Philip Dunne responds to NHS funding debate

22nd November 2016
Philip Dunne reponds on behalf of the Government to a debate on the funding of the NHS.

I am very pleased to be able to close what the hon. Member for Ellesmere Port and Neston (Justin Madders) described as an interesting debate I would describe it as an occasionally high-pitched debate, to which a number of Members made constructive contributions. I must say to the hon. Gentleman that those constructive contributions came from the hon. Member for Central Ayrshire (Dr Whitford), who made a characteristically impressive speech, and from Back Benchers on my side of the House, whose contributions, I might add, outnumbered those from Back-Bench Labour Members by four to three—or one third—although this was an Opposition day debate. Where are the Labour supporters for the motion, I ask the hon. Gentleman? We shall have to see whether they turn up to vote; they certainly were not prepared to turn up to speak.

The funding of the NHS is clearly a subject that is close to the hearts of most Members in the Chamber, precisely because it, along with the contribution of all who work in the NHS—to whom I pay tribute, as did the Secretary of State, but as the hon. Member for Ellesmere Port and Neston failed to do—is what keeps the NHS going. The Government are committed to the NHS, and committed to ensuring that it is free at the point of use.


On a point of order, Mr Deputy Speaker. Is it in order for the Minister to imply that there was a lack of interest among Labour Members, given that the speaking time limit was cut to four minutes, and then—


Order. It has been put on the record, and it is a matter of public record, but I will say that speeches were made by nine Opposition Members and eight Government Members. Speeches were made by six Labour Members and eight Conservatives. That may help the House, and may prevent any further arguments.


Mr Deputy Speaker, the facts speak for themselves, as you have just told us: eight Conservative Back Benchers and only six Labour in an Opposition day debate—what a shambles.

I do not question the fact that the NHS faces a significant challenge. Increasing demand for healthcare is a consequence of our ageing and growing population. It is our determination to look after each and every NHS patient with the highest standards of safety and care. These all contribute to the challenge, but, despite increasing pressures, the NHS is rising to meet this challenge, carrying out more than 5,000 operations every day compared with 2010, and handling 780,000 more accident and emergency attendances in the second quarter this year. That is 15.1% more than in the same quarter in the last year that Labour was in office. Today it is the Conservative party that is the party of the NHS. That is why we pledged more than Labour and why we are delivering more funding, with a higher proportion of total Government spending going into health in each year since 2010.

Some hon. Members have drawn international comparisons on spending. I gently remind the more excitable Opposition Members that, according to the OECD, total health spending in the UK for 2014 is 9.9% of GDP, which is 10% above the OECD average of 9% and just above the EU15 average of 9.8%.

Several hon. Members have today also questioned the figures around the rises in funding that we are providing over the term of this Parliament. I welcome confirmation from my hon. Friend the Member for Totnes (Dr Wollaston), the Chairman of the Select Committee, that she can see how the Secretary of State arrives at his figures, and she graciously conceded that both sides are correct. I want to focus directly on the straightforward maths.


All I clarified was that the way it had been arrived at is not a way that the public would understand health spending, so I think the Minister is perhaps taking my words out of context, if he will forgive me.


We never claimed that we were increasing the Department of Health’s budget; we were talking about the increases to the NHS. For complete clarity, in 2014-15 the NHS budget was £98.1 billion; in 2020-21, it will be £119.9 billion. For Opposition Members who cannot do the maths, that is a £21.8 billion increase in cash terms to NHS England, or £10 billion in real terms. We promised £8 billion; we are delivering £10 billion.

We also listened to NHS leaders’ requests for a front-loaded settlement and delivered on that—it was welcomed by hon. Members in today’s debate—with £6 billion of the £10 billion increase coming by the end of this year, including a £3.8 billion real-terms increase in this year alone.

We have also created a £1.8 billion sustainability and transformation fund for the current year to help providers to move to a sustainable financial footing. This fund will mainly be allocated to emergency care provision, which faces some of the greatest demand growth and financial pressures within the system.

This brings me to the next important point I want to address. While more funding is obviously welcomed, hon. Members have drawn attention to rising deficits in the budgets of NHS providers. We recognise that stronger financial management is required to turn this situation around, and we have introduced robust governance arrangements to get things back on track. There are four main elements to this plan: extra investment in the spending review, as I have discussed, and freeing up local government to spend more on adult social care; restoring financial discipline in the short term, through the measures set out by NHS England and NHS Improvement in July, with a wide-ranging set of actions; reducing demand for acute care in the longer term; and driving efficiency and productivity across the provider sector, building on the work of Lord Carter, who has identified large variations in efficiency across non-specialist English acute hospitals, and controlling cost pressures. The need to reduce variations was raised by my hon. Friend the Member for South West Bedfordshire (Andrew Selous) in his very constructive contribution, and by the hon. Member for Strangford (Jim Shannon). We agree that we need to reduce the variability in the poorly performing trusts and bring them up to at least the average standard, if not higher.

We are now beginning to see the first fruits of the plan, with the publication last Friday of the figures for the second quarter deficit, which has been reduced to £648 million, down from £1.6 billion in the same period last year, representing a £968 million improvement. Progress halfway through the financial year is therefore encouraging, but there is no room for complacency. That is why the system needs to stick to its strong financial plan, supported by our investment and by a series of measures set out to help hospitals to become more efficient and to reduce the use of expensive agency staff.

Several hon. Members talked about the sustainability and transformation plans, 28 of which have now been published. The remainder will be published by the end of next month. Half of the Labour Members who spoke in the debate talked specifically about the STP covering Cheshire and Merseyside. It was disappointing that only one of those three Members was able to attend the Westminster Hall debate earlier today in which we discussed conditions in Cheshire and Merseyside. I remind Labour Members that that STP was led by the chief executive of Alder Hey hospital in Liverpool, with whom I would strongly encourage hon. Members who are complaining about a lack of engagement to have a conversation.


Will the Minister give way?


No, I will not. I also remind all Members of the House that any reconfiguration proposals—


Will the Minister give way?


Order. If the Minister is not going to give way, the hon. Lady will have to sit back down.


The Minister should not talk about something like this and then refuse to give way.


Unfortunately, it is for the Minister to choose.


Thank you, Mr Deputy Speaker.

I remind all Members of the House that any reconfiguration proposals that emerge from the STPs will be subject to statutory consultation, and I encourage all Members to—


Will the Minister give way?


I have already said that I will not give way.

I encourage all Members to engage with STP leaders in their area so that they can play their full part in considering how these plans should be taken forward. I remind the House that Chris Ham, the chief executive of the King’s Fund—




Order. If the Minister wishes to give way, he will do so. The bottom line is that the hon. Lady is quite right to ask him if he will do so, but we cannot have people standing up and shouting—[Interruption.] We do not want people on one side saying no and people on the other side saying yes. The bottom line is, I want the Minister to get to the end. He may give way if he wishes to; otherwise, he should carry on.


Thank you, Mr Deputy Speaker. I have explained to the hon. Lady that I do not intend to give way to her. I have only a limited amount of time left, and I would like to remind her of what Chris Ham, the chief executive of the King’s Fund, said. He regards the STPs as

“the best hope to improve health and care services”.

Hon. Members referred to the role of the independent sector in the provision of NHS care. The test for commissioning decisions must always be the value provided for patients and taxpayers, not the type of provider. The vast majority of NHS care has been and will continue to be provided by public sector organisations, but Opposition Members would do well to listen to Stephen Dalton, the chief executive of the NHS Confederation, which represents commissioners and providers of NHS services, who wrote today in The Guardian, of all papers, that private and wider independent sector health care providers

“increase the system’s capacity to respond to demand, help meet waiting time targets and enable investment bring important benefits for patients—most of whom are entirely relaxed over who provides their care, so long as it’s of high-quality and remains free at the point of use.”

I entirely agree with him.

My right hon. Friend the Secretary of State and I have acknowledged that the NHS faces challenges, and I recognise concerns raised by many in the House today. As I have made crystal clear, however, this Government are fully committed to the NHS.

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