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NHS Winter Crisis

Volume 635: debated on Monday 5 February 2018

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the Government’s response to the resolution of the House of 10 January on the NHS winter crisis.

Winter is challenging for health services worldwide. With a high number of flu cases this year, we have seen an increase of about 35% in accident and emergency attendances for flu—triple what it was last year—with about 3,000 hospital beds occupied as a result of flu and a further 700 because of norovirus. The NHS saw 1,200 more patients at A&E compared with this time last year. The guidance issued by the national emergency pressures panel sought to free up capacity for emergencies given the high number of flu cases, including from two dominant strains of flu co-circulating this year.

It is important to remind the House that the deferment of operations referred to in that guidance applies to about 13% of hospital beds dealing with elective patients, of which about half were protected within the guidance in respect of cancer and other urgent elective treatments. The guidance was updated on 26 January to confirm that further deferment of hospital operations is no longer needed. In terms of the impact that the guidance has had on operations, we will not know that until mid-March, when that data will be published and placed in the Library for the benefit of those on both sides of the House.

I welcome the new Minister to his place. However, the Secretary of State should have been here giving an oral statement, because those were the terms of the motion endorsed by the whole House.

The reason that motion was endorsed is that this winter, in recent weeks, over 95% of hospital beds have been full, we have seen the highest-ever number of A&E diverts, 50,000 elective operations have been cancelled, and urgent operations have been cancelled too. The crisis that our NHS is now in is so deep, and the underfunding so severe, that on Friday NHS England was forced to announce that the target of seeing 95% of A&E patients within four hours is now effectively abandoned until March 2019. If the Secretary of State had come to the House last Thursday, he could have been questioned on the NHS guidance.

Last year, more than 2.5 million patients waited longer than they should have done in A&E. Does the Minister expect that number to rise or fall this year? The 18-week target has already been abandoned. Is it not unprecedented that patients will have to accept, even before the financial year starts, that the NHS will not deliver on key constitutional standards of care? The waiting time standards are legal duties contained in the NHS constitution. What legal advice have Ministers received, or will they be seeking to amend the NHS constitution?

On Saturday, thousands of us took to the streets to demand a fully-funded, universal public national health service—and by the way, we will take no lessons from Donald Trump, who wants to deny healthcare to millions with a system that checks your purse before it checks your pulse. The NHS model is not broke but it does need funding. If this Government will not give it the funding it needs, then the next Labour Government will.

A party preparing for a run on the pound will be in no place to give funding to the NHS. It is the agreed convention of the House that responses to Opposition day debates are provided by the Department within 12 weeks. The Secretary of State will of course do that within that period, and there is a good reason for that. As I set out in my opening remarks, the data will not be available until mid-March, so the hon. Member for Leicester South (Jonathan Ashworth) is premature in asking this urgent question.

The facts are that the NHS was better prepared for winter this year. The number of 111 calls dealt with by a clinician has doubled compared with last year. Over 1 million more people have been vaccinated for the flu virus, 99% of A&Es have GP streaming and over 3,000 more beds have been made available since November, reflecting the extent of the plan.

If the hon. Gentleman would like to compare with the performance of the NHS in Wales, we will undertake a comparison. The reality is that this year, we have had pressure on the NHS as a result of flu. The difference is that in 2009, the Conservative party did not play politics with the flu pressures. This year, the hon. Member for Leicester South has done so. He should compare it with the pressure in Wales and see the excellent performance we have had in comparison.

The Minister will know that pressures in the NHS cannot be viewed in isolation from pressures in the community. It is great to see that he is now part of a Department of Health and Social Care. Will he say what is being done about making beds available in the community, to free up pressures in the NHS?

My hon. Friend, the Chair of the Health Select Committee, makes a valid point about the need for much more integration in our approach to the NHS. That is reflected in the appointment of my hon. Friend the Member for Gosport (Caroline Dinenage) as the Minister for Care, to look at that exact point.

Part of it is also looking at how we address other areas to deliver better outcomes. For example, 43% of bed occupancy at present is from just 5% of patients—those staying over 21 days. One key issue is how we bring down the current average stay from 40 days to, say, 35 days. That alone would unlock around 5,000 beds. We are looking at a more integrated model to address the pathways that I know my hon. Friend has highlighted in the Health Committee as a key priority.

Scottish National party Members want, first and foremost, to put on record our thanks to NHS staff. A number of members of my family work for the NHS. I spent time with them at the weekend, and we got that time because they were working over the Christmas period. We know that Christmas and the winter period has been profoundly challenging due to flu, but it is important that resources follow that. That is why we have record funding support for the NHS in Scotland and NHS Scotland A&E departments are the best performing in the UK.

Last week, the Scottish Parliament voted to abolish the public sector pay cap and to look at bringing in a 3% pay increase for our public sector workers. That is action, rather than warm words. Far too often we hear warm words from this Government, but in the national health service we need to see action, particularly on the public sector pay cap. What steps is the Minister taking to tackle wage stagnation within the national health service?

I thank the hon. Gentleman for his more mature approach, in recognising the huge amount of work performed by NHS staff. Indeed, as I pointed out, 1,200 more people a day are being treated in A&E, which reflects how much more is being done in our NHS with more resource, more money, more doctors, more nurses and more paramedics.

In terms of the specifics on money, the Government have given £1.6 billion to support performance improvements, which will be used to treat a quarter of a million more patients in 2018-19. The NHS planning guidance also shows that it expects performance to improve in the face of growing demand. That shows how more is being done, and more needs to be done.

All over the world, every winter sees a spike in illness and pressures on healthcare. Does the Minister agree that this Government have been proactive? In fact, for the first time ever, care home staff can receive vaccinations for free.

My hon. Friend is right to highlight the importance of vaccinations. This year we have seen 1 million more vaccinations than last year, which is part of addressing the demand on A&E. The number of 111 calls dealt with by clinicians has more than doubled, which has mitigated much of the demand from the flu virus.

In the light of the funding problems exposed by the winter crisis, what is the Government’s response to the recommendation of the last chief executive of the NHS, the heads of the Royal College of Nursing and the Royal College of General Practitioners and the retiring head of the Treasury that there has to be a form of earmarked taxation to provide stable, sustainable funding?

Addressing the challenge of funding was reflected in the Budget, with the additional money set aside by my right hon. Friend the Chancellor. On the comments of Simon Stevens, it is important to note what he said about the connection between a strong economy and delivering the finance that the NHS needs. Simon Stevens said:

“It has been true for the 68 years of the NHS’s history that when the British economy sneezes the NHS catches a cold.”

The reality is that if we are to fund the NHS as all of us want it to be funded, we need to ensure that there is a strong economy and only one party will ensure that that happens.

If we restore the beds to Milford-on-Sea lost under Labour, it will reduce the pressure on Southampton General, will it not?

My right hon. Friend is absolutely right. The other issue that puts pressure on beds and hospital finances is many of the legacy private finance initiative deals. We also inherited those deals from the Opposition, which they very rarely seem to want to talk about.

Will the Minister tell the House why, on Friday, NHS England suspended the requirement for A&E patients to be seen within four hours until 2019, contrary to the NHS constitution, and will he amend the NHS constitution to reflect this advice?

I thought the hon. Lady was going to stand up to reflect on the fact that her trust got £2.9 million of additional funding from what the Chancellor set about doing. The reality is that this Government are putting more money into the NHS and addressing the demands on the system.

May I ask my hon. Friend what scope there is as we go forward for conversations between his Department, NHS England and NHS trusts about maximising staff numbers in acute settings in our hospitals during the winter months?

We are in discussion with Health Education England on workforce planning and ensuring that we address concerns about retention and training, part of which is the fact that the Chancellor has lifted the 1% cap as it applies within the health service, and we are of course in active discussions with the trade unions on that point.

It has been reported to me that out of the 17 cubicles at Lewisham A&E one morning last November, five people were awaiting section with severe mental health problems. One person was there for over 72 hours, another for over 26 hours and another for over 21 hours, and all were there for over four hours. When will the Minister acknowledge that the reason why A&Es cannot cope is that the entire system—from social care and GPs through to mental health—is buckling under the enormous pressure of increasing demand, and when is the NHS going to get the funding it needs?

I have already said that I recognise there is increasing demand, and set out many of the measures we are taking through the 111 service and other areas. The hon. Lady’s own trust has received an additional £3.2 million to address many of those pressures, and the key question is how that will be deployed by the trust to address many of the blockages in the pathways at the moment.

Despite the challenges this winter, does my hon. Friend not agree that we can be extremely proud in this country that we have an NHS free at the point of delivery to all of our citizens? Will he confirm that that will continue to be the policy of this Government, and does he agree with me that we should not listen to the voices from across the Atlantic saying we should adopt a different system?

I absolutely agree with my hon. Friend that the NHS will remain free at the point of delivery. The reality is that for the majority of the NHS’s existence, it has been run by the Conservative party. We know the value of retaining healthcare free at the point of delivery, and the Secretary of State has repeatedly reaffirmed his absolute commitment to that.

In my constituency surgery, two sisters came to speak to me about their father, who went to hospital last month. Because the staff were so overstretched, he was placed in the wrong ward, so he did not get seen by a doctor for four days. Will the Minister reassure the sisters, and will he will pause the downgrade of Huddersfield Royal Infirmary and rethink this so that the winter crisis does not become a daily crisis in the NHS?

As the hon. Lady knows, local commissioning decisions are for the clinical commissioning group and local commissioners, but again, not one Opposition Member has recognised the additional funding that has gone in. Her own trust received an additional £3.4 million—[Interruption.] Well, it never is enough for the hon. Lady. The question is, how, with the economic mismanagement under their party, Labour Members are ever going to deliver what they want? Her trust received an additional £3.4 million to address the pressures.

Not only are this Government increasing the funding available to the NHS; crucially, they are also training more doctors, with 1,500 more medical school places. Does my hon. Friend agree that that is not only a crucial factor that will address areas such as Lincolnshire, which are under-doctored, but another reason to put a medical school in Lincolnshire?

I very much note my hon. Friend’s bid for further training places, and he is absolutely right: there has been a 25% increase in the number of places. That is part of ensuring that we have more doctors, nurses and paramedics, which this Government have put in, to address the increasing demand that the NHS faces.

Given that, according to Age UK, one in three older people admitted to hospital is suffering from malnutrition, will the Minister now accept that cuts to adult social care are putting an avoidable and increasing strain on the NHS?

What the hon. Lady’s question points to is how we better integrate care as between hospitals and the care sector. That is exactly the issue that the Minister of State, my hon. Friend the Member for Gosport (Caroline Dinenage), who has responsibility for care, is looking at in the Department, to ensure better outcomes from the money being put into the system.

Will the Minister join me in praising the foresight, dedication and hard work of the staff and management of Luton and Dunstable, which was the first hospital to bring in A&E streaming and now regularly and comfortably achieves the 95% target? Does he agree that we need to be better at moving best practice in the NHS around the whole system more quickly?

My hon. Friend is absolutely right. What he points to is the variance in performance between some of the best trusts, such as Luton and Dunstable, and other trusts. One of the key challenges is how we ensure that that best practice is better socialised across the NHS, because unlike Labour we recognise that it is not just about how much money we put into the NHS; it is what we get out for that money. Luton and Dunstable illustrates that point, and more trusts need to follow suit.

North Tees Hospital staff are doing a great job of dealing with the winter crisis, but even they have been struggling this year. The trust says it is going to record its first ever deficit, because it cannot make the £18 million cuts demanded by the Government. Is the answer really to deprive it of more money or to have it set up a wholly owned subsidiary company to cut the terms and conditions of future staff?

The hon. Gentleman’s trust has received an additional £1.6 million, so it is simply factually incorrect to say that its budget has been cut.

May I thank my hon. Friend the hospitals Minister for the extra £2.6 million given to Kettering General Hospital to help it to cope with winter pressures this year; and, through him, my I congratulate the NHS on this year undertaking the most comprehensive flu vaccination programme in Europe and the largest in this country’s history?

My hon. Friend is an assiduous campaigner for his constituency, and he is absolutely right to highlight both the progress made and the importance of the prevention offered through the increased number of vaccinations. I hope many more people next year will continue to take up the vaccination, including Members of this House.

Does the Minister not realise that 14,000 beds have been taken out of the national health service on this Government’s watch? People are now being treated in ambulances, which is a disgrace. Is he not taking us back to the Major Government of the 1990s, when people were sleeping on trolleys?

Again, the hon. Gentleman is ignoring the increase in the number of doctors. There are now 14,900 more doctors and 14,200 more nurses in the system. As I alluded to earlier, it is not just the number of beds; it is also how we manage those beds. It is how we manage the fact that 5% of the patient population is occupying 43% of beds that will best address bed occupancy rates.

I strongly welcome the extra investment in Essex and Harlow in terms of the winter crisis in the national health service, and I very much hope we get a 10-year plan, as suggested by the Secretary of State. Is my hon. Friend aware of the difficulties that Harlow Hospital faces, in that we have among the highest A&E figures per head in England and a hospital that is literally falling down and not fit for purpose, as recognised by the Department? Will he visit the hospital to see what can be done to help us in our campaign for a brand-new hospital for Harlow?

As my right hon. Friend knows, the challenge at Harlow is recognised by the Department. That is why, from memory, its outline business case has been approved and it is now going through the next phase in terms of getting the final business case approved. I am very happy, as always, to discuss the progress of Harlow with my right hon. Friend.

Before the Minister seeks to deflect my question by telling me how much extra my trust has got—his Parliamentary Private Secretary is diligently looking that up at this moment—let me tell him that I am aware of how much we received: £1.1 million. However, I can also tell him that winter cost us £11 million, so there is still a £10 million cost to our trust budget.

However, there is a double hit, because my hospital will be hit by fines as a result of missing A&E targets and handling targets for ambulances, with £120 per missed four-hour target, £1,000 per missed 12-hour target and £200 for each ambulance affected. Will the Minister make sure that those fines are not levied by clinical commissioning groups, and that that money stays where it is needed, which is in frontline care?

Again, the hon. Gentleman is ignoring the huge number of measures that have been put in place. As Sir Bruce Keogh himself recognised, there was much more planning this year at a much earlier stage. We have had better integration between NHS England and NHS Improvement. We have had a much more comprehensive planning cycle. We have had better access to primary care, reducing pressure on the front door. We have had stronger action on delayed discharges, addressing issues at the back door. We have had changes to the way ambulance services respond to calls, so there is better prioritisation. We have also had financial incentives focused on A&E performance, so there is a huge range of measures, in addition, as I said earlier, to 1 million more people being vaccinated against flu. Those are all part of the actions taken by this Government to prepare and plan for the pressure of the flu issue we have had to manage.

While my constituents will welcome the £1.1 million of extra winter funding, they do not want to believe that this issue is decided purely by knockabout in the House of Commons, which is what some others wish to focus on. Will the Minister reassure me that he will look for independent clinical advice on how to deal with pressures in the NHS and then base his response on that advice?

My hon. Friend is right. There is a desire among Labour Members to avoid the reality of what is happening in Wales, where clinicians said that their best performance is often akin to the worst performance in England. However, we recognise that there needs to be much more integration in the system. That is why the Minister of State, my hon. Friend the Member for Gosport, is looking at how we have better integration in the NHS and the community in terms of domiciliary care, and at how we address some of the issues in the pipeline—the pathways—in hospitals to get a better flow, so that the discharging of patients is not delayed. Much progress has been made, but we recognise that more needs to be done.

We all knew this was going to be a difficult winter for the NHS, but I just wondered whether the Minister felt that his Department had helped the situation by delaying the announcement of additional funds until the November Budget, with most trusts not receiving that money until December. That meant that my trust, for example, had to make plans without knowing whether it would get additional funding and that it was taking a risk.

The Labour party seems to have moved from complaining about the amount of money to complaining that it was not delivered early enough. The hon. Lady’s trust received £3.4 million of additional money, but, as Sir Bruce Keogh has made clear, the point is that preparation for winter this year began much earlier than normal and was far better advanced than has been the case before. That is what the medical director of the NHS has said about how we prepared for winter this year.

Could I reflect on the rather rosy picture that my colleague from the Scottish National party, the hon. Member for Glasgow East (David Linden), painted of the NHS in Scotland? We have poor waiting times at A&Es, we are closing a paediatric ward in Paisley, and the chemotherapy unit at Station 15 in Ayr is under threat. Does the Minister think that having the highest tax base in the United Kingdom is a threat to recruitment in NHS Scotland, and that higher taxes in Scotland might play to the advantage of NHS England?

My hon. Friend points to a key point that I have made throughout this session. It is not just about how much money is put into the NHS, but about the outcomes that are delivered as a result. He is right to allude to the fact that in Scotland the SNP has not delivered the improvements it promised on the NHS. That is why there is so much dissatisfaction in Scotland with what is happening in the NHS there.

It is not just integration that will solve the problems in the social care sector. In Trafford, social care providers are being promised £14.61 an hour from this April—well short of what we need to sustain the home care market. What will the Minister do to ensure that there is adequate funding for home care providers?

The hon. Lady raises a very valid point. It is exactly why we will have a Green Paper this summer looking at what steps need to be taken to address this issue. On both sides of the House, we recognise that more needs to be done on how we address these concerns, and that is what the Green Paper will tackle.

I am sure that the Minister did not mean to mislead the House regarding the impact of the flu epidemic on our A&Es, so will he confirm that the delays to people being treated in A&E, and the fact that people have been waiting on trollies in corridors and that ambulances have been queueing at the doors of A&E, predated the flu epidemic?

The hon. Gentleman makes quite a serious allegation of my misleading the House. What I was very clear about is that there has been a 35% increase in attendances at A&E as a result of flu this year compared with last year, and that around 3,000 beds are currently occupied by patients with flu and around 700 beds are occupied by those with norovirus. Clearly, that has resulted in significant seasonal pressures this year, which have placed strain on the system. That was recognised by the Government in the additional funding that was put in place. It was recognised by the NHS, as Sir Bruce Keogh set out in the early planning that was undertaken, and it is simply wrong for the hon. Gentleman to ignore the impact of flu this year, given the way that in 2009 the then Opposition were very responsible in recognising its impact.

Can the Minister confirm that accountable care organisations, accountable care services and place-based care are being rebranded as integrated care services? Will he explain whether there is actually any difference between those terms, and will he do all he can to ensure that Members in this House are given the opportunity to scrutinise them, as I believe that they are here to act as a Trojan horse to bring in the break-up and privatisation of the national health service?

We continually hear this myth about privatisation. The reality is that this Government appointed to run NHS England, first, Sir David Nicholson, who had previously been appointed by the Labour party, and then Sir Simon Stevens, who has worked for both sides of the House. Numbers show that the level of private healthcare provision has not changed this year compared with last year. I understand that the Health Committee is due to look into ACOs and integration within a matter of weeks as part of its deliberations, and I very much look forward to reading the conclusions in that Committee’s report.

The programme to reduce acute hospital services and close blue-light A&Es, like that at Charing Cross Hospital, is about to undergo its fourth change of name in five years—“Shaping a healthier future,” “sustainability and transformation,” “accountable care,” and “integrated care”. Would it not be better to reconsider that policy, which is being driven not by local clinicians, but by his Department?

The impression given by the hon. Gentleman is that he always seems to oppose reconfiguration of any sort. The reality is that most clinicians will say, “We do need to reconfigure. We do need to look at how services are operated.” The evidence of that can be seen within London in terms of the reconfiguration of stroke, which from memory, he opposed—

If the hon. Gentleman did not oppose it, I will happily correct that, but he will recognise that the reconfiguration of stroke in London to fewer sites significantly improved outcomes for patients. There is always a discussion to be had about how reconfiguration operates, but clinicians and the royal colleges recognise that the benefits of reconfiguration are better outcomes for patients as well as better outcomes for the NHS.