– in the House of Commons at 3:36 pm on 30th January 2023.
Today we have published our new delivery plan for recovering urgent and emergency care services, which has been deposited in the Libraries of both Houses. Given the scale of the pandemic pressures that healthcare systems around the world and across the UK are collectively facing, we are building the NHS back to where we want it to be. That requires the widespread adoption of innovation, building on best practice already applied in specific trusts, together with significant investment in new ways of working, including a £14.1 billion funding boost for health and social care, as set out in the autumn statement.
Today’s announcement is the second of three plans to cut waiting times in the NHS. Our elective recovery plan is already in action, virtually eliminating the backlog of two-year waits in England. Our primary care recovery plan will be published in the next few weeks, to support the vital front door to the NHS through primary care. Today, together with NHS England, we are setting out our plans to reduce waiting times in urgent and emergency care through an increased focus on demand management before patients get to hospital, and greater support to enable patients to leave hospital more quickly through care at home or in the community, supported by a clinical safety net. In addition, the plan sets out how we will adopt best practice in hospitals by learning from the trusts that have displayed the greatest resilience in meeting the heightened pressures this winter.
Today’s announcement on urgent and emergency care does not sit in isolation, but is part of a longer-term improvements plan that builds on the legislative change enacted last year to better integrate health and social care through the 42 integrated care boards, which became operational in July. That was prioritised for additional funding through the £14.1 billion announced for health and social care in the autumn statement. Following the quick spike in flu cases over Christmas, with in-patient flu admissions 100 times that of the previous year and a sevenfold increase in December, we announced £250 million of immediate funding on
Today’s plan, developed in partnership with NHS England and social care partners, builds on the actions and investment that I set out to the House earlier this month as we put in place the more substantive changes required to enable the NHS to have greater resilience this time next year. To do that, this plan involves embracing technology and new ways of working to transform how patients access care before and after being in hospital. That in turn will help to break the cycle of emergency departments in particular coming under significant strain in winter.
Our plan has a number of commitments that are both ambitious and credible. First, we are committing to year-on-year improvement in A&E waiting times. By next March, we want 76% of patients to be seen within four hours. In the year after that, we will bring waiting times towards pre-pandemic levels. Our second ambition is to improve ambulance response times, with a specific commitment to bring category 2 response times—those emergency calls for heart attacks and strokes—to an average of 30 minutes by next March. Again, in the following year we will work to bring ambulance response times towards pre-pandemic levels. I am pleased that the College of Paramedics has welcomed the plan, saying that it is
“pleased to see a strong focus in the recovery of those people in the Category 2 cohort”.
Of course, this will not be the limit of our ambition, but it is vital that we get these first steps right and that we are credible as well as ambitious. To put these targets in context, achieving both would represent one of the fastest and largest sustained improvements in the history of the NHS.
Underpinning these promises is one more essential commitment: a commitment to better data and greater transparency. On data, the best-performing hospitals have benefited from the introduction of patient flow control centres to quickly identify blockages in a patient’s journey, and e-bed management systems to speed up the availability of beds when they become free. Through this plan, we will prioritise investment in improving system-wide data, both within the integrated care boards and on an individual trust and hospital site basis. This will allow quicker escalation when issues arise and a better system-wide response when individual sites face specific challenges.
On greater transparency, for some time voices across the NHS have called for the number of 12-hour waits from the time of arrival in A&E to be published. This is something I know the Royal College of Emergency Medicine has long campaigned for—I can see Daisy Cooper nodding her head—and there has been criticism of the Government, including from Opposition Members, for refusing to provide this transparency. Instead, the data published to date has been a measure of 12 hours from the point of admission rather than from arrival in A&E. For the commitment to transparency to be meaningful, we must be prepared to publish data, even when that transparency will bring challenges, so today I can inform the House that from April we will publish the number of 12-hour waits from the time of arrival. Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, has previously said:
“The full publication of this data will be an immensely positive step that could be the catalyst for transformation of the urgent and emergency care pathway that should help to improve the quality of care for patients.”
I hope this transparency will be welcomed across the House.
Our plan focuses on five areas, setting out steps to increase capacity in urgent and emergency care; grow the workforce; speed up discharge; expand and better join up new services in the community; and make it easier for people to access the right care. Action in each area is based on evidence and experience, learning lessons from the pandemic and building on what we know can work. More than that, we are backing our plan with the funds we need, and the Government are committing to additional targeted funding to boost capacity in acute services and the wider system. That is why this package includes £1 billion of dedicated funding to support hospital capacity, building on the £500 million we have provided over this winter to support local areas to increase their overall health and social care capacity.
Taken together, this plan will cut urgent and emergency care waiting times by, first, increasing capacity with 800 new ambulances on the road, of which 100 are new specialised mental health ambulances. This comes together with funding to support 5,000 new hospital beds, as part of the permanent bed base for next winter.
Secondly, we are growing and supporting the workforce. We are on track to deliver on our manifesto commitment to recruit more than 50,000 nurses, with more than 30,000 recruited since 2019. The NHS will publish its long-term workforce plan this year. We are also boosting capacity and staff in social care, supported by investment of up to £2.8 billion next year and £4.7 billion in the year after.
Thirdly, we are speeding up the discharge of patients who are ready to leave hospital, including by freeing up more beds with the full roll-out of integrated care transfer hubs, such as the successful approach I saw this morning at the University Hospital of North Tees.
Fourthly, we are expanding and better connecting new services in the community, such as joined-up care for the frail elderly. This includes a new falls service, so that more elderly people can be treated without needing admission to hospital.
Virtual wards are also showing the way forward for hospital care at home, with a growing evidence base showing that virtual wards are a safe and efficient alternative to being in hospital. We aim to have up to 50,000 people a month being supported away from hospital, in high-tech virtual wards of the sort that Watford General Hospital has been pioneering, as I saw last month.
Finally, we are improving patient experience by making it easier to access the right care, including a better experience with NHS 111 and better advice at the front door of A&E, so that patients are triaged to the right point in the hospital without always needing to go through the emergency department—this new approach can currently be seen at Maidstone Hospital, as I saw earlier this month.
These are just some of the practical improvements already being delivered in a small number of trusts that, through this plan, we will adopt more widely across the NHS and, in doing so, deliver greater resilience ahead of next winter.
I am pleased that NHS Providers has welcomed today’s plan, and that the Royal College of Emergency Medicine has called it
“a welcome and significant step on the road to recovery”.
Taken together with all the other vital work happening across health and care, including our plan to cut elective and primary care waiting times, today’s plan will enable better care in the community and at home, for that care to be more integrated with hospital services and for existing practice to be more widely adopted. I commend this statement to the House.
I call the shadow Secretary of State.
I thank the Secretary of State for advance sight of his statement.
After 13 years of Conservative mismanagement, patients are waiting longer than ever before. Heart attack and stroke victims are waiting more than an hour and a half for an ambulance. Mr Speaker, “24 Hours in A&E” is not just a TV programme; it is the grim reality for far too many patients. Some 7.2 million people are waiting for NHS treatment. Why? The front door is broken—people are finding it impossible to get a GP appointment—so they end up in A&E. At the same time, the exit door is broken because care in the community is not available. Patients are trapped in hospitals, sometimes for months. Between the two is a workforce who are overstretched, burnt out, ignored by Government Ministers and forced out on strike.
Does this plan even attempt to get patients a GP appointment sooner? No. Does this plan restore district nursing so that patients can be cared for in the comfort of their own home? No. Does this plan see Ministers swallowing their pride and entering negotiations with nurses and paramedics? No. And does this plan expand the number of doctors and nurses needed to treat patients on time again? No.
The Health Secretary said a lot of things, but he did not say when patients can expect to see a return to safe waiting times. His colleague the Minister for Social Care, Helen Whately, rather let the cat out of the bag this morning. She was asked, “Is there any plan at all for when we will get back to 95% of patients in A&E being seen within four hours?” Her answer—and I am not joking—was, “I can’t tell you that.” How can the Secretary of State claim that his plan is ambitious and credible? What kind of emergency care plan does not even attempt to return waiting times to safe levels? It is a plan that is setting the NHS up to fail right from the start—a plan for managed decline.
These targets are not plucked out of thin air; patients waiting more than five hours in A&E are more likely to lose their lives, and so are heart attack and stroke victims waiting more than 18 minutes for an ambulance. Sadly, that is exactly what has happened this winter, it is what happened this summer and it has been going on since before the pandemic began. The four-hour A&E waiting time target has not been met since 2015. The only time the Conservatives have met the 18-minute target for ambulance response times was during lockdown. What is the Secretary of State’s ambition now? It is 30 minutes —30 minutes waiting for a heart attack or stroke victim to receive an ambulance, when every second counts. Is not the truth that the Government missed the targets, so they are moving the goalposts? They are fiddling the figures, rather than fixing the crisis.
The Secretary of State boasts that he is pouring more money in—£14 billion, which is almost as much as his Department has wasted on dodgy, unusable personal protective equipment—yet standards are being watered down. So can he explain why patients are paying more in tax but waiting longer for care? Why is it that under the Conservatives we are always paying more but getting less? So what is their answer? It is:
“There are so many people in hospital who wouldn’t need to be there if we could provide quality care at home… medical science and technology…offers a world of possibility for the NHS to transform patient care… Virtual wards allow people to receive hospital care at home.”
Those are not his words—that is my party conference speech! He did not have a plan for the NHS so he is nicking Labour’s.
I am happy for the Secretary of State to adopt Labour’s plans, but here is what he missed: you cannot provide good care in the community, in people’s homes or in hospital without the staff to care for people. That is the supermassive blackhole in his plan published today: people. Virtual wards without any staff is not hospital at home; it is home alone. So where is his plan to restore care in the community? Labour will double the number of district nurses qualifying every year, so can he hurry up and nick that plan too?
Of course, good care in the community is not a substitute for good care in hospital—we need both, now. So why, in the middle of the biggest crisis in the history of the NHS, with hospitals so obviously short of staff, is the universities Minister writing to medical schools to tell them not to train any more doctors? This is ludicrous. Labour will double the number of medical school places and create 10,000 new nursing and midwifery clinical placements, all paid for by abolishing the non-dom tax status. I know that the Prime Minister might not like that last bit—[Interruption.] Government Members are all complaining, but they did not complain when they put up income tax. The Prime Minister does not like it, but perhaps this would be a good time for the Conservatives to act tough on tax dodgers. So when is the Secretary of State going to nick that plan?
And when is the Secretary of State finally going to get his act together and end the strikes in the NHS? Perhaps I am speaking to the monkey when the Chancellor is the organ grinder. If that is the case, when will we get a chance to question the real Health Secretary on the strikes that this one is causing in the NHS? Labour will create more front doors to the NHS and we will tackle the crisis in social care. The Secretary of State offers sticking plasters and by now it is very clear: only Labour can offer patients the fresh start the NHS needs.
The hon. Gentleman started by thanking me for advance sight of the statement, and then he made a series of remarks that simply ignored what was in it. Even his last point shows how riddled with contradictions the Opposition’s approach is. He says in interviews that he supports the pay review body process—that is the official position, or at least it was—but then he says, “No, we should be negotiating individually with the trade unions and disregarding the pay review process.” There is no consistency on that at all.
The shadow Secretary of State talks about operational performance—[Interruption.] He has just had his go; he should listen to the answers. He says that it is about operational performance, but in my remarks I tried to be fair and said that these are challenges that are shared across the United Kingdom and globally. He seems to think that they are unique to England alone. We need only look at Wales to see that more than 50,000 people—notwithstanding the fact that Wales has a smaller population—are waiting more than two years for their operations, when we cleared that figure in the summer in England, leaving fewer than 2,000 in that cohort.
The shadow Secretary of State talks about the workforce. Obviously, he did not bother to read or listen to what was said in the statement. We are on track to deliver our manifesto commitment of more than 50,000 nurses. We have more than 30,000 so far. We have 10,500 more nurses in the NHS this year compared with last year. The grown-up position is to recognise—[Interruption.] Well, in the first five years we were dealing with what that letter said, which was that there was no money left. [Interruption.] Labour Members just do not like the response, but the facts speak for themselves. We have 10,500 more nurses this year than last year. The grown-up position, as I was saying, is to recognise that we have an older population with more complex needs, and that the consequences of the pandemic are severe—they are severe not only in England, but across the United Kingdom, in Wales and Scotland, and indeed in countries around the globe.
The shadow Secretary of State says that the statement did not cover the plan for GPs. Well, again, I was clear that this was one of three plans. We had the elective plan in the summer, which hit its first milestone. We have the second component today on urgent and emergency care, and we will set out in the coming weeks our approach to primary care. That is the approach that we are taking. [Interruption.] The shadow Secretary of State keeps chuntering. We did not have the pandemic 13 years ago. [Interruption.] I can only surmise that he did not get his remarks quite right the first time, which is why he feels the need to keep chuntering now and having a second, third and fourth go—perhaps next time.
On ambition, the shadow Secretary of State ignores the fact that we need to balance being ambitious with being realistic. These metrics, in the view of NHS England, show the fastest sustained improvement in NHS history. Clearly, his remarks are at odds with NHS England.
On funding, we are putting an extra £14.1 billion of funding into health and social care over the next two years, which reflects the fact that the Chancellor, notwithstanding the many competing pressures he faced at the autumn statement, put health and social care, alongside education, as the key areas to be prioritised.
On virtual wards, I had not quite realised that the shadow Secretary of State was the clinician who had invented virtual wards. I think that the credit for virtual wards actually goes to the staff, such as those I met at Watford, who are driving forward that innovation. It is slightly strange that he sometimes wants to claim ownership of something that has been clinically led by those working on the frontline. We have recognised the value of virtual wards, which is why, at North Tees this morning, at Watford last month, or on various other visits, I have been discussing how to scale up those plans.
I call the Chair of the Health and Social Care Committee.
We look forward to going through the plan in detail with the Secretary of State when he speaks to the Select Committee tomorrow. May I just ask him about the ambition on the two-hour response to falls at home of the frail and elderly to prevent them from being admitted into the acute sector? Obviously, he will know that that was committed to in the long-term plan. What does he need to put that ambition into practice?
The funding to put that in place has been earmarked from the £2.8 billion next year. The key thing is less to do with the funding than the accuracy of the data, which will help us to see where there are gaps in coverage and how we get the right levels of community response. The integrated care boards have been set up to take an integrated approach on that. One of the best enablers will be the control centres that the ICBs will set up, which will allow us to get much greater visibility on where that has been delivered and how we escalate it when it has not.
The 300,000 vacancies in health and social care mean that, whatever the Secretary of State puts on the table, his plans will never be delivered. What is he doing to retain the burned-out, traumatised staff who currently work in the NHS, to resolve their pay dispute and to put enough money on the table to pay social care staff enough to come and work in the service?
We recognise the huge pressure on social care; that is why, at the autumn statement, the Chancellor set out the biggest-ever increase in funding into social care of any Government, £7.5 billion over two years. We are putting more funding in. On the workforce more generally, the Prime Minister and Chancellor have committed themselves to bringing forward the workforce plan, which will set out the longer-term ambition on workforce and will be independently verified. In addition, we are recruiting more staff, as I updated the House, whether that is the 3% more doctors this year than last year, the 3% increase in nurses, or the 40% more paramedics and 50% more consultants compared with 2010. We are recruiting more staff, but the grown-up position is to recognise that there is also more demand.
I warmly welcome the plans set out by my right hon. Friend today, but he will know that one reason emergency care faces so much pressure is that successive Governments have not focused enough on the prevention agenda. Indeed, last week’s news that the Government will not go ahead with individual focused plans on cancer, dementia and mental health has concerned many. Can he assure this House that the Government’s new major conditions strategy will be published promptly and will be comprehensive and significant?
I am happy to give my right hon. Friend that assurance. I assure the House that our commitment to the cancer mission and the dementia mission through the Office for Life Sciences is absolutely there. He is right that we are bringing that together in one paper—I think we should take a holistic approach—but I share his ambition on prevention. In early January, I set out a three-phased approach: first, the £250 million immediate response to the pressures we saw from the flu spike over Christmas; secondly, as I announced today, building greater resilience into the system looking ahead to next winter; and thirdly, the major conditions paper on prevention, which is about bringing forward the innovative work that colleagues are doing through the Office for Life Sciences to impact the NHS frontline much sooner than might otherwise have been the case.
I want to raise the case of a constituent who described to me the state of Salford Royal’s A&E earlier in January, saying:
“My partner was taken by ambulance yesterday at about 11am. He has a severe chest infection and breathing problems. He was left sitting in a chair on oxygen until 10pm when a trolley was found for him to sleep on. There are no beds available.”
My constituent said that patients and staff
“feel that no one cares”.
After such a long wait, my constituent’s partner was found to have pneumonia and he has been very poorly. Now the Secretary of State is talking about a target of 76% of A&E patients being seen within four hours by next March. Will he tell me and my constituent why he thinks it is acceptable for patients to wait longer than is safe?
We are bringing times down; I think the current mean response for C2s is much more in the region of 25 or 26 minutes than it was in late December-early January, because across the UK there was a massive spike in flu. The hon. Lady will have seen exactly the same in the Labour-run NHS in Wales. Over December there was a 20% increase in 999 calls, for example. That is why we need to put in place greater resilience, as the plan I have set out to the House does.
I strongly support the £1 billion for 5,000 additional beds and 800 more ambulances. I have long argued that, with a growing population and a growing elderly population, we need more capacity. Is it also possible to take some of the £14 billion of additional money to provide even more capacity? I think we are going to need it.
Within my right hon. Friend’s question is, I think, how we get more flow into hospital: once bed occupancy goes above a certain threshold, lack of flow is the key interaction that drives inefficiency within hospitals. That is why we are putting in the extra capacity. It is also a question of reducing the numbers going to hospital in the first place and speeding up the discharge of those who are fit to leave. Whereas at the moment someone might sit on a ward for three days because they have to have antibiotics every day, if one continuous dose of antibiotics can be administered through new kit at home, not only is that a much better patient experience but it relieves pressure on the wards.
I welcome the additional transparency on data for 12-hour wait times, because it is only by shining a light on the problem that we can see just how bad it is, but the targets set out in the plan today are utterly woeful. The Royal College of Emergency Medicine says that we need 13,000 beds; the Government are offering 5,000. The percentage of patients who are seen within four hours should be 95%; the Government are aiming for 76%. Heart-attack and stroke victims should be seen within 18 minutes; the Government are aiming for only 30 minutes. Surely the truth is that this woeful lack of ambition means that our emergency care services are themselves on life support and that patients will continue to die needlessly for a very long time to come.
First, I thank the hon. Lady for recognising the steps that we have taken on transparency. That has been an area of challenge and it is part of my wider commitment to transparency.
The ambition of the targets has to be realistic, and targets are not a ceiling but a floor. It is about saying, “How do we set a target that is realistic?” Of course, we will aim to do better than that, but it is about setting something that the system feels is achievable, because that in turn gets much more buy-in.
On beds, we are increasing capacity, as my right hon. Friend John Redwood alluded to. What it is really about is freeing up patients who are fit for discharge from hospital, who should not be there and would actually prefer to be getting care at home. It is about looking at the end-to-end bed capacity, not simply at beds within the acute sites.
I welcome my right hon. Friend’s statement. In the pandemic, the use of local private hospitals by the NHS, particularly in places such as Basingstoke, kept services such as cancer care going uninterrupted. Could the NHS be using more private facilities more widely to relieve some of the pressures that he so eloquently outlined in his statement?
My right hon. Friend makes an important point. Again, within that is patient choice and how we empower more patient choice—providing services that are free at the point of use—to use what capacity there is within the system, including in the independent sector. I absolutely agree that we should be maximising capacity. At Downing Street with the Prime Minister, we had a very useful roundtable with the independent sector about how we can make more use of its capacity. That is certainly an area that we are exploring.
I saw for myself only a few weeks ago the real crisis in our hospitals when I accompanied a close relative to Whiston Hospital, where I saw every single space in the corridors taken up by a bed, a trolley or a chair. Quite frankly, what the staff—doctors, nurses and support staff—were doing was amazing, and they deserve all our praise for the hard work that they are putting in. The Secretary of State’s lauding of the fact that two-year waits have virtually been eliminated is bizarre: when Labour left office, waits were somewhat less, with an 18-week target and many people being seen within weeks, not months. The Secretary of State said that the Government are on track to recruit 15,000 new nurses, but how many have left the NHS in the last two years?
First, the hon. Gentleman is right to recognise the work that the staff have been doing. He mentioned a family member; when I made a statement earlier in January, I recognised that there has been huge pressure on the system. We saw the flu numbers and the spike in cases. On the two-year waits, the point is simply that there has been pressure on services—the pandemic impacts—across the United Kingdom, but the two-year wait is far worse in Wales, whereas we have cleared it in England. On recruitment and retention, we are bringing forward the workforce plan. The fact is that we are recruiting more nurses, but it is about meeting demand pressure as well.
There is no doubt that the 5,000 extra beds will help the NHS to provide the best possible patient care. Community hospitals across East Devon and NHS Nightingale Hospital Exeter can play their part, too. Does my right hon. Friend agree that community hospitals can play a key role in helping to cut waiting lists?
Community hospitals are key to tackling the issue of delayed discharge. Community settings have been a bit of a Cinderella in the past. The data on community settings tends to be weaker than it is in other parts of the NHS. Alongside domiciliary care and making better use of residential care capacity, the third element for discharge is to look at how we use community step-down in a much more constructive way. One key issue there is to have wraparound services so that people do not simply get transferred to a community setting, but that it is a staging post before getting to the home, which is where most patients want to be.
The social care sector is dominated by dedicated staff who are paid low wages. High profits are made from it and there is an insufficiency of spaces. Will the money that the Secretary of State has announced go to local authorities? Can it be spent on public provision? Does he not think it is time to recognise that the internal market and privatisation have sucked money out of health and social care—money that could have been spent on patient care and caring for people in the community and in special facilities?
One area of the right hon. Gentleman’s question where I do agree with him is the importance of local authorities. One reason I am keen to see more clarity on data and transparency is that there can sometimes be a tendency for the local authorities to be blamed for discharge, when often it is factors within the NHS that contribute to some of those who are fit to leave hospital not doing so. On the money allocation, the £2.8 billion is targeted to local authorities—funding set out by the Chancellor—with £4.7 billion the following year. We are increasing the money for local authorities, but alongside that we are working with them to improve the data so that we can see where there are blockages due to local authorities. For example—Mr Speaker will be familiar with this—Blackpool often has visitors from out of the area, so the NHS there deals with a number of local authorities, not simply the nearest one. We are working intently on how we support local authorities as part of the wider discharge package.
I welcome my right hon. Friend’s statement and commend his approach to this difficult problem that he faces and we as a nation face. Does he agree that while speeding up discharge from hospital and freeing up beds for patients needing urgent and emergency care is absolutely necessary, there is a real need for the expansion of new services in the community, which must be a top priority? In my area, one of the biggest reasons for bed blocking in hospitals is that there is no community service to pick up when people go home.
My right hon. Friend hits the nail on the head. He is right: it is about how we better manage demand in the community before people get to the emergency department. That is where, for example, action targeted at the frail elderly is so important. It is also about how we enable people to discharge sooner, where they are fit to do so, so that they can recover, whether in a community setting or, ideally, at home, with the right wraparound support.
The people of Bristol South will be ever so grateful to have data that they are waiting 12 hours, rather than perhaps ringing me up to tell me they have been waiting 12 hours. The Secretary of State is a Treasury man, so he must know we are now paying more for less. In the interest of transparency, can he be assured that in his own ICB, demand and capacity are matched, and will he know that? How will I know that demand and capacity are matched in my own ICB?
I think the hon. Lady was welcoming the transparency on 12 hours—I certainly hope so. The ICBs became operational in July, and we are working with them as to how, by taking a system-wide view, they can baseline the gaps in data, and one key area of that is on the community side. When she talks about matching capacity, part of that is about understanding virtual ward capacity, what conditions that applies to, what the physio wraparound services are, what is available within residential care versus community care and other domiciliary care packages, as Jeremy Corbyn touched on in terms of local authorities. We need to look at the data package across the piece on a system-wide basis. That is why we are setting up control centres. I am keen to make that much more transparent, because to be blunt, as a Secretary of State, I get the transparency anyway when things go wrong. Like the hon. Lady, I would rather have much more transparent data so that ICBs themselves can be better held to account, and indeed that is what the Hewitt review is looking at in terms of that wider transparency piece.
I welcome the fact that Barnet Hospital’s emergency department will be expanding and improving its facilities and taking on new staff, and of course I welcome today’s announcement, but I urge the Secretary of State to ensure that it is effective on the ground soon, because there is a real crisis out there. This is a good announcement, but it must be delivered so that patients and staff feel it on the frontline as soon as possible.
I could not agree more, which is why this morning the Prime Minister and I were at University Hospital of North Tees, where it is effective on the ground. It is about looking at hospitals where such measures have been effective and are having an effect on the ground, such as in North Tees and at Maidstone Hospital, and how we take best practice from them. We then have to do what has sometimes been more difficult in the NHS, which is to scale those innovations and get them adopted across the piece.
There are 165,000 vacancies in social care and there was nothing in the statement about how the Secretary of State will address them. Will he do that through better terms and conditions?
We are dealing with that through additional funding—the £500 million for this winter. That relates to the point made by my right hon. Friend Theresa Villiers about the impact on the ground, which will be to give ICBs and local authorities discretion. Some of that £500 million is being spent on the workforce, including in social care, so there is discretion as to how they spend that. There is also the £2.8 billion of local authority and ICB funding that will be in place next year, and £4.7 billion the following year.
The Secretary of State will be aware of Torbay’s demographics, particularly the growth in the number of people aged over 85. They are living a good long time but, at that age, they need some level of support from the NHS, which obviously creates demand and puts pressure on our systems. On the resources announced today, what engagement is he planning to have with local ICBs, particularly those that cover areas where the demographics mean that they are at the leading edge and driving innovation, but need support to do so?
My hon. Friend makes an important and nuanced point about demographic pressure, which is not evenly spread and is more concentrated in certain parts of the country than others, so the pressure on ICBs is greater in those areas. That is why the ministerial team met almost all the ICBs in a series of meetings with chairs and chief execs in the run-up to Christmas, and it is why we want to bring greater transparency, so that we can right-size solutions for emergency departments and ensure that those facilities keep pace with the increased demand.
Last night, my constituent’s 11-month-old son had to wait in A&E for eight hours, which my constituent found extremely unacceptable. The waiting experience in our hospital is like being in a “disaster zone”, in the words of my constituent, who went on to explain about parents having to sit on floors and wait for hours for their children to be seen by a doctor. I press the Secretary of State on whether there is a plan to return to the standard of 95% of patients who come to A&E being seen within four hours.
As I said, we are not setting out that ambition in this statement, because the impact of the pandemic has been so severe. We need to set a target that is ambitious but achievable, which is what we have done. The president of the Royal College of Emergency Medicine said:
“This plan is a welcome and significant step on the road to recovery and we are pleased to see it released.”
It is about taking best practice from the areas that are working and ensuring that they are socialised across the piece. It is obviously concerning to hear about individual cases, such as the specific one that the hon. Lady mentioned, which are very traumatic for the families. That is why we have set out this plan and why we are putting in the extra funding.
From 2005 to 2006, there was a campaign within the NHS to close many in-patient beds in community hospitals. I was pleased by what the Secretary of State said earlier about beds in community hospitals having a role to play. In that connection, will he reconsider the future of the site of Fenwick Hospital in Lyndhurst in my constituency, where the in-patient beds were closed? The NHS is now proposing to sell it off, but I would have thought that, with a bit of imagination, such a site could increase capacity.
We are encouraging integrated care boards to take ownership of individual decisions, rather than trying to make all the decisions centrally from Westminster, so that those closer to the ground and to the issues are in power to make the trade-offs. I am sure my right hon. Friend will want to have those discussions with the chair and chief executive of his ICB. There is a wider issue of how we make greater use of community sites, not least given the workforce pressures and different staffing ratios that they have, and that is absolutely the way we help to get more people out of hospital who are fit to leave.
Ten days ago, I shadowed one of the brilliant emergency department consultants at Derriford Hospital. They are working their socks off under some very difficult conditions. The additional capacity for beds is welcome, especially because of the structural under-funding and lack of beds in the south-west, but doctors and nurses were saying that they want to slow the flow of people getting to the emergency department in the first place.
Can the Minister look again at the mothballed Cavell Centre programme—the super health hub programme—which would have done so much to slow the flow and deal with collapsing primary care services? In particular, can he look again at the Government’s decision to withdraw £41 million from the super health hub in Plymouth, which would have been the national pioneer, would have shown that this project works and could help our hospitals to deal with the crisis they are facing?
The hon. Gentleman asks how we slow the flow of people going to emergency departments and how we accelerate their discharge once they are fit. The substance of the point he raises is valid and absolutely right. It is why there are schemes such as the community response service and the falls service. We are looking at the likes of the North Tees model and getting more staff into community support, thereby integrating the health and social care side. As I said to my right hon. Friend Sir Julian Lewis a moment ago, the trade-offs for individual sites are best determined by ICBs. I am very happy to look with ministerial colleagues at any specific proposals, but it is really for the ICBs to be looking at how to best use their estate.
I warmly welcome my right hon. Friend’s clear and credible plan, but on the uplift of 800 ambulances, which is good news, I urge him when it comes to their deployment to look at rural areas first. In these areas, ambulances by definition spend much longer per patient on the road going in between much more diversely spread out hospitals.
I recognise my hon. Friend’s point, not least as a rural constituency MP myself. I have talked to paramedics, as I am sure he has, and the principal cause of frustration of late has not been the issue of pay—important though that is. It has been frustration over long handover times, which has had a particularly damaging impact. I am happy to look at any specific issues in his area but he is right on the wider point about the pressures in rural areas.
When can the people of Warrington, and indeed Halton, expect to hear about the new hospital campuses, which are much needed by both communities—with sufficient staff to resource them?
This statement is focused on urgent and emergency care. At Health oral questions and on other occasions, we often discuss the wider capital programme and the increased funding we are putting into that programme. Part of that is about outcomes and how we get more from that investment in capital. That is why through the NHS estate we are starting to standardise our builds, starting with the Hospital 2.0 programme. We will be rolling that out more widely through the estate. I am not familiar with the specific issues at the hon. Member’s local site, but I am happy to look at them after the statement.
I welcome this recovery plan and my right hon. Friend’s comments on the role community hospitals have to play in future. The 16-bed Hopewell ward at Ilkeston Community Hospital was re-opened ahead of this season to ease pressures, but it is due to be decommissioned in the spring. To aid with more efficient planning, will he work with my local community health trust and ICB to ensure that these beds form part of the extra beds for next winter and, more importantly, become permanent—rather than this ad hoc approach we have had until now?
Again, decisions on the estate are principally for the ICBs, but I am happy to look at any individual proposals my hon. Friend has on how we get more flow into the system, and that is about putting more capacity into the community.
I think I welcome what has been said about mental health ambulances and trying to divert people in mental health crisis from A&E, but I am a little concerned about whether those attending the scene in those ambulances will have access to the past records of people in that situation or be able to carry out a proper risk assessment for them. Will the Secretary of State reassure me on that, and also on whether there will be places other than A&E to take them to? It is one thing to say that we want to divert them, but we need to have other resources in place.
The hon. Lady raises a fair and important point about what is in the wider package, alongside the mental health ambulances, which I think are a positive step. Last week, I met Baroness Buscombe as part of the pre-legislative scrutiny of the proposed mental health legislation, which will pick up some of the points that the hon. Lady raises. Examples of innovation include empowering people before they have a mental health crisis to use one of the apps that have been developed to set out their statement of wishes and other information, which is very helpful for paramedic crews when they have a mental health crisis. We are looking at how we use innovation to better give voice to the patient, and often to do that before they have the mental health incident, rather than when the ambulance arrives.
I welcome the announcement today; I think the key thing is that it makes a difference in the short term. The Secretary of State will be aware of plans to build a new A&E department at Ipswich Hospital. The plan is for it to open in January 2024. What assessment has been made of the difference that that could make in the medium to long term by increasing capacity and improving waiting times? Will he also be prepared to work with me and the hospital’s trust to potentially expedite the plan, so that it might even happen slightly before January 2024?
In a former role, when I was Chief Secretary to the Treasury, I signed off a significant expansion of A&E facilities. I hope that reassures my hon. Friend of my commitment to putting more capacity into emergency departments, not least because they need a certain level of capacity to be able to ensure same-day access, triage and ways of getting flow into the system. As for the wider site proposal, clearly the ICB for his area will want to prioritise that.
The urgent care and ambulance crisis has been brewing since autumn 2021 in Shropshire, and it has worsened since. Last week, a doctor went on the record to say that the emergency department was “like a war zone” and expressed her fear that, in a fire, not everyone would get out alive. In a six-week period to
I am very happy to meet with the hon. Lady and colleagues to discuss this further. I think most people recognise that, since the huge pressures from flu over the Christmas period, the flu numbers have come down, but of course there is continued pressure in the system.
I welcome my right hon. Friend’s statement. In particular, I welcome the announcement today of over £26 million of funding to expand the emergency department at Great Western Hospital in Swindon. He knows from his previous incarnation that we have worked together on this issue. It is particularly important, not just for the integration of emergency services, but for the freeing up of other space in the hospital to allow for further beds or other clinical interventions. Does he agree that it is this sort of long-term measure that will guarantee progress in our much pressed national health service?
My right hon. and learned Friend has been key to securing the funding. He has assiduously lobbied me and ministerial colleagues to make a powerful case on behalf of his constituents, and I think he should be proud of the outcome, which reflects his and his parliamentary colleagues’ work on this issue. He is right; indeed, the case he made was around how this frees up capacity in the system, which will result in much better care for patients in Swindon.
There is nothing in this plan to address the fact that thousands of people are now turning up at A&E as a direct result of being unable to get regular access to an NHS dentist. Last week, another Cumbrian dental practice, in Grange-over-Sands, wrote to all of its 5,800 patients, as it had been forced to quit the NHS too. There is now not a single NHS dental place available anywhere in Cumbria. What will the Secretary of State do to fix an NHS dentistry crisis that leaves a family of four having to cough up an extra £1,000 a year during a cost of living crisis to get access to dental care that they have already paid for through their taxes?
I have addressed that point, in that we are bringing forward the third component of our three plans. I spoke earlier about the elective recovery plan; today’s announcement is on the urgent and emergency care recovery plan; and the third element will be the primary care recovery plan. Of course, alongside the work we are doing on dentistry it is also about access to services, both dentistry and A&E. That comes together in things such as the 111 service and how we review that, as well as the NHS app. It is about looking at how we better manage demand at the front door, and the demand for dentistry is not only through NHS dentistry but often manifests itself through a lot of patients coming forward for dentistry at A&E.
I warmly welcome my right hon. Friend’s plan, particularly his focus on increasing capacity in urgent and emergency departments. I welcome the Government’s recent investment of £8 million to reconfigure the A&E at my local hospital in Southend. Does my right hon. Friend agree that this will increase not just the capacity but the quality of the urgent and emergency care on offer in Southend?
I commend my hon. Friend for her assiduous campaigning on behalf of her constituents in Southend, through which she played a key role in securing the extra £8 million of funding. She is right that that will make a material difference not only to flow and capacity within the hospital but through that to the overall standard of patient care.
I thank the Secretary of State for his clear commitment to extra funding for the urgent and emergency care recovery plan. Will he outline whether he is prepared to make additional funding available to meet the needs on maternity wards, which midwives feel are teetering on the brink? In reality, that means it is an issue of life and death, due to staffing levels. Will the Secretary of State ensure that additional funding makes its way to each devolved nation under the Barnett consequentials, to be used before the scheduled new financial year ends?
As the hon. Gentleman will know, the additional funding that the Chancellor announced in the autumn statement will lead to an uplift in health funding for Northern Ireland through the Barnett consequentials. On the flexibility within that, the hon. Gentleman will know that I agreed flexibility when I was Chief Secretary; it will of course be for Treasury colleagues to look at the requirements for ongoing flexibility within Barnett consequentials.
I warmly welcome what my right hon. Friend has said. He is right to recognise that one of the long-term impediments to discharge is the disconnect between the NHS and social care and local authorities. Will he confirm that, to ensure that the additional money is well spent, the integrated care boards will be not only responsible for the establishment of the hubs and extra care packages but properly monitored and held responsible for their performance and for generating value for the extra money that is being put in?
As a former Minister in the Department, my hon. Friend speaks with great experience on these matters. He is right that the crux of the plan is now in its delivery. As I alluded to in my statement, a key component of that is more transparency in the data so that he and colleagues throughout the House can hold to account not only the ICBs but the local authorities. We need to bring those two datasets more closely into alignment.
I warmly welcome today’s announcement, but will my right hon. Friend explain how for remote rural hospitals, such as the fantastic North Devon District Hospital, the workforce challenges that were present pre-pandemic might be addressed post pandemic, when we are now also dealing with a housing crisis? Might there be an opportunity to expedite the next phase of the redevelopment programme, which includes key worker housing?
I am keen to explore with colleagues how we can put more key worker accommodation on to the NHS estate, particularly by making use of modern methods of construction to expedite that. On the workforce plan, Devon is an area that has seen particular growth, given its older population, and greater pressure as a consequence. Those pressures will be worked through in the workforce plan that we will bring forward shortly.
Order. We are under a lot of time pressure today, so may I ask the remaining Members and those who are going to take part in the next statement to please think of very short, focused, single questions?
I welcome the statement and the extra investment in the NHS. It was a privilege to visit Bournemouth Hospital recently and meet the dedicated staff, and as the Secretary of State will know, it is expanding with a new A&E facility. Will he visit Bournemouth, meet the staff, and see the progress taking place?
I would be very keen to visit, subject to my diary. If it is not me, I am sure a ministerial colleague will do so.
I welcome the £1 billion funding announced today, and it is good that hospitals have benefited from innovations such as patient flow control centres, care transfer hubs, and virtual wards. When will hospitals and ICBs such as Nottingham and Nottinghamshire ICB, which has not been part of the pilot, be able to access those innovations, so that my constituents can start to access the benefits?
They can start to access them now. We announced £250 million at the start of the month, as part of the £500 million that was announced in the autumn statement, and hospitals know that funding of up to £8 billion is coming in the new fiscal year, so this is an opportunity for them to move at pace.
The Secretary of State told the House that the NHS was put under pressure with a spike in influenza cases in December. Will he say where he thinks that influenza virus has been hiding for two and a half years?
I do not think it has been hiding. Flu seasons are not uncommon in the NHS and come round on a periodic basis, and that is why we anticipated it through the flu vaccine. On the hon. Gentleman’s wider point, it is also recognised that as a consequence of covid some resistance to flu may have been lowered, but we have had flu pressures on the NHS in past years.
Would the Secretary of State consider more use of existing urgent care centres, such as that at St Cross in Rugby? Our nearest full A&E is 12 miles away at University Hospitals Coventry and Warwickshire NHS Trust, in Coventry, which means that 83% of my constituents are more than 15 minutes’ drive from an A&E. The hospital at Coventry serves a population of 600,000, which is twice the national average. Does he agree that extending provision at St Cross would go a long way towards reducing pressure at the hospital in Coventry?
My hon. Friend is right that not every patient accessing an emergency department needs a tier 1 A&E facility. This is about right place, right treatment for the patient, and making better use of urgent care centres. How those centres can better triage patients who can be treated there is a key part of the plan we have set out.
In Stockton South we are incredibly grateful for the Government’s commitment to build a new diagnostic hospital so that local people can get access to lifesaving scans, tests and checks. We are also grateful for the £3 million announced to establish a new mental health crisis hub, so that people can get support in their hour of need. What is my right hon. Friend doing to ensure that we have the right people with the right skills in the right place to deliver great service at those facilities?
I am delighted that, thanks to my hon. Friend’s assiduous campaigning, he has secured his diagnostic centre, and that he assures me he will get it operational in one of the fastest times seen by any area. We are bringing forward our workforce plan, and as I set out, we have 2,500 more nurses this year compared with last year. We are on track for our manifesto commitment of an extra 50,000 nurses, with more than 30,000 recruited already.
May I take my right hon. Friend back to the response he gave to Mike Amesbury about Warrington Hospital? That A&E unit is incredibly under pressure. Over the weekend nurses talked to me about the 120 patients currently waiting to be discharged, which is putting intolerable pressure on that unit. My right hon. Friend said that he was not particularly familiar with those issues, but perhaps I can invite him to Warrington to see the pressure. While he is there, perhaps he will also look at the Health and Social Care Academy, which was set up by the local college to try to address the shortage in social care. A great level of innovation seems to be happening there, and I am sure he would like to see Warrington for himself.
That last question gives me a beautiful opportunity to correct an earlier answer regarding the constituency of my hon. Friend. He knows I am familiar with this issue, because I remember calling him at about half past 10 one evening to discuss his A&E when some particular issues had come to the attention of the media. I am familiar with the pressures on his hospital—[Interruption.] I was just placing the constituency of Mike Amesbury vis-à-vis that of my hon. Friend. Now clarified on place, I am familiar with the fact that that hospital is under pressure. I know the Minister of State is due to visit, and I am sure she will look forward to meeting both the hon. Gentleman and my hon. Friend.
I thank the Secretary of State for his statement and responding to questions for over an hour.