Ambulance and Emergency Department Waiting Times
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The Minister for Health (Edward Argar)
I am happy to do so, Mr Stringer.
It is a pleasure to be here on the Front Bench responding to this very important debate. If I am still in this role on Sunday, I think I will be the third longest-serving Minister for Health since 1970, which says something about either longevity or churn in this role. It is a genuine pleasure to respond to the hon. Member for Bath (Wera Hobhouse), and I congratulate her on securing this debate.
As hon. Members across the House have acknowledged, the NHS has faced extraordinary pressures over the course of the pandemic and continues to face them. Although I suspect that not everything I say will meet with agreement from Members from both sides of the House, I join them in expressing our gratitude to all those who work not just in our NHS and health services but in social care.
I will start with a couple of words of caution about the use of history and statistics. Hon. Members made a number of points. I have been doing this job for almost three years, and I have often found that assertions are made with statistics or other facts from the history of the NHS, and I want to provide a counter-narrative to three or four before turning to the specifics of the hon. Lady’s debate.
First, I urge a little caution from Opposition Members when raising bed closures, not least because between 1997 and 2007, about 32,000 beds in the NHS were closed, which is more than double the number that were closed between 2010 and now. I say that simply to caution hon. Members that statistics can be used in different ways. There has been a long-term trend under Governments of both parties as the nature of care has changed.
Edward Argar
I just want to make a few more points, and then of course I will give way to the shadow Minister. She and I spent many happy hours in the Health and Care Bill Committee over many days.
On engagement with the private sector, again I would urge a little caution. It was of course the Labour Government in 2004 who first introduced the private sector into the provision of frontline clinical services with the out-of-hours contract. A Nuffield Trust blog in 2019 highlighted the fact that the increase in the use of the private sector in the NHS began before 2010 under that Government. I do not think the hon. Member for Jarrow (Kate Osborne) was asserting anything other than that, but it is important that I put that on the record.
Of course resources are hugely important. One of the first pieces of legislation that we introduced following the 2019 general election was the NHS Funding Act 2020, which will increase funding by £33.9 billion—a record amount—by 2023-24. As the hon. Member for Weaver Vale (Mike Amesbury) would expect me to say, we introduced the health and care levy to bring more funding into our NHS and social care. It was disappointing that Opposition Members voted against additional funding for the NHS when that was put to a vote.
Karin Smyth
The Minister talks about the bed reduction, but that was in the context of massively increasing primary and community care, and the private sector capacity was brought in to reverse the horrendous waiting lists following 18 years of Conservative government. We decided to govern. The point that hon. Members are making is: why does the Minister not govern?
Edward Argar
That is exactly what we are doing: we are leading and putting forward measures. Disappointingly, Labour voted against that extra funding.
Edward Argar
I just want to finish this point, but I will give way to the hon. Lady because it is her debate.
My hon. Friend the Member for Broadland (Jerome Mayhew) and others are right in their analysis that this is about patient flows. It is about a whole-system approach and the challenges across the system. My hon. Friend asked what the solution is to making the join-up work better. A key element of the solution is the new integrated care boards and integrated care systems, which genuinely seek to bridge the gap between two parts of the system, to which the hon. Member for Bath—health and social care. They both have, for want of a better way of putting it, different DNA. The NHS, since the legislation in 1946 and its implementation in 1948, has been essentially a vertical system, whereas we have retained local care by local councils on a social care level. This is an attempt to integrate them far more effectively.
Wera Hobhouse
It is not very helpful that we are entering into a party political ding-dong. There is a crisis, and we owe it to our constituents to face it. We are asking the Government, who are in charge, to do something about it.
Edward Argar
I am grateful to the hon. Lady, but when hon. Members raise party political points, it is incumbent on me as Minister to respond and to put the facts on the record. I will turn to the specific points she has raised. I will also turn, in that context, to the various points that she and the hon. Member for North Shropshire (Helen Morgan) made about various tangible suggestions from the Liberals on the issue.
The hon. Member for Bath is right to have secured and introduced the debate, because this issue is one of growing concern, understandably, and not just for all our constituents but for those who work on the frontline of our NHS. I think it was the hon. Member for Weaver Vale who highlighted the challenges faced by those staff, who want to be there and want to help. When someone rings for an ambulance, it is not a case of making an appointment with their GP; they are deeply concerned for their health, or the health of someone else, in an emergency. All those staff want to do—I have met many of them—is be there for those people, and the hon. Gentleman was right to highlight that issue.
As the hon. Member for Bath will be aware, the pandemic has caused significant strain across the NHS and the social care sector, and emergency care performance, as hon. Members have been open in acknowledging, is recognised as a whole-system issue. The challenges in performance can be traced along the entire patient pathway. Indeed, as I think the hon. Lady acknowledged in her Adjournment debate in the main Chamber on 31 March, although there are elements of that that we need to look at, we also need to look at the issue as a whole. She was right to say that.
For example, as hon. Members have said, the problems and delays in discharging patients home or to community services once they have recovered have a genuine impact on hospital bed occupancy—taking up beds that could otherwise be used by patients who need them. I want to give my hon. Friend the Member for Broadland a slightly more optimistic picture, which is in no way to diminish the challenge that remains. The number of beds taken up by people who are clinically fit to be discharged is not 20,000; it hovers at around 10,000. We have set up a national discharge taskforce, which is working actively with trusts and across local systems, particularly those that are most challenged, to support that discharge work. The situation is not as acute as he suggested, but it remains challenging because every one of those beds could be used to admit patients from an urgent and emergency care setting, or indeed to tackle elective backlogs and waiting lists.
Edward Argar
I would like to make a little progress before giving way again. I am conscious that I need to leave enough time for the hon. Member for Bath to respond.
That affects how quickly patients can be admitted from A&E, and such delays increase waiting times, as has been said, and lead to that crowding in departments, which has an impact on how quickly new patients arriving in A&E can be seen and treated, including those arriving by ambulance. When this causes ambulance queues to form, the local ambulance resource available to be dispatched to incoming 999 calls is reduced. It is fair to say that although the ambulance queues and delays are often the most visible manifestation of challenge, they are in many ways a symptom of that broader patient flow and the systemic challenge we face.
The root cause of these issues is hospital bed occupancy. That has consistently remained nationally at around 93%—a level usually seen only during winter pressures, as hon. Members have said. The pandemic has played a significant part in driving those pressures, and there are nearly 9,500 in-patients either with covid or for covid in clinical settings, as of 1 July. That is about 10% of all general and acute beds in the NHS.
Edward Argar
I will give way to the hon. Lady, but I want to make a little progress. There are points I want to make before I run out of time, but then I will give way.
That number, as we know, has frequently been higher during the pandemic, and there is the challenge of staff absences during waves.
Margaret Greenwood
The Minister will be aware that I have expressed extreme concern and tabled written questions about what happens to those people who are discharged under what was known as discharge to assess and their clinical outcomes. Will he commit to carrying out a review of the patient outcomes of all the patients discharged in that way, to see how many were readmitted to hospital within 30 days of discharge?
Edward Argar
I will not commit myself to what the hon. Lady specifically asks for because of the challenge of data collection, but I will say that I see where she is coming from and appreciate the underlying point, which is about understanding the impact of the policy. It has been in use since 2020 as a pandemic measure and is now in statute. The NHS will be monitoring it carefully. We do not agree on everything, but I am always happy to talk to her about these matters because she takes a close interest in them.
With regard to local actions in the patch covered by the hon. Member for Bath, as an illustration of the sorts of measures being put in place across the country, the local integrated care system is working to improve patient flow and reduce handover delays at acute trusts, including the Royal United Hospital in Bath. I join her in paying tribute to the work that her local team there are doing. That hospital is working well with community partners to help patients to return home as soon as they are well. That includes work with the hon. Lady’s local council to develop its domiciliary care provider, which will provide an additional 1,000 hours of domiciliary care a week. A £2 million investment will also be made in the Home First programme, whereby experts from across health and care help patients to get safely back home as soon as possible. The system is also working on opening an additional 20 beds at St Martin’s Community Hospital, while also developing same-day emergency care for frailty to avoid unnecessary admissions to hospital and to care for patients safely in the community.
There is of course nationally a wide range of support in place to improve urgent and emergency care more widely. That includes growing the number of call handlers for 999 and 111, and the investment that we have seen going into our ambulance services and A&Es. It is the case that £450 million of capital investment has already gone into increasing capacity in urgent and emergency care departments. In addition, we have kept, I think, over 155 more ambulances on the road over winter with our investment of £55 million more going into ambulance services. We are investing those resources in the frontline. If I recall my statistics correctly, there has been a 38% increase in the paramedic and ambulance workforce since 2010. The hon. Lady and her party can rightly claim a degree of credit for that, because a degree of that took place between 2010 and 2015. We do continue to grow the workforce.
Turning to workforce issues more broadly, it is absolutely right that, as well as providing the support to which the hon. Member for York Central (Rachael Maskell) alluded—mental health and physical support for the workforce—we continue to grow the workforce in order to ease the workload pressures. We have already witnessed over 30,000 more nurses in the NHS since that pledge was made in 2019. We continue to grow all workforces. In section 41 of the Health and Care Act 2022 we set out a very clear duty on the Secretary of State in relation to workforce planning, and that work is already under way.
I will turn to a couple of further points very briefly, because I want to give the hon. Member for Bath her two minutes at the end. She raised a number of specific points. She called for greater resources to be put in. That has been done. She called for an increase to be made in paramedics and ambulance staff. That has been and continues to be done. None of these are completed works, but they continue to be done. She called for action to stop ambulance station closures or community ambulance station closures. I have to say that those decisions are made clinically by local trusts; the power was not there for the Secretary of State to intervene. In fact, it was the Labour party that argued against giving the Secretary of State and Ministers the power to take action on those things when it voted against and spoke against that measure during the passage of the Health and Care Bill. It is right that clinicians determine what is the best set-up for clinical services in their area. I just gently make that point.
In summary, I think that both sides of the House recognise fully the challenges faced in these unprecedented times by our urgent and emergency care sector, and particularly by patients and those who work in the sector. We have a plan to fix it. We continue to invest in that plan and to support our workforce, and we will continue to do that for the benefit of patients.