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Urgent and Emergency Care

Volume 824: debated on Tuesday 6 September 2022


The following Statement was made in the House of Commons on Monday 5 September.

“With permission, Mr Deputy Speaker, I would like to make a Statement on our support for urgent and emergency care. I know that this is an issue of great concern to right hon. and hon. Members, and I wanted to update the House at the earliest opportunity on the work that has been undertaken over the summer.

Bed occupancy rates have remained broadly at winter-type levels, with Covid cases in July still high, with one in 25 testing positive—that compares with about one in 60 currently. This is without the decrease in occupancy that we would normally expect to see after winter ends, and ambulance waiting times have also continued to reflect the pressures of last winter, although I am pleased to see recent improvements. For example, the West Midlands service is meeting its category 2 time of less than 18 minutes.

I would like to update the House on the nationwide package of measures we are putting in place to improve the experience of patients and colleagues alike. First, we have boosted the resources available to those on the front line. We have put in an extra £150 million of funding to help ambulance trusts deal with ambulance pressures this year. On top of that, we have agreed a £30 million contract with St John Ambulance so that it can provide surge capacity of at least 5,000 hours per month. We are also increasing the numbers of colleagues on the front line. We have boosted the national 999 call handler numbers to nearly 2,300, which is about 350 more than we had in September last year, and we have plans to increase this number further to 2,500 by December, supported by a major national recruitment campaign. By the end of the year we will have also increased 111 call handler numbers to 4,800. As well as that, we have a plan to train and deploy even more paramedics, and Health Education England has been mandated to train 3,000 paramedic graduates nationally each year, which is double the number of graduates that were accepted in 2016.

Secondly, we are putting an intense focus on the issue of delayed discharge, which, as many Members know, is the cause of so many of the problems we see in urgent and emergency care—I think that is recognised across the House. This is where patients are medically fit to be discharged but remain in hospital, taking up beds that could otherwise be used for those being admitted. Delayed discharge means longer waits in accident and emergency, lengthier ambulance handover times and the risk of patients deteriorating if they remain in hospital beds too long—this is particularly the case for the frail and elderly. The most recent figures, from the end of July, show that the number of these patients is just over 13,000—these are similar numbers to those for the winter months. We have been working closely with trusts where delayed discharge rates are highest, putting in place intensive on-the-ground support.

More broadly, our national discharge task force is looking across the whole of health and social care to see where we can put in place best practice and improve patient flow through our hospitals. As part of that work, we have also selected discharge frontrunners, who will be tasked with testing radical solutions to improve hospital discharge. We are looking at which of these proposals we can roll out across the wider system and launch at speed. Of course, this is not just an issue for the NHS. We have an integrated system for health and care and must look at the system in the round, and at all the opportunities that can make a difference. For instance, patients can be delayed as they are waiting for social care to become available, and here too, we have taken additional steps over the summer. We have launched an international recruitment task force to boost the care workforce and address issues in capacity. On top of that, we will be focusing the better care fund, which allows integrated care boards and local authorities to pool budgets, to reduce delayed discharge. In addition, we are looking at how we can draw on the huge advances in technology that we have seen during the pandemic and unlock the value of the data that we hold in health and care, including through the federated data platform.

Finally, we know from experience that the winter will be a time of intense pressure for urgent and emergency care. The NHS has set out its plans to add the equivalent of 7,000 additional beds this winter, through a combination of extra physical beds and the virtual wards which played such an important role in our fight against Covid-19. Another powerful weapon this winter will be our vaccination programmes. Last winter, we saw the impact that booster programmes can have on hospital admissions, if people come forward when they get the call. This year’s programme gives us another chance to protect the most vulnerable and reduce the demand on the NHS. Our autumn booster programmes for Covid-19 and flu are now getting under way, and will be offered to a wider cohort of the population, including those over 50, with the first jabs going in arms this week as care home residents, staff and the housebound become the first to receive their Covid-19 jabs.

Over the summer, we became the first country in the world to approve a dual-strain Covid-19 vaccine that targets both the original strain of the virus and the omicron variant. This weekend, the MHRA approved another dual-strain vaccine, from Pfizer, and I am pleased to confirm that we will deploy it, along with the Moderna dual-strain vaccine, as part of our Covid-19 vaccination programme in line with the advice of the independent experts at the JCVI. Whether it is for Covid-19 or flu, I would urge anyone who is eligible to get protected as soon as they are invited by the NHS, not just to protect themselves and those around them but to ease the pressure on the NHS this winter.

Today I have laid before the House a Written Ministerial Statement on further work that we have been doing over the summer, and I want to draw the House’s attention to one particular feature in that Statement which has garnered interest in the House in the past. In November 2021, the Government announced that they would make £50 million of funding available for research into motor neurone disease over five years. Following work over the summer between my department and the Department for Business, Energy and Industrial Strategy, through the National Institute for Health and Care Research and UK Research and Innovation, to support researchers to access funding in a streamlined and co-ordinated way, we are pleased to confirm that this funding has now been ring-fenced. The departments welcome the opportunity to support the MND scientific community of researchers as they come together through a network and are linked through a virtual institute.

I commend this Statement to the House.”

My Lords, as the new Prime Minister is appointing her first Government, I am very glad to see the Minister in his place this evening. I have a sense of despair over the dire situation in the ambulance service that led to yet another Statement. However, I welcome the inclusion of the importance of vaccination and the funding for motor neurone disease. I also pay tribute to St John Ambulance and am pleased that it has now been formally commissioned. Could the Minister confirm that this extra capacity is being used by the system today?

The outgoing president of the Royal College of Emergency Medicine has said that ambulance delays have got so bad that the NHS is now “breaking its promise” that life-saving emergency care will be there when it is needed. The facts are that 29,000 patients waited more than 12 hours in A&E in June—more than ever before—and 10,000 urgent cases waited more than eight hours for an ambulance last month. But this is not just about life and death; it is about the distress and severe discomfort of those who are kept waiting. Analysis by the Financial Times estimates that the deteriorating state of emergency services could be costing 500 lives a week, so can the Minister give an estimate of the number of people the department believes have died unnecessarily because they have been stuck in an ambulance waiting to get into A&E, or because an ambulance has turned up late or not at all?

We have gone from no crisis in the system in 2010 to annual winter crises, and now to there being a crisis all year round. We hear that the NHS will tell patients to avoid A&E as the winter crisis bites early. Can the Minister tell your Lordships’ House when the winter crisis will now start? What is the forecast of how much worse excess deaths will be over this winter? What is the Minister’s response to the QualityWatch report’s assessment that the roots of record waiting lists and delays to ambulance services predate the pandemic?

Ambulance delays are directly related to one in seven hospital beds being occupied by patients medically fit to leave but who cannot be discharged because there is no social or community care to support them. To give but one example, there are reports today of an elderly man who, sadly, died last month in the back of an ambulance after waiting six hours to be admitted to Norfolk and Norwich University Hospital. The chief nurse at the hospital said that the man

“remained in the ambulance due to significant pressure on our emergency department and inpatient wards.”

However, at the same time, more than 200 patients in the hospital were medically fit to be discharged. Will this matter be considered in the investigation? How will situations such as this up and down the country be resolved?

How do the Government intend to ensure that we have the supporting social and community care workforce we so desperately need? Why is there continued resistance to workplace planning and reporting to this House?

Care workers, who are desperate for a decent wage, are being lost to the likes of Amazon. The Government’s answer has been to pull the “immigration lever” and to recruit people from overseas on lower wages. How will this be sustainable? What difference will it make in the long term?

The Statement mentioned the new mandate for Health Education England to train 3,000 paramedic graduates. What is the Government’s reasoning behind conversely capping the equally important number of medical graduate training places, which the Medical Schools Council has criticised?

We all know that the cost of living crisis is likely to be devastating. If people cannot afford to keep themselves warm, they are more susceptible to illness and infections. We know that 10,000 people a year already die as a result of cold homes, and that this could be far worse this year without action. Could the Minister say what the Government will do to address this? Have they assessed the impact of the cost of living, which continues to rise alarmingly, on health outcomes and well-being? Do they have a strategy to help people proactively?

What consideration has been taken of the fact that rising energy costs will push care providers to breaking point, with some homes facing closure, unable to absorb increases of 500% or more? What plans do the Government have to protect care home residents from finding that they have no home?

The reality of the ambulance services’ situation is that things are getting worse, not better. Can the Minister advise your Lordships’ House on what exactly the Government will do to reverse this trend?

My Lords, I echo the comments of the noble Baroness, Lady Merron, that it is good to see the Minister in his place, although I notice that since he came into the Chamber his Secretary of State has changed. I wish the new Secretary of State well in her new role.

After many of the angry words over the past few weeks between the contenders to become the leader of the Conservative Party and the next Prime Minister, it is important to say that the crisis we face is not caused by the NHS and its staff, or the same in social care. Ambulance response times are still appalling, so much so that I have a friend who was once again advised by their GP this week to bypass the ambulance system to get their husband direct to hospital. Despite the numbers talked about in the Statement, the situation does not appear to be easing at all in the country.

It was encouraging to read at the beginning of the Statement that resources will be boosted on the front line, but from examining these figures it is quite difficult to follow the real increases on the front line and when they will happen. Some £150 million extra for trusts to deal with ambulance pressures is welcome, and I echo the thanks and congratulations to St John Ambulance; it is good that the Government have finally put on a formal footing the work it has been doing behind the scenes. But the number of extra 999 call handlers to be appointed between June this year and this Christmas is another 150, which, split between the 11 ambulance trusts, is not that many extra call handlers. Of course, they are taking not just health 999 calls.

Similarly, I cannot get to the bottom of the increase in call handlers to 4,800 or find out the previous figure. Call handlers on 111 refer callers mainly to primary care; 64% was the last data I saw. The issue is that there is no mention anywhere in this Statement of the pressure on primary care—whether that is GPs, community nurses or physiotherapists. There is absolutely zero mention, which means that the extra 111 call handlers will essentially be pushing patients into the void that primary care currently faces, given the pressure that GPs in particular are facing.

I echo the points about the training of more paramedic graduates, but it is outrageous that young people who have just qualified as doctors at university this year have been unable to find jobs because the money has not been found in the NHS for their training places.

It is important to note that the discharge frontrunners “testing radical solutions” will be testing on people in live situations to work out what happens.

On these Benches we welcome the international recruitment task force and particularly the code of practice, which the Government published just over a year ago and have updated in the last few weeks. The code of practice is vital for making sure that this recruitment happens ethically and that staff who come from abroad are supported. It sets out the fair framework for payments that they might have to pay back. But this is still fixing our problem by taking people from other countries. I note that this list includes red countries, which the Minister has referred to in the past, including Pakistan, Bangladesh and some countries in Africa. The rules must be followed very carefully, because those countries desperately need their own staff. While we need to be very grateful to all of them for coming to help us at this time, this is not a long-term solution. I hope the Minister can talk about what that longer-term solution might be.

The Statement makes reference to the better care fund. I am bemused that the better care fund is being used

“to pool budgets, to reduce delayed discharge.”

That is one of the things it was created for at the tail end of the coalition, and it has indeed been the focus of it.

My big worry about this Statement is that ICBs, which we have spent a lot of time discussing in your Lordships’ House over the last few months, are now trying to implement a new system for shared care and shared costings. This Statement says the entire focus will be on delayed discharges, so what extra resources will be available for ICBs?

The Statement also talks about the need for additional beds. It is good that the Government are at last recognising this; 7,000 additional beds is a start, but how many of those 7,000 are real beds and how many are beds in virtual wards—that is, people at home being observed by telemetry? What extra support is going into primary care to support the nurses and doctors who will also be fulfilling some of that? The Statement is completely silent on that.

The end of the Statement talks about Covid and the new vaccine, which is very good news, but why has Covid testing for staff in hospitals been stopped in the last couple of weeks? Too many patients are still catching Covid in hospital. A friend’s mother in her 90s had been tested on arrival in A&E and was then admitted. Three weeks later, when she was about to be discharged for a care home, the hospital refused to test her. Eventually it was pressed to do so. She had Covid, but it did not test anyone else on her ward. She died of pneumonia, and the death certificate said the reason for the pneumonia was Covid.

Another friend died last week, aged 51. She was on the shielding list and had had all her vaccinations, but had a stroke. She caught Covid in hospital and died. She would have been eligible for Evusheld, so it is very disappointing to hear that the Government still will not approve this drug for the 500,000 who are clinically extremely vulnerable.

Finally, the booster campaign is great, but why have the Government decided to stop giving boosters to under-12s who either are immunocompromised or have family who are immunocompromised? We know that schools where air circulation is still poor are an absolute vector. All the experts are warning us that there is likely to be another wave of Covid, and schools without ventilation will be a real problem. If the Minister cannot answer that question today, perhaps he can write to me.

This Statement admits that our NHS and social care sector are still under the most phenomenal pressure. It is the first time I have heard Ministers talk about the system being “at winter state”. When and how on earth will we cope with the winter months when they arrive?

I thank both noble Baronesses for their welcome that I am still in post; let us see for how long.

I pay tribute to my right honourable friend the former Secretary of State for Health, Stephen Barclay. When he came into office, he was quite clear that he saw the headlines, the issues about access to GPs and primary care and the ambulance waiting times. He said, “Look, I don’t know how long I’m going to be in office, but I’m determined to work on this over the summer”. This Statement is the result of that. Had he stayed in post, no doubt some of the questions that the noble Baronesses, Lady Brinton and Lady Merron, raised would have been answered with other Statements. Hopefully he has set in place the process to enable his successor to deal with some of these issues.

When he came into position, he was quite clear. In fact, he was so clear that he said, “I want the latest numbers on my wall”. He also asked, “Who do I need to talk to?”. He got the NHS England leadership in, contacted the most challenged trusts and the ambulance services and asked, “What can we do to help and how do we understand about discharge?” As the noble Baronesses rightly said, it is about not just ambulances but the whole system of discharge, making sure that there is somewhere in the community for patients to go from hospital. Are there sufficient beds? He has tried to work on this. Clearly, some of this will take time to work through.

Both noble Baronesses referred to the fact that we have contracted St John Ambulance to deliver auxiliary ambulance services. My understanding from when I checked is that this is immediate, but I will have to clarify that to make sure I have given an accurate answer to the question. Because ambulance trusts receive central monitoring and support from the NHS England-funded ambulance co-ordination centre, the Secretary of State worked closely with NHS leadership to look at how to put money into the system and to make sure it gets spent and gets through the system. It is all very well talking about inputs, but how about that? We have provided £150 million extra to improve response times, additional call handler recruitment and investment in the workforce. We have seen an increase of about 12% in ambulance staff and support staff since 2019.

On the handling numbers, it is really important that it is not just about signposting individuals. There are health professionals on the line who can deal with the patients when they ring up for advice. When I had to call 111 just before the summer break, I spoke to the call handler, who then arranged for a GP to ring me back to have a further, detailed conversation. As a result, the GP then made an appointment for me at the local A&E, so I just had to turn up at an allotted slot. That is what they are looking to do to ease pressure on A&E. Can they deal with it without having to go to A&E in the first place? For the less urgent but immediate cases, can they allocate a time slot?

So we are boosting the 999 and 111 call handler numbers and providing targeted support to some of the hospitals facing the greatest delays. The former Secretary of State was quite clear about looking at the areas where we have the most trouble, seeing what we can do about it and getting all the system leaders together. I am afraid it will not be resolved overnight—I am sure that noble Lords recognise that—but trusts are now closing 12.5% of incidents over the phone, which is nearly twice the pre-pandemic rate. We are also providing investment to upgrade the accident and emergency facilities at more than 120 separate trusts.

There is also the national discharge task force, which is focusing on how we address the discharge problems in particular areas and work with local system leaders to understand those problems. The former Secretary of State has been having those conversations and diving into real detail, either convening people or bashing heads together to make sure that we tackle this. He has put in a place a number of processes, which my right honourable friend the new Secretary of State for Health, Thérèse Coffey, will have to deal with. He has at least put that process in place so she can hit the ground running. As I said, he has taken a close interest in the most difficult and challenged areas.

I will try to deal with some of the specific issues. First, the former Secretary of State was quite clear that we need to think about the winter plan now and not wait until we hit winter. That means preparing for variants of Covid-19, and increasing capacity outside of acute trusts and resilience in 111 and 999 services, as we have mentioned; it means looking at target category 2 response times and ambulance handover delays, at how we reduce crowding in particular A&E departments, and at how we reduce hospital occupancy.

In response to the question from the noble Baroness, Lady Brinton, about the breakdown between virtual beds and hospital beds, I cannot give that data at this point; it might be a dynamic situation, as and when, and will depend on whether individual patients’ homes are suitable to accommodate a virtual bed. They will have to meet certain standards; it is not just a word but a proper virtual bed. We also need to look at how we can ensure timely discharge and provide better support for people at home.

On mortality rates, we see the headlines and, clearly, we have conversations with our officials within the NHS. They do not believe that it is correct to link those performance figures directly to current excess mortality rates but they recognise that there are, sadly, far too many cases of people who should have been seen. There have been deaths but I do not have exact numbers. I will try to get more details for the noble Baroness.

On the overall workforce, as I have said a number of times, I would disagree with noble Lords who say that there is no plan; that is not correct. We have already commissioned Health Education England to work with partners. The department has also commissioned NHS England on long-term workforce planning. As noble Lords will know, the Health and Care Act makes it incumbent on the Secretary of State to publish a report on the workforce and the challenges ahead.

I will stop there for now. I apologise to the noble Baronesses; I will try to answer in writing the questions that I have not answered here this evening.

My Lords, would my noble friend agree that the problems in the ambulance service are essentially reflective of the problems in the National Health Service more generally? Would he also agree that there is a widespread feeling that the National Health Service as presently constituted is no longer fit for purpose? Given that, and bearing in mind that proposals coming from individual parties or Governments are unlikely to command general consent, has the time not come for the Government to appoint a royal commission to consider how best health services in this country should be provided and funded? Such a way forward might provide the basis for a proper, agreed change.

I thank my noble friend for his question. We have a debate this week tabled by the noble Lord, Lord Patel, on reform of the health system. One thing the noble Lord believes, as do a number of other practitioners and noble Lords who have worked in the health service, is that it is time to reform the old model of seeing your GP, getting five or 10 minutes if you are lucky, and then being referred to secondary care elsewhere. In this day and age, we need such reform. We need to take advantage of data and new technology but also to look at work processes. Some of the stuff that was being done in secondary care until recently can now be done at primary care level. Even in primary care, it does not always have to be the doctor who sees the patient; it can be a practice nurse, a physiotherapist or a local civil society group.

Clearly, there is a need to look at the model of the NHS and how services are provided; all parties recognise that there are areas for reform. It would be great if we could get consensus but, sadly, this issue is too much of a political football. When I speak with my friends from other parties, we say candidly that something has to change and that there has to be reform, but it is clearly too tempting to bash any Government. I know that, when we were in opposition, we would have bashed the Government of the day on health. It is, sadly, too tempting a political football.

My Lords, I follow on from a point raised by the noble Baroness, Lady Merron. The Statement refers to the new contract with St John Ambulance—I join others in welcoming that—and to recruiting call handlers, paramedics and social carers. There is no reference to the acute crisis we have regarding doctors, nurses, midwives and associated health professionals.

To pick up on the question of whether we need a royal commission and systems change, the underlying situation is that the UK has 2.8 doctors per 1,000 people and 7.9 nurses, which is the second lowest in the OECD. Our number of hospital beds per head of population is on average lower than everywhere in the OECD but Denmark and Sweden. We simply have an acute lack of resources, which is independent of systems and is putting enormous pressure on services. We are now seeing huge pressure being put on medical professionals. Being a specialist in A&E is an acutely difficult and challenging task. The issues of ambulance response times and the queues of ambulances outside A&E are clearly putting huge pressure on people.

The Minister referred to the fact that, as we speak, we have a new Secretary of State. Surely it is time to acknowledge the contribution that those doctors, nurses and other medical professionals are making, through some kind of new, big gesture from the new Secretary of State to say, “We have to keep you. We really value you.” We are recruiting new people but others are walking out of the door as quickly or more so. This has to change. Surely a recognition of the care and service that has been given and continues to be given would help.

The noble Baroness makes a very important point which noble Lords across the House will agree. We should pay tribute to the hard work of medical staff in our system of care; there is no doubt about that. I take the point that this is about not just the ambulance service but other parts of the health service. In fact, had my right honourable friend the former Secretary of State stayed in post, he would have issued subsequent Statements on what we are doing about the GP workforce and some of the other issues that noble Lords have raised.

It is clear that one of the issues is retention. The NHS has its people plan, published in July 2020. We understand that people are leaving and, yes, there are newspaper headlines, but what are the issues behind those headlines? There is a very difficult issue around pensions and, particularly for some of the wealthier GPs, whether it is worth their while, having built up a massive pension over the years. There has been a bit of discussion and to and fro with the Treasury over that. However, it is quite clear at trust and workplace level that we have to make sure there are well-being courses and that we are looking after staff. We also have to look at the individual decisions as to why people may want to leave.

No doubt many staff are exhausted after the last couple of years. An amazing amount of pressure has been put on them and, as the noble Baroness says, it is right that we find ways to send a strong message that we value them and want to keep them as well as recruit new staff. We also have to look at this against the wider picture. We have more doctors and nurses than ever before. The question is: why, despite that, do we have this pressure? It is because the demand is outstripping supply.

We are now aware of far more health conditions than we were, say, five, 10 or 20 years ago. When preparing for a debate on neurological conditions the other day, I asked my officials to list them all. They said, “We can’t do that, Minister—there are 600.” Let us think about that. We were not even aware before of all those conditions. How many staff does that require? Or let us think about mental health: 30 or 40 years ago, it was not taken seriously; it was all about a stiff upper lip and pulling yourself together. Now we take it all seriously, and have mental health parity in the health Bill, which will need more staff. We will have more staff—more doctors and nurses—but the demand will outstrip supply. That is why a proper debate is needed across parties.

My Lords, I apologise for leaping rather prematurely to my feet before my noble friend the Minister just now.

It is often the case that you read things in the newspaper and either you doubt the veracity of the information or you feel it is apocryphal, and you have to wait until such time as something occurs to you personally before you understand how vital it is. Last week I visited my 97 year-old mother, and I was there when she suffered a fall as a result of which she broke her hip. I rang the emergency service at 5.30 pm on Wednesday afternoon and at 4.30 am on Thursday morning the ambulance arrived—so she had been disabled on the floor for 11 hours at that stage. I said to the ambulance people that I thought it was appropriate that I follow them to the hospital, but they said, “I wouldn’t do that if I were you. It’s an hour’s journey to the hospital and there’ll be a waiting time of two hours before she’s admitted because we’ve just come from a queue there”. So that took it up to 14 hours.

I have to say that the good cheer and good manners of the people on the 999 line when I was calling them every two hours was exemplary, as were the good humour and good treatment that my mother subsequently received at the hospital, but I had difficulty answering her rather acerbic comment at 3 am that she wondered why she had fought so vigorously in the last war if she was going to be left lying on the floor for that length of time before being taken to hospital. I myself really felt the comment about the darkest moment of the night coming before the dawn, being completely helpless and not knowing what to do with someone in considerable pain, with no one able to tell me whether or not to administer painkilling pills and whether or not to give her something to eat or drink. It made me realise how helpless other people feel in similar circumstances.

So I ask the Minister to do whatever he possibly can all the way down the chain to make sure that this sort of situation does not occur to too many people. We have had noble Lords in this debate talk about the length of hours that people are now waiting to be admitted to hospital, but it is perfectly clear, on the strength of my mother’s experience, that in many cases those hours are extended. It really is a third-world situation in which we find ourselves, so anything that the Minister can do to help with that, I, she and the public in general would be extremely grateful for.

I start by thanking my noble friend for sharing that very personal experience with us. One of the reasons why my right honourable friend the former Secretary of State wanted to issue this Statement was that when he came in he saw that they were sadly far too many such stories—my noble friend will not be the only one with such a story; undoubtedly, there will be other noble Lords with similar stories—and it was important for him to say, “Look, this has gone on long enough. Let’s get all the people together in the room”. That is why he made this a priority. He wanted to put the numbers on the wall but was told he should not do so for various reasons—but at the same time he wanted to make sure that he spoke to the leadership of trusts as well as NHS England to make sure that they were really focused on this.

Some of the measures announced in the Statement will take time to filter through while others, hopefully, will be immediate, such as the St John Ambulance. All I can say is that I will continue to push and, if I stay in post, I will encourage my right honourable friend the current Secretary of State to continue the work that their predecessor put in place to really make sure that we get a grasp of this issue and try to pull as many levers as we can to tackle it.

My Lords, I declare my interest as a non-executive director of Chesterfield Royal Hospital NHS Foundation Trust and as a vice-president of the Local Government Association.

It is not hubris when I say that the Minister needs to understand that this is a crisis and the health service is at the point of breaking, when you see what is happening to patients and to staff trying to deal with the total number of procedures and patients coming into the health service. An absolutely breathtaking statistic from analysis shows that in July only 40% of patients who were ready for discharge were discharged on the day that they were medically fit. That meant that 60% of beds were blocked in England by people who could not get social care or go home.

It is anticipated that at a bare minimum £7 billion per year is required to deal with the social care issue. The Government have a vision but no road map, no timetable, no milestones and no measures of success for social care. What is happening with social care? It is one of the key issues that are leading to ambulances being held at A&E and potential deaths before people can get into hospital for the medical care that they need.

I assure the noble Lord that we are aware of the situation; it is one of the reasons why this Statement was made in the first place. We know there are problems with delayed hospital discharges. That is why we have the national hospital discharge task force, which has been set the 100-day discharge challenge, focused on improving the processes but also on digging deep—not just the Secretary of State issuing an edict from afar and saying “Get on with it” but following up with NHS leadership to make sure that we are looking at this issue.

We are selecting these national discharge frontrunners from among ICSs and places to look at new ideas but also to see what has worked in a particular place. A number of noble Lords often give me an example of a hospital that they believe is doing very well. When we take it back to the NHS and say, “Can we replicate this elsewhere?”, they talk about the specific circumstances of that local area and the way that system is set up and why it could work. The ICBs and the integrated care partnerships have committees to look at this, and they know it has to be done as quickly as possible. So first there is the 100-day challenge between DHSC, the NHS and the local government discharge task force.

Adult care capacity is a problem that has been brewing for a long time. One of the things that we have been trying to do with social care, particularly through the integration White Paper but also with the Health and Care Bill, is finally to put it on an equal footing with health so that it is no longer the poor Cinderella service, and indeed to professionalise it. One of the reasons why we have the voluntary register is to make sure that we understand what is out there, who is out there, who is working and what qualifications they have so that we can build a proper career structure for people in social care to make sure that it is an attractive vocation for life and not just something that they do rather than working in Asda or elsewhere, and also that they have parity with the health service.

We are also looking in the medium to long term at some of the discharge frontrunners and at streamlining the intermediate care service, which could reduce delays by about 2,500 by winter 2023-24. Some of this stuff is to tackle the crisis now but some of it is long term to make sure that if we resolve it and get the numbers down we still do not forget about it, and that we build resilience into the system.

My Lords, I phoned 999 two weeks ago after my wife had a nasty fall at home. The good news for the Minister is that the ambulance and paramedics turned up within half an hour, they were extraordinarily good and she was admitted to a major hospital—it was St George’s Hospital; I may as well name it. Unfortunately, it was just before the bank holiday. She had problems with her spine and she waited five days in a brace before they could do an MRI because, apart from the most acute emergencies, MRI scanning had closed down. In 2014, the Government were attacked for failing to provide proper services over bank holidays. They said they would look at it and change it, but here we are eight years later, and it is no different. Had it been done quickly, she could have been out, the bed would have been freed and the waiting list would have been shortened. I actually offered to pay for an MRI to be done if they would do it quickly to relieve her of the pain and torture she was going through, but they said, “Sorry, we can’t do that.” This is the problem we have with the NHS.

The real elephant in the room is that much, much more money has to go in. Those who can pay more must pay more and be willing to pay more. That will shorten the lists and produce more money to make conditions for staff even better so that they work in a different way. It would reduce the lists for everybody, but we are not radical enough and not prepared to do it. With the change that has taken place, nothing fundamental is going to happen in the next two years and this problem is, regrettably, going to continue. My question is: can the Minister please do something to make sure we use the equipment available to the maximum, which is not happening at present?

I thank the noble Lord for sharing that personal story—the good and bad side of it. I was on a visit to a hospital a few months ago where they showed us a nice, new scanner, which they were very proud of. The question was: how much is that used? Does it sit empty at weekends? With more networks and being more connected, we can find out where there is capacity in the system. If there is equipment, why are there not staff available? It could be for staff absence reasons. If it is not there, where can people go? With more community diagnostic centres, you will find lots more diagnosis facilities and scanners, so if the acute place does not have it, there should be availability in the community.

On the wider question about being “radical”, the noble Lord will know that, while we may have candid conversations as friends from different parties, sadly, health is too tempting to use as a political football. There are some issues that people feel very strongly about. Some of the points about charging that the noble Lord mentioned would be seen as too radical by some, or as undermining the very ethos of the NHS. I think we have to be prepared to be radical and think the unthinkable, but, sadly, this is the formal, political debate that we have got, and we have to work within the remit of that debate. Why should it be, for example, that millionaires could not pay a little bit more to help—not through taxation, but maybe direct?

Some local trusts have tackled this issue. For example, my local trust has set up a private arm, but the money paid for private diagnosis or surgery is reinvested into the hospital to help NHS patients. I know that more than one trust has done that. That might be an interesting way of raising more money and making sure that people value the service and care they get.

On the specific issues, one of the reasons we are having this discussion is because the former Secretary of State was looking at all the issues that need to be tackled now, both in the short term and the long term.

My Lords, the noble Baroness, Lady Brinton, referred to overseas recruitment of doctors and nurses. The Statement refers to the “international recruitment task force” for social care. I am not sure if the Minister is aware of the report prepared by the Rights Lab at the University of Nottingham, The Vulnerability of Paid Migrant Live-in Care Workers in London to Modern Slavery. If not, I ask him to assure me that the department will be looking at this. The report highlights real issues about the treatment of migrant care workers, particularly in live-in situations. It is a cross-departmental issue, looking also at immigration issues like being tied to one employer where migration status is a real problem. It also looks at the need for a registration system for recruitment agencies. Can the Minister assure me that the department will look at that?

I thank the noble Baroness for the question. I am not aware of that report. If the noble Baroness would be happy to send a copy to my parliamentary email, I will happily forward it to officials in my department and see if we can get an answer to that.

House adjourned at 8.03 pm.