Monday 7 January 2019
Health and Social Care
This Government recognise that winter, with demand placed on services with colder weather and seasonal flu, is a challenging time for the NHS as it is for health services around the world. DHSC Ministers meet weekly with our systems leaders in the NHS to ensure that our services are equipped for winter to support those who need them.
We have been busier than ever, but our NHS has been rising to the challenge over the festive period.
The latest data to November shows that compared to last year, we have seen 3.6% more attendances per day at A&E, and that over 1,600 more patients per day were seen within four hours so far this year. Despite that, the published NHS winter operational updates show that in December there have been fewer ambulance handover delays and diverts to other A&Es compared to last year. This means ambulances spend less time at hospitals and more time on the roads reaching patients.
Ahead of winter
We started the run up to the winter period with over 2,200 more doctors and 1,600 more nurses on our wards than just a year ago, bringing the total increase since 2010 to 16,500 more doctors and 13,400 more ward nurses
We also increased NHS funding by £1.6 billion at the start of this year, to support and improve A&E and elective care performance.
On top of this, in advance of winter, more than £420 million has been provided to help the NHS this winter:
£240 million for adult social care—allowing councils to plan to provide care for 40,000 more people.
£145 million capital funding to hospitals for winter improvements—to upgrade wards and redevelop A&Es—the benefits of which the NHS expects will bring the equivalent of an additional 900 beds.
£36.3 million has been invested into the ambulance services for new vehicles and ‘make-ready hubs’. This will pay for more than 250 new ambulances, with 100 delivered by Christmas Eve.
The NHS has continued to work to improve services in advance of winter, to help people avoid a hospital visit or admission, and get them home quickly if they do have to stay. This has included:
Increased access to GP appointments at the evening and weekends. The latest figures (August 2018) show that full extended access was available for 40 million people, which is an increase of over 4 million from March 2018.
Fully embedded clinical streaming in A&Es following our investment ahead of last winter of £100 million, which means patients are directed to the most appropriate service.
Improved NHS 111. Half of calls to NHS111 now receive clinical input and ahead of this winter we have rolled out 111 online across the country so that the public can access care advice and services through digital channels and reduce additional pressures on A&E. 91% of the population have access to NHS Digital’s 111 online service.
Work to standardise services provided by urgent treatment centres and increasing public awareness of this as an alternative to A&E for minor illness and minor injury.
Increased implementation of ‘hear and treat’ and ‘see and treat’ by ambulances—reducing unnecessary conveyance to hospitals.
Joint working between hospitals, councils and other local partners to reduce long lengths of stays in hospital and helping improve transfers to community and social care. The published NHS winter operational updates show that the number of beds occupied by patients staying more than 21 days in hospital on average per day is down by more than 2,000 (12.5%) this winter so far, when compared to the equivalent period last year.
Extending the flu vaccination programme—already the most comprehensive in Europe—even further. Vaccination remains the best line of defence against flu and this year, we have more effective vaccines available than ever before.
This winter we have also encouraged all healthcare workers to be vaccinated, are funding the vaccination again for frontline social care workers, and have extended the offer to staff giving direct care in the voluntary managed hospice sector. Free vaccine eligibility has also been extended to include children up to nine years old (Year 5) so that all two to nine year olds are now offered the vaccine.
Performance over the next few weeks
The NHS continues to make some progress in rising to the seasonal challenges, but we also know that there is no room for complacency at this early stage of winter.
There are clearly a number of hospital trusts where the situation has been challenging. The most recent statistics showed that 75% of all 12-hour trolley waits occurred in just 10 trusts.
In addition, NHS England and NHS Improvement continue to monitor NHS performance daily. They are supporting hospitals nationally and, working with regional teams, will maintain a close grip and oversight during winter of their performance.
The Care Quality Commission will be continuing to monitor hospital services over the winter months with over 30 visits to hospital emergency departments planned. The CQC is able to undertake further visits in response to any emerging risks identified.
And we will go further to support this through our long-term plan to guarantee the future of the health service—backed by an extra £20.5 billion a year in real terms by 2023-24.
The Government have entered into three contracts with ferry operators to provide additional ferry capacity and services into the UK as part of no-deal EU exit contingency planning.
While the ambition of Government is to ensure an orderly exit from the EU, the Department for Transport has been undertaking a wide range of work to mitigate the impact on the transport system of a no-deal EU exit.
Significant work has taken place to understand the effect that this would have on the UK border and the impact on flows of goods between the UK and EU. While the Government have made clear they are committed to ensuring frictionless movement across the UK border, the scale of the potential disruption to the Dover Straits, if additional customs checks were introduced in Calais, Coquelles and Dunkirk, where freight services disembark, could be very significant. Given the importance of these routes, contingency work is being undertaken to mitigate potential impacts and ensure that goods can continue to flow into and out of the UK as freely as possible.
A priority for Government is to ensure that the Port of Dover and the Eurotunnel can continue to operate at the maximum possible capacity. The Government are therefore working with both organisations and our French counterparts in Calais, Coquelles and Dunkirk so that any disruption or drop in throughput is managed effectively and mitigated.
There is a clear willingness to reach agreements which secure the continued operation of these vital trade routes in all scenarios and the Government remain confident that there will not be major disruption to the flow of goods across the border. Nevertheless, the potential for a decline in throughput remains possible in a worst-case scenario and the Government are therefore planning for all eventualities.
As one of several contingency measures being undertaken, the Department for Transport has completed a procurement process to secure additional ferry capacity between the UK and the EU which can be used for critical goods such as medical supplies in the event of disruption to cross-Channel crossings. A negotiated procurement procedure without prior publication was concluded as allowed for by regulation 32 of The Public Contracts Regulations 2015. An accelerated competitive process was carried out in order to ensure that capacity can be in place in time for a no-deal exit while at the same time securing value for money for the taxpayer. The Department approached a number of shipping providers capable of providing additional freight capacity in order to ensure fairness for the market and also engaged external expertise to ensure value for money for the taxpayer.
Bids were evaluated on the basis that they met our strategic aims of providing additional freight capacity for a no-deal Brexit scenario. Bids were reviewed against a number of criteria, including journey time, quality of delivery plans, and the pricing submitted by bidders.
The bids we received to provide capacity were subject to technical, financial and commercial assurance as part of standard due diligence procedures and consistent with that undertaken on all Government contracts. This included a price benchmarking exercise to ensure that the taxpayer was getting good value for money, and assurance on the delivery plans of our bidders.
The Department commissioned external advice from three respected professional advisers to support this work. Three contracts were agreed with operators totalling c.£103 million.
Two contracts went to established operators, Brittany Ferries (£46.6 million) and DFDS (c.£42.6 million). These contracts provide for additional capacity between the UK and EU on existing routes, via the provision of additional services and additional vessels. The contracts agreed with them include early termination provisions and other typical contractual provisions to ensure Government have the right protections in place, such as in the event of an operator becoming insolvent.
The routes agreed with Brittany and DFDS are away from the Dover Straits, and will run from the Ports of Immingham and Felixstowe (DFDS) and Poole, Plymouth and Portsmouth (Brittany) to destinations in Germany (Cuxhaven), the Netherlands (Vlaardingen) and France (Caen, Cherbourg, Le Havre, and Roscoff).
The third contract was awarded to Seaborne Freight (£13.8 million), a new operator to provide a new service between Ramsgate and Ostend. Seaborne Freight has been preparing for some time to operate services on this route. The management team of Seaborne has extensive experience in the shipping and maritime sector, including the operation of ferry services on cross-channel routes, freight brokerage, port management and vessel chartering.
While the broad contract structure is the same for all three contracts, including the provision that payment will only be made in arrears and on the successful provision of services, the Seaborne contract is also subject to the achievement of a range of key milestones including in relation to finalising funding and vessel chartering agreements.
As with many operators in the sector, it is not uncommon that they do not own their own vessels and will be chartering them through third parties. The Department has reviewed their plans for sourcing vessels with the support of external advisers. A number of large institutional investors are backing this service and the Government’s contract represents a small part of the overall investment required by Seaborne to open this route. These lenders undertake their own rigorous due diligence before making financial commitments, providing a further level of assurance to Government. Seaborne and my Department are also working closely with Thanet Council to ensure that Ramsgate Port is ready to take new services. A programme of work to prepare the infrastructure is under way.
In total the additional freight capacity delivered by these three contracts will be equivalent to around 8% of normal flows across the Dover Straits. While this will not be sufficient to mitigate the full level of disruption possible in a worst-case scenario, it will enable the Government to provide essential capacity for the highest priority goods including medical supplies.
In terms of next steps, the Department for Transport will provide support to and oversight of all operators to ensure that these services are delivered to meet the terms of the contracts agreed.
I will provide further updates to Parliament at the appropriate points.