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NHS: Winter Crisis

Volume 788: debated on Wednesday 7 February 2018


Asked by

To ask Her Majesty’s Government what assessment they have made of the effectiveness of their planning for the winter crisis in the National Health Service.

My Lords, planning for winter started earlier than ever before to ensure that robust plans were in place to support NHS delivery during the challenging winter months. Despite the NHS being extremely busy and flu rates being at the highest level for years, hard-working staff treated more than 55,000 people within four hours every day in December—more than 1,200 more than last year. NHS England and NHS Improvement will publish their review of winter by summer 2018.

I thank the Minister for his reply. As he knows, NHS spending has risen by an average of 4% each year in real terms since its inception in 1948. Since this Government took over in 2010, that 4% increase has fallen to an average of between 1% and 1.5% in real terms. Can the Government not accept that some of their meanness is one of the major causes for the crisis the NHS finds itself in?

I totally reject the accusation of meanness. If noble Lords look at the spending on the NHS, not only has it gone up in real terms every year while a massive fiscal retrenchment has had to take place to deal with £150 billion of borrowing bequeathed by the previous Government, but it now accounts for the highest percentage share of public spending that has ever been in place. We have found the money in difficult circumstances. We all agree that more is needed. More was found in the Budget; I am sure more will be found in the future.

My Lords, in 2015 the King’s Fund warned the Government that the NHS would experience a “full-blown crisis in care” if the Government did not act early enough. That crisis has now materialised, with the additional funding announced in November’s Budget having arrived too late for hospitals struggling to cope with the accepted increase in demand from patients at that time of year. If the planning is to be published in July, when will the announcement about money to support that planning also be announced?

As the noble Baroness knows, last year we had two significant spending announcements —there were two Budgets—in the March Budget on social care and in the November Budget for NHS funding, with billions extra being put into the service to meet very quickly rising demand. The review that will come out in summer will be a retrospective review of planning and the success of planning for winter. There will also be important lessons to be learned from it I am sure.

Are the Government planning to ask NHS England to review the number of beds available, given that staff at the moment are starting shift after shift with no beds available and having patients who need IV therapy or even ventilation in their departments who cannot possibly be sent home? Staff morale is inevitably being undermined because they just do not know where they can put these patients.

The noble Baroness is quite right to highlight the issue of bed occupancy; it is very high. The service managed to get it down below 85% before Christmas but inevitably it has risen since then. There is a big improvement in delayed transfers of care; we need that to continue to happen, and it was welcome that the Secretary of State for local government announced more funding for social care so that we can increase those transfers into social care and free up space in hospitals.

My Lords, following the noble Baroness’s question about bed occupancy, it is absolutely true that in 30 of the last 70 days in the winter period occupancy has been above 95%, which is dangerous. Some hospitals are at 100%. Was that part of the winter plan that the Minister assures us was timely and thorough? Will he accept that the winter plans have now been compromised in the light of pressure on beds, lack of staff and the fact that at least 23 trusts are now on black alert, which means that they are under very severe pressure?

I agree with the noble Baroness that bed occupancy is higher than we want it to be and in some hospitals it is far too high. The question, of course, is what we do about that. It necessitated the difficult decision, for which the Prime Minister apologised, to cancel non-urgent elective surgery. Happily, that has not been repeated and rolled forward into February. We think and hope that the situation with flu, in particular, has stabilised and that that will start to relieve the pressure. I absolutely understand the hard work that staff are having to put in under tremendous pressure and I know that we all appreciate that.

My Lords, I congratulate the Government on finding extra money for the National Health Service but does my noble friend agree that just putting more money in is not going to solve the crisis? Until we manage to sort out the social care system and the care of elderly people in our population the crisis will continue. We need convalescent places for older people who do not need to be in hospital in order to free up beds. I would also welcome an update on the thinking on integration between health and social care, which I so much endorse.

My noble friend is absolutely right to highlight integration. I point to two things, one that is happening now and one for the long term. In the short term, the better care fund is a pot to which local authorities and the NHS contribute and it has more money than ever before, precisely to make sure that that interface between NHS care and social care is as good as possible and people can be discharged safely home as soon as possible, which is of course what they want. We also know that we are going to have a social care Green Paper this summer. It is a really important moment; we know how many missed opportunities there have been in the past to reform care in this area and I know that noble Lords are really keen to contribute to this. I urge them to do so and in that way we can build a consensus for change.

My Lords, the Minister says there are billions extra for the health service, but the East Sussex Healthcare Trust has just announced a £21 million increase in its deficit, making it £57 million for the rest of this financial year. This is now 14% of its total budget. The finance director says that it is necessary to achieve clinical stability for this ambitious deficit reduction. Is this not just a euphemism for cuts to services? What advice can the Minister give to patients using hospitals in Hastings and Eastbourne who are waiting for treatment?

I am not familiar with the specific circumstances around the hospitals that the noble Lord has pointed to, but of course we know that there is huge pressure on services. If you look at the performance data, the NHS is seeing more people in A&E, more people being diagnosed, more people being referred to treatment, and that is why additional funding went into the budget, not just for this winter but for the next two years as well.