I beg to move,
That this House
expresses concern at the effect on patient care of the closure of 14,000 hospital beds since 2010;
records its alarm at there being vacancies for 100,000 posts across the NHS;
regrets the decision of the Government to reduce social care funding since 2010;
notes that hospital trusts have been compelled by NHS England to delay elective operations because of the Government’s failure to allocate adequate resources to the NHS;
condemns the privatisation of community health services;
and calls on the Government to increase cash limits for the current year to enable hospitals to resume a full service to the public, including rescheduling elective operations, and to report to the House by Oral Statement and written report before
I begin by paying tribute to the extraordinary efforts of our NHS and social care staff for all their work this Christmas and new year, and this winter. They continue to do all of us in this House proud.
It is almost a year since the House debated the national health service in the first Opposition day debate following the Christmas and new year break. A year ago, we debated winter pressures with a backdrop that was characterised by the Red Cross as a “humanitarian crisis”. Here we are again, a year later, debating a winter crisis worse than last year’s. This winter crisis was described by Taj Hassan, president of the Royal College of Emergency Medicine, as “even worse” than last year’s. He also said:
“In some cases, I’ve heard of 50 patients in an emergency department waiting for a bed. We have to try to manage them…as best we can, in cold, draughty corridors, while dealing with new emergency patients.”
His words are backed up by the realities on the ground, revealed in the weekly reports of what is happening. Since the start of this winter, more than 75,000 patients waited for over 30 minutes in the back of an ambulance. Almost 17,000 patients waited for over 60 minutes. This is despite the NHS Improvement directive last year that emergency departments should accept handover of patients within 15 minutes of an ambulance arriving.
Does my hon. Friend recognise the pressure across the system? At Arrowe Park on the Wirral, staff made 48 extra beds available for the winter crisis and over Christmas, and in the event they had to make 40 more extra beds available by cancelling all elective surgery. Does he believe that this is the way to plan for the winter, and does he believe that the Department of Health made robust and appropriate plans?
My hon. Friend speaks eloquently about the pressures on her local hospital. She will also be aware of how foolhardy it would have been to close the Eastham walk-in centre on the Wirral, as was proposed because there were not enough staff at Arrowe Park Hospital. Fortunately, because of her campaigns and those of my hon. Friends the Members for Wirral South (Alison McGovern) and for Wirral West (Margaret Greenwood), the Eastham walk-in centre has been saved. That is because of Labour MPs working in their constituencies.
King’s College Hospital NHS Foundation Trust in my constituency, one of the largest trusts in the country, has recently been taken into financial special measures. Does my hon. Friend agree that the failure of King’s is a canary in a coalmine for the NHS, and must be a wake-up call for the Government on the level of resource that our outstanding NHS staff need so that they can deliver for patients? Will he join me in calling on the Health Secretary to ensure that King’s emerges from financial special measures with the additional funding it needs to deliver safe, effective, world-leading care for patients?
I am grateful to my hon. Friend for raising this issue. She has been a passionate defender of King’s, speaking out in this House on numerous occasions. Before Christmas, we saw the resignation of Lord Kerslake as the chair of King’s, when he spoke out about the real pressures facing our NHS, which were dismissed at the Dispatch Box by the then Minister when we had a debate in this House.
Does the hon. Gentleman acknowledge that it was under a Labour Government that a walk-in centre in Broxtowe closed? However, I do not seek to blame a Labour Government, because it was a local decision made by local practitioners. Would he not at least accept, in a spirit of trying to build some sort of sensible debate about our NHS instead of always weaponising it, that this Government have put in an extra £437 million specifically for the winter period? Would he not at least give the Government credit for that planning, which we have never seen before?
The right hon. Lady is a former Health Minister, so she will know that in her local hospital trust 771 patients have waited longer than four hours on trolleys, unable to get a bed. She talks about the winter money. We were calling for winter emergency money back at the general election, and we repeated those calls in September. That money did not come through until the November Budget, and hospital trusts were not told about their allocations until a few days before Christmas. That is no way to prepare for the winter. I suspect that when she was a Health Minister, she would have been saying that to the officials in her Department.
The point is that for the first time a Government have done everything they possibly could—[Hon. Members: “No.”] They have, because no Government can predict what the weather may be like, or the uptake of flu vaccinations. It is wrong to suggest that this is the fault of the Government in England when there has a problem across the whole of the United Kingdom, including Scotland and Labour-run Wales.
The right hon. Lady will know that we have had eight years of sustained underfunding of our national health service because of decisions by this Government, of which she was a member until very recently.
“It is true that we are running tighter than any of us would really want to and we have not had the impact from the social care investment this year that we had hoped for;
so, it will be difficult—it will be very tight—over winter.”
This Government knew what was coming, yet they have let the whole country down.
My hon. Friend, who is an excellent member of the Health Committee, speaks with great eloquence, pointing out the hubristic response of Tory Members in saying that this was not predictable or preventable. This winter crisis was entirely predictable and entirely preventable.
Two hundred and thirty-three patients were left in ambulances for more than 30 minutes outside King’s Mill Hospital in the week of 25 to
Absolutely. I have absolute praise for the staff at King’s Mill—it is where my first daughter was born, in fact. The way in which patients have had to wait for ambulances outside King’s Mill is entirely unacceptable, and this Government need to do something about it.
Let me make a little progress, if I may. I will try to take as many interventions as possible, but this is only a half-day debate and I know that many people want to speak.
We have heard the stories of ambulances backed up outside hospitals. Ambulances have been diverted from gridlocked A&E departments 150 times. Our hospitals are overcrowded and our bed occupancy levels are running at unsafe levels. In the run-up to Christmas eve, over one third of England’s children’s care units were 100% full, with not a single spare bed. We have had reports of whole children’s wards being used for adults. In fact, we do not know the full scale of the crisis because this year NHS England is not reporting which hospital trusts have issued the OPEL—operational pressures escalation levels—alerts revealing hospital pressures. I hope that, given the Secretary of State’s keenness on duty of candour, he will explain why the OPEL data is not being collected and published nationally for England, as it has been in recent years.
But of course behind every single one of these statistics is a real human story. We have heard stories of elderly, fragile patients treated in the backs of ambulances in the freezing January weather, or elderly patients, sometimes confused, languishing on trolleys in corridors, such as the 80-year-old epileptic man with severe dementia who was stuck on a trolley for 36 hours waiting to be treated at the Royal Stoke. His daughter, Jackie Weaver, said:
“it was absolutely horrendous. You couldn’t get past for all the trolleys”.
We had 67 people sitting on trolleys. We ran out of corridor space. Two hundred people medically fit for discharge had nowhere to go. The pressure on my constituents and those of my hon. Friends in North Staffordshire was appalling, but so was the pressure on the staff who had to cope with looking after those patients. My constituents deserve better and the staff deserve better. We need money for social care—and we needed it last year.
My hon. Friend makes a moving contribution to the debate. Those people in Stoke whose relatives have been waiting so long on corridors will see the Prime Minister saying, “Nothing is perfect”, but the truth is that we do not want perfection—we just want a bit of dignity and humanity in our health service.
This time last week, I went out with an East Midlands Ambulance Service crew for a shift, and they told me that over the Christmas period they were waiting two hours and more outside A&E at Lincoln Hospital. They also said that they were not even just sitting in the ambulance—one of them, a paramedic, was going inside and cannulating patients, working in resuscitation, and clerking patients. Will my hon. Friend comment on that and on what we will do about it in government?
My hon. Friend makes a powerful, and indeed raw, contribution to our proceedings, because she was working over the Christmas holiday on the frontline in Lincoln. I pay tribute to her and all her colleagues there. I hope that the Secretary of State reflects on her contribution and responds to it in his remarks.
The stories are indeed heartbreaking, and no one wants that for their constituents or their relatives. Will the shadow Secretary of State therefore recognise and welcome the investment that the Government have made in the units for elderly and frail people? As I have seen in my hospital, the Alex, that investment has made a massive difference. It is too early to tell whether that will solve all the problems, and we of course want to do more, but it is making a real difference on the ground, as is the additional Government funding of nearly £4 million, which was put in place in time. The hospital has been in special measures, but its leadership is turning it around. Does he welcome such real examples of good practice that are helping our constituents?
I do welcome examples of good practice, but I share the hon. Lady’s frustration, which she has put up on her website, about the money taking so long to reach the frontline:
“while the money has been approved, the current frustration is the time it is taking for the Trust to gain access to the money.”
I agree with her: this money should have been announced sooner for our national health service.
If I may, I will make a little progress. I have been generous, but I will try to take as many other interventions as possible.
We have heard about Stoke, but what about the story of 87-year-old Yvonne Beer, who suffers from dementia? She was at Worcestershire Royal when, forced to wait 10 hours in hospital to see a doctor, she had to be tied into a wheelchair with a scarf after her bed was taken away. We learn that Southmead Hospital in Bristol has had a capacity of 104%. Yesterday, a leaked memo revealed:
“Acute Medical Unit physicians have been on their knees with workload pressure”, and that the
“biggest risk remains patients in corridors in the Emergency Department with no allocated doctor, no allocated bed and no treatment—some of these are very sick indeed”.
In my local hospital in Barnsley, general and acute bed occupancy reached 100% on
Absolutely. Bed occupancy rates at such a level are unsafe. I know the Secretary of State is committed to patient safety—he has made it one of his signature issues—yet he is presiding over a health service in which bed occupancy in acute hospitals is routinely well over 85%.
“The man who was lying on the floor at the bottom of my husband’s bed was being sick. He was asking for a trolley to lie on but there wasn’t one to give him.”
I am sure my hon. Friend will join me in thanking the staff for their gargantuan efforts this winter and over the festive period. Just this week, I spoke to a nurse at the very same hospital, who advised me that staff had had to clear out the cleaning cupboard to put in a bed for a patient to receive an infusion. Does he share my horror at that? What on earth is our NHS coming to under this Government?
In relation to the incident at Pinderfields Hospital, it is completely unacceptable that people should be lying in corridors, but the hospital informed me before I made the statement on Monday that the patients who were photographed had been asked whether they wanted to sit down on a seat and had decided not to do so.
I am grateful to the hon. Gentleman for taking the opportunity to clarify the situation for the House. Perhaps he should have done so on Monday. I do not know, but he may well still have been in place as a Health Minister if he had said that on Monday.
There have been huge pressures on the North East Ambulance Service, because of which it has been asking some patients, where appropriate, if they have alternative transport options, such as a family member. The East of England Ambulance Service has said that some patients were being sent taxis to get them to hospital, with paramedics stuck in ambulances queuing at hospitals for more than 500 hours in the past four days. Of course, clinicians have spoken out. Richard Fawcett of the University Hospitals of North Midlands warned that his hospital had
“run out of corridor space”.
He also felt compelled to apologise for, in his words, the “third world conditions”.
The hon. Gentleman mentioned the East of England Ambulance Service. He will be aware of the case of the elderly lady who lost her life while waiting four hours for an ambulance to arrive. That is often a result of having ambulances stacked up outside hospital, as he has described. Does he agree that it is now time to end these intolerable incidents—such failures of care are apparently widespread across the country—and to have a mature national conversation about how to increase the funding for our NHS and our care system to ensure that people get care when they need it?
I agree entirely. I am entirely happy to have a conversation about how to increase funding in the national health service, but I have huge scepticism about whether this Government—having overseen eight years of desperately tight funding allocations for the NHS, with cuts to community health services—are prepared to engage constructively in such a conversation.
On the specific case that the right hon. Gentleman mentioned, Giles Watling, whom I cannot see in his place—I apologise if he is in the Chamber and I have not spotted him—has called for an inquiry. He has actually warned that if that incident was a result of underfunding, we need to put more funding into ambulance services, and I share his concerns.
If I may make a little progress, because I have been generous; I will then try to take more interventions. I am conscious, however, that this is only a half-day debate.
The consequences of this crisis are not only for those in urgent need, but for everyone using the NHS. Let us be clear that this panic cancelling of elective operations means that patients will suffer. Not only will patients suffer longer waits for operations while in pain and distress, but they will wait for appointments with the uncertainty of not knowing what is wrong with them, and the knock-on effects on NHS services and the wider society are huge. Already, patients are facing a waiting times crisis with 4 million on the waiting list.
Let me make a bit of progress.
A lost month will mean that thousands of patients across the country are stuck with their lives on hold. To call this “routine care” misses the fact that these are big issues for the individual patients affected. The young man awaiting heart valve surgery, who will have arranged time off work and for his family to be around to care for him, now has to cancel it all and does not know when his operation will happen. He also runs the risk of a deterioration in his heart function, which could lead to further hospitalisation in an emergency, adding to the pressures on our emergency services.
Will the hon. Gentleman at least recognise that the NHS is doing more operations than ever before? In my area of Mid Essex, an incredible 72,000 operations were carried out last year, which is over 9,000 more than back in 2010. Will he join me in thanking the incredible NHS staff for the many better outcomes they are delivering?
Yes, I will. I of course thank the NHS staff. Of course, if the hon. Lady wanted to thank the NHS staff, she could have supported us when we brought in motions to give the staff a fair pay rise, but I do not think she did so.
The hon. Gentleman is extremely generous, and I always follow his remarks with a great deal of interest. Any cancellation is appallingly bad, but does he understand that the worst possible cancellation is one on the day of surgery, which is clinically unacceptable? Will he at least give the system credit for at least trying to introduce some sort of planning this year, for the first time that I can remember since 1984?
The hon. Gentleman will know that the system is in such a state because of years of sustained underfunding. His answer would be a cross-party commission, a sort of royal commission, and I have huge respect for his contributions to these debates, but let us be clear that for eight years the NHS has not been getting the level of funding it should be getting in historical terms.
My hon. Friend is being very generous in giving way. Down in Sussex, patient transport was privatised and given to a company called Coperforma. Seven months after the contract was awarded, the company was stripped of it for its appalling practices and for completely underperforming in every way, shape and form. It now transpires that Coperforma has been given more money for seven months than it would have received if it had performed properly for a full year. Is that not indicative of the way in which the NHS is being run?
Order. May I appeal for brief interventions? I would just point out to the House that no fewer than 38 Back Benchers wish to speak, and even if the debate is allowed to run on beyond 4 o’clock, which is in the hands of the usual channels, probably half of them will not be able to do so. I say now that they will just have to sit, wait and hope—I am not publishing a list; we do not do so—but long interventions do not help.
I will take that as my second telling off from you today, Mr Speaker. Given your guidance, I will try not to take any more interventions, but on the particular point raised by my hon. Friend Peter Kyle, the privatisation of patient transport services to Coperforma in his area of Sussex was an absolute disaster for patients and for the ambulance drivers, who I met—they went for eight weeks, as I recall, without pay. He has been campaigning on the issue, as has the GMB trade union, which I congratulate on the campaign it has run. We now learn that, having ended the contract, money is still going to that firm, which is an absolute scandal. I hope there can be a full inquiry into what has gone on, and I praise my hon. Friend for leading the campaign.
I have talked about the real impact of cancelled operations—for example, on someone waiting for a hip replacement who is forced to stay at home, unable to walk properly, and who, due to the pain, will no doubt at some point need to see a GP again in an emergency, which again adds to the pressures on the service. Perhaps someone in need of a cataract operation has had that operation cancelled and is now at risk of falls because they cannot see. Such a person could well end up in A&E, again needing a hospital bed. These are real people who rely on the NHS and whom the Government are letting down. The domino effect of not providing proper, timely care increases the crisis and pressures on the wider NHS.
I did say that I would try to make progress. It is clear that a lot of Members want to speak, so I will continue if I may. I have been generous in giving way.
Now we are beginning to hear that it is not just routine non-urgent operations being cancelled. Today, The Times reports of a hospital in Oxford considering delaying the start for chemotherapy due to staff shortages and lack of capacity—a four-week delay on all new patients needing chemotherapy—and there are proposals for those on the first cycle to have full chemo, but then discriminate against those on cycles 2, 3 and 4—second, third and fourth-line chemo—giving those patients a reduced number of cycles, which is a two-tier chemotherapy system.
Let me make some progress.
In The Guardian today, we read the story of Carly O’Neill, who went into hospital for her cancer operation and who was waiting in her gown with wristbands on in the hospital, only to be told her operation would have to be cancelled because there was no bed available.
Let me finish the point.
How about my constituent Mr Geoff Brooker, who was diagnosed with cancer of the bladder? He has had his planned operation cancelled twice this winter. When Mr Brooker was asked about the Secretary of State’s apology, he said:
“He may have apologised for postponements but it was as if he was apologising for the cancellation of a jumble sale.”
My constituent went on to say that Ministers were “uncaring” and he blamed “poor planning”. He added:
“If operations like mine are postponed then it’s likely it will cause deaths. The decision could even be the death of me”.
There we have it: cancer patients having operations cancelled and trusts looking at delaying chemotherapy, yet these Ministers sit there with their NHS badges on their lapels. They should be ashamed of what is happening in the NHS today.
Goodness knows the hon. Gentleman knows I am no apologist for Oxford University Hospitals Trust, but it is important that we do not make a crisis where there is not one. I have been assured by the University Hospitals Trust today that the leaked memo does not represent the current reality. I, like him, have concerns about recruitment, and I, like him, am worried about the future of recruitment in the NHS, but it is really important that we do not worry current cancer patients who will continue to receive their treatment.
I thank the hon. Lady for her contribution. The memo was emailed to oncology department staff in the last few days. If the trust is now backing down on that, all of us across the House will welcome it, but the point still stands: the trust was looking at delaying chemotherapy by four weeks and it referred to a lack of staff and capacity. As we know, this trust has cut many, many beds in recent years, including cancer beds and renal beds, and we know that it is under huge pressures.
I will make some progress.
Victoria Prentis rightly said that we do not want to make this more of a crisis, but the Secretary of State knows that cancelling elective operations impacts on hospital finances. It means a loss of revenue for trusts that are already struggling to meet their deficit targets. Rather than allowing waiting times—
I am not going to take any more interventions, I am afraid.
Rather than allowing waiting times to escalate further, why will the Secretary of State not commit today to giving hospitals emergency funds, so those cancelled operations can be rescheduled as soon as is reasonably possible and hospitals do not lose revenue and get further into problems with their deficits?
The Secretary of State knows that cancelling electives impacts on training of the next generation of surgeons and junior doctors, who are warning that they could lose out on as much as a sixth of their six-month training because the operations are not there for them to do. Will he tell us, if these cancelled electives continue, what is his plan to ensure that our junior doctors and surgeons can catch up on the training they need? Our patients deserve the best-trained surgeons and junior doctors in the world. Cancelling those electives impacts on their training. Will he tell us his plan for dealing with that?
We all agree that every penny counts in rising to the challenge of the winter crisis caused by Downing Street. I know the Secretary of State will tell us that we have had the—
I said that I would not take any more interventions.
The Secretary of State will tell us about the winter funding, but we also know that the winter funding came far too late. NHS Providers has warned that it came far too late in December, and I am sure that many hospital trusts will be telling him privately in his morning phone calls that it came too late. Hospital trusts have to turn to expensive private staffing agencies to get through this winter due to the Government’s failure to invest in an adequate workforce to enable the NHS to deliver the care the nation needs. In many places, NHS trusts are effectively held to ransom by staffing agencies.
Last month, NHS Improvement refused a freedom of information request to publish how much these private agencies are costing individual trusts. Does the Secretary of State agree that that is unacceptable and that we should know how much extra money set aside for winter is going to private agencies? Will he undertake to produce a league table naming and shaming every single agency and stating how much they have been getting from each and every trust, so we can have clarity on this matter?
The Secretary of State will no doubt tell us that the problems we are experiencing have arisen because we have an ageing society. Of course, we see pressures on the service because of the demographics not just in winter, but all year round. Patients with less acuity, often with sometimes three or four comorbidities—in particular, those being treated at this time of year—put huge pressure on the service throughout the year.
However, these demographic changes in society did not just drop out of the blue sky in the last few weeks. We have known about these trends for years and years, which makes it even more criminal that the Government have presided over eight years of underfunding in the NHS—£6 billion of cuts to social care—and have acquiesced in a reduction of 14,000 beds. We will probably see more bed reductions if we pursue the sustainability and transformation plans across the country. We have seen delayed transfers of care increase by 50% these last years.
On social care, the Secretary of State may have the name in his title now, but he has no plan to deal with the severe £6 billion cut we have had to social care in recent years.
I am not giving way because we are pressed for time.
The fact that makes this winter crisis even more serious than anything that has gone before is not just the cuts to social care and to the community care sector, nor is it the underfunding of the NHS; it is that the crisis takes place against the backdrop of some of the most serious and far-reaching neglect of health perpetrated on the people of this country for more than century.
Sir Michael Marmot, a recognised authority on public health, has warned that this country has, since 2010, stalled in the task of improving the life expectancy of our population and that differences in life expectancy between the poorest areas in the country and the better off have widened in recent years. This is what happens with austerity and cuts. This is what happens when the Government fail to invest in housing and the insulation of our housing stock. This is what happens when the Government allow fuel poverty to increase and oversee falling real incomes, benefit cuts for the poorest and rising child poverty. The shocking consequence is that the number of hospital beds in England taken up by patients being treated for malnutrition has doubled since 2010. Is not that a shame? Is not that a disgrace?
The hon. Gentleman is right about one thing, which is demographic change. That and an ageing population are directly behind some of the malnutrition figures, and he must not misuse those. Is it not the case that, as the Royal College of Nursing told the Health Committee just two or three years ago, the failure to plan for a rising and ageing population is a feature not of the past five years, but of the past 10 to 15 years? He should not pretend that the problem has appeared overnight.
When we had a Labour Government, we trebled in cash terms the investment going into the NHS. When we had a Labour Government, we had trolley waits, but under this Government we have had 560,000 people waiting on trollies and 2.5 million people waiting more than four hours in A&E. That is the difference between a Labour Government planning for the health needs of this country and a Tory Government cutting for the health needs of this country.
This is not just a winter crisis; it is an all-year-round funding crisis, a year-round staffing crisis, a year-round social care crisis and a year-round health inequality crisis, manufactured in Downing Street by this Government. We have had eight years of underfunding and cuts; 14,000 beds have been lost; the number of district nurses has been cut by 3,500; the number of mental health nurses has been cut; child and adolescent mental health services budgets have been raided; the number of GPs has fallen and we are 40,000 nurses short; community and mental health services have been privatised; and social care has been savaged and staff demoralised.
In my borough of Lewisham, CAMHS are facing a budget cut of up to £200,000, leaving many children without the treatment and services they need. Does my hon. Friend agree that the Government have failed to provide mental health services to some of the most vulnerable in society, particularly at this difficult time?
Half this country’s clinical commissioning groups are raiding children’s mental health services because the money is not in the wider NHS. Yet this Secretary of State remains in place, even though the truth is that doctors and nurses have lost confidence in him, patients have lost confidence in him, and it seems the Prime Minister has lost confidence him. He fights for his own job, but he will not fight for the NHS. Our patients are crying out for change, but they will look at the Health Secretary, still in post today, and see that, to coin a phrase, “Nothing has changed. Nothing has changed.” I commend our motion to the House.
I, too, start by offering, on behalf of the whole House, a massive “thank you” to all staff across the health and care system who went beyond the call of duty and gave up their Christmas and new year to keep patients safe. Their dedication makes the NHS the best healthcare system in the world. They visibly demonstrated their values, constantly putting the needs of patients before their own.
Attempts to politicise pressures on the NHS are a serious mistake. The last time the NHS had a difficult flu winter was 2009—Jonathan Ashworth might know that, because he was working in Downing Street at the time. In 2009, the shadow Health Secretary was Andrew Lansley. He refused to attack the Government, because it was an operational issue—in fact, the then Health Secretary, Andy Burnham, thanked him for his “measured tone”, which meant that
“together we can give a reassuring message to the public”.—[Official Report,
Vol. 493, c. 1056.]
Sadly, I cannot say that to the shadow Health Secretary today.
The hon. Gentleman, who has used some extraordinary language today, says that the NHS is on its knees. Let us look at the facts: since 2010, we have 14,000 more doctors, 12,000 more nurses on our wards and 5,000 more operations every single day; and in A&Es, which he talked about a lot, 1,800 more people are seen and treated within four hours every single day.
In the spirit of sounding conciliatory, I thank the right hon. Gentleman for giving way. The Royal Bolton Hospital made provision for the Christmas period, but despite that it has had to cancel all routine operations, as well as elective operations in trauma and orthopaedics, until
We did provide an extra £1.4 million to the hon. Lady’s local hospital before Christmas, to help it to deal with the immediate pressures, but let me deal with this issue of cancelled elective care operations. I agree with the shadow Health Secretary that it is a big deal for patients who are told that their planned procedure is to be postponed. No one minimises the distress that that causes, but last year and in previous winters operations were cancelled at the last moment, which is much more distressing and challenging for hospitals to plan around. The decision was taken this year to take a much more planned approach. We hope that, overall, fewer operations will be cancelled at the last moment, but we need to do this in a planned way.
I cannot help but intervene, because last year someone very close to me—a member of my family—was one of those people who was about to go into the operating theatre when the procedure was cancelled. I came to my right hon. Friend about the case. I can tell the House that that was not a good experience, so it is a much better approach to plan ahead and give people notice. Yes, emergencies will happen, but planning ahead makes for a better system. I think the Government have made a good move.
My hon. Friend is absolutely right. I hope she will not mind my saying that her case involved cancer, and one of the things that the planned approach allows us to do is make sure that we do not have to cancel cancer operations, which are the most important, at the last moment. That is essentially what we are trying to do: protect everyone who is in a life-critical situation.
I have to intervene. I had treatment and an operation for cancer. If my operation had been cancelled, I would have been able to come to this House and ask the Secretary of State personally to intervene, but I am speaking today on behalf of Carly O’Neill, who went to the press to talk about her cancer operation. What explanation does the Health Secretary have to give Carly O’Neill and other cancer patients for their operations being cancelled?
I say, very directly, that the instructions from NHS England could not have been clearer that cancer operations should not be cancelled, because they are deemed to be urgent. From the perspective of the Government and NHS senior leadership, such cancellations are not acceptable. If the hon. Lady knows of individual cases, she should raise them with me and we will look into the matter. It is precisely because we want to preserve capacity for people who need it the most that we have taken these difficult decisions.
The Secretary of State complains about politicisation of the NHS, but 90 colleagues from all parts of the House, including many Conservatives, are offering a different approach—a cross-party mature conversation to find a solution. Lord Saatchi, Baroness Cavendish and Nick Timothy are now arguing for the same thing. Will he now embrace that approach—a civilised approach to come up with a consensus for this country on how we secure our health and care system?
I have said publicly that, as we come to the end of the five year forward view, we need to seek a consensus on the next stage for the NHS. We will need significantly more funding in the years ahead, and we need to build a national consensus on how to find that funding. My view is that we should try to do that for a 10-year period, not a five-year period. I am open to all discussions with colleagues about the best ways to do that, but, as we heard earlier from the shadow Health Secretary, the Labour party is not interested in being part of those discussions, which illustrates how difficult it is to reach consensus.
I will make some progress before giving way again.
Let us look closely at what the hon. Member for Leicester South has said. He used a lot of hyperbole today. He says the Government are sleepwalking into winter. This, of course, has been directly contradicted by Professor Sir Bruce Keogh, the medical director of NHS England, who has said:
“I think it’s the one”— winter—
“that we’re best prepared for…This year we started preparing” a year earlier. He continued:
“We have…a good plan.”
Chris Hopson of NHS Providers, who regularly criticises the Government when he disagrees with us, has said:
“This time preparations have never been more thorough.”
I will make some progress and then give way further.
Let us look at those preparations. We have put £1 billion into the social care system. The biggest lesson from last year was that pressure in the social care system was making it difficult for hospitals to discharge. What has been the result of that investment? Combined with the extra £337 million in the Budget, it has freed up 1,100 hospital beds by reducing the number of delayed transfers of care. In total, 2,700 additional acute beds have been commissioned since November. The shadow Health Secretary told The Independent:
“It is completely unacceptable that the 85% bed occupancy target…has been missed”.
What was bed occupancy on Christmas eve? It was 84.2%, so this had a real impact.
I have said I will give way in a moment, but I want to make some progress, too.
Secondly, because many patients can be better seen by GPs, last year’s spring Budget allocated £100 million of capital to help hospitals to set up GP streaming services. In the year the shadow Secretary of State says the Government were sleepwalking, the number of type 1 trusts with GP streaming tripled to 91% of all such trusts across the country. At the same time, we made it massively easier for people to access GPs and nurses over the Christmas period. For the first time, people could get urgent GP appointments at their own surgery, or one nearby, from 8 to 8, seven days a week, except on Christmas day. The number of 111 calls dealt with by a clinician increased to nearly 40%—nearly double the figure in the year before. That, too, has massively reduced pressure on A&Es.
I draw to the Secretary of State’s attention the fact that we continue to have no Northern Ireland Executive and therefore no local Health Minister, meaning that there is a specific problem in Northern Ireland. The NHS staff there are absolutely superb, but they have also been under enormous pressure in recent weeks, as have the ambulance crews. It is terribly demoralising and wearisome for them. The Government must take some responsibility, given the continued absence of a Northern Ireland Executive. What recent discussions—and with whom—has the Secretary of State had in Northern Ireland about dealing with the crisis in the NHS and among ambulance crews in Northern Ireland?
The hon. Lady will understand that because I am the Health Secretary for England, I have not been having an enormous number of discussions about the terribly challenging political situation in Northern Ireland, but I agree that it is incredibly unhelpful for the NHS in Northern Ireland if there is not an Executive. The former Northern Ireland Secretary—I know that the whole House wishes him well with his medical challenges—was very engaged in trying to address that issue, and I know that the new Northern Ireland Secretary will make it her top priority, too, precisely because it matters so much for public services.
The Secretary of State does not want to get drawn into Northern Ireland—I understand that—yet the Prime Minister seems willing at every opportunity to attempt to smear the Welsh NHS. Can we have some facts before us? Spending per head on the NHS and social care in Wales is 8% higher than in England, and it went up 4.5% last year. We are dealing with winter pressures and we are putting funding up, yet the Prime Minister seems to suggest otherwise.
The hon. Gentleman rather inconveniently forgets that the Barnett formula is a major reason why spending is significantly higher in Wales, but I do have something to say about the situation there, so I will oblige him a little later.
May I bring the Secretary of State back to the benefit of having GP-led services in hospitals to take the pressure off A&Es? I commend Solihull Hospital for doing just that and reducing appreciably the number of examples of winter pressures being raised with us? Could that be replicated across the NHS?
This is what is so disappointing about some of the shrill tones we have heard this week in the media and today in the House. Reforms across the NHS are making a real difference. I totally commend what is happening at Solihull. The key to solving the long-term pressures on our emergency departments is to be better at treating people in the community. The growth in emergency admissions in the vanguard areas of the NHS is about half the national average. This is the five year forward view that we are rolling out across the country. We need to celebrate the successes.
I want to make some progress before I give way again.
A very important point that we have not talked about much in this debate, although it is extremely relevant to people on the NHS frontline, is flu. This year, we have had a much bigger spike in the number of flu cases than at any time since the winter of 2009, but we also have in this country the most comprehensive flu vaccination programme in Europe. This year, for the first time, it was made available to those who are eight years and under and to care home staff. As a result, a million more people have been vaccinated for flu this year than in the year before. Uptake among NHS staff is at 59.3%, which is its highest ever level.
I say that because while the shadow Secretary of State tries to make the case that no preparations were made, the reality is that the NHS could not have been working harder to prepare for this winter. The result of those preparations is that A&E performance, having declined for six years in a row, last year stabilised for the first time, according to the latest verified data. In the week after Christmas, compared with the year before, we had fewer A&E diverts and more calls to NHS 111. Many Members have talked about trolley waits. It is totally unacceptable for people to be left on a trolley for a long time, but November’s figures, which are the latest verified figures, showed that the number of trolley waits had fallen by three quarters compared with the previous November, so a huge amount has been happening.
Does the right hon. Gentleman think that patients being treated in cleaning cupboards and six patients in four-bed bays without lockers, curtains or call bells are signs of good preparation for the winter crisis?
That is completely unacceptable, but it is disappointing that the hon. Lady stands up and runs down the NHS when her own trust, which received £3.4 million before Christmas to help with winter, has managed to improve its performance: last November’s figure was 91.8% compared with 77.7% a year earlier. That is a huge achievement for Mid Yorkshire Hospitals NHS Trust. Why will she not praise what is happening, rather than running the NHS down?
I support the leadership that the Secretary of State has offered during this winter crisis and the tone he has adopted in this debate. As a result, there is not the kind of crisis we have had in past years. Now that he has widened responsibilities for social care, will he help West Berkshire and Wokingham, which have had problems with past formulas and do not have enough money to take pressure off the hospital in the way he would like?
I will certainly revisit the issues in my right hon. Friend’s local authorities because I have looked at them before and know that there are particular pressures there. He alights on something else that the Opposition have not wanted to talk about, but which is very significant: the Prime Minister’s commitment to the integration of health and social care, which eluded the previous Labour Government over 13 years, despite their talking about it a lot. We are starting to see that happen in this country. Monday’s decision means that policy leadership will come back to the Department of Health, which will help us to make even faster progress.
I would like to take the Secretary of State back to his point about caring for people before they get to hospital and, in particular, issues to do with GPs. My local area has had difficulties recruiting GPs. It is vital that there is investment in increasing medical training for new doctors, so I plead with him to consider seriously the bid from Anglia Ruskin University to become the first medical school in Essex, where there is currently no pathway for our talented young people to train as doctors within the county.
I note my hon. Friend’s persuasive plea for her local university, Anglia Ruskin, but this is not a decision that I will be taking, because my own local university is also keen to offer more medical places. However, she is absolutely right to say that training the next generation of doctors and nurses is the long-term solution to these pressures.
I will make progress and then take a final set of interventions.
The heart of the shadow Health Secretary’s case is that winter pressures are caused by political decisions, not operational issues. Let us put aside the difficult winters that Labour had in 1999, 2008 and 2009, but if he is to drag politics into this, he cannot first say that this is the fault of politicians in England and then totally gloss over the responsibility of politicians in Wales, which the Royal College of Emergency Medicine says is “a battlefield” where
“patient safety is being compromised daily” and the situation
“is unsafe, undignified and distressing for patients and their family members.”
I simply ask the shadow Health Secretary this: if it is the Government’s fault that one in nine A&E patients waits too long here in England, whose fault is it that one in six does in Wales? Whose fault is it that people in Wales are nine times more likely to wait too long for test results?
I thank my right hon. Friend for giving way. On the Welsh NHS, he is absolutely right. Mr Speaker, I ask for your indulgence while I quote an A&E nurse in Wales, speaking last week: “On every shift, both corridors are full of patients on trolleys. We are housing ambulance crews for longer than ever, due to beds not being available in the hospital. Patients are being nursed in inappropriate areas due to no space. I have seen nurses in tears. I myself have been in tears. This is the first time that I have ever been demoralised and embarrassed to say that I am an A&E nurse in Wales.” That is in Wales, under Welsh Labour. Does my right hon. Friend agree that there is pure hypocrisy coming from Labour Members, who should take notice of the mistakes being made in Wales?
I totally agree. This is the central flaw in the Labour party’s case. We know that winter is the most difficult time, but Labour says that there is political responsibility in one part of the UK while saying absolutely nothing about Wales. I notice that the shadow Health Secretary is looking down at his notes as we talk about Wales, but the reality is that that completely blows apart his case. According to the British Medical Association, there is one area in Wales where not a single doctor was available overnight, and the performance of one A&E has fallen to 40%, which is unheard of in England—or, indeed, Scotland.
However, there is a political decision, which my hon. Friend Vicky Ford mentioned, that has a big impact on NHS winter performance: the number of doctors we train. Not once in my time as Health Secretary have I heard Labour call for an increase in training places. [Interruption.] No, I have not. The simple truth is that there is no point throwing money at a problem if there are not doctors and nurses available to spend the money on. While I have been Health Secretary, we have had 40,000 more doctors, nurses and other clinicians working in the NHS, but we need more. That is why, under this Prime Minister, we have announced the biggest increase in training places for doctors and nurses in the history of the NHS.
I congratulate the Secretary of State on facing down the Prime Minister on Monday, when what emerged was one man, two jobs, no governor. He must accept that the £6 billion in cuts to social care since 2010 has had a major impact, particularly on winter crises. Does he regret the Government’s decision to take that money out of social care?
In 2010, we faced the worst financial crisis since the second world war. The hon. Gentleman will know which Government were in charge when that happened. People were talking about a run on the pound—I notice that the Labour party continues to talk about that—and the crisis had to be addressed. We, like other countries, had to make significant reductions in public funding, but when we got the economy back on its feet and started creating jobs—1,000 jobs a day since 2010—the first place into which we put extra money was the NHS and the social care system. There is £600 million more in the social care system than there was two years ago.
I want to make progress, because a lot of Members want to speak, but I did say that I would give way to my hon. Friend the Member for Brigg and Goole.
I thank my right hon. Friend for giving way. He knows of my interest in ambulance services. I was on duty for Yorkshire Ambulance Service as a responder this Christmas and new year, and will be again tomorrow night. When he talks about workforce planning, he rightly talks a lot about doctors and nurses. Will he say something about how our incredibly well-trained paramedics can be used better to relieve pressure in A&E and reduce delays there?
I thank my hon. Friend for his work as a first responder; that is a fantastic example in his community. We have 1,700 more paramedics than we did seven years ago. My hon. Friend is absolutely right because the role of paramedics has changed dramatically over recent years. It used to be about scooping people up and taking them to hospitals; now, we are treating many more people on the spot. Paramedics have an extraordinarily important role, but it has changed. There is a changed emphasis, as in other parts of the NHS—a move towards doing as much as we can to treat people safely outside hospitals and to keep them at home, because we know that is the safest way.
I am grateful to the Health Secretary for giving way. The simple fact is that if we want more care in the community, the Government have to stop slashing social care budgets. If we want to stop people appearing at hospital with preventable conditions, we need to stop cutting public health funding. The Government do not have an economic record to be proud of, but even looking at the public spending that is being made, we see that the Government are penny wise and pound foolish.
I am sorry, but 3 million additional jobs have been created, so we do have a strong economic record, and that is why we have increased funding for social care recently. We have increased NHS funding significantly. As for slashing funding, the hon. Gentleman’s local trust received £9.7 million before Christmas.
Will my right hon. Friend reflect on the issue of beds? As a result of the measures that he has taken in recent weeks, Shrewsbury and Telford Hospital NHS Trust in my area managed to release an extra 120 beds to help it to cope with the significant winter pressures that it faced. Does he agree that community hospitals such as my area’s Bridgnorth Community Hospital and Ludlow Community Hospital, which have community beds, have a role to play in releasing pressure on acute hospitals from patients who no longer need acute care?
I agree. I want to take this chance to thank my hon. Friend for being an absolutely superb Minister of State at the Department of Health. The fact that the NHS is better prepared this year than it has been for very many years is partly because of his efforts, and I commend him on his fantastic contribution.
Does my right hon. Friend agree that the calibre of local trust leadership can play a huge role? In Gloucestershire, new trust leadership has tackled serious internal financial failings head-on. As a result, A&E times have been slashed and turned around, which meant that A&E waiting targets were met in December. Does he agree that that shows what can be done with the right leadership?
It absolutely does, and no one campaigns more vigorously for his local trust than my hon. Friend. Just before Christmas, I visited his trust’s Gloucester site and met the management and staff. The situation there is extraordinarily impressive and a great inspiration to many parts of the NHS.
I finish on the issue of funding. The shadow Health Secretary has been using very strong language, but he has conveniently overlooked the fact that in the past four years, real-terms funding for the NHS has increased by £9.3 billion, which is £5.5 billion more than his party promised in 2015.
I will conclude, because a lot of hon. Members want to speak.
The shadow Health Secretary is right that there are real pressures, so what are the facts? We spend 9.9% of our GDP on health, which is 1% above the EU average, and about the same as the EU15—the western European countries—but we want to spend more, so in England, from 2011, funding went up by 15.6%. In Wales, Labour chose to increase funding by only 8%. This motion is about money. When it comes to NHS funding, Labour gives the speeches, but Conservatives give the cash.
Like others across the House, I thank all staff in all four UK systems, who, as the Secretary of State has said, have gone above and beyond the call of duty to focus on their patients, and I do not think any debate we have in here is intended to upset or insult any of them.
Before Mr Dunne perhaps leaves the Chamber, I want to thank him for his service as a Minister of State for Health, whom I often met across the Chamber, but I also want to correct a comment he made in answer to my question on Monday. He claimed that the number of patients waiting longer than 12 hours in A&E in England was half the level of that in Scotland.
Naturally, I would have expected the Minister to know all the stats and what they mean: in England data are only published for the percentage of patients who meet, or do not meet, the four-hour target. There is no publication of data on eight hours or 12 hours. The clock restarts for patients who require admissions, and that is defined as from the decision to admit until they get a bed and is known as trolley waits. So 48,000 patients waited over four hours on a trolley after their four-hour wait in A&E to get a bed, and the 109 he was referring to had waited over 12 hours on a trolley for a bed after the four or five hours they had waited in A&E. Therefore, it was utterly incorrect to compare that with the Scottish data, where we have a single clock from when the patient starts right through until they get to where they need to go. I simply want to clarify that while the hon. Gentleman is in the Chamber.
I know that comparing England and Scotland is one of the pastimes that Scottish National party Members like to engage in—it is a fascination for them—but the reality is that in my constituency of Stirling, served by the excellent NHS Forth Valley in Larbert, only 57% of patients were seen within four hours in the last week of last year because we have a flu epidemic in Scotland, as they do in England, and that should be acknowledged.
If the hon. Gentleman gives me a little longer, he will find that I intend to talk about the flu epidemic, but before he gets too celebratory he might want to wait until tomorrow when we will have comparable data, because while in Scotland the data are published every week, in England they are published only every month. I am glad, however, that we no longer wait six weeks after the end of a month, which is 10 weeks after the start of it, but get it a fortnight later. So that will be available tomorrow, and then he can compare hospital trusts in England with hospitals in Scotland to his heart’s content. I would have thought that, as someone who celebrates the United Kingdom, he might want to praise the fact that Scotland has led the entire UK since March 2015 on emergency admissions and A&E.
Having corrected that, all of us recognise that this is a particularly tough winter because there has been an outbreak of flu on top of a bad freeze. I point out to those who think the worst is past that the flu season lasts until March and at the moment this is an outbreak, not an epidemic, but it comes on top of underlying pressures, and across the four nations this has involved staff having to go above and beyond the call of duty.
Whether it was how Public Health England said it or how the media reacted to it, this business of stating in public that the flu vaccination does not work is unfortunate and irresponsible. The flu vaccination recipe is planned by the World Health Organisation at the beginning of each year. It will already be working on next year’s flu. It does not have a crystal ball and people who have what we in the medical profession call a retrospectoscope should recognise that that tool was not available at the time when the decisions were made. Producing vaccine is a biological process that takes months, so the decision is made in March for the northern hemisphere, and all the companies produce to that recipe. Headlines in Scotland implying that the Scottish Government popped down to Boots and took the wrong vaccine off the shelf are therefore facile, and that also encourages people not to bother.
We already have falling vaccination rates in childhood vaccination and in flu. We should be pointing out that multiple flu viruses are circulating. While all the talk in the media is of Australian flu, in Scotland that is about a quarter of the strains that are circulating.
One of the issues with flu is that it happens in cold weather, and in Scotland we get the coldest weather in the United Kingdom, so we have double the rate of flu that there is down here in England. We also had a worse freeze, and are continuing to have a worse freeze. So when the data come out tomorrow, I think we will see that Scotland will still lead the UK. We will not be performing to the level we want; we have not met the 95% target for emergency departments since August, but England has not met them since 2015 and, sadly, Wales has not met them since 2008. So this is a challenge across the board, but Scotland has been more resilient. I call on all MPs to encourage staff and other people to get a flu vaccination, because this will continue until March and it is still absolutely worth doing.
The Secretary of State often talks as if the problems in A&E are due to people who should not be there. If we talk to anyone who works in A&E, they will say that, by and large, that is not the case. With people getting fractured ankles and fractured wrists on the ice, A&Es will have been very busy with having people carted in and having people X-rayed and what we call in Scotland getting a stookie put on before they go home. That is all going to take time, but anyone who works in A&E would say that the key issue is frail, sick people, often with multiple conditions, and whether they fractured their hip falling on the ice or have a respiratory problem secondary to flu, they need a bed and the issue in England is that there are not enough beds.
I work in A&E and spent some shifts in recess working in A&E—on new year’s eve and just a few days ago, on Sunday. I agree that many of the people attending A&E, particularly at St George’s where I work, are there because they are frail, but they are also there because this Government have ensured they cannot get an appointment with their GP, our social care is in crisis and we do not have mental health budgets.
I thank the hon. Lady for her intervention.
Obviously, the shape of medicine has changed. More is delivered in primary care—as a surgeon, I well know that more surgeries are delivered in a day—but if we are doing a straightforward operation on an older patient, they will still always require longer rehabilitation; they are more likely to stay overnight or several days, and if they have fractured their hip, they will require full rehabilitation before they go home. The problem is that the number of beds in England has been halved since 1987—under successive Governments—and the NHS stats released for the end of the second quarter of 2017-18 show that almost 1,000 beds have been lost even since the winter of last year, when the situation was described as a humanitarian crisis. That was a mild winter that did not have a flu outbreak on top.
England has only 2.4 beds per 1,000 population, whereas the EU15 that the Secretary of State refers to has 3.7, and we in Scotland have more than four. If we are running constantly with bed occupancy rates of over 85% or 90%, that is where the issue lies.
The hon. Lady refers to the decreasing number of available beds; does she agree that we have a bottleneck now in many hospitals due to the lack of social care? In one day over the festive period in my area, just over half of ambulance transfers were completed within the required period. The Secretary of State likes to quote statistics at me, but I would like to give him that one to think about.
There will obviously be lots of bandying around of figures, and talking about the four-hour target and the achievements and the numbers, and, as I have said, it serves as a thermometer to look at the entire system from the patient turning up at A&E to their going home. That is what this is a measure of, and it is there to flag up concern. While we will be getting that data, we do not need it; we have already seen ambulances 12-deep, and have already heard that 75,000 patients are stuck in an ambulance for between half an hour and an hour and 17,000 stuck in an ambulance for more than an hour. As was mentioned by Norman Lamb, who is no longer in his place, this means that those ambulances are not available to respond to other 999 calls, which endangers patients.
I think the hon. Lady for giving way, and I apologise if she was still answering the point made by Paula Sherriff. I accept her point that many of those who are in A&E need to be in A&E, but the reality is that admissions to A&E have gone up 20% over the past 10 years to 6 million per year. Does she agree that more interventions could be made by GPs to prevent some of those admissions from being made and to allow people to be looked after in their own homes?
Attendances at A&E tend to be higher in the summer, when kids are on bikes and trampolines, and up trees. It is admissions that are higher in winter, when A&E is dominated by people who are sick. Of course we want primary care and the 111 system to work, so that people do not use A&E as a first port of call, but the problem comes when that all gets too complicated and patients cannot work out where they should go. That is when they go to A&E. It is important to make it really clear where they should go to address which problems.
Having seen the crisis last year, when there was no flu, snow or ice to blame, I believe that there are underlying structural problems. The target was met comfortably until 2013, when the Health and Social Care Act 2012 changes kicked in and NHS England started to become fragmented and to be based on competition instead of co-operation. I would welcome the establishment of a cross-party group here to work on this, so that we did not always have to have these debates, but it would have to look at the structure and unpick what has been done to NHS England in the past four and a half years. Carrying on breaking it apart will not provide a solution.
Does the hon. Lady agree that the Government’s plans to establish accountable care organisations, which will exacerbate the fragmentation in the NHS, through secondary legislation are completely wrong and will make the NHS crisis even worse?
I completely agree that establishing accountable care organisations only through secondary legislation is utterly wrong. We have had multiple debates about STPs, and I have said that going back to place-based planning is the right way to integrate and develop a local service, but there should not be a private company at the top making the decisions. There needs to be a publicly accountable body. There is going to be yet another big reorganisation in NHS England, and the proposed structure needs to be debated in this place, not behind closed doors. Yes, money is tight, with the NHS seeing rises of just over 1% a year in the past seven years compared with almost 4% in the past, but it is estimated that between £5 billion and £10 billion is being wasted in the healthcare market itself, through bidding, tendering and profits, and now through this habit of companies suing if they do not win a contract.
It is crucial to move back to developing services for a community. It is also crucial that health and social care should be integrated, and I welcome the combination of both titles in the Secretary of State’s role, if that means that we are going to work towards meaningful integration, but it must be done in a structured, responsible and legalistic way.
The Government spend an awful lot of time attacking the Welsh NHS. In terms of the Secretary of State’s new cordial attitude in not attacking any NHS services, will the hon. Lady join me in condemning former Prime Minister David Cameron’s comment that Offa’s Dyke was the line between life and death, depending on which country one lived in? Wales has an integrated health and social care service, which is also integrated with local government, with a £60 million fund having been established over the past five years. She referred to the cross-party working that could happen, particularly if the Government were willing to engage properly in these services rather than attacking the Scottish and Welsh Governments on NHS care. Does she agree that we could use such working to learn good practice?
The four health services are very different. In essence, we have four laboratories. NHS England is by far the largest, but they all face different as well as similar challenges. I am sure that if there were more discussion of how things have been done, there could be more lesson-learning in different directions.
In 2010, we were promised that there would be no more reorganisation. The same promise was made in 2015, but NHS England is now facing another reorganisation, in the STP system and in accountable care. It is crucial that the focus should be not on bottom-line, budget-centred care but on patient-centred care. It is wrong that any such changes should be introduced through secondary legislation. They must be introduced in this place—either through debate, in Committee, through convention or in a royal commission—to enable us to come up with a structure that will function. Since 2013, the deficits have gone up, the waiting time failures have gone up and the stress on staff has gone up, making it even harder to keep hold of people. Let us put the patient in the middle, but let us also support the staff who look after the patient.
Order. We are grateful to the hon. Lady for her contribution. I must advise the House that, on account of the large number of Members interested in contributing to the debate, there will be a four-minute limit on Back-Bench speeches with immediate effect.
It is good to be back after using the NHS’s maternity services.
I am proud of our NHS, and I am tired of Opposition Members talking it down. Our healthcare system is one of the best in the world, and while there is more to do, we should continue to improve our NHS with excitement for the opportunities ahead. We need to be honest about our current situation. We have an ageing and expanding population, and other strong-performing healthcare systems around the globe are facing the same pressures as we are. As a member of the all-party parliamentary group on Taiwan, I was fortunate to see at first hand the excellent healthcare provision over there, yet Taiwan’s own Ministers shared with the delegation the fact that they are facing the same pressures as we are.
It is a wonderful thing that we are living longer. It is a credit to advances in medicine and evidence of the effectiveness of this Government’s care policies and the strong performance of our NHS. This Government began preparations for winter pressures earlier than ever before. They drew up plans to free up 2,000 to 3,000 beds, extended the flu vaccine programme and provided help to GPs to extend working hours. In my own area, the Mid Yorkshire Hospitals NHS Trust and the Leeds Teaching Hospitals NHS Trust each received an extra £3.4 million for their winter preparations. As the director of acute care at NHS England has stated, the NHS is better prepared for winter than ever before. Furthermore, from 2015, the Government continued to increase investment in the NHS, from £101 billion in 2015 to £120 billion by 2020. It is simply false for the Opposition to claim that the health budget has been cut since 2010.
But this is not always about how money is invested; it is also about how it is used. During my university studies, in a dissertation focusing on economic and healthcare policy, I looked at investment per capita compared with healthcare outcome. There is a lot of waste in the NHS, but the Government’s strong record on tackling it has put us in a better position than ever before to tackle winter pressures. Cutting the use of expensive agency staff, the positive impact of NHS self-driven improvements and the consolidation of services are only some of the examples of areas in which excellent progress has been made in order to deliver better value for money for the taxpayer, to deliver results in the light of our ageing and expanding population and to prepare us better for winter.
Having sat on the Health Committee, I am fully aware that there is still more to do, but I am strongly encouraged by the Government’s actions and those of my right hon. Friend the Secretary of State. I would like to take this opportunity to congratulate him on his additional responsibilities. Integrating health and social care makes sense, and it will only serve to better prepare the NHS for winter. I wish him much success with the important task ahead. I know that this is an area he is passionate about. GP working days and a seven-day NHS are only some of the areas in which work has begun, and this will ensure that the winter preparations get better and better. I join my right hon. Friend in urging those on the Opposition Benches to look at their own record in Labour-run Wales.
During the winter months of last year, I myself required the care and help of the NHS on a number of occasions. During my pregnancy I developed a temporary heart condition, and I have to say that the care was absolutely excellent. The Government’s investment in mental health provision for people having babies is also excellent. The NHS also saved my husband’s life when he had stage 4 cancer. I commend the Government for their work, and I wish my right hon. Friend every success in his new role.
I want to talk about the situation at my local hospital, the Royal Stoke University Hospital. Winter crises there are hardly new, but they have escalated year on year, and our hospital features luridly in the national press each winter. It is often the most affected, and it is no coincidence that its funding deficit is England’s worst. This winter, however, is the first time that Royal Stoke consultants have taken to social media to apologise for 36-hour A&E waits, for corridors yet again jammed with the frail elderly on trolleys, and for what they now describe as third-world conditions.
The background is that of all the areas subject to the so-called sustainability and transformation plans, Staffordshire is the worst performing in the country. Before the 2015 general election, we exposed locally a funding deficit, prior to the STP, that would have reached £250 million a year by 2020. Since then, the issues have been exactly the same, but the figure for health and social care has now more than doubled. The Royal Stoke now accounts for over £100 million of it, having taken over the crisis-ridden Stafford hospital, for which extra Government funding has now ended. The response so far has not been to invest in change, but to launch a scorched-earth policy. Community hospitals have been closed, rehabilitation wards shut, drug and alcohol services axed, and lip service paid to the prioritising of mental health. The effect is most acutely felt at A&E and in admissions to Royal Stoke University Hospital, which is already brimming to capacity and struggling to discharge hundreds of patients because social services are also in crisis.
At the end of March last year, our local CCGs closed Bradwell Hospital, with Longton and Cheadle community hospitals have gone beforehand, and wards at Leek Moorlands Hospital have closed since then. I was not the only person at the November meeting to label the consultation a sham. I also said that I wished the meeting could have happened at the end of February this year instead, after the winter crisis, the flu and the norovirus had bitten, as they are doing now. The CCGs had tried to pull the plug on Bradwell in the autumn of 2016, but they had to keep it open for another six months to cope with last year’s winter crisis. As late as November, they were saying they had no plans to reopen the hospital, but there was an inevitable volte-face in December.
Lurching from crisis to crisis is no way to run and plan a health system, and it is not only MPs, campaigners, patients and their families who are saying that. Last year, working with local councillors, including Charlotte Atkins at Staffordshire County Council and the indefatigable Joan Bell at Stoke-on-Trent City Council, the reformed local “NHS Care for All” campaign, which is chaired by the energetic Councillor Allison Gardner from Newcastle-under-Lyme, succeeded in getting our hospital closures referred to the Secretary of State. The advice of his independent reconfiguration panel was published just before Christmas, and it was damning of the CCGs. The verdict was delivered to him on
Unfortunately, I had to rush a family member to hospital last Saturday afternoon at a time when my local GP surgery is no longer open, but that gave me a chance to see at first hand how the winter pressures are being dealt with, and I have some good news to share with the House.
Our local GPs came together this year and agreed to run an urgent care centre at the hospital with a doctor on duty 24/7. On arrival, we saw a notice in reception stating that the average waiting time was three and a half hours, so I settled down to see how it was all going to work. The absolute key to the smooth running of this healthcare frontline was triage. Calmly and efficiently, a doctor and nurse quickly assessed who needed to be seen by whom and where. People could either just turn up or they could ring 111. Dr Whitford is right that things need to be just that simple or people will just go to A&E. Sensibly, children and frail elderly patients were seen the quickest, so we were in and out of the hospital in an hour and a half, and we were even directed by the thoughtful GP to a pharmacy that was still open late at night. So I want to place on the record my thanks to the staff at Solihull Hospital and to our CGG, led by Dr Anand Chitnis, for their foresight in conceiving how to provide better emergency cover, and I commend the model to the House.
Today’s motion states that the Government have failed
“to allocate adequate resources to the NHS.”
However, investment in the NHS will increase from £101 billion in 2015 to £120 billion in 2020, which is £2 billion more than the NHS asked for in its own plan for the future. The question of how much money is needed is just as important as how it is spent. It is right to remember that we are not the only country with an ageing society that is facing such challenges. Not only do we spend more than the EU average, but new research shows that we spend more on healthcare than the average for OECD countries.
For all my 20 years as MP, Labour has claimed at every election that the Conservatives will privatise the NHS, but we have not. It is dishonest and misleads the public, worrying them unduly, and distorts the view of young people who do not yet have years of experience of Conservatives consistently putting more money into healthcare. I am therefore glad that the Prime Minister has given the Secretary of State the additional responsibility of social care, because every grown-up politician knows that we cannot sort out the problems of the NHS without also working out how to get people out of hospital in a timely fashion and into proper support in the community. Our attempts to tackle that funding issue were discredited at the general election when our policy was characterised as a dementia tax, which shows that no party will crack the problem on its own without cross-party determination. I therefore challenge the Labour party to give up the vote-harvesting approach to the NHS and to support a royal commission on health and social care for the sake of everyone who needs it.
Time is short and many hon. Members want to speak in this important debate, so I will get straight to my points. There is no doubt that the recent winter crisis is the result of the Government’s chronic underfunding of our health service. I know it, Opposition Members know it and, most importantly, the public know it. Even the Government know that the crisis is down to the underfunding that has happened while they have been in power, so why are they doing nothing serious about it? The answer is similar to what they are doing with local government funding: they are doing nothing because they just want to push their ideological agenda of privatisation.
The Government know that hospitals must still provide services, and hospitals are forced to put many contracts out to tender under the Health and Social Care Act 2012. The Government know that, willing or not, hospitals will eventually have to turn to private companies that can provide services to the NHS at cut-rate prices. One example of that back-door privatisation is currently happening at hospitals serving my constituents. Bradford Teaching Hospitals NHS Foundation Trust has been forced by Government-imposed budget restraints into planning to set up a private company to provide services that are vital to the people of Bradford, and that private company will actively seek to make a profit. Just let that sink in for a moment—hospitals are setting up private companies with the intention of making a profit for the hospital. That is how bad it has become, with hospitals needing to supplement their funding through whatever means possible. It is a slippery slope from here towards ever increasing privatisation and private company involvement in the NHS. Hospital trusts are services, but this Government are turning them into businesses.
Privatisation will not save the NHS from the ruin that the Government have eagerly forced upon it. The only way that private companies will be able to offer cut-rate prices is by cutting the employment rights of staff and cutting corners. That will not prevent another winter crisis; it will only encourage one, with private companies putting the safety of health services at risk. I am very concerned that the private company being established in Bradford will put safety at risk by lowering the rigorous hygiene standards, by cutting cleaners and slashing cleaners’ hours. Healthcare services should be provided by the best operator, which in almost all cases is the NHS itself, not the lowest bidder.
The Government need to recognise that the public will not thank them for privatising the NHS, because that will not solve the crisis in our NHS—only proper funding at the level the NHS says it needs will do that. We have to ask whether the Government want to be thanked by the public and their plans for the NHS are in the best interests of the public, or whether they want to be thanked by big business and their plans are in the best interest of big business. This crisis makes it clear to me which one it is.
It is a pleasure to follow Imran Hussain.
It is depressing to hear the Opposition laying into the NHS, which is an extraordinary group of real people working day in, day out to look after all our constituents when their health needs to be supported and mended. I commend all the staff across Northumberland’s healthcare family who work so hard not only over the past few weeks but 365 days a year to look after all of my constituents.
Much can be achieved through good planning to pre-empt the winter health crisis, as it is known, and the increased impacts that winter brings. I have an unfair advantage in Northumberland because Northumbria Healthcare NHS Foundation Trust has been led and built into what it is now under the great auspices of Jim Mackey, whom we lent to NHS Improvement for a couple of years to try to share those skills across the whole NHS. It is lovely for us to have him back, so I thank Ministers for sending him back up to Northumberland.
As a result of 15 years of intelligent planning by senior leadership, we have had no blanket cancellations in Northumberland, and we have an unchanged schedule except only for specific cases. No clinically time-sensitive operations will be cancelled, and most operations are carrying on as normal. In November, the trust decided to transfer one surgical ward to general medicine to ensure greater capacity—thinking ahead to the regular changes that winter weather tends to bring.
We have almost no delayed transfer of care in Northumberland, thanks to the sophisticated planning set in motion by Jim Mackey and his team some years ago, working directly with Northumberland County Council so that our social care and our healthcare work hand in glove. It works, and we are doing it in Northumberland. I urge every MP to encourage their councils to build that relationship, because it genuinely works. I also continue to encourage the Government to make sure our accountable care organisation is one of the first to be signed and sealed so that our holistic healthcare family works for patients.
Flu hit the north-east first, but we are functioning and coping well. Our statistics are good, with bed occupancy at 91%, and yesterday we met our A&E waiting time targets in 95% of cases. Our nursing vacancies are at a historic low of only 1%, again thanks to planning and a positive recruitment campaign in specific staff group areas where we knew there would be shortages. As a result, our nursing agency usage in Northumberland is very low.
Nothing is ever perfect, so I continue to raise the thorny local issue of community hospitals, where our bed provision is currently lower than it should be. Increased provision would help to relieve pressures caused by delayed transfer of care by ensuring that there is support for those who have a level of vulnerability and who cannot, or should not, go home straight from the acute hospital environment. In a rural patch, community nurses cannot practically provide such support in the way that it could be provided in an urban environment. Community nurses just cannot get to as many places in a day when they have to travel miles and miles between patients. The community hospital framework must be part of the new bigger social care model.
I thank both the Prime Minister and the Health Secretary for fighting to bring healthcare and social care together in one place, because that will start to do what we already see in Northumberland. I would like every MP to be able to tell the same positive story in the months and years ahead.
Here we are again discussing the latest winter crisis in our NHS. I stood here last year and spoke of the horror stories I had heard from my constituents and ex-colleagues, of hospital staff working their fingers to the bone and doing the jobs of two, three or even four people, often without food, breaks or even time to go to the toilet. Yet, 12 months on, here we are again with many of the same challenges and none of the fixes promised by this Government.
I join my parliamentary colleagues in expressing a huge thank you to each and every one of our hard-working NHS staff—doctors, nurses, receptionists, cleaners, porters, radiographers and everyone else. I often speak of our public sector heroes, and today is no different. Thank you from the bottom of my heart.
I express a special thank you to the paramedics who rushed my father, my dear dad, into hospital on
Last year, the Government said the winter pressure was due to more patients being seen by the NHS. That figure is rising year on year, so why have the Government not put sufficient resources in place to deal with it? The Health Secretary previously said there are far more doctors and nurses in our NHS than there were seven years ago. In my area, the Mid Yorkshire Hospitals NHS Trust currently has 230 nursing vacancies, compared with 110 last year, with nursing numbers across the trust down over the same period from 1,752 to 1,607. That picture is somewhat different from the one painted by the Secretary of State, who has used figures that the Library says should be “used with caution” as
“Changes in the number of staff can sometimes reflect organisational changes and changes in the structure of services, rather than genuine changes in staffing levels.”
Indeed, staffing levels are so low at Mid Yorkshire Hospitals NHS Trust that the Care Quality Commission has deemed it to be a risk to patient safety.
My colleagues and I were heavily criticised during last year’s debate for asking the Government to spend more money, and once again we hear the same criticism this year. Will they tell us what the solution actually is? We need more nurses, and obviously there are training implications, but more money is needed to pay for them, and it is the same with doctors. There needs to be less bed-blocking, and more money is needed in social care. It is only right that serious questions are asked in this House when the Budget gives more money to pay for Brexit than to pay for our NHS.
The sad reality is that NHS deficits are rising astronomically across the country, with multimillion-pound shortfalls being recorded and balancing the books becoming impossible for most trusts. The £350 million made available in the Budget is no more than a drop in the ocean, and it has been proved over and again over the past few weeks that the money does not even scratch the surface.
And what of the cost of cancelled operations, both to trusts and especially to patients? People are being left in tremendous pain and at significant risk as a result of cancellations. I know of one man who is waiting for an operation to close his skull following life-saving brain surgery earlier this year. The surgery itself is not classed as urgent, but until it is completed, he is at increased risk of death should he bang his head accidentally. As a result, he rarely leaves the house and has to wear a helmet at all times. Another person who contacted me is waiting for a new knee. He is in excruciating pain and is unable to move around unaided. He has been on sick leave for three months and is suffering severe financial hardship as a result of loss of earnings.
As well as the accounts of cancelled operations, in recent days I have heard stories from local hospitals of six patients being squeezed into four-bed bays with no curtains and no dignity, no lockers and no bells. Patients are being given hand bells or are being told to ask the patient next to them to ring the bell should there be an emergency. Patients are being placed in store cupboards, as we heard earlier. It has now become almost the norm at this time of year—
Like many Members, I wish to start by paying tribute to our primary care staff—the GPs, practice nurses, receptionists, community staff and district nurses; all those working in acute trusts in my local hospitals; mental health staff; social care workers; ambulance staff; and of course the volunteers, to whom we owe so much. They are a team, and any part of the NHS is weaker if one part is weaker, which is why I hugely welcome the change in the Secretary of State’s title, whereby we now have Department of Health and Social Care. That is a long overdue move, but we should all welcome it.
At my local Luton and Dunstable University Hospital NHS Foundation Trust, the increase in activity in recent years has been phenomenal: 83,000 more people were seen in under four hours in A&E in 2016-17 than in 2009-10; 17,000 more operations and 46,000 more diagnostic tests were carried out in 2016-17 than in 2009-10. I pay tribute to the enormous amount of work. There are 166 more hospital doctors and 224 more nurses there now than in 2010. All that is welcome, as was the £1.116 million of extra winter pressure money put in.
I have spoken to the director of operations at the hospital this morning, and she told me that it was the busiest new year we have seen in a long time and that this situation had started two days before new year and gone on until this weekend. She said things have returned to a more normal basis now and, although they have a number of contingency beds open there, things are nothing like they were over the new year period. I pay tribute to the extraordinary way in which they coped with very difficult circumstances.
I received a letter on Monday from the East of England Ambulance Service NHS Trust, which said that on an average day it receives 3,000 calls but that on new year’s day, it received 4,800 calls. I defy any ambulance trust in the country to be able to cope with that significantly increased number of calls adequately. Indeed, I understand that on the days before and after the number of calls was also topping 4,000 a day. Our constituents want us to tell it as it is, and I received an email from a practice manager in one of my local surgeries saying that on
We have committed to train 25% more doctors and 25% more nurses, and I hugely welcome the new nursing associates and nursing apprentices. What are we going to do in future, however, to put the NHS on more of an even keel? Let me briefly suggest six areas where we can make progress: first, it is unacceptable that nearly 10% of NHS England’s budget goes on type 2 diabetes; progress on tackling obesity is vital; more progress on the Getting It Right First Time scheme, which is saving billions for the NHS, will help; I make a further plea to the Treasury to make sure that we stop GPs leaving—those on the old pension scheme are disfavoured by the tax treatment; and we have to drive through the sustainability and transformation partnerships to really integrate health and social care.
Thank you for giving me the opportunity to speak in this debate, Madam Deputy Speaker. I have worked in the NHS since 1996, as a doctor, in hospitals, as a GP and as a commissioner of services, and I must say that it feels as though we are going back to the ’90s at the moment, with long waiting times. Even before this unprecedented decision to suspend operations for a month, we were already breaching 18-week targets in many trusts. From a patient point of view, it feels as though the standards are deteriorating, particularly in my constituency, with the difficulty people face in accessing an ambulance when they need it.
I wish to share two insights into the problem and two potential solutions. My first insight is that, no matter what Ministers say, some of this is about the money. We have seen an anaemic level of growth in NHS funding in the past eight years. As we have heard from others in this debate, we have also seen cuts to social care funding and to public health budgets. We have also had a long-standing underinvestment in prevention, general practice and out-of-hospital care, although I appreciate that that is being reversed now. The money that came in the Budget was too little, too late. It is hard for commissioners and providers to spend that money when they get it at the last minute, because they have to get people to come in to do the work to spend that money. Had the money come earlier, we would have been able to put in place much better contingencies.
As well as this situation being about money, it is also about having the wrong strategy. There has been planning for reactive services, but at the same time we have been cutting prevention. We have been doing planning for healthcare services, but not enough planning for social care services. We have also been planning by giving this emergency injection of cash into acute hospital services, but while we have been cutting, prioritising and fragmenting community services. We have seen 5,000 fewer community nurses and a 45% reduction in the number of district nurses since 2010.
What do I suggest should happen now? We need to change the strategy. We cannot just respond by providing more and more acute hospital beds. We need to focus on prevention; on having good-quality community services, community nursing, social care; on having better palliative care, because most people want to be able to die in their own home, not in hospital; and on having more emphasis on screening. We also need to focus on poverty reduction and tackling deprivation, as people living in poverty are much less likely to access prevention and much more likely to be acutely admitted to hospital. I include in that people with mental health problems—the most vulnerable people.
Integration is the right direction of travel, but we have to change some things about how it is being achieved, the first of which is the name. Calling these organisations “accountable care organisations” lends people to think that this is an idea captured from the United States. We might call them “public health boards”—something that puts the needs of populations at the centre of healthcare and of healthcare planning. We need to make sure that the leadership teams of these organisations are focused on out-of-hospital care and not on just providing more and more acute hospital services.
There is also a fundamental contradiction to address, because we still have section 75 of the Health and Social Care Act 2012, which mandates competition, yet we are trying to get organisations to collaborate.
So it does not have to be like this—it is not inevitable. Huge praise must go to the staff, and I myself have done shifts over the short recess. With the right type of investment, the right preventive strategy and proper collaboration, uninhibited by competition, we can do better.
It is a great pleasure to follow Dr Williams, who qualified in 1996. I have about 10 years on him, and since 1984 I cannot recall a winter when there was not talk of pressure. We have to understand that this is not a new phenomenon. I particularly recall the bad winter of 2009, and the very positive way in which the then Opposition approached it and helped the then Government, in the interests of not politicising and not weaponising this issue. It is pity we have not seen the same thing repeated.
We need to give due credit to managers in the NHS. They come in for a lot of flak all the time, but we have seen a managed process this year and it has taken a great deal of input to make sure we do the best we can to disadvantage patients the least; I pay tribute to that much-maligned group. The only way in which I can see we can make this better is by running a lower bed occupancy rate, which is okay but it has opportunity costs attendant upon it. The reality of doing such a thing, which would avoid the sort of cancellations we have seen this winter, as in any winter, is severe, and I do not think many right hon. or hon. Members would wish to see those things.
That brings me on to the Commonwealth Fund, which was rightly cited by the Prime Minister earlier in response to my question in Prime Minister’s questions. She was right to say that on access, equity, the care process and administrative efficiency—four of the five points the Commonwealth Fund looks at—the NHS does very well. The problem is with the last one, which is clinical outcomes, where we run 10th out of 11, with the 11th being the United States of America, which nobody here wishes to emulate. We do not do well on clinical outcomes—we do not do well on cancer, on stroke or on heart attack—and we need to do something about it. It is no good citing OECD averages. We need to be comparing ourselves with Denmark, Germany, France and the Netherlands, not with the basket of countries included in the OECD.
Where does all that lead us? It leads us to a debate about resources. Having talked about management, which is vital, we need to address long-term resources. I entirely support those who wish planning to be done on a 10-year rather than five-year basis. That is vital, and we must also ensure that we have the necessary funding for the improvements we need to achieve to get outcomes up to the level enjoyed by our peer-group nations in western Europe, not the basket of nations with which we are often erroneously compared. How do we do that? We have to take the public with us and work across party boundaries. None of the decisions that will ultimately be made about the future of our national health service in this, its 70th anniversary year, are necessarily going to be easy. It is important that we at least try to get some level of cross-party consensus. We can do that by establishing a body that is above politics. The route to which I am drawn is the establishment of a royal commission, with all its problems.
The Merrison commission 40 years ago was the last big royal commission that considered matters to do with the health service. It came in for a lot of criticism, but most of its recommendations, made 40 years ago, were ultimately rolled out into Government policy. With the right terms of reference, such a body would be effective. That seems to me to be the right and proper way to deal with the future, particularly the sustainable funding future of our most treasured of national institutions. I very much hope that my Front-Bench colleagues will listen to those of us from all parties—particularly the recommendation from the Centre for Policy Studies this week—who think we should set up a royal commission in this 70th anniversary year to consider the future of our national health service.
It is a pleasure to follow Dr Murrison.
As a nurse who has worked in the NHS for more than 40 years, I know too well the effects of the winter crisis. Yes, winter is the time when the NHS faces pressures, but the Government have claimed that they were better prepared for this winter crisis, with their national medical director explaining that they had been preparing since last winter. How can that be true when the Government announced that they would postpone non-urgent operations? Not only does that put patients’ physical and mental health at risk, but it creates a backlog of operations, which NHS staff will still have to catch up on.
Unison spoke out about the handling of the NHS only in February last year. It also highlighted the Government’s promise in their manifesto to properly fund the NHS. In their 2017 manifesto, the Government pledged to give the NHS the resources it needs. In the autumn, they also pledged that the NHS would receive an additional £377 million to ease winter pressures, but they failed to disclose the fact that although they are providing funding, they are undercutting that by asking the NHS to make savings in some areas.
Where has the funding the Government provided to ease winter pressures gone? The Royal Wolverhampton NHS Trust provides services to the hospitals in Wolverhampton that care for patients in my constituency. Hospital staff have been working under increasing pressure, because for more than half the days between
There has been widespread outrage over this winter crisis, but NHS staff have been highlighting the pressures on the NHS throughout the year, and for many years. We have campaigned, met the Minister, written articles and held protests about the Government’s treatment of the NHS and the underfunding over the past seven years. When will the Government face the fact that the funding they have provided is simply not enough?
I do not want to go through the increase in the number of operations carried out by the NHS, or to describe the enormous pressure of the numbers of people being seen by the NHS—plenty of other Members have already done that. I wish to concentrate on delayed discharges of care, which are an important factor not only when it comes to increasing the throughput of people in the health system, but in ensuring that people do not go into hospital in the first place.
In Oxfordshire, we have addressed delayed discharges of care in two ways, as part of our future planning for the NHS. First, with respect to the hospital in the town of Henley, I have been among those who have been active in trying to achieve the right balance with social care by ensuring that there are no beds in the hospital. There are beds in the neighbouring care home for those people who urgently need to stay, but all the emphasis is on ambulatory care—the treatment of patients in their own home—on which I have worked closely with the Royal College of Physicians. More and more patients now understand that they can get the right sort of treatment in their own homes and do not have to spend time in hospital. The approach has been taken up on the best of medical advice and I am grateful to the doctors who have supported it. I invite Ministers to come to see for themselves how the hospital works.
Secondly, we do cross-party work in the county involving all MPs who represent Oxfordshire. I chair the group that has a relationship with the clinical commissioning group, not so much to hold it to account, but to ensure that it is focused on the things on which it says it will focus. One of the CCG’s great achievements is its focus on delayed discharges of care. I shall cite a couple of the figures so that Members will understand the CCG’s enormous achievement over the past year in planning for the better treatment of delayed discharges of care. At the end of December, the number of Oxfordshire patients whose discharge of care was delayed was 96, whereas the number in May had been 181. That is a magnificent achievement, as the number of delayed discharges of care has been almost halved. When Ministers hear about that half, they should understand that it is not a half increase but a half decrease in the number of people whose discharge of care was delayed. That improvement has been achieved by making sure that the right resources are in place for those patients who need them to return home. It has not happened because people are going home without the support that they need.
Finally, on the story in The Times this morning about Churchill Hospital, I have with me a letter from the hospital saying it has not implemented any changes to cancer treatment whatsoever. I am happy to provide a copy of that letter to the Library so that Members can read it.
It is a pleasure to follow that thorough speech by John Howell.
On Monday, I asked the then Minister of State, Mr Dunne, what the Government were doing about the crisis in the ambulance service. He responded by saying that a new ambulance response programme has been introduced to try to deal with category 1 calls more rapidly. The reality is that two months after so-called improvements were put in place in the north-east, an elderly constituency of mine who collapsed in his own home on new year’s day had to wait 14 hours for an ambulance.
Last week, in the intensive care unit at the University Hospital of North Tees in Stockton, two people died from influenza on the same day. One of them was a constituent of mine. On new year’s eve, I attended the urgent care centre at the University Hospital of Hartlepool and then the ambulatory care unit at Stockton with my son. The car parks were crammed full, the sick were presenting themselves thick and fast, and the ambulances were once again backed up. When will the Government admit that this is not just a winter crisis, but a crisis in our NHS full stop—a crisis of their own making?
I am really pleased to be able to contribute to the debate. Although the Opposition have, as expected, used this occasion yet again to weaponise our NHS, I want to take this opportunity to praise it and all those who work in it, particularly in my constituency, where the staff at Southport Hospital are professional, dedicated and hard-working.
There will always be times when our NHS comes under great pressures, and winter is one of them. That was why, in 2017, the Government and the NHS began preparing for the winter earlier than ever before. Last autumn, the Secretary of State visited my local hospital. He had a meeting with me and the interim chief executive in which we talked through the plans that had been put in place for the coming winter, as well as paying tribute to excellent staff who had worked so hard and continue to do so. Those preparations involved working with a range of partner organisations, including the local clinical commissioning group, the local authority and the emergency services, which provided better joined-up thinking and better care for patients.
Although the deferment of elective operations is never ideal, fewer were deferred this winter than in previous years, which should surely be welcomed. I am certain that the situation will further improve over the coming years. It is important to remember that we have a record of continuous investment in the NHS, even though we have been faced with extraordinarily difficult economic circumstances. The Department of Health’s budget has been protected since 2010 and continues to rise. We can spend more on the NHS only when we have a strong economy, which is something that we clearly would not have under Labour. The numbers speak for themselves: our investment in the NHS will rise from £101 billion in 2015 to £120 billion by 2020. Research from the Nuffield Trust shows that the UK spends well above the EU average.
I must welcome the Government’s multi-million-pound investment in Southport District Hospital over this winter. I was delighted when Southport and Ormskirk Hospital NHS Trust was granted an additional £1.326 million in funding to help to cope with winter pressures. Southport Hospital and the wider health system has prepared earlier and more extensively than ever before for winter this year, with a focus on securing the right numbers of doctors and nurses and increasing bed availability, as well as making sure that there is strong social and community care support available to help to discharge patients from hospital quickly.
The extra funding was announced as part of a £337 million immediate funding boost for NHS hospitals this winter in the recent Budget, which is in addition to the extra £2.8 billion of investment over the next two years. This was, of course, welcome news for Southport patients and residents. We all want to know that the NHS is there for us and our families whenever we need it. I am pleased that the Government have given the NHS extra support at this critical time of year, when cold weather and flu can increase pressures on hard-working hospital staff.
One of my constituents recently contacted me to tell me about the excellent treatment that his elderly mother had received at Southport Hospital over the Christmas period, after she suffered a serious health scare. His mother and his family were unanimous in their praise for the paramedics who brought her to hospital, the nurses who treated her with unparalleled kindness, and the doctors who sought to get her back to full health as soon as they possibly could. His mother said of her treatment that
“we couldn’t have asked for more.”
It is my absolute pleasure to put on record their sincere thanks to my right hon. Friend, the Secretary of State, whose brief now includes social care. I am sure that he will make a success of that job as he has done in health.
It is ultimately thanks to our strong economy that we can make this extra investment in the NHS. Polls show that the NHS is the institution that makes us most proud—
I am afraid that too much of what we have heard from Ministers and some Government Members has tried to pass off the pressures that we are seeing in the NHS as just what happens every year. I have worked with the NHS for around 20 years, and let me tell Members that those pressures are not what we see every year. Cancelling operations for a whole month is extremely serious. In one week alone, 300 operations were cancelled in Leicester, including for patients such as 80-year-old Kenneth Roberts, who was due to have his hip operation tomorrow. He is in so much pain that he is on liquid morphine and has to use crutches or a wheelchair to get about, and his wife, Jenny, is physically and mentally exhausted, too.
One of the real problems is the absence of any acknowledgement from Ministers of the huge knock-on effect that rescheduling a whole month’s operations will have. It will simply mean that existing patients who are already on the waiting list will have to wait even longer, too, and it will be very, very difficult to bring that list back down. As my hon. Friend Dr Williams said, a number of Labour Members have a terrible sense of déjà vu. We remember the 1990s, with ambulances queuing up outside A&E and millions of patients left languishing on waiting lists. I also remember the predictable cries from some right-wing commentators that the NHS’s time was up and that it could no longer survive as a service free at the point of use. I am afraid that we will see that coming back again all too soon.
The truth is that we are not dealing with the long-term underlying demands on health and care services—our ageing population, and more people living with one, two or more chronic conditions who desperately need more preventive services in the community—and huge technical advances. Yes, the Government talk about that, but they do not understand the scale of the challenges or the response that is required. The truth is that, since 2010, the NHS has had an average annual real-terms increase of 1%. That figure compares with 3.5% historically and 5.5% under the previous Labour Government. On top of that, we have had huge cuts to social care, and the dreadful, wasteful, pointless Lansley reorganisation, which has given reform a bad name. Unless the Government change course, we will see increased rationing as patients are waiting in the NHS, leaving thousands in pain and distress, and increased rationing as a result of eligibility criteria in social care, leaving millions of older and disabled people without any support at all. That is not what the people of this country want.
The Government need to put in place a bold 10-year strategy of investment and reform for both the NHS and social care. They should drop the idea of a separate social care Green Paper—we cannot look at the two separately—and they should heed calls from 90 Back Benchers for a cross-party convention. I am worried about the idea of a royal commission, as that would take too long. We know the options for investment and reform, so we need to get on with the job. I suggest a shorter process of six to eight months to try to get cross-party agreement, particularly on funding for social care, because any party that comes up with a substantial proposal risks being obliterated by its opponents, and we need a proposal for funding that will last whichever Government are in power. In the 70th anniversary of the NHS, I urge the Government to act.
I regret that Opposition Members have continued to politicise this issue. I speak as someone who has worked in the health service for more than 20 years. I worked in A&E under the previous Labour Government and coped with the winter pressures—when there were ambulances queuing round the block, when major incidents were declared because we could not take in any more patients, and when patients were cared for in corridors, including cupboards, and left lying on floors on makeshift mattresses. To continue to blame one Government or the other does nothing for patients or staff. If we continue down that route, we will be here not just next year or the year after, but in five, 10 or 15 years’ time.
This is not just about throwing money at the problem. We have heard today that Wales gets 8% more funding per person than the rest of the UK, yet it is also facing pressures this winter. Hospitals there are also cancelling operations and appointments, so this is clearly about not just funding, but what is done with the money.
I pay tribute to my local health service. In a debate at this time last year, I asked why the two trusts in my constituency were not coping when a neighbouring trust in Worthing was able to cope with virtually all its patients. A year later, after the imposition of special measures, after the CQC put in extra resources, and after a new management team were put in place, I am proud that both my local hospitals have coped with not just a 6% increase during non-winter periods, but an 11% increase in the number of patients not just visiting A&E but being admitted to A&E. They have not had to cancel hospital appointments, they have not had patients waiting in corridors and they have not had ambulances queueing round the block.
That tells me that this is not just about how much money people put into the service; it is about what they do with that money. Let us look briefly at what my local trust has done to stop the crisis which seems to have happened in other parts of the country. NHS staff, including doctors, nurses, porters and ambulance staff, have worked tirelessly throughout, and I pay tribute to them. It is also about the management, and the new management teams in Eastbourne and Brighton have done tremendously well to turn those services around.
It is also about better planning. My local community health trust has seen a 38% reduction in delayed discharges, so going into the winter period, it had an occupancy rate of about 84% in acute hospitals. That was achieved by working together with community services. A major Government or departmental reorganisation is not needed; change can be achieved by working locally, which is what the trust is doing.
This is also about working with social services on social care. Opening up 40 community beds in Newhaven has taken a huge amount of pressure off local hospitals, and both my trusts say that the emergency money provided this winter—nearly £2 million to each hospital trust—has enabled them to keep those beds open. It has enabled patients to be admitted to the acute centre for treatment, and then moved to the community hospital and be discharged safely and securely.
We need to look at capacity. If there is going to be an 11% increase year on year in the number of patients coming through the door, the solution is not just providing more money; it is about looking at the service and how it is delivered. My local trusts have done it, and there is no reason why that cannot happen in the rest of the country. Once again, I pay huge tribute to Brighton and Eastbourne Hospitals.
The crisis in the national health service this winter is real, and patients and NHS staff are feeling its effects. Thousands of operations have been cancelled, and ambulance crews and patients are waiting in A&E. On one day at Arrowe Park Hospital in my constituency, 26 ambulances, with patients and paramedics, were forced to wait more than an hour just to hand over patients. For 21 days in the period between
It is estimated that 55,000 operations will be delayed, but there is another crisis in the NHS this winter that deserves parliamentary attention: the Government’s plan to make regulatory changes to facilitate the introduction of accountable care organisations. The Government have failed to provide any time for parliamentary scrutiny of that plan on the Floor of the House. Accountable care organisations and accountable care systems are ideas that have been imported from America. In the US, Government and private insurers award large contracts to commercial bodies to run and provide services. We all know the horror stories of how expensive healthcare is in the US and how people with complex conditions find it difficult to obtain insurance. We hear stories of people with cancer who are forced to sell their home to pay for care. Those horror stories are real, so we all have a responsibility to guard against any introduction of private health insurance models in the UK, which is why we must scrutinise ACOs.
ACOs bring together health and social care so that there is a single finite budget to provide for a specific population. Once that budget has been spent, there is no extra money. ACOs are being developed for delivery in 44 STP areas rather than the country as a whole. It follows that if there is an increase in demand for healthcare in one of those areas—because of an epidemic or a serious accident, for example—the money that is taken out for that squeezes the rest of the system for health and social care.
A great strength of the NHS is that it provides a large risk pool for everyone in England so that they can be supported. Why would a Government who are committed to a national health service choose to replace a large risk pool with 44 little risk pools? It does not make any sense. At the heart of the issue is the serious fact that ACOs are non-NHS entities, so we need clarity from the Secretary of State. We need him to answer serious questions on the Floor of the House. Will ACOs be private companies? It seems logical that they might be, given that the idea has come from America and the Secretary of State considers that the American healthcare company, Kaiser Permanente, provides one of the best examples of practice in integrated care.
If ACOs are allowed to operate, they will be given multi-billion-pound health and social care budgets for 10 years or more. They will blur the boundaries between health and social care, and there is real concern that there will be an increase in the types of things for which people will be asked to pay. An ACO, once established, would have control of a huge budget for an area’s entire health and social care needs, so it would have a huge amount of power to determine what it does and, crucially, what it does not commission.
I have received a lot of correspondence from constituents who are very concerned that the introduction of ACOs is yet another major step towards the wholesale privatisation of the national health service. They have expressed real concern that ACOs could be a means to introduce private health insurance models area by area. That could not be done on a national basis because it would be politically unacceptable. Let us have no more talk about taking the politics out of the NHS. The NHS is a political entity. People need to take responsibility for their decisions around the Health and Social Care Act 2012.
May I begin by disagreeing profoundly with Margaret Greenwood? As a health professional and as a doctor who has worked in the health service for 15 to 20 years, spending more than two hours listening to Opposition Members putting negative after negative on the NHS has been profoundly taxing, and it has been hard for me to remain in my seat.
I worked in the NHS in A&E in the Christmas and new year period. Yes, I saw people waiting much longer than we would like. I also saw a seriously injured child who came in and received the very best treatment. People and equipment were available, and all the necessary hospital staff were available for his treatment. At times there were a dozen people around his bed, and I am pleased that we could give him the treatment that he needed to survive. We need to get away from always picking out the negative points. We must remember that more people are being treated and survive and that they are real, genuine people who go on to live long, healthy lives and are really pleased with the NHS treatment that they receive from people such as me and the millions of NHS staff working over Christmas and on new year’s day.
We have heard a lot of negatives from the Opposition, but we should look at what we can do to improve. I did not hear anything from the shadow Secretary of State about what he was going to do to make things better if he was in charge.
I will not take much time, but I have some suggestions. It is the over-75s who are mainly going to A&E. They are more unwell than they used to be. Why do we not get volunteers with medical experience to phone up people on every GP list and make sure that the over-75s are okay? They could urge them to turn up at the GP as soon as they become unwell, and not to wait until they reach a state in which they need intravenous drugs and have to go to A&E.
I thank the hon. Lady for her intervention, but I fear that she is mistaken because the people most likely to attend A&E are the under-19s. The over-65s represent about 20% of attendances at A&E but, following their attendance, the vast majority require admission to hospital, so they are in a slightly different category.
Those who are awaiting admission after they have been seen are the group who are waiting on the trolleys in A&E. People are waiting for those patients to be moved on to the wards so that the ambulances can be freed up and those patients treated. I have a solution to suggest, about which I met the Secretary of State earlier this week following my work in A&E over the winter period, when I observed ambulance crew waiting next to trolleys with their patients. They could not leave until they had properly handed over their patients.
It is really important that patients’ care is handed over properly, but equally we need those ambulances back out on the streets to collect the patients who are waiting at home. We could do much better if we cohorted the patients. For example, if three ambulances came in with six ambulance crew members on board, one ambulance crew could look after the patients while the other two went back out to see more patients. It is not all about money; some of it is about the inventive use of staff to create safe and efficient protocols.
I want finally to talk about the postponement of operations, which is very upsetting when someone has waited a long time for an operation and psyched themselves up for the pain and distress they know they will experience, and they may be nervous and fearful.
We have several choices. We could run hospitals at a very low capacity all summer—which is hugely expensive—so that there is a lot of free capacity ready for the winter; we could say that we will not do as much elective work over the winter, but then we might cancel operations that do not need to be cancelled—we may be giving more notice, but patients might have been able to have their operation; or we tell people that we will plan their operation but there is a possibility that if the winter is acutely busy, it will need to be postponed. None of those choices is ideal; all have pros and cons. We need an adult, cross-party discussion about the best way; otherwise, whichever option is chosen by the Government of whichever party is in power, the other side will criticise.
As many hon. Members on both sides of the House have suggested, we need to take the politics out of the health service, recognise that the vast majority of patients receive excellent care from the health service, which is doing more than ever, and consider together how we improve the areas that need improvement.
It is interesting to follow Dr Johnson. I have to say respectfully that I wholeheartedly disagree with her. She speaks of some kind of NHS utopia, but that is not the reality that I have seen on our A&E frontline. I am an A&E specialist and I have worked in our NHS for the past 12 years.
When we look around an A&E department, everything is on display in high definition: people’s pain, fears, courage and hopes; the unfailing dedication, expertise and strength of the staff who work there; and yes, the state of the NHS, which is in turmoil. It is in crisis, which is turning into disaster. From hospitals across the country, we have heard that the problem is not a surface or temporary issue.
The symptoms of the NHS crisis are all connected and multiply into new problems. That is not seen in statistics alone, but it is seen in A&E departments, which are completely overcrowded. People feel forced to come to A&E who should not be there: people who could not get a GP appointment or who had to wait too long for a hip replacement and are now in severe pain. Taken together with the emergency cases—from heart attacks and strokes to road traffic accidents—it is simply too much for the resources that we have.
The reality is stark. Cubicles are full because there is no space to move patients on to wards. The wards are full because our social care system is woefully inadequate and broken. When all beds are full, we see ambulances queuing up outside hospitals. They are full of patients who cannot get hospital care. What do we say to a mother or a father who is in an ambulance with their child, scared and anxious, and has to wait outside the hospital for another hour?
Doctors are too stretched to do the job we are trained to do. We are the recipients of first-class education and training in the UK and we cannot deliver the very thing that we know to be right: to treat the cause, not just the symptoms. There is little time for prevention.
On new year’s eve, when I worked in A&E, we had a teenage girl who fainted. We treated her and spent time talking to her, but we pride ourselves on being able to find root causes: is there an underlying eating disorder or is she being bullied at home or at school? To have those conversations, we need to build trust, which takes time. If we do not do that, the patient is more likely to return, sometimes in pain because their operation has been cancelled. A teenager who faints at school might need to be part of child and adolescent mental health services. That all places a burden on our already stretched NHS. It will not change until this Government decide to live up to their most sacred duty: the protection of the health and security of us all. The NHS is underfunded and overwhelmed.
Does my hon. Friend agree that desperate patients should never have to resort to smuggling out secretly filmed footage of trolley-lined corridors with people sitting on the floors, such as the footage I have received from my constituents visiting and working at William Harvey Hospital in Ashford?
I agree that it is deplorable that patients should feel that they have to do that. The historic underfunding of the NHS is not an economic necessity; it is a political choice made by this Government, which is why they will not change their direction to protect us.
So, what must we do? We must change the Government. Until we do, the NHS will continue to crumble around its heroic staff, who will carry on giving their all; I am honoured to stand alongside them. We see their work not in the headlines, but in the most harrowing, important and joyful moments of people’s lives. As NHS practitioners, we cannot always change the outcome; but with time and resources, we can change the journey. It is time that we saw a change in our A&Es, our hospitals and our Department of Health.
It is a pleasure to follow Dr Allin-Khan. For what it is worth, I thank her, my hon. Friends the Members for Lewes (Maria Caulfield) and for Sleaford and North Hykeham (Dr Johnson) and other medical colleagues who have spent time working in our service over this period, looking after constituents. Their public serve is second to none. I also thank my hon. Friend Mr Dunne for the work that he has done within the Department, and I welcome the new team. I also echo many colleagues from around the Chamber—across parties and from all geographies of the country—in thanking NHS staff, ambulance drivers, paramedics and those who work in our county social services, all of whom are trying to play a part.
I am going to be distracted slightly, because I am going to take strong issue with the peroration of Margaret Greenwood, who said with full Momentum fury, “The NHS is a political entity.” I say to the hon. Lady, with the greatest of respect, that it is not. The national health service is a publicly funded service, free at the point of use, which is populated and staffed by publicly motivated and qualified public service medics and others, who look after our constituents and their health needs. They are not politicised; they are motivated by care. [Interruption.] Rather than chuntering from a sedentary position, I urge the hon. Lady to sit and reflect on her words, because her comment was one of the most dispiriting remarks that I have heard during my time in this House. While she is reflecting on her comments, she might also wish to reflect on the fact that, whenever the Treasury writes another cheque for the national health service—I am sure that practitioners will appreciate this—it always has to take into account the £2 billion a year private finance initiative albatross bequeathed by the Labour party.
I want to draw the attention of the House, as I did during the statement on Monday by my hon. Friend the Member for Ludlow, to the importance of bedded community hospitals. Dorset CCG, under the leadership of Tim Goodson, has listened to our community campaign and has saved the beds in Westminster Memorial Hospital in Shaftesbury. In my judgment, the provision of those beds is absolutely pivotal in providing the link between the acute sector and people making their journey to recovery and then being on their way home. The collaborative work between the NHS and Dorset County Council—where there are social care officers with computers that are interlinked with and embedded within Westminster Memorial Hospital, working out the discharge care programmes—is pivotal. I appreciate that what we are doing in Dorset is not unique, but I also appreciate that it is not replicated everywhere; it does merit attention.
We should be focusing on far better advertisements for the use of our pharmacies, and we should ensure that community pharmacies are a much more collegiate network of service provision, taking pressure off GPs and A&E departments. I urge the Minister to ensure that CCGs are better encouraged to make sure that their boards include a representative from the pharmacy community. This siloed approach does not help the provision of care for our constituents.
I am pleased to follow Simon Hoare because I, too, want to touch on transitional healthcare.
Before I do so, I want to acknowledge the incredible, amazing, professional care that is provided across our healthcare service. We all agree that the love and care that is there is incredible. However, there are clear challenges, and we note those too. We have heard so much about them in the evidence provided today. This is not just about the long hours and the complex challenges that are placed at the door of health professionals. It is about the stress of not having the additional conversation that you need to have, the stress of not being able to treat somebody as a whole person but only being able to focus on the acute situation before you, and the stress of trying to keep somebody alive as their respiratory condition is deteriorating but you cannot get the doctor down because you know they are caring for someone in an even more acute situation. I know; I have been there. I have worked in acute medicine for 20 years, and I know very well what has happened over those 20 years. I agree with hon. Friends who hark back to the 1990s, when, as today, our NHS was in a terrible state. It did improve when Labour put the investment into the NHS, and we cannot deny that finance is at the heart of what is happening.
Bed occupancy is an issue for my local trust, which has faced a real crisis in acute care over this winter. I commend it for all it has tried to do to avert the situation, but we have had multiple days of 100% capacity in our acute medical facilities. The council has closed care homes. The trust has closed a transitional care unit. We have an empty hospital adjacent to our acute hospital, sitting on land that NHS Property Services is going to flog off as opposed to seeing how it can invest in better care for the people of my community. We need to really invest in the facilities that we need for the future, particularly around transitional care. We should have a complete review of what is needed with regard to the NHS estate.
The influenza outbreak this winter has had a more serious impact in York than across the rest of Yorkshire and has been one of the worst in the country. That has had a real impact on staff as well as the acuity and volume of patients coming through the door. On top of that, we have had norovirus and DNV—diarrhoea and vomiting. This is all putting challenges into the system.
We absolutely must have a coherent public health strategy as we move forward. We know that there is social inequality in who gets access to inoculations. We also need to make sure that we lay out a proper strategy. That is not happening. The fact that public health is separated off from acute health is a barrier. We need to draw them together to make sure that we have a proper public health workforce in the community.
I want to touch on funding. Our trust is in the capped expenditure process. I am still waiting for a meeting with the Minister to discuss the impact of that. The trust does not have the flexibility and the resources that it needs, and that is having a serious impact on the health crisis we are seeing in York. We need to move the situation forward to make sure that we have the resources where we need them.
At the moment, the NHS is really sick. When patients are sick, they need solutions. I trust that we will start hearing solutions from the Government.
It is an honour to follow Rachael Maskell. I entirely agree with her about being very careful before the NHS sells off property or land for non-health uses. There is a reason why our health facilities are in the places they are, and they could be better used for things like intermediate care.
I had the honour of visiting County Hospital in Stafford on Christmas day, and I saw the wonderful care being provided there. County Hospital is of course the Stafford hospital, which went through the Francis inquiries and the trust’s special administration. I just want to pay tribute to the staff there, who have done an amazing job in bringing the hospital up to the standard it is now at. We want more services put back into that great place, but it is an example of what can happen when people get behind change, and when the patient and safety are put at the heart of care.
I also visited Royal Stoke on new year’s day. The hon. Members for Newcastle-under-Lyme (Paul Farrelly) and for Stoke-on-Trent North (Ruth Smeeth) have already mentioned the huge pressures that the hospital has been under during the past few weeks, and I would not deny that. I saw for myself the trolleys in the corridor and the real pressure under which the staff were working, but I have to say that the care I saw there was exemplary in those conditions. As the hon. Member for Newcastle-under-Lyme mentioned, some serious issues have to be tackled, not least the fact that Stoke, and to some extent Staffordshire, are systemically underfunded, as we can see from the figures. I will write to the Secretary of State about that in due course.
I want to bring some figures to the House’s attention. They are not the most recent figures, but they are from an international health organisation—I think it was the World Health Organisation—three or four years ago, when it asked patients in a number of developed countries whether they could get proper access to good healthcare. The UK performed highest: only 4% said that they could not get good access to reasonable healthcare. In Germany, the figure for those who said they could not do so was 15%, and in France it was 18%. When we consider the challenges we face and the needs for the future—I absolutely agree with much of what has been said in this debate—we must not forget how our national health service performs and how it is an egalitarian service, providing access to people of all backgrounds across all our communities.
I fully agree with what has been said by Members on both sides of the House—by Liz Kendall and by my hon. Friend Dr Murrison—about the fact that we need a 10-year cross-party approach and that we need it urgently and quickly. The Green Paper on social care is a start, but the approach must be more extensive. I urge the Secretary of State and his new team, as well as the Minister on the Front Bench today—the Under-Secretary of State for Health, my hon. Friend Steve Brine—who has done a great job over the past few months, to consider widening the Green Paper to cover health and social care, especially now that the Department is an integrated one. “Social Care” should not just be stuck on the end of its name.
Finally, I pay great tribute to all those who continue to work day in, day out to provide some of the best healthcare in the world. It can be better, and we must make sure that it is.
It seems like only yesterday that I was working in the NHS, leading a group of GP commissioners preparing for the Health and Social Care Act 2012 and, every year, preparing for winter. Such was my experience of preparing for that Act that it led to my giving up my day job and deciding to become an elected politician and to enter this House. My colleagues at the time said to me, “Try to bring some sense to the debate going on, which is often so ill informed.” Today, we have heard some very well informed contributions, and I hope to offer some prospect of moving forward.
I want to talk about the 2012 Act. Its purpose was to modernise and avoid a future crisis, as well as to put clinicians at the centre of commissioning, free up providers to innovate, empower patients and give a new focus to public health, and it has categorically failed on all counts. Does the Act matter to patients? All reorganisations take people’s eye off the ball, but this one has been in an altogether different league. Long-standing problems have persisted and necessary changes have been put on hold as managers try to put back the infrastructure that was so wantonly destroyed by the Act.
In my constituency, South Bristol Community Hospital, a long-awaited community hospital, serves an area of very high health need. It is intended to support those with chronic illness in the community and to work with GPs, as well as to provide an urgent care centre and access to therapies. Much has been achieved by those on the frontline in the hospital, but it falls between five NHS bodies.
This week, a constituent highlighted a problem after she was told that her appointment had been cancelled because the person it was with was no longer in post. She persevered with the booking, but it was not possible to tell her whether another appointment would be forthcoming. I have taken the matter up on her behalf, but I have to write to three different people to try to find an answer. Colleagues know that that is the situation across the piece.
No one body is assessing health needs, talking to the local population and ensuring that services meet those needs and are reversing health inequalities, so how do we move forward? My strong view is that we need to talk about not only the money, which is very important, but the superstructures. We are at a critical point. We have had centralised planning and control. It did not work, ultimately, and the era of the market and competition is also not working. We need now to put accountability at the very heart of the system.
Accountability can be a key driver of change and improvement, and it is vital in a functioning democracy. All the bodies involved spend taxpayers’ money, but no one understands who is responsible and who is accountable for how they spend that money. That includes us in the House; we are also mystified.
Local MPs are expected by their constituents to stand up for local services, ensuring that there are enough resources, and to be able to make a difference when things go wrong, but we have no role locally in how the mandate is delivered or in the alignment of the voted national budget with local delivery. Critically, neither do local people. They do not understand how their national taxes relate to the local service.
We are pivotal in helping with that understanding. Local managers should be supported in sharing the great work that they do, but they also need to share the realities of cost and quality with MPs and local people so that we are all well informed. However, that will happen only if national leaders are supported when they fulfil their duty of candour and speak out about the reality of choices, which national leaders have done.
It is no secret that the money the NHS is allocated is insufficient to do all that is promised in the NHS constitution, to the quality that we expect. It is also well evidenced that we have the most effective and efficient service in the world, with productivity outstripping other sectors of our economy. So on behalf of our constituents, we should be putting the public centre stage, considering how to actively improve the NHS and understanding what the money can deliver. We have to give patients and the public genuine influence over decisions affecting the care that they, their families and their communities receive, and the responsibility that goes with that influence.
Being able to follow the money is a key part of accountability. We should all be part of that to help to inform the next stage in the development of the NHS.
There is no doubt that the NHS is under unique pressures, with demand going up every year, especially in a county such as Somerset, where we have an increasing ageing population. Somerset is a great place, but many people retire there, which increases the problem.
First and foremost, I want to thank all those working in the NHS in Taunton Deane. The extra £435 million invested in the NHS to deal with winter pressures is to be welcomed, as is the new forward planning. While it is not desirable to have an operation cancelled, the more notice one can have of that, the better. I referred to that earlier; I have personal, family experience of it. Without a doubt, having notice definitely helps.
I shall focus on A&E in particular. The A&E department at Musgrove Park Hospital in Taunton, which is Somerset’s main hospital, has seen 68,000 people through its doors in the last year, which is a huge increase, but there are nine consultants working there and there is 24-hour senior cover. I contacted the chief executive just this week for an update on how the hospital is doing. He reports that it has been extremely busy and that there has been record demand. That has had an impact on waiting time, but the staff in that department and in hospital more widely, as well as the wider community, have been fantastic in their response, often going above and beyond.
There has been much talk today about adequate funding for our health services. While that is important, it is also important to get the right management structures in place. In that respect, I want to highlight and praise Dr Cliff Mann, a senior consultant at Musgrove Park Hospital in the emergency department. He has just been awarded an OBE for his services to emergency medicine. During his time as president of the Royal College of Emergency Medicine, Dr Mann lobbied Government to get changes in staffing and worked hard around education in A&E. He devised a special A&E hub, which is an excellent model. It is working really well at Musgrove and ought to be rolled out further. It brings together in the emergency departments primary care; 24/7 support for mental health issues; a seven-day, 12 hours a day community pharmacy, and a seven-day, 14 hours a day in-house frailty team. I believe that model is working.
To touch on equipment at Musgrove Park Hospital, it is still dealing with a pre-1948 intensive care unit and theatres. There have been redevelopment plans since the 1980s, and we are still waiting. In the autumn Budget, the Chancellor announced a welcome £3.6 billion investment in capital projects of that sort, and I make no bones about fully supporting the campaign to get new theatres at Musgrove. I know many people who would benefit—indeed, members of my own family have recently been treated at the hospital. There is a top-class team working there, producing excellent results, but those staff deserve new and better facilities. I believe Musgrove Park is the only hospital in the south-west without updated theatres, so I ask Ministers to support it.
I applaud the linking of social care with health. That is essential. Somerset County Council faces a very difficult situation in social care, so any help will be welcome. If the council got into the next pilot of retained business rates, that would help its funding and finances and therefore its efforts on social care.
I applaud the Government for their action this winter. Things are much better. There is always more to do, but this Government are right behind the best health service in the world.
I start by paying tribute to the incredible staff working in our NHS. Keeping the nation fit and healthy is a noble calling. They make the NHS what it is—a national treasure—and they ought to be proud. Many participants in today’s debate know someone who might not be with us today, or whose quality of life would be significantly worse, had it not been for the NHS.
I would like to take this opportunity to pay tribute to Elle Morris, an 11-year-old cystic fibrosis sufferer and friend in my constituency, who sadly lost her fight last week. Elle’s family have expressed their thanks to the NHS workers who looked after Elle with such love and care right until the end, and supported her parents, Becky and Ian, and her sister Cara. Elle was a pioneer of raising awareness of cystic fibrosis and opt-out organ donation, and I speak on behalf of Crewe and Nantwich in saying how much she will be missed and how proud of her we all are. Breathe easy, Elle.
Everyone has quoted the facts and figures relating to the debate, and I will not repeat them. We all treasure the NHS, and it needs to be funded. My constituents do not want the Prime Minister to apologise for the NHS crisis. They want the Government to act and to resolve the crisis. By rewarding the Health Secretary, the Prime Minister will have sent a clear message about her vision of the NHS. Conservative Members have an opportunity to prove that theory wrong by supporting the motion, which calls on the Government to increase cash limits for the current year, allowing hospitals to resume a full service to the public. Actions speak louder than words, and today we will discover whether the Prime Minister’s apology was sincere.
It is a pleasure to follow Laura Smith in this important debate on the NHS and the challenges that, unfortunately, it tends to face in winter. We should bear in mind that, for decades, winter has given the NHS challenges to meet, and as a result, clinicians have been asked not to take time off in January. Last Friday, I spent time with a GP practice, where staff confirmed that the flu epidemic is one of the worst they have seen for many years.
From the perspective of patients, it is wrong that those who have waited months for surgery—perhaps routine, but for a condition that has an impact on their lifestyle—have been told that it has been cancelled. We need to change, but I believe we need to change the entire structure. It is all very well and good for the Opposition to write cheques that they know would bounce. What we have to do is reform the NHS within the resources available. We also have to consider the impact of the ageing population and the challenge—which we embrace, of course—of looking after them. In the last decade, 17% of this country’s population was over 65; in the present decade, the proportion rises to 20%; and in the next decade, it will be 30%. That might be why the number of hospital admissions has risen by 40% over the past 10 years. I am delighted therefore that the Department of Health is now responsible for social care, particularly reform to it; that is long overdue. We need a cross-party approach. I am aware that every governing party tends to say that, but I would ask Opposition Members to please rally round. There are some great ideas that we can all get around.
I want to focus on the pressures facing GP surgeries and the pressures that puts on our hospitals. Too many patients are going to A&E because their GP surgery is not there for them. I spent some time with a GP who had just returned from visiting a patient he had made comfortable at home. He pointed me to another area my hospital trust covers where that patient would have been put into hospital for some weeks, which would not have been good for the patient or all those other patients waiting for their care. We have seen huge demand from the elderly. I am still greatly concerned that the social care system is set up on a local authority basis. Many local authorities to which people retire do not have the same business rates as other areas—they have a lot of elderly folk but not the business to fund them—and certainly not as much council tax. In looking at reforms, I would like the Government to consider putting social care on the same footing as the central NHS.
I will not, I am afraid, because of time. I am sorry.
I would like to see more powers given to CCGs, or perhaps a tier above, to enable them to intervene where GP surgeries are not functioning as they should be. At the moment, there is no sharing of data, so CCGs cannot see where surgeries might be about to fall over. We expect CCGs to intervene and take over when things go wrong, but that is often too late, so I would like to know if more taskforces could be put in place. It is clear that the GP model that we have continued with since 1947 is not the GP model that younger GPs want to buy into: they do not necessarily want to buy into the practice model, are concerned about litigation and do not necessarily want to stay in the same place for all those years. We need great reform, therefore, and I add my support to the voices on both sides of the House saying that perhaps a royal commission is the way to take this forward.
I will concentrate on my main point in the 90 seconds being given to me.
NHS staff have said that this winter crisis was predictable and preventable. Bedford Hospital NHS Trust was one of the 24 trusts that issued a warning saying they were at full capacity. Patients, including many elderly and frail people, are routinely stuck in the back of ambulances in logjams waiting to get into A&E. The NHS is coping with an increase in demand, while being severely underfunded. We have also learned that Bedford walk-in medical centre in Putnoe is now under threat. Some 40% of our walk-in centres nationwide have closed under the Tories since 2010. Commissioners take decisions in response to budgetary constraints and cut services that are on the face of it costly to provide, but the human costs of such cuts are catastrophic, especially in places such as Bedford, whose hospital is already struggling to cope.
I finish by thanking all the staff who worked hard over Christmas and gave their time, when they could have spent it enjoying time with their families.
We have heard some excellent contributions today. The depth of the crisis is reflected by the fact that no fewer than 38 Members put in to speak, and although we only managed to hear from just over 20 Back-Bench Members, they were from all four corners of England. Owing to the time constraints, I cannot refer to them all, so I will just pick out a few, particularly from those still working in the NHS, such as my hon. Friend Dr Williams, who said it felt like we were going back to the 1990s and that it did not have to be like that—this decline is not inevitable. I totally agree with him on that.
We also heard from my hon. Friend Eleanor Smith, who brought her 40 years of service in the NHS to the fore and made the valid point that cancelling operations now creates a backlog, which will cause problems later on. We know that many trusts are already failing to meet their 18-week target.
Perhaps the most compelling contribution was from my hon. Friend Dr Allin-Khan, who worked in A&E over Christmas. She was absolutely right to say that many people attend A&E because they are not getting the treatment that they need from elsewhere in the system, due to a squeeze on funding. She also made the valid point that many people are not being discharged as quickly as we would like because of massive cuts to social care over the years. Her contribution was excellent, and she made the point that these conditions have arisen not by accident, but because a political choice has been made.
After two years in which the A&E target has been missed altogether, we now know that waiting times shot up in recent weeks. Some hospitals cannot see even half their patients within four hours at A&E. The Secretary of State knows a little about waiting: there was a gap of an hour and 42 minutes between his entering No. 10 on Monday and confirmation that he was continuing in his job. Perhaps he was left waiting in a corridor. I hope that he was at least offered a chair. He would have to double that time, and double it again, to begin to appreciate how long some patients are having to wait, often in great discomfort and pain.
Following the reshuffle on Monday, the Health and Social Care Secretary has had a rebrand, but if it took him over five years to work out that his actions might have some bearing on social care, how much longer will it be before he learns that the message that he hears about underfunding in the NHS is so consistent because it is true? How long before he realises that, on his watch, standards have deteriorated by almost every measure? How long before he realises that the decisions that his Government have taken have led to the litany of woe that we have heard today?
I do not know whether my hon. Friend has seen that an emergency consultant at Charing Cross Hospital has said that staff were practicing “battlefield medicine” there. By that, he meant that when a blue-light ambulance arrived, staff had to decide whether to take someone out of the resuscitation room to put the arrival in, or to leave the arrival in the corridor until a bed space was free. That same hospital faces losing all its emergency beds and its blue-light A&E. Does he agree that we have to rethink further reductions in beds and A&E capacity, given the crisis that we are in?
I thank my hon. Friend for his contribution. He is absolutely right. Those working on the frontline have made many statements about just how acute the problem is. Bed numbers have dropped rapidly in recent years. The worry is that under STPs, even more beds may be lost.
“does he not remember his own regular NHS winter crises?”
If the House wants to make a comparison with Tony Blair, I will help it: in the last winter under Tony Blair, between October and December 2006, one in 50 patients spent longer than four hours in A&E. In November, under this Health Secretary, one in 10 did.
Of course, behind every single figure is a vulnerable patient who is being let down—a patient like 87-year-old Esme Thomas, who, according to the BBC, waited 22 hours to be admitted to a ward at Weston General Hospital, or the patients at Pinderfields Hospital in Wakefield, who, as we have heard, were photographed lying on the floor, some still attached to drips. If the best that we—one of the wealthiest nations in the world—can offer people who are ill is an uncomfortable metal chair, something has gone badly wrong. What do the Government say to the nurse who told “ITV News” that there had been times when she had spent whole days treating patients in the hospital car park? Those stories should shame the Government into action.
Of course, it is not just those attending hospital who are suffering; so are those who are not able to go to hospital at all: 55,000 operations have been cancelled this month. When asked about this, the Prime Minister said that it was all “part of the plan.” If it was all part of the plan, why were the operations arranged in the first place? This is not a plan; it is a shambles.
The human cost of this crisis is devastating. Even before the worst of the winter had reached us, a one-year-old baby with a hole in her heart had her life-saving operation cancelled five times. Her parents were told that their daughter could go into cardiac arrest during the operation, so I cannot begin to imagine the anguish that they must have gone through in preparing themselves for the operation five times. Or what about the 12-year-old autistic girl from my constituency whose operation to remove her tonsils has been postponed? She has had at least eight bouts of infection in the past year, and because of her autism, the delay to her operation has caused her anxiety. It was a huge deal to build her up for the operation after her pre-operative assessment, particularly given the prospect of spending a night in hospital, but after the cancellation, she is anxious that when she gets her new operation date, that will be cancelled as well. If leaving these children anxious and in pain was part of the plan, it is a plan this Government should be ashamed of.
Across a whole range of indicators the NHS has experienced its worst performance since records began, and that was before we headed into this winter. Let us be clear: I do not for a second hold the people who work on the frontline responsible for this. Indeed, it is only through their dedication that the health service keeps going, despite the best efforts of this Government to destroy staff morale—whether an entire generation of junior doctors alienated, the next generation of nurses deterred from entering the profession by tuition fees, or the thousands of staff up and down the country who are frankly fed up of rota gaps, pay restraints and meaningless platitudes from this Government.
Only this afternoon we hear that the Care Quality Commission is postponing routine inspections, presumably because it knows a winter crisis is on. This is an unprecedented step that sends a huge signal to the Government that this is not just normal winter pressures.
Let us hear from some of those staff working on the frontline. A&E doctor Dr Adrian Harrop said the claims that the NHS had never been better prepared were “misleading, disingenuous nonsense”. He also said:
“The system I’ve been working in in recent days and weeks seems under-resourced, underfunded and understaffed.”
Tracy Bullock, chief executive of Mid Cheshire Hospitals NHS Foundation Trust, said:
“I’m 34 years in and I’ve never seen anything like this.”
These are honest, hard-working professionals—the lifeblood of the NHS—and Conservative Members know full well we could have repeated dozens of similar comments from NHS staff, because at the bottom of all this is the unescapable, indisputable fact that under this Government the NHS is in the middle of the longest and deepest financial squeeze in its entire history, and it is a squeeze that, as we have heard today, is having devastating consequences.
We have warned time and again that, unless early and substantial action was taken, we faced another severe winter crisis, and that is exactly where we are today. We have had an apology but no action from the Government. Patients deserve to know when this crisis will be solved and when their cancelled operations are going to take place, and this country deserves a Government fit to run the NHS. I commend this motion to the House.
Happy new year to you, Madam Deputy Speaker.
We have had a good debate this afternoon with some well-informed—as Karin Smyth put it—contributions from both sides.
The NHS is a service that we are all immensely proud of; we can agree on that. Even during the challenging winter period it continues to deliver overwhelmingly safe and effective care to thousands of our constituents, and we should never lose sight of that. We have heard examples of that today, including from my right hon. Friend Dame Caroline Spelman, who spoke with her usual calm about the triage model she saw working well in her area when she had to go to hospital over the holiday period. My hon. Friend Jeremy Lefroy was among many Members who visited the NHS over the recess period and he spoke, as well he might, and as well as he usually does, about the safe care he saw being delivered.
As my right hon. Friend the Secretary of State, and before him the Prime Minister, said earlier, we have done more preparation for winter this year than ever before, planning earlier to make sure the NHS is better prepared. More than that, we have put in the money, in the form of an additional £337 million for winter pressures and an additional £l billion for the social care system this year. As the Public Health Minister, I am proud of our flu vaccination programme, already the most comprehensive in Europe, which has been extended even further. This was planning ahead.
We have also allocated £100 million of capital funding to help hospitals set up GP streaming systems at their A&Es, reaching 91% coverage by the end of November. This, too, was planning ahead; they did not just appear overnight. And for the first time ever, people were able to access GPs nationally for urgent appointments from 8 am to 8 pm seven days a week over the holiday period.
Of course, there were additional pressures this year: very cold spells in December, a sharp uptick in flu and respiratory conditions, and higher hospitalisations from confirmed cases of flu than in the peak of winter last year.
There are also questions about NHS leadership. As the Minister is aware, Staffordshire is under great pressure. The Secretary of State received reports into the closure, with lack of consultation, of community hospitals in our area on
The sustainability and transformation partnerships have been established across England—I am sure that the hon. Gentleman will have engaged with the one in his area—and they take local decisions about how services are organised in local areas. I implore him to engage with his STP; indeed, I know that he is already doing so. If he wishes to talk to me about this, he can of course do so.
Let me respond to some more of our contributors. Karin Smyth always speaks sensibly. She spoke about the public representation and involvement in STPs. I agree that we could do more in that area, and as the Minister responsible for STPs, I want to see that we do so. Her point was well made. Laura Smith spoke about her constituent, Elle, who lost her battle with cystic fibrosis. She speaks up for her constituents well, and very emotionally, and if she continues to do that, she will do extremely well in this House.
Dr Williams is a new Member, and I already have a lot of respect for him. In his typically sensible contribution, he made some sensible suggestions for improvement in the NHS. He went on to talk about how we could do better on prevention, and he was absolutely spot on. We all agree that prevention is part of our one NHS. He said that this was not all about money, and I agree. Money is a key part of this, however, and that is why we spend 9.9% of our GDP on healthcare, which is above the EU average.
Liz Kendall said that this is not what happens every year, but the NHS is under great pressure at this time every year. A headline from The Guardian newspaper on
Order. I hesitate to interrupt the Minister, but I do not understand why there is so much noise on the Opposition Benches. I would not be surprised if Members were heckling the Minister, but they are simply making a noise, so the Minister cannot be heard. He is answering the questions that he has been asked this afternoon, and those who asked the questions ought to want to hear the answers.
Thank you, Madam Deputy Speaker. The Members appear to be heckling themselves.
Margaret Greenwood said that the NHS was a political organisation. I totally disagree. The NHS is an organisation run by hard-working people who are public servants. They go to work every day to do a job for our constituents, and the NHS is not a political organisation. The Labour party is a political organisation, and it is politicising the NHS—
I will not give way; the hon. Lady has had her say.
My hon. Friend Andrew Selous spoke about leadership, and he was absolutely right. He knows the Luton and Dunstable University Hospital NHS Foundation Trust, which has been ably led by Dame Pauline Philip. She has achieved 98% of patients meeting the four-hour target. That is the kind of leadership that can be achieved, which is why Dame Pauline was brought in to NHS England to help with our national response to winter pressures.
My hon. Friend Dr Murrison said that this was all about outcomes and that, on cancer, we do not do well. We have had the best cancer outcomes ever in our country, but I agree that our ambition for the long term needs to be even better and that we need to aim higher. His point on a royal commission is noted.
My hon. Friend John Howell spoke about the out-of-hospital care work that Henley hospital is doing. I thank him very much for his invitation. My ministerial colleagues also heard what he had to say, and it was good to hear about the cross-party working that is going on in Oxfordshire. My hon. Friend Damien Moore, a new Member of the House, talked about joined-up care and continuous improvement. He reminded us that without a strong economy there is no strong NHS. This is not the Government’s money; it is the public’s money. We need to spend it well, and I think we are doing so.
My hon. Friend Simon Hoare spoke about community pharmacies, a subject close to my heart. They play a key part, and better integration of them within the NHS is part of the prevention and primary care agenda. I completely agree with the points that he made. My hon. Friend Rebecca Pow spoke about the A&E hub at Musgrove Park hospital. That sounds very interesting indeed, and the new Minister of State, Department of Health and Social Care, my hon. Friend Stephen Barclay, was also interested to hear what she had to say. We would like to come and see it, and we will take her up on her invitation.
Finally, I welcome back my hon. Friend Andrea Jenkyns and congratulate her on the birth of Clifford. She spoke very well, as always, about the integration of health and social care, saying that it can only make sense and will only serve to make the preparations for next winter better.
I hope to end this debate on a note on which both sides of the House can agree. We are all truly thankful for the extraordinary dedication of NHS staff in caring for their patients—our constituents—during this extremely challenging time. As ever, they are doing a brilliant job.
Question put and agreed to.
That this House
expresses concern at the effect on patient care of the closure of 14,000 hospital beds since 2010;
records its alarm at there being vacancies for 100,000 posts across the NHS;
regrets the decision of the Government to reduce social care funding since 2010;
notes that hospital trusts have been compelled by NHS England to delay elective operations because of the Government’s failure to allocate adequate to the NHS;
condemns the privatisation of community health services;
and calls on the Government to increase cash limits for the current year to enable hospitals to resume a full service to the public, including rescheduling elective operations, and to report to the House by Oral Statement and written report before
On a point of order, Madam Deputy Speaker. Can you confirm that the effect of the Government refusing to defend their position in the Lobby this afternoon is that the motion that stands in the name of the Leader of the Opposition has been endorsed by the whole House and that we should therefore expect the Secretary of State to come to the House before the end of the month to make an oral statement to explain to our constituents when their cancelled operations will be rescheduled?
What I can confirm to the hon. Gentleman is that the House has just voted to carry the motion that was before us. The motion therefore stands. As to what the Secretary of State will say or do over the next few weeks, I am sure that he will be back at the Dispatch Box in the near future as he is a most assiduous attender of this Chamber, but we all appreciate that he has other work to do, and we look forward to seeing him doing that.