NHS 10-Year Plan

Statement

19:43:00

My Lords, with the leave of the House, I will now repeat a Statement made by my right honourable friend the Health Secretary in another place. The Statement is as follows: “There are moments in our national story when our choices define who we are. In 1948, the Attlee Government made a choice founded on fairness: that everyone in our country deserves to receive the care they need, not just the care they can afford. It enshrined in law, and in the service itself, our collective conviction that healthcare is not a privilege to be bought and sold but a right to be cherished and protected. Now it falls to our generation to make the same choice: to rebuild our National Health Service and to protect in this century what Attlee’s Government built for the last. This is the driving mission of our 10-year plan. In September, Lord Darzi provided the diagnosis: the NHS was broken by 14 years of the Conservatives’ underinvestment and by their catastrophic top-down reorganisation. In the past year, Labour has put the NHS on the road to recovery. We promised 2 million extra appointments; we have delivered more than 4 million. We promised 1,000 new GPs on the front line; we have recruited 1,900. We have taken almost 250,000 people off waiting lists, cutting them to their lowest level in two years. We have launched an independent commission, chaired by the noble Baroness, Lady Casey, to build a national consensus around a new national care service to meet the needs of older and disabled people into the 21st century. Today, the Prime Minister has set out our prescription to get the NHS back on its feet and make it fit for the future. Our plan will deliver three big shifts. The first is from hospital to community. We will turn our National Health Service into a neighbourhood health service. The principle is simple: care should happen as locally as it can—digitally by default, in a patient’s home if possible, in a neighbourhood health centre when needed, and in a hospital where necessary. We will put neighbourhood health centres in every community, so that people can see a GP, nurse, physio, care worker or therapist, and they can get a test, scan or treatment for minor injuries, all under one roof. The NHS will be organised around patients, rather than patients having to organise their lives around the NHS. It will be easier and faster to see a GP. We will train thousands more, end the 8 am scramble, provide same-day consultations and bring back the family doctor. If you are someone with multiple conditions and complex needs, the NHS will co-create a personal care plan so your care is done with you, not to you. Pharmacies will play an expanded role in the neighbourhood health service. They will manage long-term conditions, treat conditions such as obesity and high blood pressure, screen for disease and vaccinate against it. We will also reform the dental contract to get more dentists doing NHS work, rebuilding NHS dentistry. Over the course of this plan, the majority of the 135 million out-patient appointments done each year will be moved out of hospitals. The funding will follow so that a greater share of NHS investment will be spent on primary and community care. The second shift is from analogue to digital. No longer will NHS staff have to enter seven passwords to log in to their computers or spend hours writing notes and entering data. Our plan will liberate front-line staff from the parts of the job that they often hate, so that they can focus on the job they love—caring for patients. For the first time ever, patients will be given real control over a single, secure and authoritative account of their data. The single patient record will mean that NHS staff can see medical records and know a patient’s medical history so they can provide them with the best possible care. Wearable technology will feed in real-time health data, so patients’ health can be monitored while they stay in the comfort of their own home, with clinicians reaching out at the first signs of deterioration. The NHS app will become the front door to the health service, delivering power to the patient. You will be able to book and rearrange appointments for you, your children or a loved one you care for; get instant advice from an AI doctor in your pocket; leave feedback on your care and see what feedback other patients have left; choose where you are treated; book appointments in urgent care so you do not wait for hours; and refer yourself to a specialist where clinically appropriate. Of course, patients can already do all that, but only if they can afford private healthcare. With Labour’s plan, every patient will receive a first-class service—whatever their background and whatever they earn. The third shift is from sickness to prevention. Working with the food industry, we will make the healthy choice the easy choice to cut calories. We will roll out obesity jabs on the NHS. We will get Britain moving with our new NHS points scheme, and we will update school foods standards so that kids are fed healthy, nutritious meals. We will tackle the mental health crisis with support in every school to catch problems early, 24/7 support with virtual therapists for those with moderate need, and dedicated emergency departments for patients for when they reach crisis point. The science is on our side. The revolution in artificial intelligence, machine learning and big data offers a golden opportunity to deliver better care at better value. New innovator passports and reform of the National Institute for Health and Care Excellence and the Medicines and Healthcare products Regulatory Agency will see medicines and technology rapidly adopted. Robotic surgery will become the norm in certain procedures, so patients recover from surgery at home rather than in a hospital bed. The NHS will usher in a new age of medicine, leap-frogging disease so we are predicting and preventing, rather than just diagnosing and treating. It is therefore the ambition of the plan to provide a genomic test for every newborn baby by 2035. Thanks to my right honourable friend the Chancellor, this plan is backed by an extra £29 billion a year by the end of the spending review period, as well as the biggest capital investment in the history of the NHS. Alongside investment comes reform. This plan slashes unnecessary bureaucracy and devolves power and resource to the front line. It abolishes more than 200 bodies, because listening to patients, guaranteeing safety and protecting whistleblowers is core business for the NHS and should never have been outsourced. The plan commits to publishing league tables to rank providers. We will intervene to turn around failing providers, and we will reinvent the foundation trust model in a new system of earned autonomy. Pay will be tied to performance, so excellence is recognised and failure has consequences. Tariffs will be reduced to boost productivity. Block contracts will end, with funding tied to outcomes. The plan gives power to the patient, so hospitals are financially rewarded for better service. It closes health inequalities by investing more in working-class communities, and it establishes a national investigation into maternity and neonatal services to deliver the truth, justice and improvement that bereaved families deserve. I am sometimes told that NHS staff are resistant to change. On the contrary, they are crying out for it. They suffer the moral injury of seeing their patients treated in unfit conditions. They are ones driving innovation on the front line, so their fingerprints are all over this plan. The public are desperate for change too. Each of us has our own story about the NHS and the difference it made to our lives. We also know the consequences of failure. To succeed, we need to defeat the cynicism that says that nothing ever changes. We know the change in our plan is possible because it is already happening. We have toured the length and breadth of the country and scouted the world for the best examples of reform. If Australia can effectively serve communities living in the outback, we can surely meet the needs of rural England. If community health teams can go door to door to prevent illness in Brazil, we can certainly do the same in Bradford. We know that we can build the neighbourhood health service, because teams in Cornwall, Camden, Northumbria, and Stratford—where I was with the Prime Minister and Chancellor this morning—are already showing us how to do it. We will take the best of the NHS to the rest of the NHS. We will apply the best examples of innovation from around the world to benefit people here at home. Above all else, we will give power to the patient. This plan fulfils Nye Bevan’s commitment in 1948 to put a megaphone to the mouth of every patient. It will restore the founding promise of the NHS to be there for us when we need it. Of course, we know that there are those on the right who are willing us to fail. They will exploit the crisis in the NHS in order to dismantle it. The honourable Member for Clacton—Nigel Farage—and his cronies argue that universal healthcare could be afforded in the 20th century but not in the 21st. Labour rejects their declinist pessimism and so do the public. But that is the choice—it is change or bust, and we choose change. We know that the British people are counting on us. It falls to us to ensure that the NHS not only survives but thrives, and we will not let our country down. Of course, if we succeed, we will be able to say with pride that will echo down the decades of the 21st century that we were the generation who built an NHS fit for the future and a fairer Britain where everyone lives well for longer. I commend this Statement to the House”.

19:56:00

My Lords, before I begin, it is the first opportunity for me from these Benches to wish the noble Baroness, Lady Merron, a speedy but restful recovery over the summer. I look forward to seeing her back after recess. I thank the Minister for repeating the Statement. As she will appreciate, for many questions that have been asked on health in this House in the last few months, the answer has often been, “You have to wait for the 10-year plan”. As the 10-year plan is here, now is the time to have some constructive debate. We will ask questions but also perhaps suggest some improvements. It gives us a chance to scrutinise and, I hope, to work constructively to make sure that the Government can deliver on the plan. Let me be clear that the Government welcome aspects of this plan—sorry, the Opposition; it has been a year now and I am still getting used to it. I am sure that the Government welcome it too, but we have many questions. First, I know there is the Casey review, but surely, we have to understand that we must get social care right if we are to unblock many of our beds. Some 13% of NHS beds have patients waiting for discharge. It is not about the financing of social care; it is about making sure people can go into the community. Secondly, we completely agree on the use of technology. I was the Minister for Technology in the Department of Health and Social Care, and we will support pushing through technological change as quickly as possible, but we also want to make sure we can save both time and cost and improve the patient experience. Far too many functions are duplicated, but, at the same time, if you fall off your bike in an area where you do not live, surely it ought to be easy for the clinicians and paramedics there to pull up and view your record. We still have not quite got there. How will the single patient record link with the NHS summary care record and the National Care Records Service? Will there be duplication, or will the Government be merging the SCR and the NCRS into a single patient record? The plan rightly places a lot of emphasis on the NHS app. I am proud that a Conservative Government introduced that app and welcome the fact that the Government are going to build on it. Page 121 talks about wearable medical technology being integrated into the app, which is very welcome. We know that many people already have these wearables and that they integrate them with apps other than the NHS app, but what about the concerns of some patients who worry about where else their personal data will be shared when they share it with the app? How will the Government reassure those people that the data from their wearables will not be shared elsewhere? Will patients be able to see who has accessed their records and when, so that they can have greater confidence in the idea of data sharing? Turning to the shift from the hospital to the community, which is something that we also agree with. On page 36 it says: “Our aim is to establish a Neighbourhood Health Centre … in every community”, and on page 32 it says that a neighbourhood will consist of 50,000 people. However, in his answers on the Statement, the Secretary of State said: “We aim to go for 250 to 300 new neighbourhood health centres by the end of this plan and 40 to 50 over the course of this Parliament”.—[Official Report, Commons, 3/7/25; col. 449.] If the Government create 300 neighbourhood health centres that each serve 50,000 people, the total served by these neighbourhood health centres will be 15 million people. England has a much larger population of about 57 million people, so, far from there being one in every community, simple maths suggests that there will be 42 million people without one. To help noble Lords understand, can the Minister explain some of the maths behind this assertion about neighbourhood health centres and what this really means? There needs to be some clarification. If they do not serve the whole population and we are not going to have neighbourhood health centres everywhere, on what basis will they be set up? Who decides where they will be? How do we make sure that they are located on the basis of need or deprivation rather than the politics of a local area? Will they complement existing GP practices and surgical hubs, and how do we make sure that there is no duplication? On prevention, we all know that we must tackle the obesity crisis and the ill-health crisis. The problem is that quite often we are tempted to go for top-down solutions. We like to say, “Let’s ban this and let’s ban that”, but when I speak to local community civil society organisations, which work with people in local communities to encourage them to eat healthily, they are very sceptical of a lot of these top-down measures. I think of a project like BRITE Box, near where I live in south London, which goes into family homes and delivers healthy ingredients and an easy-to-read menu that children can enjoy and teaches families to cook healthily together. Surely we need to get healthy eating, healthy cooking and the sharing of meals into family homes, particularly those in deprived communities, rather than adopt a top-down solution from Whitehall or Westminster. I would have liked to see more about how we engage the power of the community and civil society at local-community level to tackle many of these issues. Finally, there is one omission in this plan: fracture liaison services. There is only one mention of it, on page 165. That is rather disappointing, because I remember in June last year, before the last election, the current Secretary of State for Health said that he would take “immediate action” on fracture liaison services. Of course, we had to give the Government time to bed in, but it has now been a year, and we have got the 10-year plan, and there is nothing concrete on fracture liaison services. This is an easy win for the Government, because the savings to be gained from the rollout of fracture liaison services will be realised in two or three years—easily within the political cycle and easily before the next general election. If the Minister does not have the answer to all these questions, she can write to us and deposit a letter in the Library. We look forward to her replies.

My Lords, we on these Benches welcome the Minister to her place. I know that, when I say that we hope that she is not too long in her place and that the noble Baroness, Lady Merron, is with us again soon, she will understand that I say it in the nicest possible way. From these Liberal Democrat Benches, our unwavering commitment to the NHS remains absolute. We welcome any stated ambition to improve the health service, particularly with a focus on prevention, leveraging technology and moving care closer to people’s homes. However, our support is contingent on plans being genuinely deliverable, properly funded and, crucially, addressing the interconnected crisis in social care. We have long championed that you cannot fix the NHS without fixing social care. I confess that, as I read the Government’s new 10-year plan, a familiar echo resonated through my mind. Having started my career in the early 1990s as a manager in the health service, much of what is proposed sounds eerily familiar. This plan speaks of a network of new neighbourhood-based care that provides services between general practice and traditional general hospitals. This mirrors strikingly similar initiatives from previous governments—echoing, for example, the advocacy of the noble Lord, Lord Darzi, for polyclinics in 2007. What does history teach us about such wholesale shifts of care from hospital? It tells us that this inevitably involves running the old and new systems simultaneously, which is, without exception, expensive. Hospitals will continue to perform their essential functions, and their fixed costs will remain. The new community service demands significant new investment in buildings, staff and technology, and there are no immediate savings to fund the shift. Let us not forget the stark reality: we currently lack the capital simply to repair our existing crumbling health estate, let alone build numerous new hubs. Crucially, for any plan that speaks of shifting care out of hospitals, the most frequent users of the NHS are our elderly population. Keeping them well and out of acute settings profoundly depends on effective social care, yet this essential pillar remains largely absent from this new plan. We search in vain for a decade-long funding and development road map for social care, or for a stand-alone, fully resourced social care strategy. This is a crucial strategic failure, undermining the very foundation upon which this shift to community is based. Moreover, while the enthusiasm for digital transformation is understandable, the detailed implementation plan of how to do it is absent. The app is a diagnostic tool; it does not provide direct care, it does not give the jabs and it does not provide the treatment. The King’s Fund has shared its concern on this: “AI scribes can only transform the productivity of the NHS if staff don’t need to spend 30 minutes every morning logging into multiple out-of-date IT systems”. The fundamental question remains unanswered: how will this be delivered? The plan is ambitious, but it has been launched into an incredibly chaotic delivery environment marked by significant structural change within the health system bureaucracy. The key question for the Government is how this will be delivered. I therefore have a few questions for the Minister. What precise funding strategy is embedded within the 10-year plan to deliver the necessary reform and integration of adult social care? Given the dual running costs of new neighbourhood health facilities, can the Minister provide a year-by-year financial breakdown of expenditure and demonstrate how these investments will lead to overall system efficiencies and net savings? Will the Minister commit to publishing within the next four months a comprehensive, independently overseen delivery road map for this 10-year plan that details specific year-by-year objectives and names leads and mechanisms for public reporting on progress? While we wish the ambitions well, the key challenge for this Government is how they will deliver and being open and transparent on that.

My Lords, I also start by sending my very best wishes to my noble friend Lady Merron. No one more than me is looking forward to her making a very speedy recovery. I am very pleased to hear from her that she is making good progress, so we look forward to her return. I think it is appropriate that I declare an interest: my son is a GP, which I think is perhaps slightly relevant to the debate before us today. To recap before I go into more of the details, I emphasise that this plan is different in so many ways to the NHS plans that have come before it. As we have heard, it is a road map for radical reform that is built on three fundamental shifts. Those of us that have been around the health agenda for a while recognise the past aspiration for some of these measures, but there was never a bold, innovative, collaborative plan to take our ambitions forward. From hospital to community care, bringing care closer to home and making access to GPs faster and simpler is absolutely fundamental, particularly in the current climate—and from analogue to digital, giving staff modern tools and patients the kind of convenience and control they expect elsewhere in their lives. All of us have heard heartbreaking stories of patients who go from one specialist to another, and there is not that join-up. This has to be changed. There is no reason why this cannot apply across all the experiences the public have, regardless of where they are seeking services. Many of us have been talking about the need to move to prevention in so many areas of life. Where better than people’s health, looking at the root causes of poor health and making healthy choices? It is the easy choice, but at the moment it is not that easy. The new NHS has patients at its heart, will deliver equity and quality, is devolved and decentralised so that we are more responsive to local community needs and the front line is freed up to harness innovations, and the rules and incentives in the system support clinicians and lead us locally to be able to make the right decisions. This means that there is no simple chapter or section within the plan for individual conditions or groups setting top-down actions. The impact on particular services and outcomes will be through successfully transforming how our health ecosystem works. As we will come on to with the more specific questions, this is very much a work in progress. I am delighted by the reach the consultation has had over the last year. That has informed the debate and the outcome that is seen in the plan, so there have been no surprises. Many people who have been involved recognise what is in the plan. The plan is backed by £29 billion per annum of extra investment by the end of the review period and, crucially, by a drive to cut unnecessary bureaucracy and empower front-line staff, giving them the tools to do what they do best: caring for patients. I thank the noble Lord, Lord Kamall, for his very constructive comments; they were exceptionally helpful. Across the House, we all look forward to taking this extremely seriously and moving forward. Turning to the comments of the noble Lord, Lord Scriven, on social care, he and I share a very positive background in local government, and nothing could be closer to our hearts than working out how we are going to bring the two together. That is fundamental. Both noble Lords made the point very clearly, and we welcome that. Over the next three years, we will focus on the neighbourhood health approach to those most let down by the current system. That includes older people with frailty and those in care homes. Social care professionals will work alongside NHS staff in local teams, supporting recovery, rehabilitation and independence. We have examples from around the country where this is already happening: services are joined up and the cultural differences between the NHS and local government have been successfully broken down. We need to make sure this is replicated and spread to every part of the country. We need to enable care professionals to take on many more health-related responsibilities, such as blood pressure checks and reducing avoidable hospital administrations. Of course, pay terms and conditions have to be improved through fair pay agreements. In the longer term, the noble Baroness, Lady Casey, will produce an interim report next week, but it is very much a work in progress.

It will be next year.

Sorry, I meant next year—I was just testing that everyone was still with us—in anticipation of the in-depth work she is already involved with. There will be cross-party discussions and a real engagement with stakeholders. On the single patient record, I will have to write to the noble Lord about how the merging of the different systems will be achieved, but it will very much be about the patient being in control and giving a full picture for staff moving forward. The digital red book for children is absolutely fantastic. On the shift to the community, as we have made clear, we will initially prioritise those living in areas of greatest deprivation. We will be opening neighbourhood health centres in places where life expectancy is low. There will be principles that we will follow, bringing all the multidisciplinary teams together. On the fracture liaison service, I will have to respond in writing. I am sorry but I do not have the specific details in front of me. Returning to the noble Lord, Lord Scriven, and his comments about social care, it is critical that we get this right and make sure that local leaders are right in there, responsible for delivery, proactive, providing a co-ordinated response and building on the work already being done. On the funding, £29 billion is quite a significant amount of resource to work from. We recognise that there are challenges, and it would be wrong of me to pre-empt the work of the noble Baroness, Lady Casey. But I know she has been encouraged to work with the best of the best, and I look forward to the outcomes. I have to finish—I am sorry; there is never enough time. Our health system is in crisis, and we need to act now. We must make sure that the NHS continues as a publicly funded service free at the point of use. We need to seize the opportunities provided by all the new technologies and medicines outlined in the plan, go forward with innovation and make sure that the patients are at the heart of everything we do.

20:17:00

My Lords, from these Benches, we too send best wishes to the noble Baroness, Lady Merron. The stress on prevention in this plan is welcome, but it does not adequately address the commercial determinants of ill health. On every high street there is alcohol for sale which does not have minimum unit pricing, and that is not coming in. There are vape shops and betting shops, and poor quality ultra-processed food is the food available for purchase. Putting the onus on the individual under the name of choice is unfair when they do not have anything reasonable to choose from that they can afford. I really push the Government to look at these broader commercial determinants of ill health. I was disappointed that palliative care was mentioned only once, because the Commission on Palliative and End-of-Life Care has shown that good care is less costly than poor care. It can avoid inappropriate admissions to hospital and support people to live well. When at peace emotionally and physically comfortable, they can gently let go of life and die gently in the place of their choice, which is usually their home. But for care at home, they need support 24/7. My concern has been that the plan does not really emphasise that there are times at nights and weekends when AI and technology are not the answer. You need a person who is available to come out and provide help and support to someone in the home. I hope that in the neighbourhoods, the 24/7 need will be addressed and that there will not be an excessive reliance on AI, thinking that it will be the answer to everything. I look forward to hearing the response.

I thank the noble Baroness for her questions and for her best wishes to my noble friend Lady Merron—I am sure that she will receive them. I thank her for bringing up the commercial determinants of health, which are critical. I reassure her that, outside of the health scenario, an enormous amount of work is happening. The NHS is going to work much more closely with local government—which has responsibility for trading standards, for example—and other local public services. We have certain things in place. Come the autumn, we will be bringing back the Tobacco and Vapes Bill, for example, with its huge opportunity to create a smoke-free generation. We are restricting junk food advertising targeted at children, banning the sale of high-caffeine energy drinks to the under-16s, and we will be the first country in the world to introduce mandatory health food sales reporting for all large companies in the food sector. The noble Baroness raised a few questions. I have to be brief to give other people the opportunity to come in, but palliative care is a real priority moving forward. I will leave it there, but I am happy to pick up anything that I have missed with her outside the House.

My Lords, I welcome the Minister to her place and, like others, send good wishes to the noble Baroness, Lady Merron. I welcome very much, as others have done, the three aspirations in Fit for the Future. I think that they are significant and that they are the right ones. I think they are bold and visionary. However, while I welcome the move from analogue to digital, for me, the document raises significant questions. We are looking to build a National Health Service which cares for whole people, not machines. We need, therefore, to be concerned for physical, mental, emotional and spiritual health, at every stage of life, across the NHS. That demands continuous investment in people, including, of course, chaplains. I have specific questions around the ethics, governance and provision of technology. Where will process and governance responsibility lie for data storage? Will the Government continue to outsource this to Palantir or another provider, or will we build and maintain the NHS’s own secure provision? I am mindful that our data stored by the NHS is a hugely valuable commercial asset. Where will the ethical debates take place around, for example, the proposal that newborns will undergo wholesale genetic sequencing from birth from 2035, which seems to raise massive issues for our society? The document as it stands, it seems to me, is wholly positive about technology—it is techno-optimism. Will the Minister please balance this by telling us about the safeguards, reservations and governance that the technology needs in order to deliver the human, humane and kind care that we need?

I thank the right reverend Prelate for his very thoughtful contribution. It is particularly of the moment, and I completely recognise everything he said about this needing to focus on people. We have to look at this technology as enabling better care and freeing up time. How many of us go to the GP and experience frustration at the restriction on the time that we are allowed to spend with the GP, because so much of their time is taken up with admin? Of course, data protection is central. The health service is not the only area where we are looking at systems of data protection, and the normal protection methodology will be brought to bear. We have to make sure that, in governance, there is a much more transparent and open style, which, frankly, we all have to admit has been missing in some cases. This is an opportunity to look at that. I must admit that I will have to have a conversation about where the ethical discussions will actually take place, but I know that, throughout the professional bodies, these considerations are taken into account all the time. It is fundamental. The direction of travel is to have people at the centre, building the workforce, so that they have the opportunities to thrive and do their jobs to the best of their abilities for their patients.

My Lord, this is a pot-pourri of worthy aspirations, with the most extraordinary sense of déjà vu: hospital to community; sickness to prevention; a patient-driven NHS; league tables; foundation trusts; funding following the patients and outcomes. I was a contemporary of Alan Milburn, and he is behind this; these were all measures that we were discussing long ago. Maybe they have not been sufficiently implemented—and I so welcome the noble Lord, Lord Scriven, asking where the timetable and implementation plan are, and how this is going to happen. But I must leap forward to the most serious issue of the day. We are all united on the importance of the NHS. It is incredibly difficult to change it, manage it and lead it. How can it be right for resident doctors to be taking industrial action for five days later in July? They have had an incredible increase compared with other members of the public sector, and the Government have said that they will help them on their work conditions. For those who say that their greatest pride is in helping patients, this is a shocking state of events—in a career that people want to join and that has long-term respect. Will the Minister ensure, very specifically, that the department checks up on whether any junior doctor taking industrial action then moonlights in another health authority, or in a private health provision, so that while they are taking industrial action they are also earning, at a premium rate, making up the gap left by the other doctors on industrial action?

As someone who has been involved in the plan, I start by saying to the noble Baroness that although it might echo things that have happened in the past, there is an enormous difference now. There is a depth of collaboration, bringing people together and recognising the different cultures in organisations. Of the 200 bodies that are going to be dismantled, Healthwatch is one; it has been very positive and has contributed to the future plan for how this is all going to look. There has been a step change in how we get out and work with people. It is a very ambitious plan, which I am pleased about. I am also very optimistic, because, quite frankly, too many professionals have gone too close to the edge and they realise what is on the other side if we do not all pull together and do something about this. We are disappointed about the BMA decision to strike. The majority of resident doctors did not vote to strike, and threatening strike action that could harm patients will set back progress. I assure the noble Baroness that no one on these Benches is welcoming the strike. The basic truth is that, thanks to this Government, resident doctors have received a 28.9% pay rise compared to three years ago, and the highest pay award in the entire public sector this year. The Secretary of State met the BMA yesterday. Although he has made it very clear that the Government cannot go further on pay than we already have this year, he has offered to work with resident doctors to resolve issues they might face around working conditions. It will, of course, be down to their managers to work with staff to come up with a plan to deal with the action that is being proposed.

My Lords, I add my welcome for this 10-year plan. I also welcome my noble friend to her position and send my best wishes to the Minister, the noble Baroness, Lady Merron; I hope she recovers very quickly. Like the noble Lord, Lord Scriven, I can see some echoes—or important themes—that the 10-year plan picks up. I was particularly interested to think about how the themes in the 10-year plan will dovetail with what I hope will be a new cancer plan that will come out in the autumn. I am particularly interested in how, for example, prompt diagnosis will be promoted. Are we going to think about stratified screening, with faster diagnosis targets, or faster access to clinical trials for patients with cancer, or speeding up access to modern medicine so that we can have those cutting-edge treatments widely available? All that is set out in the 10-year plan and the investment—particularly the capital investment, which I welcome—leads me to believe that I can feel very optimistic about what is coming down the track in the autumn. I hope the Minister can give me some assurance. After all, one in two of us may go on to develop cancer in our lifetime, and that is an awful lot of the population.

I thank my noble friend for her interest. Of course, the 10-year health plan sets out how we will fight cancer on all fronts. She is quite right that the national cancer plan is going to be published later this year, setting out in detail how we will increase survival rates through early diagnosis and access to better-quality treatment, and how we move forward with care in the community to help with lives beyond cancer. There is a great deal of detail behind this; I cannot go into it now, but I am happy to discuss it.

My Lords, I welcome the emphasis in the plan on community mental health services and the shift towards 24/7 neighbourhood working. But for this to work, it will have to be achieved by significant rebalancing of resources towards community services. The share of overall NHS spending on mental health has fallen for the last two years and is expected to fall again this year. Although I looked hard in the plan for any reference to the mental health investment standard, I could not see it. Can the Minister tell us what is happening to the standard?

I do not have that specific information to hand, but I am very happy to write to the noble Baroness. Mental health is written throughout the plan, for both adults and children. All the work we are doing in schools—opening up access and making sure that mental health is treated in the way that it needs to be—is one of the major commitments that we have made through the plan.

My Lords, the Minister has very kindly said that she will write to my noble friend Lord Kamall about fracture liaison services. I declare an interest as someone with a rather painful bone condition, and I am delighted that they were mentioned in the 10-year plan. In her letter to my noble friend, can she include an explanation as to an implementation plan and when it will be introduced? When will follow-up pump-priming to support the implementation plan be announced?

I would be delighted to add those details to the letter. I am very sorry to hear about the noble Lord’s condition and its pertinence to this part of the debate.

My Lords, I welcome this plan. As some will know, my colleagues and I have been working in this space for over 40 years, trying to encourage a move into our communities of a more joined-up approach. Are colleagues in the health department talking to colleagues about the Planning and Infrastructure Bill? Our work is now right across the country, in many communities, and we still see that lessons are not being learned. You still have major developments where the health centre is at one end of a site, the nurse is at another, the school and the community buildings are somewhere else—none of it is joined up. All this disconnection is at great expense. How, at this important moment, can steps be taken to try to join up these conversations? How can we try to ensure that in the Planning and Infrastructure Bill there are messages from the health service about the important need to enable this?

I am very aware of the noble Lord’s work in this area, particularly on regeneration. As the plan outlines, looking at the new neighbourhood provision, and how to bring different neighbourhood and community services together, gives us a fantastic opportunity to make sure that the whole community is considered—for example, it will look at connectivity with the centres, which has not always been the case in the past. It is a great opportunity and I am very much aware that our colleagues in planning, and MHCLG generally, are involved in our discussions.

My Lords, I recently had a major operation by robotic surgery. It was very successful; I was out and at home within two and a half days. How will the rollout of this happen? For example, I happen to know that the Royal College of Surgeons at the moment offers only one online module on robotic surgery, which seems to me to be not adequate. What conversations are going on to make sure that this can be delivered?

Robotic surgery is one of the areas generating enormous excitement, and I was very interested to hear of my noble friend’s experiences. I assure her that conversations are taking place, and I know that they will be part of the plan when we come to talk about delivery.

My Lords—

My Lords—

My Lords, if so many people want to speak, we should have a full debate on this plan, which is generally welcome. On digital, the plan summarises various digital improvements. There is also a red book for a child’s health, and feedback from Fitbits and data, which is all very good. However, there is no timescale for any of this and no plan to make patient records from GPs or hospitals available and viewable on the NHS app by the patient, as is the case in other countries. When will the Government give patients open access, as opposed to control by NHS professionals?

I hoped I had made it clear that this is the broad outline. Of course, more specific details will come forward and we will have the opportunity to debate them as they do so. The noble Baroness raises important points about challenges as well as great opportunities. I look forward to those debates; I think we are on a very positive way forward. However, I hope everyone understands that this is a 10-year plan for very good reason. We realise the scale of the challenges that face us, and we look forward to getting on with implementation.

My Lords, we are not going to resume until 8.42 pm, so we have four minutes.

My Lords, we have had three Cross-Benchers; perhaps we could hear from a Liberal Democrat.

My Lords, we are not due to return to the House of Lords (Hereditary Peers) Bill until 8.42 pm. The time allocated for Statement repeats is very clear in the Companion: 20 minutes for Front-Benchers and 20 minutes for Back-Benchers. We have now exceeded that allotted time so, as we were not due to return to the Bill until 8.42 pm, the House will adjourn during pleasure until that point.

20:39:00

Sitting suspended.