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NHS: Winter Challenges

Volume 824: debated on Monday 10 October 2022


Asked by

To ask His Majesty’s Government what assessment they have made of the challenges facing the NHS this winter.

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, before the Minister responds, warmly welcome him to your Lordships’ House and to his ministerial role. I wish him well.

I thank the noble Baroness. If I may respond personally first, I am delighted, honoured and privileged to be taking on this role. I look forward to working with all noble Lords and learning from the vast experience and expertise around the Chamber. The Government are aware of the pressures facing the NHS this winter due to potential surges in Covid-19, the return of respiratory conditions and impacts arising from cost of living challenges. The Government are taking a range of actions, including increasing NHS capacity this winter by the equivalent of 7,000 beds and allocating £500 million of funds to speed up the safe discharge of patients from hospital. We will keep the House updated as we progress.

My Lords, NHS Providers reports that 72% of trusts are extremely concerned about the cost of living impacting on their ability to manage winter pressures, tackle care backlogs and meet targets. Can the Minister tell your Lordships’ House what assessment has been made of the impact on health services of the ever-widening gap between the Government’s original assumption of inflation and the spiralling increase and, to protect patients, what will be done about it?

As I am sure the noble Baroness is aware, we are investing an unprecedented amount of money into the NHS and have recruited more doctors and nurses. We are setting up 7,000 new beds to cope with it all. At the same time, I accept that we are in a period of unprecedented challenge from not just the cost of living crisis but the effects of Covid and the likely impact of flu this year. That is why I very much see our role as making sure that that record level of investment is used to the best effect and that we drive performance across the NHS. I am sure we all have lots of examples of brilliant services and examples of where more needs to be done, candidly. My role in this, as someone with a background of business experience, is to try to take those areas of best practice that I have seen in some of the hospitals I have already visited and make sure they are allocated across the whole NHS.

My Lords, I congratulate my noble friend and welcome him to this place. I remind the House of my interests with the Dispensing Doctors’ Association. I commend the Government’s vaccination programme for this winter, but in rural areas there is a very difficult and dangerous situation where vaccines for the over-65s are not currently available in many rural practices but they cannot vaccinate the under-65s until they have vaccinated the over-65s. Will my noble friend personally take an interest in this matter and ensure that vaccines for the over-65s are rolled out to rural practices as soon as practically possible?

I think we are all aware of the importance of the vaccine programme, and I know that, to date, we are following the medical advice as to who the priority groups should be. If I may, I will follow up with a written response so I can give my noble friend the detail required on her question.

My Lords, the Minister, who we welcome to his post, will know that the efficient use of NHS resources, particularly during the winter, depends in many ways on the availability of social care services. As time is rushing on toward the winter, could the Minister say what action is being taken now to improve the availability of effective social care services during this coming winter?

The noble Lord is correct that care is at the centre of all of this. The flow of patients through hospitals is vital, and we are all aware that 13% of all hospital beds are held up by people who should be discharged into care. The £500 million investment is all about freeing up those beds. That will ease the flow right the way through the system—right the way into A&E, so that people can be discharged straight into hospitals, and right back to ambulances being able to discharge into A&E. I completely agree with the noble Lord; that is the focus of what we are doing.

My Lords, the noble Lord has talked about £500 million going in, but he knows that the efficiency savings target annualised is £12 billion. He also knows that unfunded inflationary pressures are estimated by NHS England to be £6 billion to £7 billion on top of this—and the Treasury is demanding further cuts in order to shore up its disastrous mini-Budget. Given that, how are the Government going to meet winter pressures, cut the Covid backlog and balance the books?

We are facing unprecedented challenges, as the noble Lord states. We also have unprecedented investment, a plan for patients which is focused on the key elements that will make a difference—ambulances, the backlog, care, and doctors and dentists—and a group of Ministers who are focused on making a difference where it really counts. We have record investment, and a record number of doctors, nurses and people ready to face those challenges.

My Lords, the plan for patients refers to the expansion of virtual wards in hospitals this winter. My local hospital, Watford General, pioneered this in 2020, but it put considerable pressure on GPs, community nurses and social care. Will there be extra funding for those areas that have virtual hospitals this winter to make that work?

I had the pleasure of visiting Watford General just a week ago, and I saw the virtual wards first hand, so I agree on the excellence we saw there. To give the House a sense of that, the wards have reduced 90-day readmission rates from around 45% to 7%. When I talk about performance improvements, those are precisely the sorts of areas in which I wish to see investment made, so that we can roll that out across the NHS. It is in those areas that we can make a real difference.

My Lords, we are now on our 10th Secretary of State in 20 years and we have had slightly more Lords Ministers. In that time, spending on the NHS has more than doubled, yet the answer always seems to be to look for more money. Does the Minister consider that we need to take a more fundamental look at the National Health Service to see whether priorities can be moved so that the money we are presently spending will be spent more wisely and we will not, every single year, have the same headlines, the same problems and the same inability to solve them?

My noble friend is correct that we have to make sure that the record investment is put to good use. We have 200,000 more people working in the health service than in 2010. It is correct that we have more resources invested in this area than ever before and also that we have to make sure that those are used to best effect. Noble Lords can rest assured that that is very much in my remit.

My Lords, will the Government now ask NHSE to publish the 12-hour length of stay times for emergency departments in order to be able to evaluate the efficacy of the proposed 7,000 beds and financial investment? Data shows that, at the moment, 52% of all emergency medicine trainees are already burned out. On top of that, there is the flight of nurses from emergency departments because of stress. The emergency departments are already in crisis, yet the key data on 12-hour waits there is not being collected.

I do not have the detail on the 12-hour wait-list at this moment, but I will come back to the noble Baroness with a detailed written response.

My Lords, I welcome the Minister. I am delighted that he has his position but I have to say that I do not envy him. Some months ago, I pointed out to his predecessor—who, very fortunately, is sitting next to him—that the number of people on waiting lists had increased over the past 20 years from 0.5 million, which the last Labour Government still regarded as far too high, to 4 million before Covid and 6 million when I asked the question. I asked the then Minister what the Government were doing about it. He kindly explained what they would do, but since that time the number on waiting lists has moved from 6 million to 6.8 million. Since that means that 6.8 million people are waiting in pain, trepidation and fear, will the Minister make it his highest priority to bring what business acumen he can to make sure that choice is extended to patients? It is choice for patients that will bring down the waiting lists, whether they wish to go to another NHS hospital or to a hospital in the private sector provided free at the point of need.

I agree with those excellent points. As someone who is also responsible for the new hospital build programme, which can give that choice and make sure we have the most effective system, that is top of my agenda.