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Elective Treatment

Volume 708: debated on Tuesday 8 February 2022

With permission, Mr Speaker, I would like to make a statement on a new, ambitious elective recovery plan—the NHS’s delivery plan for tackling the covid-19 backlog of elective care.

The NHS has responded with distinction during the country’s fight against the virus, caring for over 700,000 people with covid-19 in hospital in the UK and delivering a vaccination programme that is helping this country to learn to live with the virus, while at the same time doing so much to keep non-covid care going. Nobody—no institution—felt the burden of the pandemic more than the NHS. There have been 17 million cases of covid-19 and the NHS has had to respond to the original variant, the alpha wave, the delta wave and, most recently, of course, the omicron wave. Despite these pressures, we had one of the fastest vaccination programmes in the world, including one of the fastest booster programmes in the world.

Sadly, as a result of focusing on urgent care, the NHS could not deal with non-urgent care as much as anyone would have liked. The British people have of course understood this. Despite those exceptional efforts, there is now a considerable covid backlog of elective care. About 1,600 people waited longer than a year for care before the pandemic. The latest data shows that this figure is now over 300,000. On top of this, the number of people waiting for elective care in England now stands at 6 million, up from 4.4 million before the pandemic. Sadly, that number will continue rising before it falls.

A lot of people understandably stayed away from the NHS during the heights of the pandemic, and the most up-to-date estimate from the NHS is that that number is around 10 million. But I want these people to know that the NHS is open and, as Health Secretary, I want them to come forward for the care they need. We do not know how many will now come forward—we do not know whether it will be 30% or 80%—because no country has faced a situation like this ever before. So in developing this plan, the NHS has had to make a number of assumptions. Even if half of these people come forward, this is going to place huge demand on the NHS, and we are pulling out all the stops so that the NHS is there for them when they do. We have already announced that we are backing the NHS with an extra £2 billion of funding for elective recovery this year and £8 billion on top of that over the next three years. In addition, we are putting almost an additional £6 billion towards capital investment for new beds, equipment and technology.

Today we are announcing the next steps, showing how we will help this country’s health and care system to recover from the disruption of the pandemic but also how we will make reforms that are so important for the long-term future. That will allow the NHS to perform at least 9 million extra tests, checks and procedures by 2025 and around 30% more elective activity each year in three years’ time than it was doing before the pandemic. This bold and radical vision has been developed with expert input from clinical leaders and patient groups. It will not just reset the NHS to where it was before covid but build on what we have learned over the past two years to transform elective services and make sure that they are fit for the future.

This plan focuses on four key areas. The first is how we will increase capacity. On top of enormous levels of investment, we are doing everything in our power to make sure that we have even more clinicians on the frontline. We now have more doctors and nurses working in the NHS than ever before. We have a record number of students at medical school and a record number of students applying to train as nurses. The plan sets out what more we will be doing, including more healthcare support workers and the recruitment and deployment of NHS reservists. We will also be making greater use of the independent sector, which formed an important part of our contingency plans for covid-19, so that we can help patients to access the services they need at this time of high demand.

Secondly, as we look at the backlog, we will not just strive to get numbers down but prioritise by clinical need and reduce the very longest waiting lists. Assuming that half the missing demand from the pandemic returns over the next three years, the NHS expects the waiting list to be reducing by March 2024. Addressing long waits is critical to the recovery of elective care, and we will be actively offering longer-waiting patients greater choice about their care to help to bring down these numbers.

The plan sets the ambition of eliminating waits of longer than a year for elective care by March 2025. Within this, no one will wait longer than two years by July 2022, and the NHS aims to eliminate waits of over 18 months by April 2023 and of over 65 weeks by March 2024, which equates to 99% of patients waiting less than a year.

I have heard the concerns that have rightly been raised, including by many hon. Members, about the pandemic’s impact on cancer care. On Friday, World Cancer Day, I launched a call for evidence that will drive a new 10-year cancer plan for England, a vision for how we can lead the world in cancer care. This elective recovery plan, too, places a big focus on restoring cancer services.

The NHS has done sterling work to prioritise cancer treatment throughout the pandemic, and we have consistently seen record levels of referrals since March 2021, but waiting times have gone up and fewer people came forward with cancer symptoms during the pandemic. The plan shows how we will intensify our campaigns to encourage more people to come forward, focusing on areas where referrals have been slowest to recover such as lung cancer and prostate cancer. It also sets out some stretching ambitions for how we will recover and improve performance in cancer care: returning the number of people waiting more than 62 days following an urgent referral to pre-pandemic levels by March 2023; and ensuring that 75% of patients who have been urgently referred by their GP for suspected cancer are diagnosed or have cancer ruled out within 28 days by March 2024.

I am determined that we tackle the disparities that exist in this backlog, just as I am determined to tackle disparities of any kind across this country. Analysis from the King’s Fund shows that, on average, a person is almost twice as likely to experience a wait of over a year if they live in a deprived area. As part of our recovery work, we are tasking the NHS with analysing its waiting list data according to factors such as age, deprivation and ethnicity to help to drive detailed plans to tackle these disparities.

Thirdly, this new chapter for the NHS provides an opportunity to radically rethink and redesign how services are delivered, to bust the backlog and to deliver more flexible, personalised care for patients. The pandemic has shown beyond doubt the importance of diagnostics. Although over 96% of people needing a diagnostic test received it within six weeks prior to the pandemic, the latest data shows that has fallen to 75%. Our aim is to get back to 95% by March 2025.

A major part of this will be expanding the use of community diagnostic centres, which have already had a huge impact. These one-stop shops for checks, scans and tests help people to get a quicker diagnosis and, therefore, the treatment they need much earlier. Sixty-nine community diagnostic centres are already up and running, and the plan shows our intention to have at least 100 in local communities and on high streets over the next three years.

We will also keep expanding the use of surgical hubs, which will be dedicated to planned, elective surgeries. They will allow us to do more surgeries in a single day than can be carried out in out-patient settings, so that we can fast-track operations and ensure that patients are more likely to go home on the same day. We have already been piloting these hubs, and we will now be rolling them out across the country.

Finally, we will improve the information and support for patients. I know the anxiety that patients feel when they are waiting for care, especially if they feel that they do not have certainty about where they sit in the queue, and I am determined to ensure that, as we enter this next phase, we will be open and transparent with patients. We will be launching a new online platform called My Planned Care, which will go live this month, offering patients and their carers tailored information ahead of their planned surgery. They will be able to see waiting times for their provider, so they can better understand their expected wait. A third of on-the-day cancellations are due to people not being clinically ready for treatment, and the new platform will also be able to link patients to the most appropriate personalised support before their surgery. This shows the approach that we will be taking in the years ahead, putting patients at the heart of their care and giving the support that they need to make informed decisions. We will also put in place a payment system that incentivises strong performance and delivers value for money for the public.

Just as we came together to fight this virus, now we must come together on a new national mission to fight what the virus has brought with it. That will mean waiting lists falling by March 2024, strong action to reduce long waiting times, and stretching targets for early diagnosis and for cancer care. This vital document shows how we will not just recover, but reform and make sure that the NHS is there for all of us, no matter what lies ahead. I commend my statement to the House.

I thank the Secretary of State for advance sight of his statement, but it falls seriously short of the scale of the challenge facing the NHS and the misery that is affecting millions of people stuck on record high NHS waiting lists. We have been waiting some time for his plan to tackle NHS waiting times. We were told that it would arrive before Christmas; we were told that it would arrive yesterday; and it is not clear from his statement today that the delay was worth the wait. There is no plan to tackle the workforce crisis, no plan to deal with delayed discharges, and no hope of eliminating waits of more than a year before the general election in 2024. I wonder whether the Conservatives will be putting that on their election leaflets. The only big new idea seems to be a website that tells people that they are waiting for a long time, as if they did not already know.

Perhaps the Secretary of State can tell us whether the plan itself contains two other measures that have been floated in the press: the cancellation of patients’ follow-up appointments, whether they need them or not, and an offer enabling people to seize the opportunity to travel hundreds of miles around the country, if they can find a hospital in England that does not already have a waiting list crisis of its own. What we did hear was a series of reannouncements, including some perfectly sensible proposals for community diagnostic and surgical hubs. We welcome those, but the Secretary of State cannot pretend that they meet the scale of the challenge.

The Secretary of State reaffirmed the Prime Minister’s commitments on cancer, announced only yesterday. He announced a new target that no one should wait more than two months for cancer diagnosis, but there is already a target for the vast majority of cancer patients to be treated within two months of referral. Can he tell us which target he is aiming to meet? Is it the target that has not been hit since 2015, or the target announced yesterday, which seems to lower standards for patients because the Government consistently fail to meet them? The Prime Minister has also announced that three out of four patients should receive a cancer diagnosis within 28 days, but that is an existing target which was introduced in April and has never been met, and nothing that the Secretary of State has announced today gives me any confidence that it will be met in the future. Given that half a million patients with suspected cancer are not being seen in time, it seems that the Secretary of State declared a war on cancer after more than a decade of disarming the NHS, and is now sending the NHS into battle empty-handed.

Indeed, it is hard to believe that this is the announcement that the Secretary of State wanted to make. One Government official briefed Robert Peston that the plan was being blocked by the Chancellor, who is, “reluctant to rescue the Prime Minister”. Putting to one side the appalling spectacle of the Tory leadership crisis impacting on life and death decision making in Government, it seems from the statement that the Chancellor has won the day. What other explanation can there be for a plan to recover the NHS and bring down waiting lists that does not contain a workforce plan? The single biggest challenge facing the NHS is the workforce challenge. There are 93,000 staffing vacancies in the NHS today. The NHS is understaffed, overworked and, if the Secretary of State is not careful, he will lose more people than he is able to recruit. This is not a new development, and it should not be news to him.

In April, the NHS called for a national workforce plan. Polling from the Health Foundation found that the public want more staff with fewer workload pressures. The Secretary of State himself told the Health and Social Care Committee in November that his plan would include a strategy for the workforce crisis. We know the NHS wants a workforce plan and the public want a workforce plan. He promised a workforce plan, so where is it? There is not even a budget for Health Education England let alone a serious plan to recruit and retain the workforce that we need. Instead, he is proposing new NHS reservists. Who are they? Where are they coming from? How many does he imagine there will be? How does he imagine that they will make a dent in the 93,000 vacancies? It seems more “Dad’s Army” than SAS.

Then there is the issue of wider NHS and social care pressures that impact directly on waiting lists and waiting times: the pressures on GP practices that see people ringing the surgery at the crack of dawn in the hope of getting through before the appointments have gone; the pressures on social care that lead to delayed discharges from hospital, as we saw in more than 400,000 cases in November alone; and the missed opportunities and the wasted money that comes from a failure to invest in community services that lead to people turning up at A&E at greater cost to patient health and at greater cost to the taxpayer.

This plan falls well short of the challenge facing our country. Six million people are waiting for care. Cancer care is in crisis, with half a million patients with suspected cancer not seen in time. Heart and stroke victims are waiting more than two hours for an ambulance when every minute matters. It is clear from what the Secretary of State said today, from what his colleague, the Minister for Health, the hon. Member for Charnwood (Edward Argar), said yesterday, and no doubt what will be heard repeated in the Tory scripts in the days and weeks to come, that the Conservatives are hoping to blame the state of NHS waiting lists on the pandemic—the “covid waiting lists”, they called them. But this is not a covid backlog; it is a Tory backlog. After a decade of Tory mismanagement, the NHS had: record waiting lists of 4.5 million before the pandemic; staff shortages of 100,000 before the pandemic; 17,000 fewer beds before the pandemic; and 112,000 vacancies in social care before the pandemic.

In conclusion, it is not just that the Government did not fix the roof while the sun was shining, they dismantled the roof and removed the floorboards. With the ceiling of their ambition that the Secretary of State outlined today being to go back to where we were before the pandemic, it is now clear that the longer that we give the Conservatives in office, the longer patients will wait.

I am surprised with the argument and the tone of the hon. Gentleman. It is 2022, not 2024. We have all come to expect the scaremongering that we have just heard from the Labour Benches at election time—that has happened in every election campaign since the war—but what I did not expect is this scaremongering from the hon. Gentleman on the plans to recover in the wake of a deadly pandemic.

I am astonished and disappointed that the hon. Gentleman is willing to stand there and claim that there is no covid backlog. [Interruption.] That is what he just said. He just said that there is no covid backlog. He is well aware that this country has just gone through its biggest health challenge in history. He is also well aware that there has been a national mission across the NHS to deal with that challenge and to recover from it. I paid tribute to the hon. Gentleman just last week in this House—perhaps I was just a bit too early—when he rightly supported the nation’s vaccination programme, because he understood just how important it was. Perhaps some of his Back Benchers have now got to him, so instead of standing up for the British people, he is just thinking about his own leadership prospects in his party—perhaps that is what is actually going on.

Today, instead of doing the right thing and backing the NHS—backing the hundreds of thousands of doctors, nurses and everyone working heroically across the NHS—the hon. Gentleman decided to play party politics. A moment ago, he heard me talk about the 10 million people who the NHS estimates have stayed away from the NHS and who need reassurance from both sides of the House about what the NHS is doing. He should reconsider his approach and work together in the national interest.

I welcome the statement and I am grateful to the Secretary of State for setting out a covid recovery plan to tackle the challenges that lie ahead. Every single Member of the House should support him in that endeavour. I ask him, however, how he will tackle the staffing crisis.

I thank my hon. Friend for her support. Over the past two years, the number of clinicians in the NHS has risen by about 40,000. In the past year, we have 10,000 more nurses, 5,000 more doctors and more people in medical school than ever before, so a huge amount of record investment is going into the workforce. Recently, I also asked the NHS to put together a long-term 10-year-plus workforce strategy and I look forward to receiving it.

The elective care backlog is not the only crisis facing the NHS. Covid has affected the care being delivered by mental health services, primary care, emergency care, community care and social care. In the Health and Social Care Committee’s recent report on tackling the NHS backlog, we recommended that a broader national health and care recovery plan be published to set out a clear vision for how patient care will be improved. Will the Secretary of State confirm that that will be published before April, as the Committee recommended?

I thank the hon. Lady for her work on the Committee. She is right to raise the importance of mental health. Although today’s plan is focused on elective surgical procedures and diagnostics, she is right to talk about other types of care, especially mental health care. I know that she supports the huge amount of record investment going into the NHS for mental health care. Under the NHS long-term plan, it is an additional £2 billion a year. She is also right to raise the importance of patient care. I believe that there is a lot in this plan on patient care that she will support.

I welcome the statement and the national mission. I must say that for the Labour party to try to play party politics with it is a serious misjudgment. Surgical hubs have been successfully piloted in London by the Getting It Right First Time programme. As they are rolled out across the country, will the Secretary of State ensure that GIRFT continues to be properly resourced and is given a key role in leading the programme in future?

Absolutely; I agree wholeheartedly with my hon. Friend. There are already 44 surgical hubs up and running across the country, including in London. I went to see one at Moorfields, which is getting through cataract operations more quickly and seeing more people per day than ever before. He is right to talk about their importance and the funding is there in the plan to see many more of them across the nation.

The key issue seems to be the workforce. It is about trying to ensure that people do not leave the workforce now or do not leave it early. It is also about recruiting enough people, sometimes into specialties that are not necessarily the sexiest ones that people are pushed into at the beginning. For instance, there is no chance of getting diagnoses within the target set in 2018, which we now hope to meet in 2024, unless we train more pathologists every single year. This year, we will not train enough pathologists to meet the number who are leaving this year, so we are going backwards rather than forwards. How will the Secretary of State address that?

I agree with the hon. Gentleman about the importance of the workforce, especially in the context of specialisms, and pathology is a really good example. That is why we are putting record amounts of investment into the workforce and training. It is also one of the reasons why, to get a more joined-up plan in health, I have decided that Health Education England should be merged with the NHS. This will enable more joined-up thinking and much better planning for the future, especially in specialist areas.

I declare my interest as a doctor. Will the Secretary of State look again at how we structure doctors’ pay and remuneration? At the moment, we are training lots of doctors—more and more of them—which is a great thing, but typically they leave in their late 50s, so we are losing a whole decade of productive medical time. That cannot go on. Will he look again to see how we can disincentivise early retirement of medical professionals?

My hon. Friend speaks with great experience and raises a really important issue. The short answer is yes. We have fantastic doctors throughout the NHS and more in training in medical schools than ever before, but we should also focus on retaining talent throughout the NHS. I assure him that that work has already begun.

I am shocked that some Government Members are trying to pat each other on the back, because right now my heart is breaking for all those constituents who have emailed me to tell me that they are in fear and in pain, and what they have just heard is that that may continue for years to come. The Secretary of States talks about new tech, new hubs and new scanners, but without people to operate them they may be of limited use. Where is the plan to fill the almost 100,000 NHS vacancies?

The hon. Lady, like other hon. Members, is absolutely right to raise the importance of workforce. To deliver on this plan, of course we need to do so much more to keep increasing the workforce and make sure all the skills we need are there. Just last week, I believe, the NHS published that it has more doctors, nurses and clinicians than ever before; 40,000 people have joined the NHS over the last two years, including many more doctors and nurses. Also, as I mentioned, I have asked the NHS, with HEE, which will become part of the NHS, to come up with a long-term plan. We look forward to that plan and will invest in it.

People of a certain age, of whom, unfortunately, I am one, are terrified because they think that if something goes wrong, they might have to wait in pain for two years. We cannot wait until March 2024 to join the back of a slightly shorter queue. Then we see our friends who have private health insurance—I am not one of them; we cannot afford it—being seen within days. May I suggest a policy that would be wildly popular with many of our own supporters, which every Conservative Government until 1997 followed, which is to give tax relief to private health insurance? Why not look at every innovative solution that unleashes new money? Before the Secretary of State says that that is a matter for the Chancellor, will he at least put it at the back of his mind, so that when he next talks to the Chancellor they will at least discuss it?

I am always pleased to talk with my right hon. Friend about his ideas and suggestions, and I am happy to meet him to discuss this further, but I am sure he agrees with me on the importance of making sure that we invest in the NHS and the workforce so that they can deal with as many people as possible.

Across the country, millions of people are waiting for potentially life-changing procedures, and it is absolutely right that every effort be made to bring this backlog down, but the Secretary of State should be aware of just how big an ask he is making of frontline staff. This will be a herculean effort, especially for all those who have spent the last two years on the frontline of the fight against covid-19. When he considers the enormous sacrifices that NHS workers have made over the course of this pandemic and everything that they will be asked to do in the very difficult months ahead, will the Secretary of State concede that last year's 3% pay rise was pitiful and commit to giving our healthcare heroes the substantial pay rise they truly deserve?

I agree with the hon. Gentleman that all those working in health, and social care for that matter, have been the heroes of this pandemic. Everything that they have delivered and gone through over the last two years is something that the whole nation will respect. He is right to also point out that the expectation over the next few years for delivering on the plan is very high, and the workforce of course deserve maximum support. When it comes to pay, it is right that the Government listen to the independent pay review bodies, which will take into account a number of factors, and that is exactly what we did last year.

I am grateful to the Secretary of State for coming to the House and making this announcement here first. Does he agree that, as other Members have said, particularly Opposition Members, we need to increase the workforce? How then can the mandatory vaccination of NHS health workers, which was going to lose us 80,000 people, possibly have been right? We knew the covid backlog was there, so how on earth was that ever a good policy? I know that Opposition Members supported it hugely, but Conservative Members had their doubts. Was it not a wrong decision?

I agree with my hon. Friend about the importance of the workforce, but I am afraid I do not agree with his comments about the plans for mandatory vaccination. I will not go through the details again; I did make a statement to the House on that last week, and in fact it was supported by the vast majority of Members of this House. The short answer to his question is that it is all about patient safety. The Government and the NHS are always absolutely right to put patient safety first, and although the Government have now, in the light of omicron, rightly changed their plans, it is still the professional responsibility of everyone working in healthcare to get vaccinated.

I am grateful for what the Secretary of State said about diagnostic hubs. Will he investigate personally why the planned hub for Westmorland general hospital has been delayed until 2023? I am also grateful for what he said about cancer services more generally. He knows that there have been 60,000 missed cancer diagnoses over the last two years, and I am sure he knows that radiotherapy is a key factor in tackling the backlog. Is he aware that radiotherapy ought to be accessed by 53% of cancer patients in this country but is accessed by only 23%, and that, as a proportion of our cancer budget, funding for radiotherapy in this country is only a little more than half the average for similar developed countries? Will he therefore make it a priority to meet with the all-party parliamentary group for radiotherapy and look at our manifesto, so that we can work together to save tens of thousands of lives that would be needlessly lost otherwise?

The hon. Gentleman raises a series of very important points, especially in what he said about cancer and radiotherapy. I believe he already has a meeting in the diary with Health Ministers, and I will look out for the output of that meeting. I agree with what he said about radiotherapy and the importance of investment in that, and there is a lot more investment. I referred earlier to the £6 billion extra capital budget, and a large part of that will be used for new diagnostics. I hope he also agrees with me that, as well as radiotherapy, we need to invest in the very latest cutting-edge technology for cancer care, such as proton beam therapy, which I saw for myself last week in London.

The Secretary of State will know that many on this side of the House were very reluctant, but did support the increase in resources for the NHS through the increase to national insurance and then the health and social care levy. When we are making that argument to our constituents, they will expect that money to deliver results, so may I make one observation and ask one question? The observation is that, while the plan is welcome, only getting to 99% of patients waiting less than a year by March 2024 is not ambitious enough, so will he perhaps be more ambitious? Will he also say a word about how the resources raised through national insurance will be removed from the NHS and flow into social care? From October 2023, we will have to fund social care with the same money. He did not talk about that, and social care is as important as the NHS, so will he say a word about that?

My right hon. Friend is absolutely right about the importance of making sure that every penny spent in the NHS, or social care for that matter, is spent wisely and in the very best interests of taxpayers. I absolutely agree with him on that, and that also has to translate into the ambition. My right hon. Friend, like other hon. Members, will not have had time yet to look at the plan. I am happy to discuss it with him afterwards if he wishes. I hope he agrees that it is full of ambition. Indeed, if the NHS can go much further than the targets I set out earlier, that is what we all want. As I said in my statement, it does depend on how many people come back to the NHS, and that is very hard to estimate, but I want as many people as possible to come back.

My right hon. Friend is right to raise the importance of social care and the need for much better integration between healthcare and social care. We will set out more detailed plans on just that very shortly.

As a clinician, I am astounded by what the Secretary of State has brought forward today. First, he talks about health inequality, then puts forward a solution that will exclude people who experience the greatest health inequality because they also experience digital inequality. Not only that, but people on waiting lists are in a lot of pain. They are put on waiting lists because of the advancement of their condition. They do not need a website; they need clinicians surrounding them to give them the physical and psychological support they need over the two or more years they will have to wait. What plans has the Secretary of State got to ensure that they get the physical and psychological support that they need over that time?

The hon. Lady is of course right to talk about the importance of health inequalities. I hope that when she has had time to look at the plan she will see just how seriously the NHS and the Government take that. More broadly, I will have a lot more to say about tackling health inequalities shortly. Of course, the hon. Lady is right that there need to be alternatives to digital access for those who cannot easily access digital, be it through a web platform or the NHS app. There are alternatives in place, but I hope she agrees that for those who can use digital tools, we should make them part of the offering. The new “my planned care” service will be hugely important in providing more transparency than ever before, but also in helping people prepare for their surgical procedures. She may have heard me say earlier than one third of on-the-day cancellations of surgical procedures happen because people were not prepared.

I declare my interest as an NHS doctor and I echo much of what has been said by colleagues across the House about the workforce challenges.

As the Secretary of State said, covid has been a huge challenge to the NHS and it is a testament to NHS workers that cancer treatment was maintained at 94% of pre-pandemic levels throughout the pandemic and that 95% of people who needed cancer treatment started that within a month. However, I am sure the Secretary of State agrees that one month is a very long and frightening time to know that cancer is growing inside and that every day’s delay could be the day that costs your life. How does he intend to reduce that time and what will be his target from diagnosis to treatment?

I agree with my hon. Friend about the importance of the workforce. She is right to raise the importance of cancer care and to note that it has remained a huge priority for the NHS despite all the pressures of the pandemic. In the plan that we are publishing today, we have set out a number of cancer targets. They are all very ambitious with record amounts of investment. Once my hon. Friend has looked at the plan, I would be happy to discuss it further with her, either the cancer aspects or anything else.

I thank the Secretary of State for a progressive and positive statement on the way forward. With statistics showing that there were some 10 times more patients waiting six weeks or more for cancer diagnostic tests at the end of November 2021 than in November 2019 in England, and with similar UK-wide statistics, what specifically is the Secretary of State doing to address the massive backlog in those life-saving tests?

I welcome the hon. Gentleman’s comments. With respect to life-saving tests and scans, including for cancer, the plan sets out a huge amount of new investment in diagnostic capacity. One area of investment is the new community diagnostic centres, some 69 of which have already opened across England in convenient places such as shopping malls and car parks, which people can access much more easily and get their results from much more quickly.

I welcome the plan. I am most intrigued by the “my planned care” website, because one of the biggest problems for clinicians is that they spend a lot of time chasing admin. It is a great opportunity for pre-operative checks and for people to know where their follow-ups are. Will the Secretary of State look at expanding it to out-patient settings? People over the age of 80 may well have four, five or six specialists, so trying to keep track of their letters, of where they should be and of their appointments is really difficult.

During covid, 29 million people downloaded the NHS app and we had the fantastic covid dashboard, so we have seen what we can do with technology to help our patients and clinicians. Will the Secretary of State encourage the NHS to build on the measures that he is bringing forward to help with the backlog?

Yes. My hon. Friend is absolutely right to talk about the importance of technology in delivering world-class care. He will know that I have already announced that the parts of our health system that contribute to the best use of technology, NHSX and NHS Digital, will become part of the wider NHS so that we have a more joined-up strategy. “My planned care” will start as an online platform, but will move to an app-based service as soon as possible. My hon. Friend is right to talk about the importance of having something similar for out-patient care; we are already on it.

Will my right hon. Friend work with our excellent GPs to increase access to primary care? Will he encourage them to open up more channels of communication such as email, text and chat apps to ensure that people feel able to raise their health concerns at the earliest possible stage rather than putting them off until they become more serious, when it is potentially too late?

Yes. I join my hon. Friend in thanking GPs up and down the country for all their phenomenal work throughout the pandemic amid the huge pressure that they have had to deal with. He is right about making sure that channels of communication with GPs are as varied as possible and are available to everyone in all age groups so that we can better support early diagnosis.

I thank my right hon. Friend for his statement and for his leadership as we recover from covid. I must say that I find the words of the hon. Member for Ilford North (Wes Streeting) a bit hollow when the Opposition voted against £36 billion recently.

May I raise the matter of recovery in our emergency care? The Secretary of State will know that too many people in Newcastle-under-Lyme have had to wait too long for ambulances recently. Will he or his Ministers help to bring together West Midlands ambulance service, Royal Stoke University Hospital and the clinical commissioning groups to find a solution so that we can get patients into hospital and back out again as quickly as possible?

I thank my hon. Friend for reminding the House that the Labour party voted against additional investment in the NHS. He is right to talk about the impact on urgent care, particularly for ambulance services and especially during the recent omicron wave. We invested an additional £55 million in ambulance services over the winter. A lot more needs to be done to support urgent care, but the plans that we will shortly set out for the integration of healthcare with social care will certainly help to relieve many of those pressures.

Kettering General Hospital performed heroically during the pandemic and is now gearing up with determination to increase its elective surgery capacity by 30%. Does the Secretary of State take on board the point that in addition to having to clear the covid backlogs, areas such as Kettering and north Northamptonshire are seeing a very steep rise in the local population, with tens of thousands of new houses being built, and are expecting a very sharp rise in the next five years in the number of people aged 80 or over? Will he ensure that Kettering General Hospital gets all the resources it needs?

I join my hon. Friend in thanking the staff at Kettering General Hospital for everything they have been doing, especially over the past two years. Of course, challenges remain. I understand that my hon. Friend the Minister for Health will visit Kettering General Hospital shortly; I look forward to hearing about it. I can assure my hon. Friend the Member for Kettering (Mr Hollobone) that when we look at funding and directional resources, we will certainly take account of not just the current population, but the forecast population.