisfactory response. As he knows, we have actually put our money where our mouth is and demonstrated that we are committed to the NHS, with one of the biggest single injections of cash in the history of the NHS.

I am glad that both my right hon. Friend and the Prime Minister have welcomed the fact that all parties have supported the health service: the Liberals first with Christopher Addison, for whom my father once worked, in 1919; Henry Willink, a Conservative member of the coalition Government, in 1944; and Aneurin Bevan, who made some changes and nationalised the hospitals, rather than the family doctors. Both the resources and the reform are needed, and future generations will be grateful to this Government—hopefully with the support of other parties—for taking this forward.

I thank my hon. Friend for that comment. If there is ever a memorial built to Sir Henry Willink for his role in the White Paper that critically announced to this House that we were going to have a national health service, my hon. Friend should certainly be the person to unveil it because he has done a huge amount to make the point that, although Nye Bevan’s role was absolutely critical, other people in other parties also played a vital role.

Well done. But is it well done enough? For 20 years some of us have been calling for a reform of NHS and social care financing by showing that the public’s wish is for a reform of the national insurance base. When is the Secretary of State going to win that battle for us, please?

Given that I thought the response from the right hon. Gentleman’s Front Bench was a bit churlish, I am going to be very grateful for the fact that he said well done. I think that “well done enough” is what we say when we deliver the plan that is now being developed because, as he knows incredibly well, having a plan is not the same as delivering it. With respect to imaginative proposals as to how we fund the NHS, the right hon. Gentleman always speaks incredibly interestingly and powerfully on the subject. The Prime Minister has said that she will listen to all views on that ahead of the Budget.

I congratulate my right hon. Friend not only on being the longest-serving Health Secretary, but on the tenacious way in which he has campaigned for the money that we are hearing about today. In talking about improving cancer outcomes, does he agree that the patient experience is very important, and that the campaign of Hertfordshire MPs for a radiotherapy centre in our county is something that may possibly benefit from this new largesse?

I have listened carefully to what my right hon. and learned Friend says. With regard to cancer care for people who have had a cancer diagnosis, I commend the work of Dimbleby Cancer Care—a really fantastic charity. The shadow Health Secretary, the Lib Dem health spokesman—the right hon. Member for North Norfolk (Norman Lamb)—and I attended the start of its annual 50 km walk on Friday night.

The Secretary of State closed by saying that he wants to transform health and social care, but every economic expert, from the Institute for Fiscal Studies to the Health Foundation, tells us that with a growing ageing population increasingly living with long-term conditions, this announcement will do nothing more than see the NHS stand still. Will he now admit that it is not enough to repair the damage of the past eight years of cuts to public health, GPs, and social care? How will he ensure that we have a service with new models of care fit for the 21st century?

It is funny, isn’t it: the hon. Lady says that this is not enough, but she did not say that when her own party was offering almost half the amount at the last election. She also says that every economic expert says that it is not enough. Let me tell her about one economic expert that does not say that—the Institute for Public Policy Research, left-leaning, in a piece of work done by Lord Ara Darzi, a former Labour Health Minister, who says that 3.5% is enough.

May I wholeheartedly congratulate my right hon. Friend on this historic achievement in securing a long-term funding increase for the NHS? I suspect that it is because he is now the longest-serving Health Secretary that he has the credibility within Cabinet to secure this achievement. I also congratulate him on proposing to get the NHS to develop a 10-year plan alongside a long-term workforce plan—which is such a critical element of this—and a long-term capital funding plan, because this needs to be seen coherently alongside the social care Green Paper. Bringing them all together at the right time must be the right thing to do. Will he, as part of the deployment of this new-found funding, look to use the data revolution to innovate to ensure that we have world-class data driving better patient outcomes?

As usual, my hon. Friend speaks very perceptively. When he was a Minister in my Department, he did a fantastic job in getting our capital funding and our workforce planning into a much, much better place. He is right. Although this is a big opportunity for the NHS, we must not make the mistake of solving yesterday’s problems tomorrow. A huge data and tech revolution is about to happen in healthcare all over the world, and we must make sure that we are at the forefront of it.

How does the Secretary of State plan to lead the transformation from reactive hospital care to preventive community care? He has presided over a fall in community nurses, a fall in GP numbers, cuts to public health and social care, and widening health inequalities. How are the next five years going to be any different from the past five years?

Let me tell the hon. Gentleman what I presided over: 10,100 more doctors; 14,300 more nurses; the Commonwealth Fund saying that our healthcare system is the best in the world; the biggest expansion in mental health provision; and improved outcomes for cancer, heart attacks, strokes and nearly every other disease category. I can do that because this Conservative Government have put the economy back on its feet. Everyone in the NHS knows that, in the end, that is how we get more resources into it.

Clinicians tell me that half of interventions have no value to the patient whatsoever, and yet the Medicines and Healthcare Products Regulatory Agency wages war on new entrants with inexpensive and effective remedies. There is plenty of scope for reform, isn’t there?

There certainly is. The pattern to date had been very different in tone between the two sides. My right hon. Friend is right to challenge the NHS on this, because the truth is that we do not adopt new treatments and new medicines nearly quickly enough. I hope that this new settlement will mean that we can change that.

The Government have promised parity of esteem for mental health. Can the Secretary of State clarify whether there is a ring-fenced element of this funding for mental health?

I can clarify that NHS England has a mandatory—[Interruption.] I can confirm, if the Opposition would be kind enough to listen to what I am about to say, that NHS England has a mandatory mental health standard, which means that every CCG is required to increase its mental health funding by more than its total funding. That is an effective ring fence.

To follow on from the question asked by my right hon. Friend the Member for New Forest West (Sir Desmond Swayne), will the Secretary of State look at making greater use of the Professional Standards Authority’s accredited register of 85,000 practitioners? If he made it possible for them to refer to doctors, he would reduce the burden on doctors. That is a recommendation of that statutory body.

I am happy to look again at that issue, which I have looked at in the past for my hon. Friend.

I welcome any new money for the NHS, but does the Secretary of State agree that prevention is better than cure? Durham County Council has had its public health budget cut every single year for the last eight years. Can he tell me how much of this new money will be going to public health, or is he now going to have another fight with the Treasury to get it to release more money for public health?

Today’s announcement is for NHS England’s core frontline services, but the right hon. Gentleman is right about the critical role of public health. Many of those services are delivered by the NHS, and we are very clear in what we are saying today and in a further announcement we will make in due course that there cannot be a transformation of the NHS without a proper emphasis on public health.

The Secretary of State recently visited my constituency, so he will be aware of the important capital investments in my area, such as the new St Luke’s Hospital in Market Harborough, the decision to keep Glenfield Hospital’s children’s heart unit and the brand new state-of-the-art A&E at Leicester Royal Infirmary. Does the Minister agree that capital investments that improve productivity have an important part to play in the long-term plan for the NHS? Does he also agree that Leicestershire would be a very good place to make those investments?

Leicestershire would, I am sure, be a very good place to make them. Indeed, my hon. Friend will know that there has been considerable capital investment in Leicestershire. He makes an important point: one of the real benefits of a long-term plan is that we can create a stable environment for capital investment. One of the problems we have had is that when the budget is set hand to mouth, year in, year out, people do not make long-term investments in things such as IT systems. We have to put that right.

It is important to be honest about where public spending is coming from. Can the Secretary of State confirm that the Government’s own estimates, released in part by the Brexit Select Committee, show that far from there being a Brexit dividend, the plan that they are set to follow is scheduled to increase public borrowing by £55 billion a year by the end of the forecast period, meaning that this spending will have to be funded in spite of Brexit, not because of it?

It is a matter of fact that when we leave the EU we will not have to pay membership subscriptions. There will be a divorce bill, and when that is settled, those subscriptions will be available for the NHS, which was exactly what the British people voted for. The right hon. Gentleman is talking about the projections for the economy in the meantime. All I will say is that there is a lot of debate about those projections. They have not always been right in the past, and the British economy has been much more resilient than many people predicted.

An announcement of the largest ever new injection of funds into the NHS is a triumph for our longest ever serving Health Secretary and the Prime Minister, because it shows the outstanding priority of this Government. Every Member of the House should welcome that. When my right hon. Friend looks at productivity gains in the NHS, will he focus on the implementation of IT projects? Although Gloucestershire Hospitals NHS Foundation Trust does a remarkable job in many ways and its staff work unbelievably hard, the expensive and underperforming Smartcare project could have been better done.

I thank my hon. Friend for hosting me at his local hospital, which was very informative. He is absolutely right: it is an enormous cause of frustration to staff throughout the NHS that so many of our hospital systems are, frankly, antediluvian. We must put that right, because so many nurses could spend so much more time with patients if they were not having to fill out forms, and the same is true for doctors.

We cannot put the NHS on a steady financial footing without a proper funding settlement for social care, yet the Secretary of State now says that that will not happen until the spending review, which in reality means no substantial extra money for social care until 2020 at the earliest. We cannot transform care for older people or reduce pressure on the NHS until we look at the two together. Why are the Government still ducking this vital issue?

I always listen to the hon. Lady very carefully when she talks about the social care sector. I would say to her that while we are not announcing a new long-term plan for social care today, we are making some very important commitments to the NHS and the social care system, including the commitment that we will not allow the pressure from the social care system on the NHS to increase further. That means that, even before the date she mentioned, we are going to have to look very carefully at the settlement for social care.

I congratulate my right hon. Friend, whose commitment to our NHS is very clear. Does he agree with me, however, that the Commonwealth Fund indicator that really matters concerns clinical outcomes, some of which he referred to in his statement, and on that the news is not good? Will he do everything he can to make sure that the increased funding he has announced today is absolutely dedicated to improving outcomes for stroke, cancer and heart attack, on all of which we still lag well behind countries with which we can reasonably be compared?

I absolutely agree 100% with my hon. Friend, and we really must look at outcomes. The Commonwealth Fund was kind enough to say that that was actually one of the areas in which we are one of the fastest improving Commonwealth Fund countries. However, it has to be said that that was from a very low base, and we need to sort that out.

Can we get the facts straight? The Welsh NHS is spending 8% more per head on NHS and social care combined than in England—per head—so let us not have any more stories about the Welsh NHS.

It is absolutely clear that there is no Brexit dividend. The Institute for Fiscal Studies says it, the Financial Times says it and the Government’s own analysis from the Treasury shows it. What is more, Brexit is already having a cost. The Home Office has had to have an extra almost £500 million in the past two years to pay for Brexit preparations, such as registering EU nationals, which would pay the salaries of 20,000 nurses. Will the Secretary of State admit that that is what is really going on—a Brexit deficit, not a dividend?

We do need to get the facts straight about what is happening in Wales. A&E performance is over 8% lower in Wales, according to the latest figures, which means that Welsh NHS patients are 70% more likely to wait too long in their A&Es than patients in England. The Welsh Government have taken a series of decisions not to invest every penny available in the Welsh NHS, which is why spending has risen at a slower rate. Had they not done so, hundreds of millions more could have gone into the Welsh NHS.

On Friday, I was lucky enough to visit the award-winning neck of femur service at the great Horton General Hospital. The length of time that patients stay is very dependent on great links between the hospital and social care. Does my right hon. Friend agree that spending to save is possible, so that even more of this great funding can be spent on patient returns?

Absolutely. The most important way of spending to save is to invest in prevention, and a lot of that work comes from strong local hospitals. Before my hon. Friend finally leaves this place, I have no doubt at all that her local hospital will be called not the Horton General Hospital, but the Great Horton General Hospital.

Does the Secretary of State agree with me that without the reinstatement of the nursing bursary, we cannot even hope to train enough nurses. The figures show that the numbers training have fallen—this is a serious inquiry—and until we can train enough nurses, we can talk about extra nurses, but we will always need agency nurses. Does he agree that we need to reinstate the nursing bursary so that people can afford to train?

The reason why we took what I fully accept was a very difficult decision was that we wanted to fund the training of an additional 5,000 nurses every year. When there is a reform of higher education funding, there is always an initial dip in applications. In this case, record numbers of 18 to 19-year-olds applied, but there was a dip among mature students. That is why we have introduced the apprenticeship route. We need to make sure that that works if that dip is to be reversed.

I welcome my right hon. Friend’s statement. Like all colleagues in the House, I am a great supporter of community hospitals. Under the latest Dorset clinical commissioning group review, Portland Community Hospital is to be replaced with a medical hub on the island. Will the extra money allow the CCG to review the review, and perhaps save hospitals such as Portland Community Hospital?

Obviously, that would be for the CCG to look at; it will focus on anything that allows it to focus on prevention and not cure. I do not know the specifics of that case, but in general there is a strong and important role for community hospitals, although not always doing exactly the same things they have done in the past. Often, they can become local NHS hubs, offering a wide range of services. That tends to be the best way to preserve their future.

Standing at that Dispatch Box, the Secretary of State made the astonishing claim that when it comes to NHS funding, the Conservatives write the cheques and Labour writes the speeches. Let me tell him about increases in health spending under every Government in my lifetime: a measly 1.4% increase under David Cameron; 2.7% under Mrs Thatcher; even John Major managed a better 4.7%. It was only under the Labour Governments of Gordon Brown and Tony Blair that we saw increases in NHS spending of 5.4%, under Gordon Brown, and 6.1%, under Tony Blair. Does that not demonstrate that we cannot trust the Conservatives on the Brexit dividend and we cannot trust their claims on NHS spending? Until the Conservatives sort out social care and public health spending, the Labour Governments will have a record that this Government cannot even begin to touch.

The hon. Gentleman has just proved my point about Labour making speeches about the NHS. He talked about a “measly” increase under David Cameron; what he forgot to tell the House was that his own party’s plans that year were to cut the NHS budget because of the train crash of an economy that they left the country with.

This is a massive and welcome boost for our NHS, and I very much welcome it. Will my right hon. Friend say more about the importance of public health and social care in the context of his announcement today and what his plans are? The issue is not just about getting people to live longer, but getting them to live well for longer.

My hon. Friend asks a very smart question. The truth is that no healthcare system anywhere in the world, faced with our demographic challenge, would ever feel it had enough money unless it transformed its model of care to one based on prevention rather than cure. That is why public health and the social care system are absolutely critical. One of the big lessons that we need to learn with this new funding is to spend it in a way that brings down the long-term rate of growth in demand for hospital services. That is the only way in which we can make it work.

World-leading childhood cancer research and treatment take place in Newcastle, but those leading that research are clear that there is no sight of a Brexit dividend, given the loss of EU staff and the uncertainty hanging over intra-EU collaboration and EU funding. Rather than peddling Brexit mythology, will the Secretary of State take on board those very genuine and very serious concerns?

We have taken on the concerns of everyone in the NHS. Whether someone agrees with Brexit or the Brexit dividend, the Government are making a commitment for a £20 billion annual increase in the NHS budget in five years’ time. I hope that will help people in Newcastle and everywhere else in the country.

As the Labour Welsh Government are the only Government in recent times to reduce funding for the NHS, will my right hon. Friend do all he can to ensure that the very welcome £1.2 billion that will come to Wales under the Barnett formula will not be spent on another Welsh Labour Government pet project, but will be spent on the health of the people of Wales?

My hon. Friend speaks on behalf of not just his constituents but all NHS users in the whole of Wales who are asking themselves why it is that their Government have chosen not to invest in the NHS in the way that has happened in England, as a result of which they have much longer waits in their A&Es.

I very much welcome the Secretary of State’s statement. I congratulate him on staying the course, and on his perseverance and dedication. I say very well done. It has been indicated that the Northern Ireland Department of Health will also benefit over the next few years. What discussions have taken place with the Northern Ireland Department of Health to ascertain the monies to be allocated, and the focus and priorities?

This is, as the hon. Gentleman knows, a devolved matter, but I would say that England, Scotland, Wales and Northern Ireland are all on the same journey when it comes to the NHS. We are all moving to integrated out-of-hospital care built around the person and focused on prevention. In one respect, Northern Ireland has gone further faster than anywhere in the UK: I refer to the integration of the health and social care systems. There is plenty we can learn from them and they from us.

I congratulate the Secretary of State on this very welcome announcement and reiterate what others have said about the importance of prevention and public health. Since this is a long-term settlement, may I ask him to ensure that the disparities between various parts of England are narrowed over the coming years? They are too great, with some getting £300 or £400 a year per person less than other areas. That is just too much of a difference.

I totally take on board what my hon. Friend says. I am happy to engage with him and with NHS England. As he knows, we have taken the politics out of that particular process by giving it to NHS England, which I think is the right thing to do. I know NHS England would be happy to engage with him on that.

I welcome long-term planning in funding for the NHS, which is needed. However, as chair of the all-party group for disability, I know there are concerns that the learning disability workforce has fallen by a third, learning disability training is not yet compulsory and there are 1,200 avoidable deaths in the learning disability population annually. In Learning Disability Week, people are asking to be treated well. Will the Secretary of State prioritise this area and make sure our most vulnerable people with learning disabilities are no longer left behind?

I thank the hon. Lady for asking that important question. We have introduced a £10,000 golden hello for postgraduates who go into the learning disability field. She is right that we have had particular pressure on the learning disability workforce. In the aftermath of Mid Staffs, there has been a whole range of measures to improve hospital ward staffing ratios for nurses and that has had an impact on learning disability nurses. That is absolutely something we hope to address with this new funding.

I echo the thoughts of my hon. Friend the Member for South Dorset (Richard Drax) on the role of community hospitals as the segue between the acute sector and patients going home. Will my right hon. Friend confirm that, with this very welcome new money coming into the health service, the drive for efficiencies and increases in productivity will continue and indeed be increased to ensure that the biggest bung—the biggest bang is felt for those bucks?

My hon. Friend is absolutely right not to use the word “bung” in his question and to correct that very quickly indeed. He is also right to talk about productivity. The last Labour Government made important progress in bringing down waiting times. That required significant extra resources. When Alan Milburn had a 10-year plan, there was not a big productivity element to it. This time, when resources are much tighter, we have to make sure that productivity and efficiency gains are at the heart of the progress we make.

The Secretary of State is right that more funding is urgently needed, because he knows better than anyone that the percentage of NHS trusts in deficit rose from 5% in 2010 to 44% last year. Today, he has talked repeatedly about prevention, but he has failed to say directly what will happen to public health. Will he therefore clarify whether any of the settlement he has announced today will go towards public health services, vital for prevention and tackling health inequalities, which are being cut by £800 million over five years?

Today’s settlement covers NHS frontline services. As I explained in the statement, it does not cover public health, but we fully recognise its importance. The hon. Lady talks about the increase in trust deficits. It is true that the number of hospitals in deficit has gone up, but that is because we deliberately decided to be very careful in the way that we performance-managed trusts with deficits. In Mid Staffs, getting rid of the deficit was one of the reasons why the number of nurses in wards was stripped down to totally inappropriate levels. We have to make sure that we handle this in an appropriate way.

This announcement is really welcome and the Secretary of State’s commitment shines forth. The financial commitment is much needed, but, as two GPs said to me on the platform as I left Taunton this morning, waste in the NHS must be tackled, as well as funding. On top of that, best practice systems must be introduced, particularly in the cancer pathway.

My hon. Friend knows about that from her own family experience and I thank her for telling me about some of the challenges she has had in the interests of improving them for all NHS patients. She is right that one of the biggest opportunities the NHS has is to standardise best practice across the whole health economy. We collect, share and publish more data than any other healthcare system anywhere in the world, so we have the chance to get this right in a way that is not possible in other countries. I know we are absolutely determined to do so.

Given the crisis in access to NHS dentistry, in particular for our children, will the Secretary of State confirm that dentistry will get its fair share of this funding in line with demand?

The hon. Lady campaigns hard on this issue and I believe she is meeting the Minister with responsibility for dentistry tomorrow to talk about it further.

I warmly welcome this enormous funding boost, which is far in excess of that proposed by any Opposition party. Does my right hon. Friend agree that local trusts should consider using these further resources to help to attract and retain additional doctors in tough-to-recruit fields such as emergency medicine, to support and extend A&E in hospitals such as Cheltenham General Hospital?

Of course I agree with that. My hon. Friend campaigns extremely vigorously on behalf of his own hospital in Cheltenham. Recruitment will be one of our top priorities. One way we want to tackle that is very simply by giving hope to people in the NHS and to people thinking of going into medicine that there is a long-term plan that has the support of the NHS, and which is at one remove from the party politics that we always get around the NHS. I think that is something doctors and nurses overwhelmingly want.

How much of this welcome additional money will be used simply to pay off accumulated debt and current deficits, and how much will be a real increase?

The think-tanks who pore over the numbers disagree on that. Some say that it is about enough to stabilise the current situation—that is what Paul Johnson of the IFS says—and others say there is enough room to transform. Who is proved right will depend on how much we do on productivity and efficiency to create the headroom for the real changes we all want to see. That is why we have to get that bit of the equation right.

An extra £20 billion a year in real terms in five years’ time is a massive financial boost for the NHS. The Secretary of State knows Kettering General Hospital well because he has been there twice. Would he ensure that just £20 million to £30 million of that goes on funding the new urgent care hub at Kettering General Hospital, which everyone says is what the hospital desperately needs?

I am feeling extremely generous this afternoon, and it is incredibly tempting just to say yes, but I think I had better not and say that my hon. Friend should follow the right processes. However, Kettering could not have a stronger advocate than him.

Given that the Secretary of State has confirmed this afternoon that increased NHS funding will not be wholly accounted for by any fantastical Brexit dividend, could he clarify whether the Welsh Government will be expected to increase the Welsh rates of income tax if the UK Government’s promise of an additional £1.2 billion for Wales is to be realised?

Any funding commitment made by the UK Government will be appropriated to Wales in accordance with the Barnett formula. That is the procedure that we have followed. The choice for the Welsh Government is whether they put all that money into the NHS or, as they have done in the past, choose to prioritise it elsewhere.

I very much welcome my right hon. Friend’s announcement that some of the subscriptions that we will no longer be paying to the European Union will be redeployed for the national health service. Under the last Labour Government, Crawley Hospital lost its A&E department and its maternity department. Over the last eight years, services have been returning. Can I have an assurance that this additional spending on the NHS will follow through with the return of further local services?

It absolutely needs to boost local services. If there is one lesson that we have learnt from the last few years, it is that we will not, in the long run, crack the funding pressures in our health system unless we find a way of properly investing in local services, which I know my hon. Friend has campaigned for so hard.

An omission from this otherwise welcome statement was any mention of capital spending. It is vital for future health outcomes in the Black country and west Birmingham that the midland metro hospital, currently half built and suspended following Carillion’s collapse, is completed. Will the Secretary of State tell me where in this package the funding will be found for that, and when?

The hon. Gentleman is right to raise that issue, which is of great concern to us, as I know it is to him. The Minister of State responsible for hospitals, my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), visited the trust last Thursday and I know is working incredibly hard to try to resolve that situation as soon as possible.

I congratulate the Secretary of State on his very welcome intervention in ensuring the longevity of our NHS with these wonderful proposals. Will he give some consideration to the way in which doctors are trained? At present, it is a costly and time-consuming affair. Only around 10 UK medical schools have a graduate entry system. In his long-term plan, looking at recruitment, will he consider how the skillset that we see among our population—for example, medical scientists and other related professionals—can best be harvested in training future medics?

My hon. Friend asks a profoundly important question. The medical school students who are going to medical school this year will become consultants in 2031 at the earliest, so we have to make sure that we update the way people are trained for the totally different world that they will be facing in terms of technology, medical innovation and the demarcations and roles inside hospitals and community care. This is very much part of the long-term workforce plan that will be announced alongside the NHS long-term plan later this year—it is what that will be about.

I can understand why some in Government think that there is a Brexit dividend. After all, we know that the Health Secretary’s colleagues in the Home Office have been given enough money from Brexit to cover the cost of 20,000 nurses. His colleagues in the Department for Environment, Food and Rural Affairs have been given 14,000 nurses’ worth of money and even his colleagues in the taxman’s office have been given 11,000 nurses’ worth of money. I am sure that the Secretary of State would not want to betray the good will of a single doctor, nurse, cancer patient or future patient by making promises that he cannot keep, so can he tell us, once and for all, whether he personally believes that there is a Brexit dividend—yes or no?

I have answered this many times, and I am very happy to answer it again. Yes, we will be able to access extra funding by not paying subscriptions to Brussels once the divorce bill has been settled, and that will mean many thousands of extra nurses.

I and my constituents warmly welcome this extra money for the NHS. Does the Secretary of State agree that the British public are not stupid? They, unlike some of the Opposition, are well aware that any and all Government expenditure always comes from taxation, either now or in future. We have listened. We have had a conversation. They have told us that they want more spending on the NHS. We have said, “But that may mean you paying more taxes,” and they have said, “Fine, it’s that important.” Is that not a good and honest agreement between the public and the Government?

My hon. Friend could not have put it better. The only surprise here is that having spent years and years saying that we should invest more in the NHS through the tax system, when the Government actually stand here and say that is what they are doing, the Opposition tell us that they are against it.

Whether it is mentioned by the Prime Minister, the Leader of the Opposition or anyone else, there is only one fact about the Brexit dividend, and that is that it does not exist. Will the Secretary of State tell all the staff in the NHS how much of the money announced today is contingent on the Brexit dividend, so that they can bank for the future based on how much will actually materialise come autumn?

I am very happy to tell the hon. Gentleman that all this money will materialise, because this is a Government that keep their promises. If he is so worried about the Brexit dividend, he should be speaking not to me but to his own leader, who said that he wants to

“use funds returned from Brussels after Brexit to invest in our public services”.

Have a word with him!

I also welcome the statement from the Secretary of State, but I note that it relates to health spending in England only. Will my right hon. Friend spell out what this means for Scotland in particular, thanks to the Barnett consequentials, and how can we ensure that the additional funds provided to the Scottish Government are spent on the NHS in Scotland, which has not always happened in the past?

My hon. Friend is right to raise that question, because under the Barnett consequentials, for every £1 per head additional for the NHS in England, there will be £1 per head available for the NHS in Scotland. The Scottish National party has chosen to invest only 84p of every £1, which is why people in Scotland are 30% more likely to wait too long for their elective care in Scotland. That is a choice made by the SNP in Scotland and I hope that it will do it differently this time.

I welcome any additional funding because, let us face it, it is not just the NHS that is in deep crisis, but social care, too. However, as others have said, it is still not enough—3.5% was the minimum that was needed to see actual improvements. What assessment has the Secretary of State done to gauge what the improvements will be in the next 12 months? What financial scenarios is the Chancellor considering, and will the Secretary of State commit to stop tendering health services to the private sector, which is a waste of money for the public?

It is really extraordinary that on a day that we have announced a £20 billion annual rise in the NHS budget—you could not get a bigger commitment from a Government to state-funded healthcare—Labour is still running off down the rabbit hole of privatisation. If it is any reassurance to the hon. Lady, last year the proportion of NHS services contracted to the private sector went up by the enormous amount of zero.

This statement is very welcome, but I have raised in this place before how the money is distributed around the UK; it is well known that the south-west gets about 2% less a year of increased NHS funding. When the Secretary of State has a moment, will he look again at how funding is distributed, and ensure that as it increases, it is increased fairly?

I am happy to do that. My hon. Friend asks the same question as my hon. Friend the Member for Stafford (Jeremy Lefroy). These matters are now decided at arm’s length by NHS England because we think that the fairest way is to take the politics out of it, but I am happy to work with him to engage with NHS England on the Cornish questions.

I listened to what the Secretary of State said earlier about how there can be no transformation of the NHS without a proper emphasis on public health. How will the planned £800 million of cuts to public health help with that transformation, particularly when it comes to tackling the child obesity crisis, the growing sexual health services crisis and the cuts to addiction services, which are causing enormous problems for individuals and the communities now having to deal with them?

I fully recognise the pressures the hon. Lady is talking about. I said what I said about public health because I do not believe there is a sustainable long-term solution to NHS funding pressures unless we have an equally sustainable solution for public health, and indeed for social care, which she also talks about. She will have to wait for us to negotiate our next spending review settlement to understand how we intend to address those.

I welcome the Secretary of State’s statement and congratulate him on securing cross-Government support for his proposals. He rightly said that every pound must be spent wisely, and he will know that there is great variation in procurement across the NHS. What will he do to ensure better procurement?

We will set up a single, central procurement system so that every hospital in the NHS can benefit from the efficiencies gained from bulk buying, but we have to do that in a way that does not shut out smaller companies from bidding for NHS contracts.

The Government’s new NHS funding includes no additional funding for social care. The Secretary of State has said that the Government will publish a social care Green Paper in the autumn. Will he confirm—yes or no—whether the Green Paper will include social care funding for working-age disabled adults?

We will consider the provision for working-age disabled adults as part of our review of the whole social care system, because that is extremely important.

Will it be in the Green Paper?

We are doing that work in parallel to the Green Paper, but the hon. Lady is absolutely right to highlight it.

I call Mr Afzal Khan.

Will the Secretary of State clarify how this money will be divided between the regions? Children growing up in the north, in constituencies such as mine, have vastly different life chances from their counterparts in the south. We do not want this funding to reinforce the north-south divide.

As the hon. Gentleman knows, we take deprivation into account very seriously when we allocate NHS funding, because it has a direct impact on people’s demand for NHS services, but other things also have an impact on people’s health, such as housing and employment prospects. The bigger lesson is that we need to integrate all our services for our most disadvantaged citizens.

I apologise to the hon. Member for Boston and Skegness (Matt Warman), who was missed out just now, but he has the compensation of knowing that he has an adoring audience who now await his important question.

I would never accuse you of misleading the House, Mr Speaker.

I welcome this bold, ambitious and sufficient funding settlement. Does the Secretary of State agree that over this period we will be able to eliminate not just the funding inequalities but the workforce inequalities so that units such as paediatrics at Pilgrim Hospital no longer face the kind of challenges we have historically?

My hon. Friend is absolutely right, and that is a big priority for us, which is why this year we will publish a final 10-year NHS workforce plan, at the same time as the NHS plan that Simon Stevens is putting together. Together they are designed precisely to avoid shortages in particular and very important specialties.

Community pharmacies feel stretched at the moment, yet they are well placed, at the heart of the community, to have a real impact by taking pressure off GPs. Will the Secretary of State give a commitment that some of this money will go to reinforce the strength of community pharmacies so that they can play their part in prevention as well as cure?

The hon. Gentleman is right that community pharmacies have a vital role to play. I do not think we use them enough. We need to find better ways for them to help us in the prevention agenda, and one way we are doing that is by integrating medical records so that they can be accessed by pharmacies, which will help them to give good advice to patients.

May I press the Secretary of State on the issue of transformation and his hint—I think—at ring-fencing? If the people of Bristol South are to be asked to spend more money on the NHS, how will they know that it is being used to improve health outcomes and not simply to bail out local hospital deficits?

The hon. Lady is right to ask that question, and I encourage her to hold her local NHS to account on that. There are some simple metrics, which we can share with her, that can tell us whether the NHS is using the money wisely, and one of them is whether her local hospitals are managing to reduce their emergency admissions by providing better care in the community. She is right that it is the litmus test of whether the money is being spent wisely.

May I press the Secretary of State on his answer to my hon. Friend the Member for Battersea (Marsha De Cordova), particularly in relation to profoundly disabled adults, who need not just excellent healthcare, not even just excellent physical and social care, but access to services that maximise their social participation? Will he say a little more about the work being done in parallel with the social care Green Paper?

I want to reassure the hon. Lady that, in all our discussions about core social care funding and the funding accessed by local councils, we discuss working-age disabled adults every bit as much as the frail elderly. They are central. Many councils actually spend more on that group than on older people. We will not crack the social care problem unless we take that group of people extremely seriously.

The Secretary of State talked about mental health funding without mentioning the crisis facing our young people. He knows that across the country there are appalling waiting times to access child and adolescent mental health services. How significant is today’s announcement to tackling that issue?

It is very significant, first, because we have been clear that a transformation in mental health is central to our ambition for the new 10-year plan, and secondly, because, as the hon. Gentleman knows, the Green Paper will over that period see the number of people employed in looking after young people with mental health problems increase from 9,000 by an additional 8,000—a near doubling in the size of the workforce. This financial plan gives us the confidence to say we can deliver that.