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NHS Winter Crisis

Volume 788: debated on Monday 8 January 2018


My Lords, with the permission of the House, I will repeat as a Statement the response to an Urgent Question given by my honourable friend the Minister of State for Health in the other place. The Statement is as follows:

“Thank you, Mr Speaker. I thank the right honourable gentleman for tabling this Question, as I agree with him that it is helpful for colleagues in this House to be updated on the current performance of the NHS during this challenging time.

We all know that winter is the most difficult time of year for the NHS, so I would like to start by saying a heartfelt thank you to all staff across the health and care system who work tirelessly through winter, routinely going above and beyond the call of duty to keep our patients safe. They give up their family celebrations over the holiday period to put the needs of patients first. It is these dedicated people that make the NHS truly great.

Winter does place additional pressure on the NHS, and this year is no exception. The NHS saw 59,000 A&E patients every day within four hours in November; that is 2,800 more each day compared with the year before. The figures for December will be published this coming Thursday. We have done more preparing and planning this year than ever before, with planning beginning earlier, meaning that the NHS is better able to respond to pressure when it does arise. In the words of Professor Sir Bruce Keogh, the national medical director:

‘I think it’s the one [winter] that we’re best prepared for. Historically, we begin preparing in July/August. This year we started preparing last winter. We have, I think, a good plan’.

Let me tell the House about some of the things that have been done differently this year. We have strengthened further the NHS’s ability to respond to risk, including the NHS setting up the clinically led national emergency pressures panel to advise on measures to reduce the level of clinical system risk. We are supporting hospital flow and discharge. We allocated £1 billion for social care this year, meaning local authorities have funded more care packages. Delayed transfers of care have been reduced, freeing up 1,100 hospital beds by the onset of winter. Additional capacity has been made possible through the extra £337 million invested at the Budget, helping 2,705 more acute beds to open since the end of November. We have also ensured that more people have better access to GPs.

We allocated £100 million to roll out GP streaming in A&Es, and I am pleased that 91% of hospitals with A&E departments had this in place by the end of November. For the first time people were able to access GPs nationally for urgent appointments from 8 am to 8 pm seven days a week over the holiday period. In the week of New Year’s Eve the number of 111 calls dealt with by a clinician more than doubled, compared to the equivalent week last year, to 39.5%, reducing additional pressures on A&E. We also further extended our flu vaccination programme, already the most comprehensive in Europe. Vaccination remains the best line of defence against flu, and this year an estimated 1,175,000 more people have been vaccinated, including the highest-ever uptake among healthcare workers, which by the end of November had reached 59.3%.

We all accept that winter is challenging for health services, not just in this country but worldwide. The preparations made by the NHS are among the most comprehensive, and we are lucky to be able to depend on the extraordinary dedication of front-line staff at this highly challenging time”.

I thank the Minister for that Answer, and I am pleased to see that he is still with us and in his place at this time. I wish him a very happy and prosperous new year. I question the idea that the Government and the NHS were prepared for this winter crisis. It seems to me that, if extra funding was made available in November and December, that does not smack of preparedness at all. I was very struck and somewhat chilled yesterday by what Andrew Marr said to the Prime Minister on his show. He said that had he experienced, when he had his stroke, the kind of five-hour delay experienced by Leah Butler-Smith and her mother, he would not have survived. I invite the Minister to have a stab at making a better job of answering that question today. What would he say to those whose lives have been put at risk by this winter crisis?

Will the Government be making available to us an analysis of the impact on patients, and the lives cost, of a combination of: 55,000 cancelled operations; 75,000 people held in ambulances; overstretched accident and emergency departments, with people on trolleys and even on the floor; up to 90% bed occupancy, which is very dangerous; a shortage of GPs; and inadequate social care due to the starving of funding to local authorities over a long period? When will we know what the impact of this has been on people? When will the Government properly fund and manage the winter stresses in our NHS?

I thank the noble Baroness for her good wishes, and I wish her and all noble Lords a happy new year. She asked several questions, and I will try to deal with them all. Her first question was about being well prepared. Those were the words of Sir Bruce Keogh from NHS England, not mine. I should also point out that Keith Willett, the director for acute care for NHS England, said that the service is better prepared than ever. Of course, that does not mean that there are not challenges. We know that this happens every year.

One of the ways that we see challenges happen is that there are cancelled elective procedures. I have been looking back over the data for the past 20 years. In quarter 4 of each year—January to March—those cancellations do happen. In fact, I was looking back at 2000-01 and there were 24,000 cancelled or postponed operations that year, which is actually one of the highest over that period. These things do happen during winter, and that is one of the ways of coping. The Prime Minister has apologised for that, and I endorse that. Of course, it is not a state of affairs that we want to happen, but it is necessary to make sure that the most urgent cases are treated. It should be pointed out that the direction about elective procedures made it clear that time-critical procedures around cancer operations and others can go ahead. We will see over time what the impact of that was.

I will mention one other thing about preparedness. The noble Baroness talked about bed occupancy. Of course, we know that high levels of bed occupancy are a concern. Bed occupancy was below the target of 85% going into this period—on Christmas Eve it was 84.2%, I believe—so that was put in place. We know it is going to be challenging. We know that flu is going to continue to have an impact over the next few weeks, and we will see what we can do, but we know that the NHS has put in unprecedented levels of preparation to make sure that we can get through what is always a difficult period.

My Lords, is it not encouraging that at least this year there was preparation for winter? The fact that it was not an enormous success everywhere is a lesson that I hope Her Majesty’s Government will take on board. Against that background, will my noble friend be preparing a report on the experience this winter? Will he confirm that next year there will be a plan which takes on board the experience of this year? I can quote only from local experience but is it not a fact that Luton and Dunstable University Hospital, which has had a special A&E unit for some years, did not have difficulty, whereas other hospitals that were not prepared to that extent appear to have had difficulty? If that is the case, is it not time we brought the other hospitals up to a better standard—the sort of standard that Luton and Dunstable University Hospital gives to its community?

I thank my noble friend. He is right to point out that there is variation across the country. He mentions Luton and Dunstable University Hospital. It has been a pioneer of how to make sure that people coming into A&E are properly dealt with. Indeed, the £100 million that was invested in A&E services to support better triaging was based on the Luton and Dunstable model. Obviously, we need to make sure that those high standards are replicated across the country.

I will give one further example of an area where that planning has taken place. We know that there has been pressure on ambulance services and that there has been a variability of performance there. There is now a national ambulance control centre which is keeping real-time data and looking at how to manage that performance so that we can get a proper national grip on this picture.

My Lords, does the Minister acknowledge that 59,000 people a day going into A&E is an indicator that there simply is not enough support in the community? Can he give us any indication of how many people he thinks could have been prevented from going into A&E and causing these sorts of problems in hospitals if there were more support in the community, which would mean, for example, that people with infections were caught early and would not need to be admitted? Does he also note that a recent survey showed that one-fifth of the people in adult mental health hospitals were there simply because there was no provision for them in the community? That does not mean just social services; it means housing.

I thank the noble Lord for that point. He will have experienced a few of these difficult winters when he was running the NHS. It is difficult to say what number or proportion of those 58,000 or 59,000 people could have been treated in the community. We do know that the 111 service has been successful this year, with nearly 40% of calls involving a clinical opinion keeping people out of A&E, as has primary care. It is difficult to estimate, but we know that a number of people have been kept away. Of course, there is a growing and ageing population, and that is the underlying driver of demand. On mental health, the noble Lord is quite right. We have not done enough in mental health over many years, and that is one of the reasons that it has been a priority for the Prime Minister, with a big increase in the number of mental health staff in the years ahead.

My Lords, I understand there is a new strain of flu in circulation this year, for which the flu jab was not designed. Does that mean that elderly people, who are particularly vulnerable to this new strain of flu, should have a second inoculation?

There are of course at any one time a number of flu strains going around. There is particular concern about one of those strains affecting elderly people. Its circulation has come about quite late, as it were, and I would absolutely point out that the best way for elderly people and all at-risk groups to protect themselves is still to get that inoculation. For those who have not—

I am not in a position to say whether they should have a second inoculation, but there are still a number of people who have not had that inoculation. Those vaccines are available in GPs, surgeries, and we absolutely encourage all groups to have at least a first one.

My Lords, it seems as if a winter crisis, year on year, is totally predictable. I cannot remember a year when there was not one, but I echo the Minister in paying tribute to those NHS staff, right across the system, who have worked flat out 24/7. Part of the problem is that the social care system and health system are not properly integrated—although I note from Twitter just now that Secretary of State Hunt has responsibility for social care, with immediate effect. Can the Minister tell me whether there are hospital beds occupied by people who no longer need them but are unable to return home? Can he give me an indication of the shortfall in accommodation or beds in the public, private and not-for-profit sectors in nursing and care homes? What gives the Government confidence that the £335 million in the autumn Budget will help, and can he give us some clarification on how that money is to be distributed?

First, I join the noble Baroness by reiterating on a personal basis a tribute to the staff who have worked so hard over this period. I think we all know many of those people, and they do an extraordinary job. Social care is clearly a really important part of the picture because it is not just the flows into hospitals but the flows out. A lot of that is to do with delayed transfers of care. That is one reason why additional funding has been going in—I think it is £1 billion this year. It is important to point out that all local authorities have now signed up to plans to reduce what are called DToCs, in the jargon. DToCs have been falling, which means that there is the opportunity to get people out of hospital. That could be into a care home or residential care or it could be to their own home.

My Lords, the disastrous white elephant which is HS2 will cost a minimum of £60 billion. The NHS needs £5 billion to balance the books, and a fraction of HS2’s cost would provide finance for the NHS for years to come. I urge the Minister to please urge the Government to scrap HS2 and spend the money saved on sensible projects, with the NHS at the top of the list.

My Lords, I am happy to endorse calls for more funding for the National Health Service. That is precisely what the Chancellor provided in the Budget.