The Secretary of State for Health and Social Care (Steve Barclay)
Today we have published our new delivery plan for recovering urgent
and emergency care services, which has been deposited in the
Libraries of both Houses. Given the scale of the pandemic pressures
that healthcare systems around the world and across the UK are
collectively facing, we are building the NHS back to where we want
it to be. That requires the widespread adoption of innovation,
building on best...Request free trial
The Secretary of State for Health and Social Care ()
Today we have published our new delivery plan for recovering
urgent and emergency care services, which has been deposited in
the Libraries of both Houses. Given the scale of the pandemic
pressures that healthcare systems around the world and across the
UK are collectively facing, we are building the NHS back to where
we want it to be. That requires the widespread adoption of
innovation, building on best practice already applied in specific
trusts, together with significant investment in new ways of
working, including a £14.1 billion funding boost for health and
social care, as set out in the autumn statement.
Today’s announcement is the second of three plans to cut waiting
times in the NHS. Our elective recovery plan is already in
action, virtually eliminating the backlog of two-year waits in
England. Our primary care recovery plan will be published in the
next few weeks, to support the vital front door to the NHS
through primary care. Today, together with NHS England, we are
setting out our plans to reduce waiting times in urgent and
emergency care through an increased focus on demand management
before patients get to hospital, and greater support to enable
patients to leave hospital more quickly through care at home or
in the community, supported by a clinical safety net. In
addition, the plan sets out how we will adopt best practice in
hospitals by learning from the trusts that have displayed the
greatest resilience in meeting the heightened pressures this
winter.
Today’s announcement on urgent and emergency care does not sit in
isolation, but is part of a longer-term improvements plan that
builds on the legislative change enacted last year to better
integrate health and social care through the 42 integrated care
boards, which became operational in July. That was prioritised
for additional funding through the £14.1 billion announced for
health and social care in the autumn statement. Following the
quick spike in flu cases over Christmas, with in-patient flu
admissions 100 times that of the previous year and a sevenfold
increase in December, we announced £250 million of immediate
funding on 9 January for the pressures this winter, giving extra
capacity to emergency departments to tackle the issue of patients
who are fit to leave hospital but are delayed in doing so.
Today’s plan, developed in partnership with NHS England and
social care partners, builds on the actions and investment that I
set out to the House earlier this month as we put in place the
more substantive changes required to enable the NHS to have
greater resilience this time next year. To do that, this plan
involves embracing technology and new ways of working to
transform how patients access care before and after being in
hospital. That in turn will help to break the cycle of emergency
departments in particular coming under significant strain in
winter.
Our plan has a number of commitments that are both ambitious and
credible. First, we are committing to year-on-year improvement in
A&E waiting times. By next March, we want 76% of patients to
be seen within four hours. In the year after that, we will bring
waiting times towards pre-pandemic levels. Our second ambition is
to improve ambulance response times, with a specific commitment
to bring category 2 response times—those emergency calls for
heart attacks and strokes—to an average of 30 minutes by next
March. Again, in the following year we will work to bring
ambulance response times towards pre-pandemic levels. I am
pleased that the College of Paramedics has welcomed the plan,
saying that it is
“pleased to see a strong focus in the recovery of those people in
the Category 2 cohort”.
Of course, this will not be the limit of our ambition, but it is
vital that we get these first steps right and that we are
credible as well as ambitious. To put these targets in context,
achieving both would represent one of the fastest and largest
sustained improvements in the history of the NHS.
Underpinning these promises is one more essential commitment: a
commitment to better data and greater transparency. On data, the
best-performing hospitals have benefited from the introduction of
patient flow control centres to quickly identify blockages in a
patient’s journey, and e-bed management systems to speed up the
availability of beds when they become free. Through this plan, we
will prioritise investment in improving system-wide data, both
within the integrated care boards and on an individual trust and
hospital site basis. This will allow quicker escalation when
issues arise and a better system-wide response when individual
sites face specific challenges.
On greater transparency, for some time voices across the NHS have
called for the number of 12-hour waits from the time of arrival
in A&E to be published. This is something I know the Royal
College of Emergency Medicine has long campaigned for—I can see
the hon. Member for St Albans () nodding her head—and there
has been criticism of the Government, including from Opposition
Members, for refusing to provide this transparency. Instead, the
data published to date has been a measure of 12 hours from the
point of admission rather than from arrival in A&E. For the
commitment to transparency to be meaningful, we must be prepared
to publish data, even when that transparency will bring
challenges, so today I can inform the House that from April we
will publish the number of 12-hour waits from the time of
arrival. Dr Adrian Boyle, the president of the Royal College of
Emergency Medicine, has previously said:
“The full publication of this data will be an immensely positive
step that could be the catalyst for transformation of the urgent
and emergency care pathway that should help to improve the
quality of care for patients.”
I hope this transparency will be welcomed across the House.
Our plan focuses on five areas, setting out steps to increase
capacity in urgent and emergency care; grow the workforce; speed
up discharge; expand and better join up new services in the
community; and make it easier for people to access the right
care. Action in each area is based on evidence and experience,
learning lessons from the pandemic and building on what we know
can work. More than that, we are backing our plan with the funds
we need, and the Government are committing to additional targeted
funding to boost capacity in acute services and the wider system.
That is why this package includes £1 billion of dedicated funding
to support hospital capacity, building on the £500 million we
have provided over this winter to support local areas to increase
their overall health and social care capacity.
Taken together, this plan will cut urgent and emergency care
waiting times by, first, increasing capacity with 800 new
ambulances on the road, of which 100 are new specialised mental
health ambulances. This comes together with funding to support
5,000 new hospital beds, as part of the permanent bed base for
next winter.
Secondly, we are growing and supporting the workforce. We are on
track to deliver on our manifesto commitment to recruit more than
50,000 nurses, with more than 30,000 recruited since 2019. The
NHS will publish its long-term workforce plan this year. We are
also boosting capacity and staff in social care, supported by
investment of up to £2.8 billion next year and £4.7 billion in
the year after.
Thirdly, we are speeding up the discharge of patients who are
ready to leave hospital, including by freeing up more beds with
the full roll-out of integrated care transfer hubs, such as the
successful approach I saw this morning at the University Hospital
of North Tees.
Fourthly, we are expanding and better connecting new services in
the community, such as joined-up care for the frail elderly. This
includes a new falls service, so that more elderly people can be
treated without needing admission to hospital.
Virtual wards are also showing the way forward for hospital care
at home, with a growing evidence base showing that virtual wards
are a safe and efficient alternative to being in hospital. We aim
to have up to 50,000 people a month being supported away from
hospital, in high-tech virtual wards of the sort that Watford
General Hospital has been pioneering, as I saw last month.
Finally, we are improving patient experience by making it easier
to access the right care, including a better experience with NHS
111 and better advice at the front door of A&E, so that
patients are triaged to the right point in the hospital without
always needing to go through the emergency department—this new
approach can currently be seen at Maidstone Hospital, as I saw
earlier this month.
These are just some of the practical improvements already being
delivered in a small number of trusts that, through this plan, we
will adopt more widely across the NHS and, in doing so, deliver
greater resilience ahead of next winter.
I am pleased that NHS Providers has welcomed today’s plan, and
that the Royal College of Emergency Medicine has called it
“a welcome and significant step on the road to recovery”.
Taken together with all the other vital work happening across
health and care, including our plan to cut elective and primary
care waiting times, today’s plan will enable better care in the
community and at home, for that care to be more integrated with
hospital services and for existing practice to be more widely
adopted. I commend this statement to the House.
Mr Speaker
I call the shadow Secretary of State.
3.47pm
(Ilford North) (Lab)
I thank the Secretary of State for advance sight of his
statement.
After 13 years of Conservative mismanagement, patients are
waiting longer than ever before. Heart attack and stroke victims
are waiting more than an hour and a half for an ambulance. Mr
Speaker, “24 Hours in A&E” is not just a TV programme; it is
the grim reality for far too many patients. Some 7.2 million
people are waiting for NHS treatment. Why? The front door is
broken—people are finding it impossible to get a GP
appointment—so they end up in A&E. At the same time, the exit
door is broken because care in the community is not available.
Patients are trapped in hospitals, sometimes for months. Between
the two is a workforce who are overstretched, burnt out, ignored
by Government Ministers and forced out on strike.
Does this plan even attempt to get patients a GP appointment
sooner? No. Does this plan restore district nursing so that
patients can be cared for in the comfort of their own home? No.
Does this plan see Ministers swallowing their pride and entering
negotiations with nurses and paramedics? No. And does this plan
expand the number of doctors and nurses needed to treat patients
on time again? No.
The Health Secretary said a lot of things, but he did not say
when patients can expect to see a return to safe waiting times.
His colleague the Minister for Social Care, the hon. Member for
Faversham and Mid Kent (), rather let the cat out of
the bag this morning. She was asked, “Is there any plan at all
for when we will get back to 95% of patients in A&E being
seen within four hours?” Her answer—and I am not joking—was, “I
can’t tell you that.” How can the Secretary of State claim that
his plan is ambitious and credible? What kind of emergency care
plan does not even attempt to return waiting times to safe
levels? It is a plan that is setting the NHS up to fail right
from the start—a plan for managed decline.
These targets are not plucked out of thin air; patients waiting
more than five hours in A&E are more likely to lose their
lives, and so are heart attack and stroke victims waiting more
than 18 minutes for an ambulance. Sadly, that is exactly what has
happened this winter, it is what happened this summer and it has
been going on since before the pandemic began. The four-hour
A&E waiting time target has not been met since 2015. The only
time the Conservatives have met the 18-minute target for
ambulance response times was during lockdown. What is the
Secretary of State’s ambition now? It is 30 minutes —30 minutes
waiting for a heart attack or stroke victim to receive an
ambulance, when every second counts. Is not the truth that the
Government missed the targets, so they are moving the goalposts?
They are fiddling the figures, rather than fixing the crisis.
The Secretary of State boasts that he is pouring more money
in—£14 billion, which is almost as much as his Department has
wasted on dodgy, unusable personal protective equipment—yet
standards are being watered down. So can he explain why patients
are paying more in tax but waiting longer for care? Why is it
that under the Conservatives we are always paying more but
getting less? So what is their answer? It is:
“There are so many people in hospital who wouldn’t need to be
there if we could provide quality care at home… medical science
and technology…offers a world of possibility for the NHS to
transform patient care… Virtual wards allow people to receive
hospital care at home.”
Those are not his words—that is my party conference speech! He
did not have a plan for the NHS so he is nicking Labour’s.
I am happy for the Secretary of State to adopt Labour’s plans,
but here is what he missed: you cannot provide good care in the
community, in people’s homes or in hospital without the staff to
care for people. That is the supermassive blackhole in his plan
published today: people. Virtual wards without any staff is not
hospital at home; it is home alone. So where is his plan to
restore care in the community? Labour will double the number of
district nurses qualifying every year, so can he hurry up and
nick that plan too?
Of course, good care in the community is not a substitute for
good care in hospital—we need both, now. So why, in the middle of
the biggest crisis in the history of the NHS, with hospitals so
obviously short of staff, is the universities Minister writing to
medical schools to tell them not to train any more doctors? This
is ludicrous. Labour will double the number of medical school
places and create 10,000 new nursing and midwifery clinical
placements, all paid for by abolishing the non-dom tax status. I
know that the Prime Minister might not like that last
bit—[Interruption.] Government Members are all complaining, but
they did not complain when they put up income tax. The Prime
Minister does not like it, but perhaps this would be a good time
for the Conservatives to act tough on tax dodgers. So when is the
Secretary of State going to nick that plan?
And when is the Secretary of State finally going to get his act
together and end the strikes in the NHS? Perhaps I am speaking to
the monkey when the Chancellor is the organ grinder. If that is
the case, when will we get a chance to question the real Health
Secretary on the strikes that this one is causing in the NHS?
Labour will create more front doors to the NHS and we will tackle
the crisis in social care. The Secretary of State offers sticking
plasters and by now it is very clear: only Labour can offer
patients the fresh start the NHS needs.
The hon. Gentleman started by thanking me for advance sight of
the statement, and then he made a series of remarks that simply
ignored what was in it. Even his last point shows how riddled
with contradictions the Opposition’s approach is. He says in
interviews that he supports the pay review body process—that is
the official position, or at least it was—but then he says, “No,
we should be negotiating individually with the trade unions and
disregarding the pay review process.” There is no consistency on
that at all.
The shadow Secretary of State talks about operational
performance—[Interruption.] He has just had his go; he should
listen to the answers. He says that it is about operational
performance, but in my remarks I tried to be fair and said that
these are challenges that are shared across the United Kingdom
and globally. He seems to think that they are unique to England
alone. We need only look at Wales to see that more than 50,000
people—notwithstanding the fact that Wales has a smaller
population—are waiting more than two years for their operations,
when we cleared that figure in the summer in England, leaving
fewer than 2,000 in that cohort.
The shadow Secretary of State talks about the workforce.
Obviously, he did not bother to read or listen to what was said
in the statement. We are on track to deliver our manifesto
commitment of more than 50,000 nurses. We have more than 30,000
so far. We have 10,500 more nurses in the NHS this year compared
with last year. The grown-up position is to
recognise—[Interruption.] Well, in the first five years we were
dealing with what that letter said, which was that there was no
money left. [Interruption.] Labour Members just do not like the
response, but the facts speak for themselves. We have 10,500 more
nurses this year than last year. The grown-up position, as I was
saying, is to recognise that we have an older population with
more complex needs, and that the consequences of the pandemic are
severe—they are severe not only in England, but across the United
Kingdom, in Wales and Scotland, and indeed in countries around
the globe.
The shadow Secretary of State says that the statement did not
cover the plan for GPs. Well, again, I was clear that this was
one of three plans. We had the elective plan in the summer, which
hit its first milestone. We have the second component today on
urgent and emergency care, and we will set out in the coming
weeks our approach to primary care. That is the approach that we
are taking. [Interruption.] The shadow Secretary of State keeps
chuntering. We did not have the pandemic 13 years ago.
[Interruption.] I can only surmise that he did not get his
remarks quite right the first time, which is why he feels the
need to keep chuntering now and having a second, third and fourth
go—perhaps next time.
On ambition, the shadow Secretary of State ignores the fact that
we need to balance being ambitious with being realistic. These
metrics, in the view of NHS England, show the fastest sustained
improvement in NHS history. Clearly, his remarks are at odds with
NHS England.
On funding, we are putting an extra £14.1 billion of funding into
health and social care over the next two years, which reflects
the fact that the Chancellor, notwithstanding the many competing
pressures he faced at the autumn statement, put health and social
care, alongside education, as the key areas to be
prioritised.
On virtual wards, I had not quite realised that the shadow
Secretary of State was the clinician who had invented virtual
wards. I think that the credit for virtual wards actually goes to
the staff, such as those I met at Watford, who are driving
forward that innovation. It is slightly strange that he sometimes
wants to claim ownership of something that has been clinically
led by those working on the frontline. We have recognised the
value of virtual wards, which is why, at North Tees this morning,
at Watford last month, or on various other visits, I have been
discussing how to scale up those plans.
Mr Speaker
I call the Chair of the Health and Social Care Committee.
(Winchester) (Con)
We look forward to going through the plan in detail with the
Secretary of State when he speaks to the Select Committee
tomorrow. May I just ask him about the ambition on the two-hour
response to falls at home of the frail and elderly to prevent
them from being admitted into the acute sector? Obviously, he
will know that that was committed to in the long-term plan. What
does he need to put that ambition into practice?
The funding to put that in place has been earmarked from the £2.8
billion next year. The key thing is less to do with the funding
than the accuracy of the data, which will help us to see where
there are gaps in coverage and how we get the right levels of
community response. The integrated care boards have been set up
to take an integrated approach on that. One of the best enablers
will be the control centres that the ICBs will set up, which will
allow us to get much greater visibility on where that has been
delivered and how we escalate it when it has not.
(York Central)
(Lab/Co-op)
The 300,000 vacancies in health and social care mean that,
whatever the Secretary of State puts on the table, his plans will
never be delivered. What is he doing to retain the burned-out,
traumatised staff who currently work in the NHS, to resolve their
pay dispute and to put enough money on the table to pay social
care staff enough to come and work in the service?
We recognise the huge pressure on social care; that is why, at
the autumn statement, the Chancellor set out the biggest-ever
increase in funding into social care of any Government, £7.5
billion over two years. We are putting more funding in. On the
workforce more generally, the Prime Minister and Chancellor have
committed themselves to bringing forward the workforce plan,
which will set out the longer-term ambition on workforce and will
be independently verified. In addition, we are recruiting more
staff, as I updated the House, whether that is the 3% more
doctors this year than last year, the 3% increase in nurses, or
the 40% more paramedics and 50% more consultants compared with
2010. We are recruiting more staff, but the grown-up position is
to recognise that there is also more demand.
(Bromsgrove) (Con)
I warmly welcome the plans set out by my right hon. Friend today,
but he will know that one reason emergency care faces so much
pressure is that successive Governments have not focused enough
on the prevention agenda. Indeed, last week’s news that the
Government will not go ahead with individual focused plans on
cancer, dementia and mental health has concerned many. Can he
assure this House that the Government’s new major conditions
strategy will be published promptly and will be comprehensive and
significant?
I am happy to give my right hon. Friend that assurance. I assure
the House that our commitment to the cancer mission and the
dementia mission through the Office for Life Sciences is
absolutely there. He is right that we are bringing that together
in one paper—I think we should take a holistic approach—but I
share his ambition on prevention. In early January, I set out a
three-phased approach: first, the £250 million immediate response
to the pressures we saw from the flu spike over Christmas;
secondly, as I announced today, building greater resilience into
the system looking ahead to next winter; and thirdly, the major
conditions paper on prevention, which is about bringing forward
the innovative work that colleagues are doing through the Office
for Life Sciences to impact the NHS frontline much sooner than
might otherwise have been the case.
(Worsley and Eccles South)
(Lab)
I want to raise the case of a constituent who described to me the
state of Salford Royal’s A&E earlier in January, saying:
“My partner was taken by ambulance yesterday at about 11am. He
has a severe chest infection and breathing problems. He was left
sitting in a chair on oxygen until 10pm when a trolley was found
for him to sleep on. There are no beds available.”
My constituent said that patients and staff
“feel that no one cares”.
After such a long wait, my constituent’s partner was found to
have pneumonia and he has been very poorly. Now the Secretary of
State is talking about a target of 76% of A&E patients being
seen within four hours by next March. Will he tell me and my
constituent why he thinks it is acceptable for patients to wait
longer than is safe?
We are bringing times down; I think the current mean response for
C2s is much more in the region of 25 or 26 minutes than it was in
late December-early January, because across the UK there was a
massive spike in flu. The hon. Lady will have seen exactly the
same in the Labour-run NHS in Wales. Over December there was a
20% increase in 999 calls, for example. That is why we need to
put in place greater resilience, as the plan I have set out to
the House does.
(Wokingham) (Con)
I strongly support the £1 billion for 5,000 additional beds and
800 more ambulances. I have long argued that, with a growing
population and a growing elderly population, we need more
capacity. Is it also possible to take some of the £14 billion of
additional money to provide even more capacity? I think we are
going to need it.
Within my right hon. Friend’s question is, I think, how we get
more flow into hospital: once bed occupancy goes above a certain
threshold, lack of flow is the key interaction that drives
inefficiency within hospitals. That is why we are putting in the
extra capacity. It is also a question of reducing the numbers
going to hospital in the first place and speeding up the
discharge of those who are fit to leave. Whereas at the moment
someone might sit on a ward for three days because they have to
have antibiotics every day, if one continuous dose of antibiotics
can be administered through new kit at home, not only is that a
much better patient experience but it relieves pressure on the
wards.
(St Albans) (LD)
I welcome the additional transparency on data for 12-hour wait
times, because it is only by shining a light on the problem that
we can see just how bad it is, but the targets set out in the
plan today are utterly woeful. The Royal College of Emergency
Medicine says that we need 13,000 beds; the Government are
offering 5,000. The percentage of patients who are seen within
four hours should be 95%; the Government are aiming for 76%.
Heart-attack and stroke victims should be seen within 18 minutes;
the Government are aiming for only 30 minutes. Surely the truth
is that this woeful lack of ambition means that our emergency
care services are themselves on life support and that patients
will continue to die needlessly for a very long time to come.
First, I thank the hon. Lady for recognising the steps that we
have taken on transparency. That has been an area of challenge
and it is part of my wider commitment to transparency.
The ambition of the targets has to be realistic, and targets are
not a ceiling but a floor. It is about saying, “How do we set a
target that is realistic?” Of course, we will aim to do better
than that, but it is about setting something that the system
feels is achievable, because that in turn gets much more
buy-in.
On beds, we are increasing capacity, as my right hon. Friend the
Member for Wokingham () alluded to. What it is really
about is freeing up patients who are fit for discharge from
hospital, who should not be there and would actually prefer to be
getting care at home. It is about looking at the end-to-end bed
capacity, not simply at beds within the acute sites.
Dame (Basingstoke) (Con)
I welcome my right hon. Friend’s statement. In the pandemic, the
use of local private hospitals by the NHS, particularly in places
such as Basingstoke, kept services such as cancer care going
uninterrupted. Could the NHS be using more private facilities
more widely to relieve some of the pressures that he so
eloquently outlined in his statement?
My right hon. Friend makes an important point. Again, within that
is patient choice and how we empower more patient
choice—providing services that are free at the point of use—to
use what capacity there is within the system, including in the
independent sector. I absolutely agree that we should be
maximising capacity. At Downing Street with the Prime Minister,
we had a very useful roundtable with the independent sector about
how we can make more use of its capacity. That is certainly an
area that we are exploring.
(Halton) (Lab)
I saw for myself only a few weeks ago the real crisis in our
hospitals when I accompanied a close relative to Whiston
Hospital, where I saw every single space in the corridors taken
up by a bed, a trolley or a chair. Quite frankly, what the
staff—doctors, nurses and support staff—were doing was amazing,
and they deserve all our praise for the hard work that they are
putting in. The Secretary of State’s lauding of the fact that
two-year waits have virtually been eliminated is bizarre: when
Labour left office, waits were somewhat less, with an 18-week
target and many people being seen within weeks, not months. The
Secretary of State said that the Government are on track to
recruit 15,000 new nurses, but how many have left the NHS in the
last two years?
First, the hon. Gentleman is right to recognise the work that the
staff have been doing. He mentioned a family member; when I made
a statement earlier in January, I recognised that there has been
huge pressure on the system. We saw the flu numbers and the spike
in cases. On the two-year waits, the point is simply that there
has been pressure on services—the pandemic impacts—across the
United Kingdom, but the two-year wait is far worse in Wales,
whereas we have cleared it in England. On recruitment and
retention, we are bringing forward the workforce plan. The fact
is that we are recruiting more nurses, but it is about meeting
demand pressure as well.
(East Devon) (Con)
There is no doubt that the 5,000 extra beds will help the NHS to
provide the best possible patient care. Community hospitals
across East Devon and NHS Nightingale Hospital Exeter can play
their part, too. Does my right hon. Friend agree that community
hospitals can play a key role in helping to cut waiting
lists?
Community hospitals are key to tackling the issue of delayed
discharge. Community settings have been a bit of a Cinderella in
the past. The data on community settings tends to be weaker than
it is in other parts of the NHS. Alongside domiciliary care and
making better use of residential care capacity, the third element
for discharge is to look at how we use community step-down in a
much more constructive way. One key issue there is to have
wraparound services so that people do not simply get transferred
to a community setting, but that it is a staging post before
getting to the home, which is where most patients want to be.
(Islington North) (Ind)
The social care sector is dominated by dedicated staff who are
paid low wages. High profits are made from it and there is an
insufficiency of spaces. Will the money that the Secretary of
State has announced go to local authorities? Can it be spent on
public provision? Does he not think it is time to recognise that
the internal market and privatisation have sucked money out of
health and social care—money that could have been spent on
patient care and caring for people in the community and in
special facilities?
One area of the right hon. Gentleman’s question where I do agree
with him is the importance of local authorities. One reason I am
keen to see more clarity on data and transparency is that there
can sometimes be a tendency for the local authorities to be
blamed for discharge, when often it is factors within the NHS
that contribute to some of those who are fit to leave hospital
not doing so. On the money allocation, the £2.8 billion is
targeted to local authorities—funding set out by the
Chancellor—with £4.7 billion the following year. We are
increasing the money for local authorities, but alongside that we
are working with them to improve the data so that we can see
where there are blockages due to local authorities. For
example—Mr Speaker will be familiar with this—Blackpool often has
visitors from out of the area, so the NHS there deals with a
number of local authorities, not simply the nearest one. We are
working intently on how we support local authorities as part of
the wider discharge package.
(Bexleyheath and Crayford)
(Con)
I welcome my right hon. Friend’s statement and commend his
approach to this difficult problem that he faces and we as a
nation face. Does he agree that while speeding up discharge from
hospital and freeing up beds for patients needing urgent and
emergency care is absolutely necessary, there is a real need for
the expansion of new services in the community, which must be a
top priority? In my area, one of the biggest reasons for bed
blocking in hospitals is that there is no community service to
pick up when people go home.
My right hon. Friend hits the nail on the head. He is right: it
is about how we better manage demand in the community before
people get to the emergency department. That is where, for
example, action targeted at the frail elderly is so important. It
is also about how we enable people to discharge sooner, where
they are fit to do so, so that they can recover, whether in a
community setting or, ideally, at home, with the right wraparound
support.
(Bristol South) (Lab)
The people of Bristol South will be ever so grateful to have data
that they are waiting 12 hours, rather than perhaps ringing me up
to tell me they have been waiting 12 hours. The Secretary of
State is a Treasury man, so he must know we are now paying more
for less. In the interest of transparency, can he be assured that
in his own ICB, demand and capacity are matched, and will he know
that? How will I know that demand and capacity are matched in my
own ICB?
I think the hon. Lady was welcoming the transparency on 12
hours—I certainly hope so. The ICBs became operational in July,
and we are working with them as to how, by taking a system-wide
view, they can baseline the gaps in data, and one key area of
that is on the community side. When she talks about matching
capacity, part of that is about understanding virtual ward
capacity, what conditions that applies to, what the physio
wraparound services are, what is available within residential
care versus community care and other domiciliary care packages,
as the right hon. Member for Islington North () touched on in terms of local
authorities. We need to look at the data package across the piece
on a system-wide basis. That is why we are setting up control
centres. I am keen to make that much more transparent, because to
be blunt, as a Secretary of State, I get the transparency anyway
when things go wrong. Like the hon. Lady, I would rather have
much more transparent data so that ICBs themselves can be better
held to account, and indeed that is what the Hewitt review is
looking at in terms of that wider transparency piece.
(Chipping Barnet)
(Con)
I welcome the fact that Barnet Hospital’s emergency department
will be expanding and improving its facilities and taking on new
staff, and of course I welcome today’s announcement, but I urge
the Secretary of State to ensure that it is effective on the
ground soon, because there is a real crisis out there. This is a
good announcement, but it must be delivered so that patients and
staff feel it on the frontline as soon as possible.
I could not agree more, which is why this morning the Prime
Minister and I were at University Hospital of North Tees, where
it is effective on the ground. It is about looking at hospitals
where such measures have been effective and are having an effect
on the ground, such as in North Tees and at Maidstone Hospital,
and how we take best practice from them. We then have to do what
has sometimes been more difficult in the NHS, which is to scale
those innovations and get them adopted across the piece.
(Walsall South) (Lab)
There are 165,000 vacancies in social care and there was nothing
in the statement about how the Secretary of State will address
them. Will he do that through better terms and conditions?
We are dealing with that through additional funding—the £500
million for this winter. That relates to the point made by my
right hon. Friend the Member for Chipping Barnet () about the impact on the
ground, which will be to give ICBs and local authorities
discretion. Some of that £500 million is being spent on the
workforce, including in social care, so there is discretion as to
how they spend that. There is also the £2.8 billion of local
authority and ICB funding that will be in place next year, and
£4.7 billion the following year.
(Torbay) (Con)
The Secretary of State will be aware of Torbay’s demographics,
particularly the growth in the number of people aged over 85.
They are living a good long time but, at that age, they need some
level of support from the NHS, which obviously creates demand and
puts pressure on our systems. On the resources announced today,
what engagement is he planning to have with local ICBs,
particularly those that cover areas where the demographics mean
that they are at the leading edge and driving innovation, but
need support to do so?
My hon. Friend makes an important and nuanced point about
demographic pressure, which is not evenly spread and is more
concentrated in certain parts of the country than others, so the
pressure on ICBs is greater in those areas. That is why the
ministerial team met almost all the ICBs in a series of meetings
with chairs and chief execs in the run-up to Christmas, and it is
why we want to bring greater transparency, so that we can
right-size solutions for emergency departments and ensure that
those facilities keep pace with the increased demand.
(Lewisham East) (Lab)
Last night, my constituent’s 11-month-old son had to wait in
A&E for eight hours, which my constituent found extremely
unacceptable. The waiting experience in our hospital is like
being in a “disaster zone”, in the words of my constituent, who
went on to explain about parents having to sit on floors and wait
for hours for their children to be seen by a doctor. I press the
Secretary of State on whether there is a plan to return to the
standard of 95% of patients who come to A&E being seen within
four hours.
As I said, we are not setting out that ambition in this
statement, because the impact of the pandemic has been so severe.
We need to set a target that is ambitious but achievable, which
is what we have done. The president of the Royal College of
Emergency Medicine said:
“This plan is a welcome and significant step on the road to
recovery and we are pleased to see it released.”
It is about taking best practice from the areas that are working
and ensuring that they are socialised across the piece. It is
obviously concerning to hear about individual cases, such as the
specific one that the hon. Lady mentioned, which are very
traumatic for the families. That is why we have set out this plan
and why we are putting in the extra funding.
Sir (New Forest East) (Con)
From 2005 to 2006, there was a campaign within the NHS to close
many in-patient beds in community hospitals. I was pleased by
what the Secretary of State said earlier about beds in community
hospitals having a role to play. In that connection, will he
reconsider the future of the site of Fenwick Hospital in
Lyndhurst in my constituency, where the in-patient beds were
closed? The NHS is now proposing to sell it off, but I would have
thought that, with a bit of imagination, such a site could
increase capacity.
We are encouraging integrated care boards to take ownership of
individual decisions, rather than trying to make all the
decisions centrally from Westminster, so that those closer to the
ground and to the issues are in power to make the trade-offs. I
am sure my right hon. Friend will want to have those discussions
with the chair and chief executive of his ICB. There is a wider
issue of how we make greater use of community sites, not least
given the workforce pressures and different staffing ratios that
they have, and that is absolutely the way we help to get more
people out of hospital who are fit to leave.
(Plymouth, Sutton and
Devonport) (Lab/Co-op)
Ten days ago, I shadowed one of the brilliant emergency
department consultants at Derriford Hospital. They are working
their socks off under some very difficult conditions. The
additional capacity for beds is welcome, especially because of
the structural under-funding and lack of beds in the south-west,
but doctors and nurses were saying that they want to slow the
flow of people getting to the emergency department in the first
place.
Can the Minister look again at the mothballed Cavell Centre
programme—the super health hub programme—which would have done so
much to slow the flow and deal with collapsing primary care
services? In particular, can he look again at the Government’s
decision to withdraw £41 million from the super health hub in
Plymouth, which would have been the national pioneer, would have
shown that this project works and could help our hospitals to
deal with the crisis they are facing?
The hon. Gentleman asks how we slow the flow of people going to
emergency departments and how we accelerate their discharge once
they are fit. The substance of the point he raises is valid and
absolutely right. It is why there are schemes such as the
community response service and the falls service. We are looking
at the likes of the North Tees model and getting more staff into
community support, thereby integrating the health and social care
side. As I said to my right hon. Friend the Member for New Forest
East (Sir ) a moment ago, the trade-offs
for individual sites are best determined by ICBs. I am very happy
to look with ministerial colleagues at any specific proposals,
but it is really for the ICBs to be looking at how to best use
their estate.
(Buckingham) (Con)
I warmly welcome my right hon. Friend’s clear and credible plan,
but on the uplift of 800 ambulances, which is good news, I urge
him when it comes to their deployment to look at rural areas
first. In these areas, ambulances by definition spend much longer
per patient on the road going in between much more diversely
spread out hospitals.
I recognise my hon. Friend’s point, not least as a rural
constituency MP myself. I have talked to paramedics, as I am sure
he has, and the principal cause of frustration of late has not
been the issue of pay—important though that is. It has been
frustration over long handover times, which has had a
particularly damaging impact. I am happy to look at any specific
issues in his area but he is right on the wider point about the
pressures in rural areas.
(Weaver Vale) (Lab)
When can the people of Warrington, and indeed Halton, expect to
hear about the new hospital campuses, which are much needed by
both communities—with sufficient staff to resource them?
This statement is focused on urgent and emergency care. At Health
oral questions and on other occasions, we often discuss the wider
capital programme and the increased funding we are putting into
that programme. Part of that is about outcomes and how we get
more from that investment in capital. That is why through the NHS
estate we are starting to standardise our builds, starting with
the Hospital 2.0 programme. We will be rolling that out more
widely through the estate. I am not familiar with the specific
issues at the hon. Member’s local site, but I am happy to look at
them after the statement.
(Erewash) (Con)
I welcome this recovery plan and my right hon. Friend’s comments
on the role community hospitals have to play in future. The
16-bed Hopewell ward at Ilkeston Community Hospital was re-opened
ahead of this season to ease pressures, but it is due to be
decommissioned in the spring. To aid with more efficient
planning, will he work with my local community health trust and
ICB to ensure that these beds form part of the extra beds for
next winter and, more importantly, become permanent—rather than
this ad hoc approach we have had until now?
Again, decisions on the estate are principally for the ICBs, but
I am happy to look at any individual proposals my hon. Friend has
on how we get more flow into the system, and that is about
putting more capacity into the community.
(Bristol East) (Lab)
I think I welcome what has been said about mental health
ambulances and trying to divert people in mental health crisis
from A&E, but I am a little concerned about whether those
attending the scene in those ambulances will have access to the
past records of people in that situation or be able to carry out
a proper risk assessment for them. Will the Secretary of State
reassure me on that, and also on whether there will be places
other than A&E to take them to? It is one thing to say that
we want to divert them, but we need to have other resources in
place.
The hon. Lady raises a fair and important point about what is in
the wider package, alongside the mental health ambulances, which
I think are a positive step. Last week, I met as part of the
pre-legislative scrutiny of the proposed mental health
legislation, which will pick up some of the points that the hon.
Lady raises. Examples of innovation include empowering people
before they have a mental health crisis to use one of the apps
that have been developed to set out their statement of wishes and
other information, which is very helpful for paramedic crews when
they have a mental health crisis. We are looking at how we use
innovation to better give voice to the patient, and often to do
that before they have the mental health incident, rather than
when the ambulance arrives.
(Ipswich) (Con)
I welcome the announcement today; I think the key thing is that
it makes a difference in the short term. The Secretary of State
will be aware of plans to build a new A&E department at
Ipswich Hospital. The plan is for it to open in January 2024.
What assessment has been made of the difference that that could
make in the medium to long term by increasing capacity and
improving waiting times? Will he also be prepared to work with me
and the hospital’s trust to potentially expedite the plan, so
that it might even happen slightly before January 2024?
In a former role, when I was Chief Secretary to the Treasury, I
signed off a significant expansion of A&E facilities. I hope
that reassures my hon. Friend of my commitment to putting more
capacity into emergency departments, not least because they need
a certain level of capacity to be able to ensure same-day access,
triage and ways of getting flow into the system. As for the wider
site proposal, clearly the ICB for his area will want to
prioritise that.
(North Shropshire) (LD)
The urgent care and ambulance crisis has been brewing since
autumn 2021 in Shropshire, and it has worsened since. Last week,
a doctor went on the record to say that the emergency department
was “like a war zone” and expressed her fear that, in a fire, not
everyone would get out alive. In a six-week period to 12 January,
the category 2 response time in the Oswestry area was two hours
and 10 minutes. Will the Secretary of State acknowledge that in
some areas the crisis is worse than in others? Will he agree to
meet me and the other MPs representing Shropshire to discuss how
we progress Shropshire further along this track to solve the
urgent care crisis that is so serious there?
I am very happy to meet with the hon. Lady and colleagues to
discuss this further. I think most people recognise that, since
the huge pressures from flu over the Christmas period, the flu
numbers have come down, but of course there is continued pressure
in the system.
Sir (South Swindon) (Con)
I welcome my right hon. Friend’s statement. In particular, I
welcome the announcement today of over £26 million of funding to
expand the emergency department at Great Western Hospital in
Swindon. He knows from his previous incarnation that we have
worked together on this issue. It is particularly important, not
just for the integration of emergency services, but for the
freeing up of other space in the hospital to allow for further
beds or other clinical interventions. Does he agree that it is
this sort of long-term measure that will guarantee progress in
our much pressed national health service?
My right hon. and learned Friend has been key to securing the
funding. He has assiduously lobbied me and ministerial colleagues
to make a powerful case on behalf of his constituents, and I
think he should be proud of the outcome, which reflects his and
his parliamentary colleagues’ work on this issue. He is right;
indeed, the case he made was around how this frees up capacity in
the system, which will result in much better care for patients in
Swindon.
(Westmorland and Lonsdale) (LD)
There is nothing in this plan to address the fact that thousands
of people are now turning up at A&E as a direct result of
being unable to get regular access to an NHS dentist. Last week,
another Cumbrian dental practice, in Grange-over-Sands, wrote to
all of its 5,800 patients, as it had been forced to quit the NHS
too. There is now not a single NHS dental place available
anywhere in Cumbria. What will the Secretary of State do to fix
an NHS dentistry crisis that leaves a family of four having to
cough up an extra £1,000 a year during a cost of living crisis to
get access to dental care that they have already paid for through
their taxes?
I have addressed that point, in that we are bringing forward the
third component of our three plans. I spoke earlier about the
elective recovery plan; today’s announcement is on the urgent and
emergency care recovery plan; and the third element will be the
primary care recovery plan. Of course, alongside the work we are
doing on dentistry it is also about access to services, both
dentistry and A&E. That comes together in things such as the
111 service and how we review that, as well as the NHS app. It is
about looking at how we better manage demand at the front door,
and the demand for dentistry is not only through NHS dentistry
but often manifests itself through a lot of patients coming
forward for dentistry at A&E.
(Southend West) (Con)
I warmly welcome my right hon. Friend’s plan, particularly his
focus on increasing capacity in urgent and emergency departments.
I welcome the Government’s recent investment of £8 million to
reconfigure the A&E at my local hospital in Southend. Does my
right hon. Friend agree that this will increase not just the
capacity but the quality of the urgent and emergency care on
offer in Southend?
I commend my hon. Friend for her assiduous campaigning on behalf
of her constituents in Southend, through which she played a key
role in securing the extra £8 million of funding. She is right
that that will make a material difference not only to flow and
capacity within the hospital but through that to the overall
standard of patient care.
(Strangford) (DUP)
I thank the Secretary of State for his clear commitment to extra
funding for the urgent and emergency care recovery plan. Will he
outline whether he is prepared to make additional funding
available to meet the needs on maternity wards, which midwives
feel are teetering on the brink? In reality, that means it is an
issue of life and death, due to staffing levels. Will the
Secretary of State ensure that additional funding makes its way
to each devolved nation under the Barnett consequentials, to be
used before the scheduled new financial year ends?
As the hon. Gentleman will know, the additional funding that the
Chancellor announced in the autumn statement will lead to an
uplift in health funding for Northern Ireland through the Barnett
consequentials. On the flexibility within that, the hon.
Gentleman will know that I agreed flexibility when I was Chief
Secretary; it will of course be for Treasury colleagues to look
at the requirements for ongoing flexibility within Barnett
consequentials.
(Wimbledon) (Con)
I warmly welcome what my right hon. Friend has said. He is right
to recognise that one of the long-term impediments to discharge
is the disconnect between the NHS and social care and local
authorities. Will he confirm that, to ensure that the additional
money is well spent, the integrated care boards will be not only
responsible for the establishment of the hubs and extra care
packages but properly monitored and held responsible for their
performance and for generating value for the extra money that is
being put in?
As a former Minister in the Department, my hon. Friend speaks
with great experience on these matters. He is right that the crux
of the plan is now in its delivery. As I alluded to in my
statement, a key component of that is more transparency in the
data so that he and colleagues throughout the House can hold to
account not only the ICBs but the local authorities. We need to
bring those two datasets more closely into alignment.
(North Devon) (Con)
I warmly welcome today’s announcement, but will my right hon.
Friend explain how for remote rural hospitals, such as the
fantastic North Devon District Hospital, the workforce challenges
that were present pre-pandemic might be addressed post pandemic,
when we are now also dealing with a housing crisis? Might there
be an opportunity to expedite the next phase of the redevelopment
programme, which includes key worker housing?
I am keen to explore with colleagues how we can put more key
worker accommodation on to the NHS estate, particularly by making
use of modern methods of construction to expedite that. On the
workforce plan, Devon is an area that has seen particular growth,
given its older population, and greater pressure as a
consequence. Those pressures will be worked through in the
workforce plan that we will bring forward shortly.
Several hon. Members rose—
Mr Deputy Speaker ( )
Order. We are under a lot of time pressure today, so may I ask
the remaining Members and those who are going to take part in the
next statement to please think of very short, focused, single
questions?
(Bournemouth East) (Con)
I welcome the statement and the extra investment in the NHS. It
was a privilege to visit Bournemouth Hospital recently and meet
the dedicated staff, and as the Secretary of State will know, it
is expanding with a new A&E facility. Will he visit
Bournemouth, meet the staff, and see the progress taking
place?
I would be very keen to visit, subject to my diary. If it is not
me, I am sure a ministerial colleague will do so.
(Rushcliffe) (Con)
I welcome the £1 billion funding announced today, and it is good
that hospitals have benefited from innovations such as patient
flow control centres, care transfer hubs, and virtual wards. When
will hospitals and ICBs such as Nottingham and Nottinghamshire
ICB, which has not been part of the pilot, be able to access
those innovations, so that my constituents can start to access
the benefits?
They can start to access them now. We announced £250 million at
the start of the month, as part of the £500 million that was
announced in the autumn statement, and hospitals know that
funding of up to £8 billion is coming in the new fiscal year, so
this is an opportunity for them to move at pace.
(North West Leicestershire)
(Ind)
The Secretary of State told the House that the NHS was put under
pressure with a spike in influenza cases in December. Will he say
where he thinks that influenza virus has been hiding for two and
a half years?
I do not think it has been hiding. Flu seasons are not uncommon
in the NHS and come round on a periodic basis, and that is why we
anticipated it through the flu vaccine. On the hon. Gentleman’s
wider point, it is also recognised that as a consequence of covid
some resistance to flu may have been lowered, but we have had flu
pressures on the NHS in past years.
(Rugby) (Con)
Would the Secretary of State consider more use of existing urgent
care centres, such as that at St Cross in Rugby? Our nearest full
A&E is 12 miles away at University Hospitals Coventry and
Warwickshire NHS Trust, in Coventry, which means that 83% of my
constituents are more than 15 minutes’ drive from an A&E. The
hospital at Coventry serves a population of 600,000, which is
twice the national average. Does he agree that extending
provision at St Cross would go a long way towards reducing
pressure at the hospital in Coventry?
My hon. Friend is right that not every patient accessing an
emergency department needs a tier 1 A&E facility. This is
about right place, right treatment for the patient, and making
better use of urgent care centres. How those centres can better
triage patients who can be treated there is a key part of the
plan we have set out.
(Stockton South) (Con)
In Stockton South we are incredibly grateful for the Government’s
commitment to build a new diagnostic hospital so that local
people can get access to lifesaving scans, tests and checks. We
are also grateful for the £3 million announced to establish a new
mental health crisis hub, so that people can get support in their
hour of need. What is my right hon. Friend doing to ensure that
we have the right people with the right skills in the right place
to deliver great service at those facilities?
I am delighted that, thanks to my hon. Friend’s assiduous
campaigning, he has secured his diagnostic centre, and that he
assures me he will get it operational in one of the fastest times
seen by any area. We are bringing forward our workforce plan, and
as I set out, we have 2,500 more nurses this year compared with
last year. We are on track for our manifesto commitment of an
extra 50,000 nurses, with more than 30,000 recruited already.
(Warrington South) (Con)
May I take my right hon. Friend back to the response he gave to
the hon. Member for Weaver Vale () about Warrington Hospital?
That A&E unit is incredibly under pressure. Over the weekend
nurses talked to me about the 120 patients currently waiting to
be discharged, which is putting intolerable pressure on that
unit. My right hon. Friend said that he was not particularly
familiar with those issues, but perhaps I can invite him to
Warrington to see the pressure. While he is there, perhaps he
will also look at the Health and Social Care Academy, which was
set up by the local college to try to address the shortage in
social care. A great level of innovation seems to be happening
there, and I am sure he would like to see Warrington for
himself.
That last question gives me a beautiful opportunity to correct an
earlier answer regarding the constituency of my hon. Friend. He
knows I am familiar with this issue, because I remember calling
him at about half past 10 one evening to discuss his A&E when
some particular issues had come to the attention of the media. I
am familiar with the pressures on his hospital—[Interruption.] I
was just placing the constituency of the hon. Member for Weaver
Vale () vis-à-vis that of my hon.
Friend. Now clarified on place, I am familiar with the fact that
that hospital is under pressure. I know the Minister of State is
due to visit, and I am sure she will look forward to meeting both
the hon. Gentleman and my hon. Friend.
Mr Deputy Speaker ( )
I thank the Secretary of State for his statement and responding
to questions for over an hour.
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