NHS England Update

11:44:00

With permission, I would like to make a statement on the future of NHS England. Since coming into office, this Government have made big strides in fixing our broken NHS. Under the Conservatives, the NHS suffered years of industrial action, costing taxpayers billions and costing patients more than 1 million cancelled operations and appointments. We negotiated an end to the resident doctors strike within three weeks. We have delivered the 2 million extra appointments we promised in our first year, and we did it seven months early. After 14 years of rising waiting lists under the Conservatives, we are finally turning the tide, cutting waiting lists for five months in a row, cutting waiting lists through the winter pressures and cutting waiting lists by 193,000 so far and counting. We have agreed the GP contract with GPs for the first time since the pandemic—our first step to bringing back the family doctor—and we have delivered the biggest uplift in hospice funding for a generation. However, there should be no doubt about the scale of the challenge ahead. We inherited an NHS going through the worst crisis in its history, so there is no time to waste. We inherited public finances with a £22 billion black hole, so there is no money to waste. The urgency of the crisis means we have to go further and faster to deliver better value for taxpayers and better services for patients—something the Conservative party cannot even begin to speak to a record on. Lord Darzi’s independent investigation into the national health service traced the current crisis back to the 2012 top-down reorganisation of the NHS by the right hon. Lord Lansley. The Darzi investigation said the reorganisation was “disastrous” and a “calamity without international precedent” that “scorched the earth” for health reform, “the effects of which are still felt to this day.” The Health and Social Care Act 2012 established more than 300 new NHS organisations, created a complex and fragmented web of bureaucracy and, to quote the Darzi investigation, “imprisoned more than a million NHS staff in a broken system”. Today, we are putting the final nail in the coffin of the Conservatives’ disastrous top-down reorganisation of the NHS. There are more than twice as many staff working in NHS England and the Department of Health and Social Care today than there were in 2010—twice as many staff as when the NHS delivered the shortest waiting times and the highest patient satisfaction in history. Today, the NHS delivers worse care for patients, but is more expensive than ever before. The budget for NHS England staff and admin alone has soared to £2 billion. Taxpayers are paying more, but getting less. We have been left with two large organisations doing the same roles, with an enormous amount of duplication. It is especially in times like these, when money is tight, that such bloated and inefficient bureaucracy cannot be justified. However, even if the Conservatives had not left a £22 billion black hole in the public finances, the Prime Minister would still be announcing the changes he is today, because every £1 that is wasted on inefficient bureaucracy—in good times or bad—is £1 that cannot be spent on treating patients faster, nor can it be spent on fixing our crumbling schools, lifting children out of poverty or putting money back into people’s pockets. There is always a duty on Ministers to get as much value for taxpayers’ money as is possible, and I cannot honestly say that it is achievable with the way that my Department and NHS England are set up today, nor can I say that the current set-up is getting the best out of the NHS. I am sure Members will have heard their local NHS leaders complain about the top-down way in which the NHS is run. It is something I have heard for years. Now that I find myself at the peak of this enormous mountain of accountability, I do not just recognise the complaint; I agree with it. Frontline NHS staff are drowning in the micromanagement they are subjected to by the various and vast layers of bureaucracy. In the Hewitt review, the former Health Secretary my right hon. Friend Dame Patricia Hewitt reported that one local service was required to send 250 reports and forms to NHS England and the Department of Health and Social Care in a single month. That is time and energy that is not being spent delivering care for patients. The review also concluded that having two organisations doing the same jobs has led to “tensions, wasted time and needless frictional costs”. Since coming into office I have sought to correct that, by building a one-team approach between my Department and NHS England, working towards our shared mission of building an NHS fit for the future. Today, the Prime Minister has announced that we are turning one team into one organisation. I acknowledge that there are talented, committed public servants working at every level of the NHS and my Department, including at NHS England, who I have had the privilege of working with over the past eight months. The reforms we are announcing today are not a reflection on them. They have been set up to fail by a fragmented system that holds them back. The actions we are taking today will change that. Work has already begun to strip out the duplication between the two organisations, and bring many of NHS England’s functions into the Department. NHS England will have a much clearer focus over this transformation period. It will be in charge of holding local providers to account for the outcomes that really matter: cutting waiting times, and managing their finances responsibly. And it is tasked with realising the untapped potential of our national health service as a single-payer public service: getting a better deal for taxpayers through central procurement; being a better customer to medical technology innovators, to get the latest cutting-edge tech into the hands of staff and patients much faster; and being a better partner to the life sciences sector, to develop the medicines of the future. Over the next two years, NHS England will be brought into the Department entirely. These reforms will deliver a much leaner top of the NHS, making significant savings of hundreds of millions of pounds a year. That money will flow down to the frontline, to cut waiting times faster and deliver our plan for change. By slashing through the layers of red tape and ending the infantilisation of frontline NHS leaders, we will set local NHS providers free to innovate, develop new productive ways of working, and focus on what matters most: delivering better care for patients. I cannot count the number of Conservatives who have told me in private that they regret the 2012 reorganisation and wish they had reversed it when in office. But none of them acted. They put it in the “too difficult” box while patients and taxpayers paid the price, because only Labour can reform the NHS. And this Government are proving that only Labour can be trusted to reform the state. The Prime Minister has committed to cutting the number of quangos. Today, we are abolishing the biggest quango in the world. I am delighted that Sir James Mackey will be leading the transformation team, as the Chief Executive of NHS England. Jim has an outstanding track record of turning around organisations, balancing the books, driving up productivity, and driving down waiting times. He is putting in place a new transformation team to drive change, and alongside Dr Penny Dash as the incoming chair, I am delighted to have such a capable leadership team of radical reformers to lead NHS England with me through this transformation. I also take this opportunity to place on record my heartfelt thanks to Amanda Pritchard, who has shown an outstanding commitment to our national health service over her decades of service—which I know remains undiminished. She has also been a rock of enormous support, not only in the past eight months, but also in the past few weeks as we have worked together with Jim preparing for this change. I also place on record my thanks to her deputy Julian Kelly, who is one of the most outstanding public servants of his generation, along with the rest of the leadership team departing at the end of the month. They deserve our thanks and best wishes for the future. Change is hard. There will always be cautious voices warning you to slow down. However broken the status quo is, there will be those who resist any change away from it. But we should be in no doubt: we inherited a national health service going through the worst crisis in its history. Patients are waiting unacceptable lengths of time for an operation, a GP appointment or an ambulance. This Labour Government will never duck the hard yards of reform. We will take on vested interests and change the status quo, so the NHS can once again be there for us when we need it. The Prime Minister has set an enormously ambitious target for the NHS: to cut waiting times for operations from up to 18 months to a maximum of 18 weeks by the end of this Parliament. That will require us to go further and faster than even the last Labour Government achieved, but patients in our country deserve nothing less. The reform the Prime Minister is setting out today will mean fewer checkers and more doers. It will cut through the complex web of bureaucracy, and devolve more resources and responsibility to the frontline, to deliver better value for taxpayers’ money and a better service for patients. It will set the NHS up to deliver on the three big shifts needed to make the service fit for the future: from hospital to community, analogue to digital, and sickness to prevention. The NHS is broken, but it is not beaten. Together, we will turn it around. I commend this statement to the House.

I call the shadow Minister.

11:56:00

I thank the Secretary of State for advance sight of his statement. It is disappointing, once again, that it was not made to the House first; in recent days, there have been numerous media briefings about this potential restructure. Under new leadership on the Conservative Benches, we believe in a leaner and more efficient state. That means using resources effectively, reducing waste and preventing duplication, spending money where it is most beneficial. After all, the public understandably want to see the focus on patient care and not on backroom managers. Therefore, we are supportive of measures to streamline management, and we do not oppose the principle of taking direct control, but we need to know what steps will be taken to meet targets while all the upheaval happens. We need to know the specifics of what is being planned. What are the timeframes for the abolition of NHS England? By what date will it be completed? How many people will be moved into different roles? How many people will lose their jobs altogether? How much money is that expected to save? Labour runs the NHS in Wales, which has the highest waiting lists and the longest waiting times in Great Britain. What lessons has Labour learnt from its failure in Wales? NHS England, as the Secretary of State said, has just lost much of its leadership. Is that because they no longer had confidence in the Secretary of State, or because he did not have confidence in them? Perhaps he can tell the House whether Alan Milburn will keep his job in the upheaval. We also need to be clear that moving people into different roles will not fix the challenges that face the NHS. The Secretary of State has spoken about taking direct control. That may help him ensure that the NHS stops wasting money on expensive diversity, equity and inclusion staff, and ensures that it provides dignity and privacy for female staff and patients, but what does it mean for clinical prioritisation? Will conditions that are less common and have less glitzy campaigns and fewer celebrity backers suffer because the Secretary of State now has political considerations? Does the Secretary of State have the bandwidth for this, given he has such a busy role already? How does the centralisation of power measure up with the commitment to give more powers to regional bodies and local integrated care boards? In the first six months after entering office, the Government announced 14 reviews, consultations and calls for evidence, all of which require more staff. Are those jobs at risk, or are other pre-existing roles set to be cut? This announcement comes the same week as Labour’s Employment Rights Bill passes through the Commons. Is the Secretary of State getting a move on because he knows that red tape and bureaucracy will dramatically increase afterwards and make the decisions he has to take more difficult to deliver? A drive to improve efficiency in the civil service and the management of the health service is welcome, but what about the NHS itself? The Government slimmed down our productivity plan and delivered a 22% pay rise in return for no modernisation or reform. How will those decisions improve efficiency? I asked the Department what proportion of people with a nursing qualification working in the NHS are in patient-facing roles, but the Minister said that they did not know. How can he use the skills and resources effectively if he does not know where those skills and resources are? The Prime Minister is making a lot of noise about productivity and cutting waste, but he still refuses to set a target for cutting the civil service headcount. Thanks to the decisions he and the Chancellor took at the Budget, the size of the state is growing rapidly, not shrinking, while changes to national insurance contributions have diverted funding away from the frontline into compensating the Treasury. Ultimately, any restructure will be challenged by the Government’s continued failure to tackle immigration. While steps to improve efficiency in the healthcare service are welcome, these words ring hollow across Government.

I will take the more serious questions from the shadow Minister first. On timeframes, we will work immediately to start bringing teams together, as we have done with the one-team culture we have been building over the past eight months. I want the integration of NHS England into the Department to be complete in two years. The shadow Minister asks about the reduction in the number of officials. NHS England has 15,300 staff; the Department of Health and Social Care has 3,300. We are looking to reduce the overall headcount across both by 50%, which will deliver hundreds of millions of pounds of savings. The exact figures will be determined by the precise configuration of staff, and we will obviously keep the House updated on that. The shadow Minister asks about clinical leadership. One change we will be making with the transformation team is to have two medical directors succeeding Professor Sir Stephen Powis, whose departure from NHS England was planned long before these changes. There will be one medical director for primary care and one for secondary care, underpinning our commitment to the shifts we have described. I must say, there are enormous improvements to be made in clinical leadership for patient outcomes, patient safety and productivity, and I am demanding stronger clinical leadership to drive those improvements to productivity. Frankly, many consultants and clinical teams on the frontline will welcome that liberation—they are hungry for change. The shadow Minister asks about the workforce data and complains that we have not been able to give her the precise answers. I agree: it is frustrating not having that precise information at my fingertips. I would gently remind her, though, on this as on so many things, that her party was in power for 14 years. She cannot very well complain eight months in given that they left us a woeful, embarrassing data architecture and infrastructure. The shadow Minister asks about efficiency. Once again, she refers to the resident doctors deal as if it was a failure. The actual failure was leaving doctors on the picket line, not on the frontline, and wasting huge amounts of taxpayers’ money, with cancellations and delays to patients’ appointments, operations and procedures. We stopped that within weeks of coming into office. The deal does include reforms to improve productivity—if she is any doubt about the results, she should look at the fact that despite winter pressures, NHS waiting lists have fallen five months in a row. Once again, we get the facile points about my right hon. Friend Alan Milburn, who is the lead non-executive board member for my Department. I honestly do not know why he bothers to pay for a mortgage; he lives rent-free in the Conservatives’ heads. They need to move on. By the way, just for the record: Alan Milburn has a record on the NHS that the Conservatives cannot even begin to touch. The shadow Minister asks about confidence. I am delighted to be introducing a new transformation team. Different leadership challenges require different leadership skills. As I say, I have been really pleased to work with Amanda Pritchard for the past eight months, including on this transition; people should have no doubt about the confidence I have in her skills, talents and abilities, and I think she has a lot still to contribute to our NHS. We do not need to ask about confidence in the Conservative party; it is reflected in the scarce numbers on the Opposition Benches. What is the lesson from Wales? The lesson is that when there is a Conservative Government in Westminster, the national health service suffers in England, Wales, Scotland and Northern Ireland. That is why we are creating a rising tide to lift all ships. I am sure we will see improvements across the United Kingdom. SNP Members, who are not in their place, do not have any excuses now. As I said before the election, all roads lead to Westminster, and the biggest funding settlement since devolution began is going down the road to Holyrood. There are no hiding places there for the SNP. If people want real reform of the NHS in Scotland, they should vote for Scottish Labour under Anas Sarwar and Jackie Baillie. People can see here in Westminster the difference that new leadership provides. The shadow Minister laughably referred to new leadership in the Conservative party. Well, it is certainly leaner and meaner, but it is the same old Conservative party. The only thing that the Conservatives have shrunk is their own party. The only jobs that they have laid off are those of their poor party staff. The only thing that they are capable of changing—[Interruption.] Well, come to think of it, I do not think that there is anything they are capable of changing. Instead they look over their shoulder at a party leader who cannot even manage a five-aside team, let alone a country. The Conservatives are just so diminished as a party. I appreciate that it must be so painful for them to watch a Labour Government doing the things that they only ever talked about: reducing bloated state bureaucracy; investing in defence; reforming our public services; and bringing down the welfare bill. The public are asking: “What is the point of the Conservative party?” I bet they are glad that they chose change with Labour.

I applaud my right hon. Friend for his leadership and for the reduction in waiting lists, which we so desperately need. We all know that there is still a struggle with budgets in the health service—my excellently run Honiton hospital is facing a deficit for the first time in its history—so can he give more detail about how he will reform NHS procurement, so that we can use the purchasing power of the NHS to get more bang for our buck?

My hon. Friend is absolutely right about the need to improve procurement. One thing that Attlee and Bevan could not have predicted in 1948 is that the single-payer model of the national health service makes it ideally placed for this world of artificial intelligence, genomics, machine learning and big data. We must unlock that potential so that we have new treatments, new technology, productivity gains and efficiencies, but we also have to get the basics right on procurement. We have to change the culture of profligacy, routine deficits and routine over- spending. That is why, today, the leadership of NHS England has summoned to London chairs and chief executives from across the country to get an immediate grip on the £5 billion to £6 billion deficit that was already being baked in for the 2025-26 financial year. Those chairs and chief executives have just become so accustomed to the idea that Governments will just come in and bail them out. I said before the election that there would be no release of money in winter, because winter is predictable. The NHS was given additional resources and it must learn to live within its means. Despite howls of outrage before and since the election, I have kept to my word. I said that there would be accountability for people who think that the Government are there to bail them out. Having come from local government, where that culture would never be tolerated, I and this Government are bringing that same financial discipline to the NHS. We will not tolerate deficits. It is important that we get better value for money, while also making sure that, nationally, we are providing support through the procurement platform. That is how we will help the system deliver better value, and we will liberate frontline leaders to focus on the things that really matter, which are services for patients.

I call the Liberal Democrat spokesperson.

The Secretary of State’s NHS shake-up is well under way. Many Members would agree that the NHS used to be the envy of the world, but years of Conservative failure have left patients suffering and unable to get the care that they desperately need. I and my Liberal Democrat colleagues therefore welcome steps to reform the NHS. The new leadership of the NHS has much to do, but can the Secretary of State advise the House whether new legislation will be needed to scrap NHS England given that he told the shadow Minister that it will take two years to complete this merger? When will that new legislation, if it is required, be brought forward? Any attempt to fix the NHS will ultimately fail if we also do not address the crisis in social care. The Secretary of State must show the same urgency in reforming social care as is being shown on the NHS. Where is that urgency? Long-promised cross-party talks have now been postponed indefinitely with no new date in sight. Care providers are hanging by a thread due to the rising cost of national insurance contributions. Does the Secretary of State agree that any attempt to fix the NHS will prove futile if we ignore the elephant in the NHS waiting room that is the crisis in social care? We will clear our diaries for cross-party talks, so will the Secretary of State give us a date today?

I am grateful to the Liberal Democrats for those questions. Much of the change needed can be delivered without the need for primary legislation, which is a relief because, as right hon. and hon. Members will have noticed, this Government have come into office with the most ambitious legislative programme of any incoming Government. Time is at a premium, given the business of this House and the other place. We will work immediately to move forward without changes to primary legislation, but we will need to make them. I am working with the Leader of the House and business managers to ensure an appropriate timetable that enables us to do the things that we need to do in a timely way, but that also safeguards the ambitious legislative programme that has already been set out. The hon. Lady is right to talk about the importance of social care. She asked where the urgency is. It was to be found in the immediate steps that the Chancellor took on coming into office to stabilise the finances of my Department, with an immediate release of funding. It came with the Budget, which delivered an extra £26 billion for the Department for Health and Social Care, protected funding specifically for social care and boosted spending power for local authorities. It came with the biggest expansion of carer’s allowance since the 1970s, and an £86 million increase in the disabled facilities grant not just from next year but released in January for the remainder of this financial year. The urgency is reflected in the Employment Rights Bill, which makes provision for fair pay agreements to deal with the work- force crisis—work with employers and trade unions to prepare for that legislation and the introduction of fair pay agreements is already under way. I regret that we have not convened cross-party talks. That is genuinely due to practicalities on the part of a number of parties involved. We will be in touch over the next week to make arrangements for Baroness Casey to engage with parties across the House.

I thank my right hon. Friend for his excellent statement. As he knows, I am a working GP in Stroud. We clinicians are simply fed up with the micromanagement of our caring clinical role, and many hospital colleagues feel the same. We want to be free to deliver excellent clinical care. Does he think that the abolition of NHSE will reduce the admin task for doctors?

I do think that is the case. I also think that this is not just about form and function but about the opportunities for productivity gains through modern technology and practices. One of my frustrations is that whenever we talk about the exciting frontiers of life sciences and medical technology—this country’s competitive advantage, and how we need to build on that position— I am greeted with a weary sigh from poor frontline NHS staff, and managers for that matter, who say, “That’s lovely, and we agree with you, but we’d just like a machine that turns on reliably, and it would be nice to use systems that do not require seven passwords to deal with a single patient.” I feel their pain. We will prioritise that investment in technology. Finally, we do want to liberate the frontline, and I am grateful for the leadership that GPs have shown in agreeing a contract with the Government for the first time since the pandemic, which contains substantial reform to benefit them and, even more importantly, their patients. We also have to liberate management in the NHS. As Lord Darzi said, it is not the case that there are too many managers, but there are layers and layers of bureaucracy between me as the Secretary of State and frontline staff. We have to liberate frontline staff and managers to help them be more effective, to manage their resources more efficiently and, most importantly, to deliver better and safer care.

I call the Chair of the Health and Social Care Committee.

This is a bold change indeed. The job of my Committee is to help the Secretary of State to do it, so let me start by asking him to come in front of the Committee as quickly as possible—certainly before Easter—because there is a lot of detail that we need to drill down into. On a more substantive point, the right hon. Member mentioned the financial reset that Sir Jim Mackey announced to integrated care boards just yesterday, which means that they need to cut their running costs by 50%. I am concerned that when my Buckinghamshire, Oxfordshire and Berkshire West ICB struggled with money, the first thing it cut were the place-based teams. If we are to deliver the neighbourhood NHS that the Secretary of State and I both want, those are not the teams to cut. Will he send a signal to ICBs that cost savings should not be at the expense of the broader shifts in the 10-year plan?

First, I give the Chair of the Select Committee my assurance that I would be delighted to appear in front of her Committee at the earliest opportunity —that means soon. I appreciate that it will want to scrutinise these changes in more detail, and I would welcome the constructive challenge that it offers. I also reassure her that the direction that we are giving to frontline leaders is to deliver the three big shifts in our 10-year plan, and to ensure that as we take immediate steps to bring the finances under control, we do so in a way that lays the firm foundations for the future of the NHS that we need to build. My cautionary note to Members across the House is that when we ask frontline leaders to reform and to change ways of working, sometimes that requires not just changes to the bureaucracy as it were—the easier and lower hanging fruit—but service reconfiguration in the interests of patient outcomes and better use of taxpayers’ money. Sometimes, they get those changes wrong. I have successfully campaigned against closures of services such as the King George accident and emergency department, which should not have closed and where we won the case on clinical grounds. Sometimes, let us be honest, the public can get anxious, and Members of Parliament feel duty bound to act as megaphones and amplifiers for public concerns. It is important that we support and engage with local NHS leaders. By all means, we should scrutinise, challenge and ask questions, but we must give local leaders the support to do the task that we are asking of them on behalf of patients and taxpayers. The powers that I have to intervene in those frontline service reconfigurations are ones that I will use only in the most exceptional and necessary cases, and that is why I have not used them once in the past eight months.

The crisis in our NHS goes deep. I am sure that the Secretary of State agrees that it is an existential crisis that poses a threat to the future of the NHS if fundamental change does not happen. While I strongly welcome today’s statement, what assurances can he give me and the House that the right people will be in the right place in leadership positions to drive the fundamental change that is necessary?

That is an excellent question. We are building an outstanding transformational team with Sir Jim Mackey, which will be announced very shortly. It will bring together some of the best leaders across the country, and expertise from outside the NHS, to drive the scale and pace of transformation that is necessary. My hon. Friend is right to say that it is existential, because we cannot allow the curve of cost and demand to continue to rise to the extent that it is. The NHS’s long-term workforce plan has one in nine people in our country working for the NHS. On the current trajectory, in 50 years’ time, 100% of the public would be working for the NHS. That is clearly not a sustainable position. I tell people who resist this reform out of love for the NHS not to kill it with kindness. We have to bend the curve of cost and demand to ensure that our health services are sustainable for the long term on the equitable foundations of a public service, free at the point of use, that we will always defend. I also say to my hon. Friends on the Government Back Benches that if we do not get this right, goodness knows what will come next. The Leader of the Opposition says that she wants a debate on the funding model for the NHS. The leader of the Reform party—I am not sure whether he is the Leader of the Opposition yet—says that he is up for anything. I am sure he is. That should worry us. To those who want to debate the funding model of our NHS and the equitable principle of it being a public service, free at the point of use, I say that we are happy to have that debate but the Government are unequivocal: under Labour, the NHS is not for sale. It will always be a public service, free at the point of use, so that when people fall ill, they never have to worry about the bill.

May I commend the boldness of today’s announcement? If the NHS is to be turned around, it will need radical reforms. If the result of today is to replace bureaucratic overcentralisation with political overcentralisation, it will fail. But if we move to the decentralised model that we have for the police and schools, it could be the start of a real transformation. Will the Secretary of State give the House more detail about the changes he has in mind? Are we going to get rid of the central targets that make the NHS the most micromanaged system in the world and make it impossible for managers to deliver real change on the ground because they are working to about a hundred operational targets? If that is the case, and we are going to decentralise the NHS, does the Secretary of State agree that there remains a vital role for a reformed Care Quality Commission to call out poor care whenever it finds it?

I am grateful to the right hon. Gentleman for that thoughtful question. Let me say two things to him. First, democratic accountability matters, both in terms of patient outcomes and value for taxpayers’ money. One of the things that I, my Labour and many of my Conservative predecessors have reflected on a lot over many years is what the role of the Secretary of State, and Government, is in a national health service where clinical decisions should always be clinically led. It is the Secretary of State’s responsibility to be the champion for patients and for taxpayers and to ensure that the system as a whole delivers better outcomes for patients and better value for taxpayers. The argument that I have started, however, which has ruffled some feathers within the NHS and even more so with some of our country’s most loved charities in recent months, is the fallacy that the Secretary of State can or should just fire endless instructions into the system, as if a Secretary of State or, for that matter, an NHS England could just pull some big levers and drive change in such a vast and complex system. That is a falsehood. Of course, we should set national strategic priorities on behalf of the public. We should ensure that there is more transparency and information so that patients, communities and staff can hold the system and themselves to account to improve performance. However, the overcentralisation has to stop. In future, it will be for the Department and the NHS nationally to do the things that only the national health service can do, providing the enablers for the system as a whole. What we are presiding over and embarking on, however, is the biggest decentralisation of power in the history of our national health service. That will put more power into the hands of frontline leaders and clinicians, but even more fundamental and transformational, more power into the hands of patients. If we get that right, we will have an NHS that can truly be the envy of the world. If people continue to indulge in the fallacy that more targets from the centre or more—or indeed, less—political control is the answer, we will fail. The right hon. Gentleman also mentioned the CQC. It has got itself into a terrible mess and I know that that is not what he intended when he rightly made the decision to create the Care Quality Commission. That is why Sir Julian Hartley knows that he has our full support, not just in turning around the CQC as it is, but in reforming it so that it can be the best guarantee and safeguard of quality that patients and the public deserve. Dr Penny Dash’s forthcoming review findings will also help to drive that reform agenda at pace.

I thank the Secretary of State for making the statement today. I want to echo the thoughts of the hon. Member for Oxford West and Abingdon (Layla Moran) that it would be helpful to see him in front of the Select Committee to outline his vision for NHS England. Will he tell us today how the new structure of the NHS will help us deliver truly excellent social care and also primary care, and what drivers he can use to make that happen?

It always worries me when my hon. Friend says he wants to see me in front of the Select Committee because he does not pull his punches, despite being on the Government side of the House. Let me reassure him that on primary care, I hope that we are beginning to turn what I think has been a deep anger, frustration and anxiety among primary care leaders about the state of the system as it is and a pessimism about its future into increasing amounts of quiet optimism and hope. I think GPs can see we are walking the talk, with the biggest funding uplift in a generation and the fact that we have worked constructively with GP leaders to reform the contract and agree that further, more radical reform is needed together. We will be embarking on that under the auspices of the 10-year plan. As well as delivering that significant achievement with GPs, the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), is also in the very final stages of work with pharmacists to stabilise the community pharmacy sector, which is vital for the NHS’s future as a neighbourhood service. May I also reassure my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn) that under the auspices of the 10-year plan for health, notwithstanding Baroness Casey’s work on the long-term future of social care, we have an eye on social care and the relationship between health and social care? People will not, therefore, be waiting until next year for the first Casey report or, indeed, later for the final Casey report on the longer term to see action from this Government on social care, particularly as it relates to the NHS.

I welcome the ambition of the Secretary of State. One area that I ask him to focus on is the future of the UK Health Security Agency. Over the last 15 years, it has evolved from the Health Protection Agency to Public Health England and now to the UKHSA. I found it impossible, both as a Treasury Minister and as a constituency MP, to penetrate the decision-making process around resource allocation, which I now believe is duplicative, as a move to a new site in Essex is being contemplated. That is an area where the Secretary of State can demonstrate to my constituents in Salisbury and at Porton Down that he means business and can resolve the future of UKHSA once and for all.

I would be delighted to speak further with the right hon. Gentleman, drawing on that valuable experience both as a constituency MP and as a Treasury Minister—always, for the record, my favourite people to work with—

What’s wrong with DCMS?

And my friends at DCMS with their considerable spending power. No, I will stick with the Treasury in my order of favourites, thank you very much. I know where my bread is buttered. To return to the point made by the right hon. Member for Salisbury (John Glen), I thank Dame Jenny Harries for her leadership of UKHSA. We are recruiting for an outstanding replacement and successor, and that is an opportunity to look in the wider context at some of the first principles. The right hon. Gentleman mentioned the specific, traditional Porton Down versus Harlow decision, which has been running around the system so long that is now used in a case study for senior civil servant recruitment. The worst decision is indecision. It has plagued us for too long and I hope we can soon report back to the House with a decision on that for everyone’s benefit.

I welcome the statement today from the Secretary of State. Clearly, there is massive duplication of functions across the many regulatory, national, local and regional NHS bodies and huge room for efficiency. I want to press the Secretary of State on two points. First, will he assure me that the bonfire of bureaucracy will not stop effective local management of NHS trusts and community settings, as IPPR has found that locally the NHS is poorly and under-managed and clinical staff are backfilling admin and management roles? Secondly, as he mentioned, the roll-out of digital technology has been far too slow, with NHS Digital’s move into NHS England not directing change fast enough, so how will the change ensure that the Department of Health and Social Care grips the digital roll-out, accelerates it and ensures the proper integration of NHS digital functions?

That is a great question from my hon. Friend. We have to give people the tools to do the job. The Prime Minister set me and my hon. Friends in the Department an enormous challenge on behalf of the public. In turn, I am setting an enormous challenge for NHS leaders at every level, but particularly for frontline NHS leaders. We have to give them the tools to do the job in terms of data platforms and the technology that they are given to work with, ensuring that they have access not just to cutting-edge treatments and medical technology, but to the back-office productivity support that can drive efficiency and improvement and, frankly, liberate managers and frontline staff from the arcane systems they are working with. Some of the very best people I have met in the last few years, shadowing this portfolio and now holding it in government, are NHS leaders, especially on the frontline. It is my responsibility to give them the tools to do the job. That is not just about financial resources; it means bulldozing through some of the regulatory barriers and overcentralised instructions that stop them making decisions in the best interests of patients, in terms of clinical pathways and value for taxpayers. I have given them an undertaking that I will have their backs, both on the decisions that they will have to take on the frontline and on bulldozing through the national bureaucracy that is tying them up in knots when we need to set them free.

I congratulate the Secretary of State on the changes announced today to cut unnecessary waste and bureaucracy. We all know and agree that healthcare should remain free at the point of delivery and, of course, that the NHS needs reform. Just last Saturday, I was in a care home in Boston with a lady—an expert—who knows Melanie Weatherley, and she was telling me about the unnecessary processes within NHS England on the frontline that constrain good care in care homes, impose unnecessary constraints on ambulances and block A&E wards. Will the Secretary of State confirm that the changes and reforms will include unnecessary processes on the frontline in care homes?

I can certainly give the hon. Gentleman that assurance. We have to cut through the unnecessary red tape that ties leaders and frontline staff up in knots, and we are absolutely determined to do that. Regulatory reform will form a big part of this Department’s agenda and the wider Government’s agenda. As to an NHS free at the point of use, he almost said it with a straight face. I am sure that he meant every word he said. I think he might want to have a word with his party leader, who is his successor and—who knows?—perhaps his predecessor.

We must remember that NHS England came out of the Tory Government’s reforms that were intended to privatise the NHS. I want to thank NHS England staff for their work. I am sorry about the way in which they have heard this announcement, because it is their jobs that are being put at risk. We have to ensure, however, that we are not replicating NHS England across the ICBs of our country, and that ICBs are also reformed to transform the NHS through the three shifts that will be placed on them with the publication of the 10-year plan. How will my right hon. Friend ensure that we have the machinery to hold the system to account, but also to put those reforms in place?

My hon. Friend is absolutely right: if we just replicate NHS England as it is with all the challenges in its set-up in ICBs across the land, we will have failed. Frankly, if we replicate NHS England and the Department as they are today just in one organisation, we will have failed to meet the challenge of change. It needs to feel and act like a completely new organisation, culture and way of working to modernise the state, so that if Disraeli, Gladstone, Churchill or Attlee walked into Whitehall at the end of this Government, it would not look so much like the Government they worked in during the 19th and 20th centuries. That is the reality of Whitehall today; it is not a reflection on the people who work in it, but it shows why it needs to change, and that is also true of the NHS. I look forward to working with ICB leaders to reform their ways of working, clarify their priorities, give them clearer marching orders and ensure that they can deliver. Finally, my hon. Friend mentions the staff of NHS England—indeed, this affects staff in my Department, too—and I thank her for the care she has shown. Change is always disruptive and it can be scary, and of course that is particularly the case when job losses are involved. I want to acknowledge that on the Floor of the House, as I have to staff across both organisations this morning. I know that the Permanent Secretary and the chief executive of NHS England have done so in recent days, and I will be holding a town hall with staff next week. This really is not a reflection on them. In fact, I think they will recognise in my description of our ways of working the many things that frustrate them. None the less, they are dedicated and talented people, and some of the best people I have ever worked with in any walk of life or career work in this system. I look forward to working with them in the coming weeks and months with the same dedication and professionalism they have always shown, so that we can all look back on this time with pride, knowing that we were part of the team that took the NHS from the worst crisis in its history to getting it back on its feet and making it fit for the future.

Does the Secretary of State agree that one of the worst and most intractable problems that the founders of the NHS had to deal with was the involvement of medical practitioners and consultants who were used to receiving a private income in a national service where they would not receive anything like the same remuneration? If he agrees, would he accept that there is a similar situation with NHS dentistry today? The Darzi report said: “There are enough dentists in England, just not enough dentists willing to do enough NHS work, which impacts provision for the poorest in society.” How does he think his reforms will help address that particular crisis, on which Members like myself and my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) are being consistently and rightly lobbied by such formidable organisations as the New Forest branch of the women’s institute?

NHS dentistry is in a terrible state and, in fact, in many parts of the country it barely exists. There are lots of reasons for that, and it is a source of constant astonishment to me that the dentistry budget was underspent year after year despite that situation. The Minister for Care is working with the British Dental Association to reform the contract. I know that Members are frustrated at the pace, and so am I. We are trying to clear an enormous challenge; it is not going to be easy, but we are committed to working with the profession. We are rolling out the 700,000 urgent dentist appointments and supervised toothbrushing, as we promised and as the BDA has welcomed, but we have a lot more to do. That requires working with the profession—not simply tinkering with the system as it is, but fundamentally rethinking it and how we rebuild it into an NHS dentistry service that we can be proud of.

I welcome the statement, particularly the commitment to ensure that as much money in the NHS as possible is spent on the frontline, where it can really affect patient outcomes. Nowhere is that more needed than in my constituency of Dartford, which is the fastest growing town in the UK. That extra population is imposing a huge strain on our local district general hospital at Darent Valley, despite the excellent efforts of the staff there. Could the Secretary of State outline how the changes will support the shift we need to see from services being delivered in the hospital to the community, thereby relieving the strain on hospitals like Darent Valley?

The frustrating thing is that we are delivering the wrong care in the wrong place at the wrong time, which is delivering poorer outcomes for patients and poorer value for taxpayers. People cannot get a GP appointment, for example, which might cost the NHS £40, and then they end up in accident and emergency, which could cost £400. If people cannot find a bed for a delayed discharge and rehabilitation outside of hospital, they end up stuck in a hospital bed, wasting away at greater cost. In fact, when I was up in Carlisle earlier this year, such intermediate care was being offered by a local social care provider, commissioned by the NHS, at half the cost and of a much better quality than the hospital bed that patients had been discharged from. That shift to the community is about delivering better outcomes for patients and better value for taxpayers, and that will be reflected in our 10-year plan.

I declare an interest as the vice-chair of the newly formed all-party parliamentary group on emergency care. A&E staffing across the country is dangerously low, especially at night, putting unacceptable pressure on staff, who warn persistently about the risks to patient safety. Hundreds of keen applicants are being turned away from emergency medicine training. Last year, there were 359 places for 2,718 applicants. Following this announcement, how quickly will emergency care and A&E departments see changes and have more permanent staff and consultancy places, but especially more training places?

We will shortly set out our emergency care improvement plan so that we can deliver the year-on-year improvements that people deserve. The long waiting times, not just in emergency departments but in ambulance response times and across the entire system, are completely unacceptable. I refuse to use terms such as “temporary escalation spaces” to describe the true grim reality of corridor care. That is a shameful situation, and I am genuinely sorry that patients are being treated in those conditions and that staff have to suffer the moral injury of working in those conditions. From the moment we came into government, we have worked to ensure that we got through the winter as well as we could. That is reflected in the fact that, despite the winter pressures, waiting lists fell five months in a row throughout the winter. On the targets and standards challenge set out by the Royal College of Emergency Medicine, ahead of the winter I was very clear with frontline leaders that patient safety must come ahead of performance targets—particularly the four-hour target—but the 12-hour target is absolutely related to patient safety, as I think the royal college would agree. We must work together to get waits of longer than 12 hours down as a priority, because those waits are directly linked to safety and patient outcomes.

Order. I gently ask right hon. and hon. Members, and indeed the Secretary of State, to keep their questions and answers short so that I can get everyone in.

Two GP practices have told me that they are waiting for section 106 money to be released so that they can improve their facilities, but that it has been stuck between decision-makers. Will the Secretary of State outline how the changes will help to release those kinds of delays and finally allow North West Leicestershire residents to get the facilities that they deserve?

I am grateful to my hon. Friend for raising that example. She is welcome to contact my office to see if we can expedite that kind of decision-making. In fact, Members will have seen the work that the Deputy Prime Minister is doing to speed up decision-making in local government, which has an impact and a bearing on the NHS. We will work together to speed that up, so that where resources are available, we get them out and deliver change as quickly as possible.

My constituents are particularly concerned about the very bureaucratic approvals process for the new hospitals programme—through investment committees, then the regional NHSE team, the a department, then NHS capital assurance, then a joint investment committee, then the Treasury and then, finally, Ministers. Can the Secretary of State guarantee that this decision, which I welcome, will speed up that process, and that the business case for the multi-storey car park at the Queen Elizabeth hospital in King’s Lynn will be approved so that work starts this year?

The hon. Gentleman makes a fair challenge on the bureaucratic nature of decision-making. We are working with Treasury Ministers and colleagues across Government to take an axe to that unnecessary bureaucracy. He will be absolutely fuming when he finds out who was responsible for it.

I am conscious that my former colleagues at NHS England will be concerned about today’s announcement, but I am very confident that the Secretary of State will do all he can to support them. It is an inescapable fact that the 2012 reorganisation led to inefficient layers of management in the NHS, delivering poorer care and greater costs to the taxpayer. How does he plan to cut excessive layers of bureaucracy, get resources to the frontline and, crucially, deliver better care for the people of this country?

That is a brilliant question. We have put in place a transformation team, led by Sir Jim Mackey, which we will work with to start fundamentally changing the way the NHS works, by shifting more power, resources and responsibility out of Whitehall and closer to the frontline and the communities where decisions are made, and by getting rid of the unnecessary bureaucracy that drives patients and staff to distraction.

I thank the Secretary of State for his statement. We all want to see a well-run NHS that delivers for patients, but as he knows, patients are being treated in corridors, staff are severely overstretched and too many people cannot get access to a GP or a dentist when they need one. In that context, I was concerned to read in the media last week that there are plans for £7 billion of cuts to services, and for ICBs to be asked to cut costs by 50%. Can he reassure us that, as we go into the new financial year, we will not see cuts to frontline services? When I meet the chief executive of Norfolk and Waveney ICB next week, will I hear that cuts to frontline services are being considered as a result of Government budgets?

The reports relate to the deficits sent into NHS England ahead of the 2025-26 financial year. Those are completely unaffordable for the NHS and completely unrealistic. Those financial plans are being revised as we speak, which is why leaders have gathered in London today to receive that message and that set of instructions. I am asking frontline leaders to improve services and reform ways of working, and they will have my support in doing that. As for the resources that are going in, I gently point out that the investment that the Chancellor unlocked for the NHS and social care in her Budget dwarfs that which was promised in the Green party’s manifesto.

I held a public consultation in my constituency on the future of the NHS. Participants were crystal clear that we need to cut bureaucracy and get resources to the frontline. When they talk about the frontline, they mean not just hospitals but people out in the community, and, crucially for my constituency, GP practices. Will the Secretary of State share more about how he intends to make that shift?

There are 889 million reasons for GPs to be cheerful. That amount was the allocation for general practice before Christmas, and it has resulted in fruitful negotiations with GP leaders that will deliver the necessary reforms and better access for patients, particularly through online access to modern appointment booking. That is something to which we have become accustomed in every other aspect of our lives, and the NHS should be no different.

It is an inescapable fact that one top-down reform is being fixed by another—one that will last about two years, according to the statement. Although I wish the reform every success, we must recognise that the experience of the NHS in Wales shows that reform on its own is no guarantee of success. The Secretary of State rightly said that change is hard, and it is inescapable, I am afraid, that while this reform is ongoing, the NHS leadership will be hugely distracted by turf wars, redundancies and the development of new working practices. What steps will he take to prevent that distraction from having a negative effect on frontline services?

The Government have come in with an ambitious reform agenda. As we embark on that reform, we are cutting NHS waiting lists—we have done that five months in a row. We are reforming the GP contract—those negotiations have successfully concluded. We are about to conclude community pharmacy, too. We have put in place a transformation team who are experienced frontline leaders with demonstrable track records—particularly in the case of Sir Jim Mackey—of delivering those changed outcomes. There will always be people who say that it is too hard, too difficult or a distraction, but that is how we have ended up with this status quo; that is how the Conservative party presided over the longest waiting lists and the lowest patient satisfaction on record while spending staggering amounts of public money. More money and no reform is not the answer; the lesson of the previous Labour Government is that investment plus reform delivers results. That is what this Labour Government are doing.

I thank the Secretary of State for his statement and pay tribute to NHS professionals in Harlow, particularly those at the Princess Alexandra hospital, for their incredible hard work every single day. Does he agree that NHS staff, who work incredibly hard, are failed by an overly bureaucratic and fragmented system, and that spiralling staff costs are partly a result of the need for additional agency staff?

We absolutely need to reduce the cost of agency staff in the NHS. That costs the taxpayer billions, and that money could be better spent on ensuring that we have the right staff in the right place, on better terms and conditions, and with permanent contracts. Where we do need flexibility, we should drive it through the NHS bank. We are determined to reform the way that works and deliver better staffing, better outcomes for patients and better value for taxpayers.

I welcome any measures to reduce the bureaucratic overload in the NHS, so I congratulate the Secretary of State on coming forward with his bold plan. We must also take a sledgehammer to the business case process, which frustrates the delivery of services and new buildings for the NHS. Will he consider bringing NHS-owned land into use for new care facilities and step-down hospitals, for example, so that we can free up hospital beds and get people into the care they need at a much lower cost?

The hon. Member is absolutely right: the estate is vast, it is underutilised, and we need to sweat our assets more effectively. We also need to reform bureaucratic processes. There are lots of reasons why we need to have tough controls on things such as spending, procurement and value for money, to ensure that there is appropriate and effective use of public money. But businesses do not operate in this way; they are able to counter fraud, waste and poor value for money, and they do it much faster. That is what the NHS needs to do. Across the public sector, we need to use our estate far more effectively to deliver better value and better services for the public.

I thank the Health Secretary for the announcement he has made. As he rightly says, staff work incredibly hard and deserve our thanks, but we all recognise the huge strain that they and the organisation have been under. The health service is consistently raised as one of the top concerns by residents in my constituency. Can he share how today’s announcement, along with other measures he has previously announced, will build an NHS that is there when people across Cramlington and Killingworth need it?

We have to deliver improved services for patients in every part of the country. Her constituency and mine, which is on the London-Essex border, will have different needs, contexts and set-ups, and services may need to be shaped differently in order to meet those needs, but the standards should be consistent, the quality should be good and the safety should be guaranteed at all times. That is a far cry from where we are, and I genuinely think that decisions about services for her constituents will be far better taken much closer to her constituents and her community than here in Whitehall. That is why, as we are delivering month by month and year by year improvements in services for patients in every part of the country, we will also deliver the biggest devolution of power in the history of the national health service.

I really welcome the Secretary of State’s statement, and I am particularly keen that he looks at the multiple layers of sign-off and the bureaucracy that sometimes forgets patients are at the other end of it. Hospitals in England have had to rely on charitable fundraising to buy some of the most cutting-edge radiotherapy machines because of NHS England’s policies and bureaucracy. This year, highly advanced machines such as the CyberKnife, which have treated thousands of NHS cancer patients over the past 10 years, will need upgrading, but NHS England is refusing to include them in this year’s funding because they were all bought by charities. The Secretary of State talked about giving people the tools to do the job. Could he change that policy, so that our hospitals do not have to continue relying on charities for the latest technology?

This Government committed in our manifesto to doubling the number of diagnostic scanners, and we will deliver that over the course of this Parliament. NHS charities have a valuable role to play. Philanthropy has a valuable role to play as an additional source of support to the NHS. When public funding is as tight as it is, we need to look at how we can maximise the benefits and the impact of bringing together sources of public investment, private investment, voluntary sector and philanthropic investment to deliver the most bang for the buck. Without knowing the details of the specific case the hon. Lady mentions, I would not want to comment too strongly, except to say that we are committed to doubling diagnostic scanners through public funds, but I am not sure I necessarily share the view that NHS charities do not have a role to play.

I know from my experience of working on the NHS frontline how hard it has become over the years to get basic things done. Nurses and matrons spend hours and hours getting basic changes made to their workplace on the frontline. I therefore welcome my right hon. Friend’s announcement. Will he ensure that by cutting bureaucracy, we can get more resources to where direct patient care takes place, which will help with the retention of nurses and healthcare assistants and see more patients being treated quicker and getting the care they need?

My hon. Friend is absolutely right. Some of the best innovation and improvements for patients I have seen has been led by frontline clinical teams that have had great executive leaders behind them, giving them the freedom and the tools to do the job. I hope that, as a result of these reforms, not only will we see the results for patients in the data, but staff and patients will feel the outcome and the difference in their experience of working in or being treated by the NHS.

I thank the Secretary of State for his statement and for his positivity on getting waiting lists down and making the change that is needed. He referred to Scotland, Wales and Northern Ireland. He will know that we in Northern Ireland are having the very same problems that he is sorting out today for England. I know that he is always keen to see the positivity that comes out of this place being shared right across this nation. Will he have discussions with the relevant Northern Ireland Minister, Mike Nesbitt, in relation to health back home, to ensure that we can follow the directives here, to make our health service in Northern Ireland every bit as good as this one will be?

I was recently in contact with Mike Nesbitt, offering some of that support and offering to work together to help improve the quality of health services in Northern Ireland, recognising that we have advantages of scale here in England. While recognising the devolution settlement, we want to work closely, just as we are working closely with our friends in the Labour Government in Wales to help them improve their services, and also learning from some of the things that the Welsh NHS does better than England.

I commend this statement and thank the Secretary of State and his Department for the excellent work they are doing. It is not a moment too soon in Norfolk, because we have failing access to dentistry, it is difficult to get a GP appointment, and both the hospitals that serve my constituents have RAAC—reinforced aerated autoclaved concrete. With that in mind, may I invite the Health Secretary to Norfolk to meet healthcare professionals, to discuss the cumulative impact of so many challenges and to discuss how these reforms can help improve patient care?

I am grateful to my hon. Friend for that question; that was a very kind way of reminding me that I had already made such a commitment and have not followed through, so let me rectify that immediately.

I thank the Secretary of State for the boldness of his statement. It will take courage to bring about the change that my constituents desperately want, and it is great that Labour is showing that courage. My constituents, particularly those in Killamarsh, really struggle with access to GPs. Could the Secretary of State assure me that this will redirect vital resources from bureaucracy to serving those in need on the frontline?

I can give my hon. Friend that assurance. That is the objective of what we are doing: to make better use of taxpayers’ money so that we can deliver better care for patients. That is not through bloated central bureaucracy, but through more frontline capability and services.

I draw Members’ attention to my entry in the Register of Members’ Financial Interests. Of the more than 26 years that I worked in the NHS, six and a half were in NHS England, in its brilliant strategy team and with brilliant people. That is why my heart goes out to so many people who will have insecurity about their jobs following this announcement, even though I believe it to be the right one. This comes after years and years of chopping and changing at NHS Improvement and NHS England, as political leadership has switched from one person to another. One of the things I am concerned about is the need to ensure that clinical leadership is still heard at the centre. As a nurse, I found it harder to get into NHS England. Doctors find it easier in their career structures. Moving NHS England functions into the Department, and moving off NHS terms and conditions, will make it harder for nurses, allied health professionals and other clinicians working in the NHS. What will my right hon. Friend do to ensure that the clinical voice comes right into the centre of Whitehall, along with the patient voice?

I am extremely grateful to my hon. Friend, and I echo what he said about the talents of people at NHS England. I did not take this decision with the Prime Minister lightly. Indeed, it was not my instinct coming into government, but it has been shaped by what I have seen and experienced over the past eight months. Clinical leadership is vital, and that is not just doctors; it is also nurses and other clinical leadership. We have a brilliant chief nursing officer, who remains in place and will be part of that clinical leadership team. I can assure my hon. Friend that we do not want any political interference in what should be decisions for clinicians. What we need is the right political leadership to give that clinical leadership the tools, power and freedom to do the job that only they can do, and that they do best.

This welcome reform cannot come quickly enough in Warwickshire where councillors, local health campaigners, I and others have been making the case for a doctor-led urgent treatment centre at our local hospital, the Hospital of St Cross, to complement the excellent nurse-led and GP out of hours service, but many of my constituents are concerned about having to travel to the larger hospital in Coventry and the long waiting times they find there. The integrated care board has a review of urgent care under way in Warwickshire, but I still do not know when it will be completed and my constituents want to know when urgent care at our local hospital will be upgraded. Does my right hon. Friend agree that his reforms to NHS England should equip ICBs more effectively to respond to local needs?

I am grateful to my hon. Friend for his perseverance in bobbing for so long; they should prescribe it on the NHS. I say to my hon. Friend that this is why I strongly believe in local decision making to make sure services are configured and designed to meet the differing needs of local communities while providing the same standard and quality of care in every part of the country. He also described the frustration of people who will often, including in the future, necessarily be living some distance from their general hospitals; that is why we have to shift out of hospital with the NHS being not just the national health service but a neighbourhood health service, with as many services as possible closer to people’s homes and indeed in people’s homes. That is the exciting future that is up for grabs, and that is the future we will realise thanks to the reforms we are making today. I am delighted they have been greeted with such support right across the House.