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Rail Minister Paul Maynard replies that since the tram extension opened last year "it is already boosting the local economy and supply levels".

While there are "immense number of positives" from the project he concedes that it has "caused disruption".

He says a "lessons learned report" will be published shortly.

And that is the final comment in the House of Commons, MPs will be back at 9.30am tomorrow for Transport questions.

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Former business minister Anna Soubry says while she is "not anti-tram" she is "anti what has happened".

The infrastructure project cost "£570m, came in eight months late" and left important shopping areas "in a stranglehold of construction", leading to lost business. 

She calls for ministers to "look at what has happened" to make sure "what has undoubtedly been a nightmare" does not happen again.

The people in the area felt they had no voice because groups using aliases on-line and offline "had created a bad atmosphere", she says. 

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And with that we turn today's adjournment debate - the final business in the Commons - on the Nottingham Express Transit phase two tram extension to Toton, led by Conservative MP Anna Soubry.

While she is not "anti-tram", she says the tram extension has been "an unfortunate and unacceptable tale of woe for two years and eight months". 

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MPs have voted against endorsing Labour's motion criticising the NHS Sustainability and Transformation Plans by 280 votes to 195. 

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David Mowat runs out of time and the Labour motion is put to a vote. 

There's no clear winner in the oral vote to a division is called to allow MPs to file out of the chamber and register their vote in person. 

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Care Minister David Mowat says the Labour party appears to "genuinely believe that an organisation that provides care to 45 million people should not do planning".

The STP is a "planning mechanism" that creates a NHS that is "care driven, properly funded and locally driven", he says. 

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Shadow health minster Justin Madders says STPs represent "yet another" reorganisation of the NHS, but with the added concern of taking place "behind closed doors".

The STP footprints are simply replacing the "strategic health authorities" introduced by Labour and "scrapped by the Coalition", he says. 

STPs are being asked "to go further than anyone has ever done before" in finding efficiencies, but have "no statutory basis", have seen no consultation and "no public scrutiny", he adds. 

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Labour MP Margaret Greenwood argues that STPs are "a key part of the government's plans to drive through privatisation".

The 2012 Health and Social Care Act removed the duty of the Health Secretary to secure a comprehensive health service in the UK, she tells MPs.

Given the savings they are being asked to make she argues that STPs are "vehicles for cuts", being "carried out in private" and being delivered "at arm's length from the Secretary of State" who no longer has responsibility.

This set of circumstances is the "final piece of the privatisation puzzle", she argues. 

She calls on the government to "put up their hands and admit they've been rumbled".

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Conservative MP Jeremy Lefroy suggests increasing the higher rates of national insurance to raise funds for the NHS.

Echoing the comments of some MPs from both sides of the chamber, Mr Lefroy says "we spend too little of our GDP on health". 

This "hypothecated tax" - a tax earmarked for a certain purpose - will directly increase the amount of GDP spent on the NHS, he says. 

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Image source, Thinkstock

As in previous years, NHS organisations are required to produce annual operational plans.

But this year "health and care systems" - made up of NHS providers, Clinical Commissioning Groups (CCGs), and local authorities - have been asked to produce an additional multi-year Sustainability and Transformation Plan (STP). 

The STP must show how local services will develop and become sustainable over the next five years – ultimately delivering the NHS Five Year Forward View vision, which includes £22bn of efficiency savings.

To deliver these plans the "health and care systems" have been divided into 44 "STP footprints", external, based on regional areas rather than around individual institutions.

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Cheryl Gillan MP asks the Cabinet Secretary about whether more could have been done before the EU referendum to make a plan which she says "felt as if the government was prepared for only one outcome".

Sir Jeremy says that question needs to be addressed to politicians, but he says: "There's something in our system that makes politicians very reluctant to put their names to two different scenarios."

The committee session closes with a thanks from the chair to Sir Jeremy Heywood.

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Image source, Getty Images

Before today's debate a series of NHS Sustainability and Transformation Plans were leaked to the BBC, which proposed ward closures, cuts in bed numbers and changes to A&E and GP care in 44 areas.

NHS England, which needs to find £22bn in efficiency savings by 2020-21, said reorganising local services is essential to improve patient care.

The STPs are being drawn up by local health and social care leaders, and many remain unpublished.

They were asked to find potential savings and efficiencies at the end of last year to meet financial targets set out by the former Chancellor George Osborne and NHS England head Simon Stevens.

Read more here.

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The Chair of the Health Committee, Sarah Wollaston, complains that government have not been open with the public about the NHS Sustainability and Transformation Plans.

She says it is a shame that the plans were "leaked to the press" leading to the hashtag #SecretNHSPlans, external - "that's no way to create genuine engagement".

"Every major re-organisation of the NHS has shown that if you take people on the journey with you they are more likely to support it," she tells MPs.

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SNP health spokeswoman Philippa Whitford says she "welcomes" the NHS Sustainability and Transformation Plans (STPs) - which mirror the health system in Scotland.

This is chance to "stop the fragmentation and re-integrate the NHS" as long as the public are involved at an early stage and the STP areas are chosen wisely, she says.

Though budgeting is not "the biggest sustainability issue facing the NHS" she complains that there are "perverse incentives that make people only consider their own budgets, rather than looking after everyone" in the NHS.

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Crossing over into Brexit territory, Bernard Jenkin asks why, given that Brexit was a huge subject for the civil service to deal with, and that Iraq and Afghanistan were also large complex subjects, he wonders why they were not given similar structures. 

Sir Jeremy says it is a perfectly good proposal. 

The committee then move on to discussing Brexit fully. When questioned about purdah - the 28-day moratorium before all polls - Sir Jeremy says he thinks there was an "unfortunate, innaccurate" view that the civil service was operating in a biased way. 

He goes on to say that this was "damaging" and that he wishes it had been debated more openly.

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Health Minister Philip Dunne says he will seek to "correct some of the misconceptions revealed" by Diane Abbott's speech.

In 2015 the NHS leadership asked for £8bn of additional cash "in excahnge for £22bn of efficiency savings up to 2020", he tells MPs.

Hospitals have been asked to "come together with their providers across health economies to develop a strategy for addressing challenges in their areas" which will form the Sustainability and Transparency plans (STPs) .

He says there have been "no proposals at this point", but adds that all proposals will be "subject to a public consultation".

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Diane Abbott is steadfastly refusing to take multiple requests to intervene from the Conservative benches, but has taken a few from her own side, much to the increasing annoyance of Tory MPs.

Trying to make a point, Conservative MP Richard Fuller raise a point of order to ask if ministers are required "know the difference between a debate and a monologue".

Deputy Speaker Lindsay Hoyle says that it is for him to decide and asks that there be no more "pointless points of order".

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Conservative MP Cheryl Gillan asks Sir Jeremy Heywood when the civil service will have a pronouncement on the lessons learnt from the Iraq inquiry and now the Libya report.

Sir Jeremy says work is underway, but he doesn't know. 

Mrs Gillan says: "It won't be several years like the Chilcot report will it?"

Sir Jeremy says he hopes it will be a matter of months, not years.