NHS Winter Update Statement The following Statement was made in the
House of Commons on Monday 8 January. “With permission, Mr Deputy
Speaker, I would like to make a Statement on the winter pressures
facing the national health service and social care, as well as the
impact of the ongoing junior doctors’ strikes. The NHS employs 1.3
million people and the social care system a further 1.5 million
people. Together, they treat and care for tens of millions
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NHS Winter
Update
Statement
The following Statement was made in the House of Commons on
Monday 8 January.
“With permission, Mr Deputy Speaker, I would like to make a
Statement on the winter pressures facing the national health
service and social care, as well as the impact of the ongoing
junior doctors’ strikes. The NHS employs 1.3 million people and
the social care system a further 1.5 million people. Together,
they treat and care for tens of millions of people every day. We
all know that winter is the most challenging time of the year for
the NHS and social care, as our workforce have to tackle the
pressures created by cold weather and seasonal viruses.
To put our health and social care system in a strong position
heading into winter, this year we started preparing earlier than
ever before. In January last year, we published our recovery plan
for urgent and emergency care and provided £1 billion of
dedicated funding to boost emergency capacity. The plan committed
to delivering 5,000 new permanent staffed beds. I am pleased to
update the House that more than 3,000 were already in place in
December, and in the coming weeks NHS England will meet the 5,000
pledge and make sure that it has almost 100,000 core beds ready
when Covid and flu peak.
Our recovery plan also pledged 10,000 virtual ward beds so that
more patients can be monitored safely at home, away from
hospital. I am pleased to update the House that we have delivered
more than 11,000 virtual ward beds, and they have been a vital
service for eligible patients over the festive period.
We have boosted our ambulance service with £200 million of
additional funding, putting new vehicles on the road, improving
response times and getting crews out and about for more hours. In
recognition of the importance of patients being discharged
promptly from hospital when it is safe to do so, we have made
sure that every acute hospital in England has access to a care
transfer hub, bringing together teams from the NHS and social
care to speed up discharge, backed by an extra £600 million for
social care. To help prevent the spread of winter viruses, we
brought forward flu and Covid vaccinations, protecting the most
vulnerable and making them less likely to require hospital
treatment.
But no matter how thorough our preparations are, winter will
always be the most challenging time of the year for our NHS. That
is why it is extremely regrettable that the British Medical
Association’s junior doctors committee has chosen to strike not
once, but twice at this time of year. It has also chosen to
strike for an unprecedented length of time, putting profound
pressure on hospitals and GP surgeries throughout the
country.
Before Christmas, the BMA’s strike caused the cancellation of
almost 90,000 appointments, some of which will have to be
rescheduled for a second or even third time. That is in addition
to the 1.1 million appointments that have already been affected
since strikes began in December 2022. This is not just another
statistic; there is a person behind every one of these
appointments, who may be in pain or distress and who now must
wait longer for the care they deserve.
Last week, a member of the BMA leadership said that
‘strike action benefits absolutely nobody’.
They were absolutely right on that. The ongoing strikes are
causing more appointments to be cancelled and more worry for
patients and are putting a significant strain on staff.
During December’s and this week’s strikes, the NHS’s priority has
been to protect patient safety. Resources have been channelled
into urgent and emergency care, including vital neonatal and
maternity services. Huge efforts were made to make the most of
the working days between Christmas and new year, because
throughout any strike action, it is crucial that every patient
who needs urgent medical care comes forward as normal. We
continue to face challenges, and strikes have stretched emergency
care, but thanks to the meticulous hard work in local trusts in
preparing for strikes, as well as to the huge personal sacrifices
that clinicians and staff are making to pick up the slack,
emergency care has largely held up and the system has coped under
the circumstances.
Staff across the NHS deserve our sincerest thanks for the heroic
efforts they have made throughout the unprecedented strikes. I
thank the doctors, nurses, paramedics and all frontline staff who
have come into work to support each other, deliver care and
protect patients; the consultants, including Members of this
House, who are working extra hours, cancelling their holidays or
even coming out of retirement to safeguard patient safety; the
managers, administrators and NHS leaders who are working day and
night to make sure that the right staff are in the right place to
protect patient safety; and all those working in social care,
from local authority staff to care workers and carers, who have
rallied round to support hospitals.
I know that work does not stop when the strikes stop. NHS staff
will begin turning their attention to recovering from the impact
of the industrial action, restarting elective treatment and
improving the flow of patients through emergency departments. The
junior doctors committee’s choice to strike at this time of year
means that that work must now be done under additional pressures,
as staff move to catch up from industrial action as well as
tackling the impacts of cold weather, Covid, flu and
norovirus.
I want to find fair and reasonable solutions to industrial
action. One of my first acts as Health and Social Care Secretary
was to bring in the British Medical Association for talks to end
these long-running disputes, as well as meeting representatives
for Agenda for Change unions who speak for frontline staff,
including nurses. We have reached agreements with unions that
represent consultants and specialty doctors on offers to be put
to their members. Those offers will modernise contracts, realign
pay scales and improve doctors’ career progression, while
delivering value for the taxpayer and protecting the hard-won
progress we have made to halve inflation. Consultants and
specialty doctors are pausing strike action while members vote on
the offers, with the results of both ballots expected shortly.
The Government and BMA agree that they are the best deals
available to us, and I very much hope that members will vote in
favour so that those positive changes can be made and we can move
the NHS forward.
On junior doctor negotiations, the talks that began in November
had been progressing with the BMA junior doctors committee. The
talks were constructive, exploring a range of proposals that
would improve the working lives of doctors across the NHS. I was
therefore extremely disappointed when the BMA turned its back on
the negotiations before they had concluded to call the damaging
strikes that we face today. The Government will not negotiate
with the BMA while strike action is under way and patient safety
is at risk. Every strike is hugely disruptive for our NHS. The
NHS and patient safety cannot be switched on and off on a whim. I
do not believe it right to negotiate with unions while they are
being unreasonable and some of their members are walking out of
hospitals at the busiest and most challenging time of year for
patients.
I remind the House that the junior doctors committee’s headline
demand of a 35% pay rise is simply unaffordable for taxpayers.
Last summer, we accepted the recommendations of the independent
pay review body in full. That meant that junior doctors received
average pay rises of almost 9% in their September pay
packets—some of the most generous increases across the entire
public sector. Meeting the 35% demand would stoke inflation just
as we as a country have halved it, burning a hole in the pockets
of families up and down the country, and it would be totally out
of step with the pay rises awarded to other dedicated public
servants and employees throughout the private sector. Staff
across the public sector have agreed fair and reasonable deals on
pay; only the junior doctors committee has repeatedly walked away
from talks.
Let me address the issue of NHS leaders asking some junior
doctors to return to work when patient safety is at risk, in what
are known as patient safety mitigations or derogations. As of
9.30 this morning, 40 patient safety mitigations have been
submitted during the current round of strikes, and two have been
accepted by the BMA. NHS leaders, many of whom are themselves
members of the BMA, have decades of combined experience. They
know their patients and they know their rotas, and they would ask
for mitigations only if they were absolutely necessary—in, for
example, a children’s emergency department. They are wholly
independent of Government: it is for them to make those
decisions. I trust them and I trust their judgment. That is the
reality, and that is the truth about patient safety
mitigations.
One of the reasons why I came into politics was the NHS and what
it had done for me and my family. That is also one of the reasons
why I am a Conservative. This is a Government who have delivered
record NHS funding, the first ever NHS long-term workforce plan,
and 50,000 more nurses for our NHS. We are providing the NHS with
the doctors it needs for the future by doubling the number of
medical school places, opening five new medical schools and
pioneering one of the world’s first medical apprenticeships. We
have also supported doctors by making changes to pensions for
those at the very top of their career path—at that point, that
was the BMA’s number 1 ask, and a policy that the Opposition
seemed to oppose.
Those are not the actions of a Government who are turning their
back on the NHS, as some have declared. They are the actions of a
Government who are building a health and social care system that
is sustainable for the long term. To do that, we must put the
strikes behind us and move forward together, because the NHS
belongs not just to the junior doctors committee: it belongs to
us all. It belongs to the millions of people who rely on its
being there when they need care, as well as the millions of
taxpayers who pay for it. For their benefit, it is time for the
members of the junior doctors committee to show that they are
serious about doing a deal. They have legitimate concerns about
their working lives, and a fair and reasonable deal can be
reached, but calling damaging strikes is not the way in which to
achieve that. Earlier this week I said that if they called off
their damaging strike action, I would get round the table with
them in 20 minutes. I am, of course, extremely disappointed that
they refused my offer, and continue to refuse it—the strikes are
ongoing as we speak—but if they come to the negotiating table
with reasonable expectations, I will sit down with them.
This Government have a clear, long-term plan for the NHS. Our
recovery plans in elective, emergency and primary care can
improve access to treatment, transform services, and give
patients more choice in and control over their care. Our
long-term workforce plan will give the NHS the staff it needs to
thrive for decades to come, our social care reforms will build a
better care workforce to support our growing number of older
people, and by creating the first smoke-free generation we will
reduce long-term pressure on our health service. We have
eliminated the longest waits, but we have not yet made a
significant enough reduction in waiting lists. To do that, we
need the junior doctors committee to come to the table and do a
deal that is in the interests of patients, in the interests of
our NHS, and in the national interest. Then we can build an NHS
that is not only stronger today, but stronger for our children
and grandchildren.
I commend this Statement to the House.”
3.03pm
(Lab)
My Lords, the Government’s urgent and emergency care recovery
plan promised the largest and fastest ever improvement in
emergency waiting times in the NHS’s history. Yet it has not
delivered in preparing the NHS for the winter, which we should
remind ourselves is a season that, as sure as eggs are eggs,
appears every single year. It should be no surprise to any of us,
including the Government.
To take just one shortcoming, the plan talked about lowering bed
occupancy rates as “fundamental”, yet in November, at the start
of winter, bed occupancy was at its highest level since the start
of Covid. It stood at 94.8%, a level which will surely lead to
serious issues. Did the Government consider taking any additional
action to lower occupancy rates? What steps will they now take to
ensure that this is not simply repeated every single year?
Today, there have been a number of reports in the media, and I
want to refer to two of them. We have read reports that NHS
England has confirmed that the NHS is failing to meet all of its
key targets: patients are waiting even longer in A&E, even
longer to start routine treatment, even longer for cancer
diagnosis and treatment, and even longer to be admitted to
hospital or for an ambulance to arrive. This is a damning
indictment. Perhaps the Minister could tell us the Government’s
response to the reports of NHS England today. Also in the news,
the Health Service Journal reported that trusts are being told by
service commissioners for Lancashire and South Cumbria that, due
to the expected deficit, they should plan for a 10% cut in
contract values on top of the annual efficiency savings that they
are already planning for next year. What is the Minister’s
response to this worrying situation? How will it affect services,
not just in winter but all year round? How many other trusts
across the country are in a similar position?
I would like to pick up a matter strongly defended by the
Secretary of State in the other place when this Statement was
first made to Parliament—the matter of 800 new ambulances. These
ambulances were promised by the Government to help NHS trusts
tackle the crisis of ever-worsening response times. But freedom
of information requests found that, across 10 of the 11 ambulance
trusts in England, there were plans to order only 51 new
ambulances. I would like to give the opportunity to the Minister
to share any information that is missing from the responses from
ambulance trusts that would show that the information referred to
in the FOI request was mistaken in some way. Perhaps the Minister
could also provide more detail on what NHS England referred to as
a problem in procurement due to the impact of global supply chain
pressures, and on whether and when it is expected pressure will
subside, so that we will see all the promised new ambulances.
What performance improvements are to be expected from the 51 new
ambulances that we know have been ordered? How would this compare
with the full 800 that were promised, had they been procured?
The Government’s Statement presents as a combination of somewhat
selectively chosen numbers and situations that do not recognise
the reality of a health service in which patients cannot get
appointments with their doctors, dentistry is in crisis, and
unprecedented numbers of people are having to wait unduly for
surgery, cancer diagnosis and treatment, and their ambulances—and
all of this while striking doctors are being blamed for the whole
situation. The strike action by junior doctors has been the
longest in NHS history, with trusts declaring critical incidents
and A&E departments telling some patients to stay away to
lessen the load. This is a situation that I am sure the Minister
will tell us cannot continue, but it continues to disappoint that
the Government do not see it as their responsibility to show
leadership and resolve the dispute. Could the Minister advise the
House of the steps the Government are now taking, or will take,
to ensure that we do not see a continuation of this damaging
situation?
Finally, I would be keen to hear from the Minister on an aspect
of the winter health situation which was not mentioned in the
Statement regarding Covid. In the run-up to Christmas, according
to the Office for National Statistics, 2.5 million people were
thought to have Covid. What assessment have the Government made
of this increased prevalence and what impact has it had on the
NHS so far this winter? What assessment have the Government made
of how the impact may continue? I look forward to the Minister’s
response.
(LD)
My Lords, we should start by recognising and thanking the nearly
3 million health and care workers whom we depend on all year but
who have to work especially hard during the winter months. We
should also show our appreciation for the many millions more
informal carers who spent the festive period looking after family
and friends. That was the nice bit, but I now turn to some
questions for the Government on what I thought was a predictably
upbeat, “It’s all going swimmingly except for the strike”
Statement; yet within it there were some significant gaps, some
of which the noble Baroness, Lady Merron, pointed out.
It is notable that the Statement says nothing about primary care
but instead focuses very much on hospital beds, which I will come
to next. Can the Minister comment on how GP appointment waiting
times remain unacceptably long in many parts of the country? This
is a poor outcome both of itself and in terms of the knock-on
effect it has on emergency services. I hope that the Minister can
confirm that the Government have been monitoring GP waiting times
during the winter months, and that he can indicate what they are
doing about these.
The Government say they have added 3,000 hospital beds as part of
their 5,000 target. That target was part of their response to
last year’s crisis. Does the Minister have any new data on the
utilisation of those beds and whether this matches up with the
predictions the Government made when they set the target, and any
analysis they made to come up with the 5,000 number in the first
place? The Statement also highlights the 11,000 virtual beds that
are now available, which instinctively seems like a positive
development to me. But the important thing is how a broad range
of people experience these and the health outcomes they deliver.
What are the Government doing systematically to collect data
about those virtual beds and whether they have been able to
deliver a comparable level of care for people who are suffering
during the winter pressures?
Another key area of delivering emergency care in winter is the
availability of ambulances, which was rightly flagged by the
noble Baroness, Lady Merron. The Minister may have seen a report
in the Health Service Journal from 30 November last year, which
said that in some areas there is a mismatch between the number of
paramedics recruited and the number of ambulances available. It
is great that the paramedics have been recruited, but if they are
sitting around in the base stations because the vehicles are not
there, that does not deliver the improved waiting times we are
all looking for. I hope the Minister can comment on this report
and whether the Government are able to deliver the vehicles in
lockstep with the newly trained paramedics, which is what we all
wish to see.
A further element of the response is the 111 service for
less-urgent services, which, again, is not mentioned in the
Statement. There are concerns about whether people are being
directed to the right place—111, GPs, 999 or accident and
emergency departments. Are the Government monitoring the
performance of 111 in respect of flu, Covid and other winter
respiratory diseases?
Finally, we have often discussed patient flow through hospital
and out into the community with the Minister, who I know takes a
particular interest in this. We know that some trusts are
piloting systems to improve flow that could be described as like
hotel booking systems that enable beds to be made available in a
much more efficient and timely fashion. Will the Government
compare the performance of trusts that have these systems in
place with those that do not, as they go through this acute
period of pressure in the winter months?
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
I wish everyone a happy new year and share in the thanks given by
noble Lord, Lord Allan—and, I am sure, the noble Baroness, Lady
Merron—for the hard work all the staff put in over the Christmas
period. We have done a lot of work to prepare for this winter,
and that was based on expanding supply. I will go into more
detail in answering the questions so far, but that included the
5,000 additional beds, of which 4,000 are currently in place. It
included the 11,000 virtual wards and 800 new ambulances, and
again, I will answer some of the specific questions about the
utilisation of those. It included the £600 million for adult
social care discharge and the 141 CDCs, with 6 million more
diagnostic tests, and the 50,000 increase in nurses—as well as
mental health.
Of course, there have also been 50 million more primary care
appointments since 2019, to answer the point made by the noble
Lord, Lord Allan. That was accompanied by extensive planning, as
I have seen. We have really tried to learn a lot of lessons from
last year and get ahead of the curve with earlier plans, putting
key management support teams in place to provide help in the
areas where it is most needed. Everything is underpinned by a
stronger technology infrastructure, digitalisation and the
patient flow systems.
We are really trying to get ahead, so we brought forward the flu
and Covid vaccines, so that, hopefully, we can make the situation
better. I will not say that it is anything more than early days,
or that one swallow makes a summer, but there are some promising
early signs. On ambulance handovers, we have seen a 20% reduction
in lost hours. The figure for category 2 response times is 45
minutes; it is still too long, but it is half that for this time
last year. As for patient flow and the use of the system, we have
seen a 10% reduction in so-called bed blocking, partly because of
the flow mechanisms and partly as a result of early investment in
the discharge fund.
All that is against the background of increased activity—and, of
course, the strikes. To date, they have cost us 1.3 million lost
appointments, 113,000 most recently. I say to the noble Baroness,
Lady Merron, that we have tried to behave in a reasonable manner.
We have reached agreements with all the other professions—the
nurses, physicians, consultants and specialist doctors—and we
have shown leadership, alongside the unions, in doing so. In
contrast with that reasonable behaviour, the 35% pay demand is
not reasonable, and nor is planning strike action at the busiest
time of the year. Coming out only twice, when you have been asked
40 times by NHS trusts to act on patient safety, is also not
reasonable behaviour. We want to resolve this issue. We have
shown a capacity to resolve it in other areas, and we have shown
leadership. I ask the BMA and junior doctors to come forward with
reasonable expectations, and let us resolve this right now.
I have a polite suggestion to make. I thought that the noble
Baroness, Lady Merron, might raise the issue of NHS targets.
People know that I am a reasonable person, and the last thing I
am going to do is say that all is rosy in the garden, but we are
showing some solid improvement. I am definitely not happy with
the fact that the England targets for a four-hour wait and 62-day
cancer care were last met in July 2015. But I note that they have
never been reached in Wales, which Labour has been running. In
Wales, the 62-day cancer care target was last reached in 2010.
Also, if you are in Wales, you are much more likely to be on a
waiting list: 21% of the population are on a waiting list,
compared with 13% here. In Wales, you are likely to wait five
weeks longer, on average; and 50% of the time, you will wait for
more than four hours in A&E, compared with 40% in
England.
The England results need to be better, and we are working to make
them better, but I politely suggest that the Opposition might
want to look at where they are running the NHS and see what they
can do to improve that, because on every standard you see a
poorer performance from the Labour action in Wales. That is what
all the evidence tells us.
I will try to answer some of the specific points. On ambulances,
300 new vehicles have been delivered to date. There is an issue
with one supplier, but we are confident that the 800 new vehicles
will be delivered. It is those, alongside the paramedics, that
are allowing us to address ambulance wait times and bring them
down. The 111 number is now on the app and is really directing
traffic; it is up 8% versus last year, so, again, we are seeing
real improvements. I think I mentioned that patient flow is
improving as well.
On Covid, bringing forward the vaccinations has been helpful in
terms of prevention. While we would all accept that 2.5 million
is a large number, if we look at the number of beds being taken
up by Covid and flu this year, we can see that it is half the
number that it was last year. It is still a big number, but it is
half what it was. We are in the early stages and a lot more work
is needed, but one reason we are starting to see these
improvements is that we have tried to get ahead of the curve with
those vaccinations.
As regards virtual wards, so far we have about 70% utilisation of
those. We need to collect the data; noble Lords have heard me say
before that the results from virtual wards in places such as
Watford and elsewhere show good results in terms of both
satisfaction and, most importantly, not returning to hospital.
Where people have gone into a virtual ward rather than just going
home, there has been a reduction of as much as 50% in people
having to return to hospital environments. So we are seeing
results.
In terms of primary care, as I mentioned, we have seen 50 million
more appointments take place. Pharmacy First, which will be
introduced shortly, is a key way of expanding that supply still
further. So I say politely that, yes, there is a lot more work
that will need to be done, but we really have expanded supply. We
have put plans in place, and the early signs are promising. I
hope, like all of us, that we will see far more of this and I
look forward to updating the House as the season progresses.
3.22pm
(Lab)
My Lords, we are very grateful to hear the increasing focus on
the need for urgent ambulance care. Obviously, for personal
reasons, I am very grateful for that, because this is the sort of
time when those things happen. I wonder, however, whether I could
probe the Minister a little more. With regard to Covid, my
impression—from making inquiries to various centres in London—is
that the uptake has not been as good as they had expected. Does
the Minister feel that we are doing enough to ensure that in
particular those who are most vulnerable are coming to get
vaccinated, first for flu and secondly, of course, for the
coronavirus?
(Con)
The noble Lord is correct; London is always our most challenging
place. I have found that across the board, funnily enough. He is
right in terms of Covid and flu vaccinations, but it is also the
case for the take-up of all sorts of different services. We see
technology as a key enabler; in fact, the number of people who
have booked their vaccinations and follow-up through the app has
multiplied significantly. I do not have the precise figures in my
head, but they really have gone up. A lot of that is through
people seeing their reminder through the app as well. It is
recognised that London in particular needs more targeted
action—in fact, noble Lords will see an advertising campaign come
out in the next couple of weeks or so. We are really trying to
promote usage of the app, which is a tool for all these sorts of
things as well.
(CB)
My Lords, I should declare that I am a registered doctor with the
GMC. I live in Wales, but I do not want to get into data-hurling
over Wales, but I do have a comment to make. I would like to
follow up on the question from the noble Lord, , about virtual wards.
The Minister may be unable to tell us now, but how many of those
patients were actually terminally ill; how many of the virtual
wards were providing 24/7 effective cover for these patients; and
what is happening across the whole country in relation to 24/7
palliative care cover? All the evidence that is emerging is that
it really is grossly inadequate. Families are left unable to
access the care and support they need.
Ten years ago, NICE recommended that every area in England should
have a helpline so that families can phone if there is a crisis,
24/7, when they are looking after someone with palliative care
needs at home; yet the Marie Curie report Mind the Gaps—I should
declare that I am a vice-president of Marie Curie—which has been
developed with the Cicely Saunders Institute—again, I should
declare my interest there as an international adviser—has shown
that only one in three areas has such a helpline available.
Two-thirds of the country has nowhere for people to phone.
Is the Minister prepared to meet me and others from palliative
care to mirror what is happening in Ireland now? From this
February, the Irish Government will be funding 100% of hospice
clinical services, because they have recognised the inadequacy of
relying on voluntary sector funding. We know that good care costs
less than poor care. We know that where there is good palliative
care in place, with 24/7 support, the number of emergency
admissions goes down, the pressure on acute beds goes down and
inappropriate transfers drop. Although I am not expecting an
answer today, I hope the Minister will seriously consider looking
at that situation.
I shall just make a comment from Wales and point out that in
Wales, paramedics are now being trained specifically in
palliative care. Some consultant paramedics are now attached to
palliative care teams and are able to administer palliative care
drugs out of hours as required.
My other question for the Minister is on what discussions he has
had with the GMC over retention. Those doctors who were
temporarily registered have received notice that, as from March,
for those who had retired, their temporary registration because
of Covid will cease. I just wonder, with the figures we have seen
come out today, whether it would be wise to negotiate with the
GMC, first, for that to be deferred and, secondly, for all those
doctors to be contacted and asked directly how they would like to
contribute to improving some of the services. There is a lot of
skill there which is currently being unused and underutilised.
Again, I guess I should declare an interest because my husband is
a dermatologist and has been in that position but has never been
called up and would have been quite willing to go and help with
clinics. Those are some of my questions for the Minister.
(Con)
I thank the noble Baroness for those points. Absolutely, I will
need to come back on some of the detail on the virtual wards and
how they are being used. One thing I will say about them, though,
from my knowledge, is that the ability of people to communicate
on a regular basis is one of the key advantages. On the point she
makes about palliative care and the ability to have 24/7
communication, the beauty of the virtual wards is that they have
that inbuilt, for want of a better word—they have that advantage.
As noble Lords know, I am always eager to learn from practices
all around the world, so I will very happily meet people and
learn from them.
On retention, absolutely, we all know that the supply of doctors
and medics is the key thing that we need, so I personally feel
that we need to look at every avenue to make sure that we can
maximise that supply. Again, it is something that I will inquire
into as a result of that, and maybe when we have our meeting we
can discuss that further.
(Lab)
My Lords, I too thank the Minister for the Statement and his
response, but it takes the biscuit in terms of the Government
really seeking to exploit the plight of the NHS by putting so
much emphasis on the industrial action being taken. As the noble
Lord has said, even before Covid the Government were way off
meeting any of the core targets. In 2010, they inherited a health
service that was running very well and met all the targets. They
threw away that inheritance. When Covid hit, the health services
were already running so hot that there was just no headroom at
all to cope with the pressure that then came, with—my noble
friend is right—hugely dangerous occupancy rates. There was
simply no headroom.
Looking at the funding, from 1948 to 2019-20 the NHS received
funding of 3.6% real annual growth, on average, per annum. The
coalition Government slashed it to 1.1%. The May and Cameron
Governments gave it 1.7%. Only with the Covid expansion were
resources over that 3.6% average. It is no wonder that the health
service is tackling such a momentous challenge. We need to hear
from the Government some real plans to get investment back in the
health service, to give it the kind of headroom it needs to start
meeting the targets that are so important—would the Minister
agree?
(Con)
I happily agree that we are investing record sums. The latest
figures show that we are investing around about 11% of GDP in the
National Health Service. I believe the figure in 2010 was
somewhere in the 7% to 8% range—I am speaking from memory and so
I will correct that if it is not quite right, but that is the
sort of massive expansion we have seen. If I take one area as an
example, the cancer workforce has trebled since 2010.
What we are seeing more than ever is a record level of investment
in the health service but also a record level of demand. I was
hoping to show in the Statement how we are looking to tackle
that. I will freely admit the challenges, and that it is early
days, but I believe we are showing signs of getting on top of it.
As I have said many times, I really think that technology will be
its future, and there will be lots more we can talk about when we
show the profound changes it is going to make.
(GP)
My Lords, one in seven UK-trained doctors has left the country to
practise overseas. That is some 18,000 doctors, a figure which is
up 50% since 2008. Last year, the General Medical Council did a
survey of doctors departing the UK to practise overseas, and one
of the key factors identified was that doctors were leaving to
work in a place where they felt supported by the state and the
employer. Does the Minister believe that the Statement—the
Government’s general position—is sending a message to doctors
that they are supported and cared for, and truly valued, by the
UK Government, given that if we look at the financial valuation,
junior doctors’ salaries are down 24% in real terms since
2009?
This is obviously an issue of money, but it is also an issue of
attitude. Have the Government got their attitude to the junior
doctors terribly wrong?
(Con)
I agree with the sentiment expressed by the noble Baroness.
Clearly, we want to make sure that we minimise any loss to the
profession. Retention is key. The long-term workforce plan was
all about trying to put a long-term footing in place, one which
looked at not just the recruitment of doctors but their
retention, which, as I say, is key.
Money is an element of that, clearly. As I say, I have not heard
or seen anyone suggesting that we should be paying the 35%
increase. I do not think that is a reasonable approach; I have
not heard any noble Lords come forward and say that. The correct
attitude of the noble Baroness is key as well. We need to make
sure that we get that right and I like to think that we are
trying to do that. The Secretary of State has been very positive
in terms of trying to do that as well. I absolutely agree that,
at the end of the day, this is a key workforce and its members
need to feel that they are key, rewarded and motivated by what
they are doing. That is key to any profession.
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