18:58 - The House divided: - Ayes: 176 / Noes: 296 - Question accordingly negatived.
19:12 - The House divided: - Ayes: 289 / Noes: 0 - Question accordingly agreed to.
The Secretary of State for Health and Social Care (Steve Barclay)
I beg to move an amendment, to leave out from “House” to end and add:
“pays tribute to the work done by the National Health Service and recognises that there are pressures on health systems around the world; recognises that all parts of the UK are facing pressures; welcomes that the Government has committed to reduce waiting times in England as part of its strategy to strengthen the NHS and care system with up to £14.1 billion additional funding being made available by government over the next two years to improve urgent and emergency care and tackle the backlog—the highest spend on health and care in any government’s history; and regrets that the Scottish and Welsh governments have refused to make similar such commitments.”
I am grateful for the opportunity to update the House further to my statement on Monday, in which I recognised the very real pressures faced by the NHS, particularly in emergency departments and with ambulance handovers, and the fact that the experience had not been acceptable for some patients and staff in recent weeks. I set out a range of actions that we are taking in response to those pressures—pressures that are being experienced by healthcare systems throughout the United Kingdom, and in Europe and beyond.
Before I turn to the honourable Opposition’s flawed motion, I want to reflect on a few points that the hon. Member for Ilford North (Wes Streeting) did not cover. For a start, he hardly mentioned social care, although that was an issue raised on his own Benches. We have made £2.8 billion and £4.7 billion available for social care in each of the next two years, recognising that what happens in one part of the system impacts the other. He also failed to mention any of our life sciences success stories, such as our 10-year partnership with Moderna, our deal with BioNTech to give 10,000 people early access to cancer therapies, and how we were the first country in the world to have the bivalent vaccines. That kind of work will shift the dial on prevention.
Karin Smyth (Bristol South) (Lab)
Will the Secretary of State give way?
Steve Barclay
I will, and perhaps the hon. Lady will explain why none of her Welsh colleagues is here for the debate.
Karin Smyth
I speak for the people of Bristol South. Let me talk about social care: can the Secretary of State explain why he will not publish information about the trailblazers on social care? The Government made a huge commitment to people in this country that they would fix social care, but they have reneged on that promise. They spent £2.9 million on trailblazers. I have asked written parliamentary questions of the Secretary of State and have been told that they are not publishing information. We do not know what has happened to that money. We do not know the outcome of that trailblazers report. If we are to learn from the disaster of the last year in which the Government marched us up the hill and back down again, we need to understand the outcomes. Will he commit to publish the evidence that we have had thus far?
Steve Barclay
I support transparency, so I will take away the issue of trailblazers that she raises. [Interruption.] The hon. Member for Wallasey (Dame Angela Eagle) chunters from a sedentary position, but I am agreeing to look at the point that the hon. Member for Bristol South (Karin Smyth) raises. She and I have debated in the past, not least when I was a Minister of State and she raised the issue of NHS property. She knows that I was a supporter then of transparency. She raises an interesting point that has not been raised with me previously.
I am very happy to take that away and look at how we get some transparency on that, because it is important that the House is able to see the evaluation of innovation and where pilots are done. Secondly, one of the challenges that the NHS faces is that it does not adopt that innovation at scale. The substance of the hon. Lady’s point is fair and I will happily take it away. On why I mentioned Welsh MPs, given Bristol’s proximity I thought she may be able to shine a light on the strange absence of any Welsh MPs, unlike the Secretary of State for Wales who is taking a keen interest in this debate.
I turn to the motion moved by the shadow Secretary of State, which seems, incidentally, to have been written before my statement on Monday. I might have thought that he would change it. We set out a further £250 million to support emergency departments and to get those patients out of hospital who are medically fit to be discharged. Across the House, people recognise that the pandemic has had a significant impact on that. It effects flow in hospitals and it is an area of common ground between the shadow Secretary of State and me: the issue of delayed discharge is a big factor in the compression in emergency departments.
Dean Russell (Watford) (Con)
My right hon. Friend’s visit to Watford just last week highlighted the incredible innovation there in virtual hospitals and the power of people being looked after at home. I know the work area that he looked at; I would like his opinion on that fantastic visit and on how we can roll that out across the country.
Steve Barclay
My hon. Friend highlights an extremely important area of innovation that speaks to the point about how to adopt that at scale. I will come on to the issue of virtual wards. At Watford, they told me that it was saving the equivalent of another ward of the hospital by enabling people to be discharged to recover in their homes where it was more comfortable. Patient satisfaction was extremely high—over 90% in the programme in Watford. Not only that; the clinical wraparound support means that if they need to return to hospital, they are able to do so.
Daisy Cooper (St Albans) (LD)
I, too, have seen the virtual ward at Watford General Hospital, which serves my constituents. We are very proud in west Hertfordshire that we were the first hospital trust to have that virtual ward, but he will know from his visit that the No. 1 priority of every member of clinical staff in that hospital is to have funding from the new hospitals programme to improve our hospitals in Watford, Hemel and St Albans. Could the Secretary of State please pledge to write to me within the next seven days to report on his meeting with the hospital trust and tell us whether and when we will finally get some funding, after being overlooked for decades?
Steve Barclay
It was extremely helpful to discuss the priorities for the new hospital build with the clinical team and the leadership team at Watford. I could see that for myself, and we are committed to it. This is an issue that my hon. Friend the Member for Watford (Dean Russell) champions assiduously on behalf of the people of Watford, but I know that it matters to a wider cohort there and I am happy to write further to the hon. Lady as she requests.
The virtual ward at Watford—it is great to have cross-party support for that innovation—is further facilitated by the funding we announced in the autumn statement: the further £500 million this year, £600 million next year and £1 billion the year after. The Opposition say we are “failing to recognise” the scale of the current challenges in the NHS, yet when I set out in the statement the additional actions that we are taking, it was both to respond to the pressures from flu—the sevenfold increase we have seen, with 100 times the number of patients in hospital with flu compared with last year—and to facilitate the innovation that they highlight in programmes such as virtual wards.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
The Health Secretary will be aware that our hospital bed numbers are approximately half the OECD average, at fewer than 2.5 per 1,000 compared with 5 per 1,000 in the OECD. He will also have read reports in The Observer about the facility that was made available in the Health and Social Care Act 2012 that allows hospitals to allocate up to 49% of their hospital beds to private patients. Does he regret that?
Steve Barclay
The issue of bed capacity does indeed matter. I made the point a few moments ago that flow in hospitals is obviously constrained when bed numbers are high. That is exactly why, in the statement on Monday, I highlighted the importance of discharge, and of things like discharge lounges so that we can better facilitate those patients that are free to leave. But this is not simply about hospital bed capacity; it is about step-down intermediate care capacity and also, as we heard a moment ago, about the innovation that means we are better able to facilitate those patients who want to recover at home but want the safety net of some clinical support when they are doing so. It is about looking at the capacity in the whole of the system, not simply in the hospital; otherwise, the hospital itself becomes a magnet.
Dame Angela Eagle (Wallasey) (Lab)
The crisis this winter was predictable and building long before we arrived here. Normally, the NHS and the Department plan for winter crises in the summer months, but this year something else was going on in the summer months, wasn’t it? The Tory leadership election. Does the Secretary of State regret what the distraction of the Tories’ internal faction fighting has led to, which is the inability of this Government to plan ahead and do the day job, and the fall below minimum standards of the Government service?
Steve Barclay
I do not think those are factors that affected what happened in Scotland, where the First Minister warned on Monday that the hospitals were almost completely full. Indeed, the Scottish Government are taking emergency measures, including cancelling some non-essential operations. I do not think that was a factor in France, where the French Health Ministry is saying that intensive care beds are at saturation point. I do not think that was a factor in Wales, where more than 54,000 patients are waiting more than two years for an operation. I am glad that the hon. Lady highlights the summer, because it was in the summer that we hit the first of our elective recovery targets in terms of the two-year wait, getting those below 2,000, in stark contrast to what we saw in Wales. The surge in flu has happened across the United Kingdom, not just in England, and it has also affected France, Germany and other countries in Europe.
John Redwood (Wokingham) (Con)
I am very conscious that this Government have put a lot of extra money into the health service, and that Ministers have consistently wanted to get waiting lists down so that we have the extra capacity we need. Will the Secretary of State share a little of the thinking of senior management, who run the NHS day to day, in not using more of that resource for extra beds and extra staff to back them up?
Steve Barclay
As so often, my right hon. Friend raises an extremely important point about how we best use the resources and significant investment being put into the NHS. He will recognise that a key part of delivering value for money is looking at the interfaces on the patient pathway through the healthcare system. Handover points are often when we have the most difficulty.
I am sure my right hon. Friend will welcome that I recently visited Maidstone to see how we track the patient journey through a hospital and into care—residential care or domiciliary care. We are putting control centres in place through the 42 ICBs, and our reforms are bringing health and social care closer together. An area of common ground across the House is on the need to bring social care and healthcare closer together, and the ICBs, which were operationalised from July 2022, are a key part of that.
I suspect that one issue on which my right hon. Friend and I strongly agree is that it has to be underscored by data, so that we can see where the blockages are and prioritise the use of technology, such as machine learning, artificial intelligence, virtual wards and other innovations.
Clive Efford (Eltham) (Lab)
Will the Secretary of State give way?
Steve Barclay
I am being pretty reasonable on interventions, so if the hon. Gentleman will give me a moment.
Steve Barclay
The Opposition want to hear what the Government are doing, and then they tell me that they do not want to hear.
Clive Efford
The Association of Directors of Adult Social Services surveyed English local authorities back in 2019, and it found that they had endured cuts of £6.3 billion in adult social care, resulting in a drop since 2014 of 425,000 beds. How much does the Secretary of State think that has contributed to today’s crisis?
Steve Barclay
I am delighted that the hon. Gentleman raises the additional funding that the Government are putting into social care. In his autumn statement, the Chancellor made the biggest social care spending increase of any Government in history: an extra £2.8 billion next year and £4.7 billion the year after. That is £7.5 billion over two years, on top of the £6.6 billion he put into the NHS over two years. At a time when, as a consequence of the pandemic and the war in Ukraine, inflation is extremely high and there are acute cost of living pressures for constituents across the country, the Chancellor prioritised spending not just on health but, as the hon. Member for Eltham (Clive Efford) helpfully highlighted, on social care. Bringing health and social care together is exactly what I set out in my statement to the House on Monday.
Imran Hussain (Bradford East) (Lab)
Will the Secretary of State give way?
Steve Barclay
I will take one further intervention, and then I will make some progress.
Imran Hussain
The Secretary of State refers to significant challenges, as though this crisis started a few weeks ago. This crisis has been ongoing for more than a decade, and it is worsening year on year, but Ministers come here blaming it on anything other than, frankly, their incompetence and negligence over the last decade. When will they wake up, move away from their ivory tower and accept that it is on their watch that their incompetence and negligence have resulted in our constituents suffering today?
Steve Barclay
The data shows very clearly the profound impact of the pandemic, and the data shows that the impact is not constrained to England. It is acute in—[Interruption.] The hon. Member for Bradford East (Imran Hussain) has just had his intervention. If he wants to hear the answer, the reality is that the pandemic has had a profound impact on the NHS in Wales and Scotland, just as it has across Europe. That is what he is ignoring. He does not like the facts, but the facts are clear.
Steve Barclay
I will answer the hon. Gentleman’s first question. I will then give him a second go, as he is chuntering. Hospital flu admissions went up sevenfold in a month. The figure is 100 times higher this year than last year, and that comes on top of the severe pressure from the pandemic—9,000 cases. Perhaps he wants to explain the situation in Wales and why he feels the pandemic has not had an effect.
Imran Hussain
Of course, the Minister did not answer my question. I ask him about two things. First, every time this Government are put on the spot, they refer to what has become the Welsh defence; they would much rather not talk about their own incompetence. Secondly, how does he explain that in at least seven of the past 12 years they have missed their target overwhelmingly? That suggests we were in a crisis a long time ago.
Steve Barclay
Again, I can understand why the hon. Gentleman does not want to talk about the performance of the Welsh Government, but I was talking about the Scottish, French and German Governments, and about the fact that the pandemic has had a severe impact across the UK and across Europe.
Steve Barclay
I know that the hon. Gentleman has been keen to get in, so I will give way, but then I must make some progress.
Grahame Morris
I am grateful to the Health Secretary for that. On the point about relative performance, I want to touch on cancer treatment capacity. Our performance as a nation is lamentable on the seven most common forms of cancer. If the buzzword is innovation, surely we have a tremendous opportunity to roll out advanced radiotherapy. About one fifth of the machines we have in our hospitals are more than the recommended limit of 10 years old. Surely that is a perfect example of a cost-effective means by which we could apply artificial intelligence and diagnostics in parallel, and we could treat many more patients and improve outcomes. Is he open to that idea?
Steve Barclay
I am very open to that idea. For all the sound and fury that there sometimes is within the political debate, I know that there are certain topics within health on which people across the House are keen to work. Cancer is one issue that affects all families and all constituencies, and there is often scope to work extremely closely together on it. Knowing the hon. Gentleman well, I am happy to work with him moving forward.
Steve Barclay
May I just answer the last point, as the hon. Member for Easington (Grahame Morris) raised an important issue, and one that matters to many families? On the substance of his point about equipment, tech and innovation, we are looking at how we innovate. GP direct access is part of that, as it provides direct access to diagnostics. More patients are having their first cancer consultation following an urgent GP appointment. If we take the cohort of more than 810,000 who have started treatment for cancer since March 2020, the statistics show that 94% did so within their first month.
Given the seniority of the hon. Member for Westmorland and Lonsdale (Tim Farron), I will take his intervention, but then I must make some progress.
Tim Farron
I wanted to seize the moment, based on the excellent question from the hon. Member for Easington (Grahame Morris). The inquiry by the all-party group for radiotherapy is on 18 January, but we have not had a response to our request for the Secretary of State, or indeed any of his ministerial team, to attend. Will at least one of them do so?
Steve Barclay
Let me check the diaries with the Department. These things are always dangerous because we need to know what the travel plans and various commitments are, but I hear the hon. Gentleman and the hon. Member for Easington, and we will absolutely look at what can be done.
Vicky Ford
As a declaration of interest, let me say that I am the daughter of two NHS doctors, the sister of a geriatrician and the wife of an oncologist. I hope that the shadow Secretary of State shows a bit more respect in the future for those of us who come from medical families. I thank my right hon. Friend the Secretary of State for giving way, given that the Opposition were not allowing me to ask my question.
We know that it takes a long time to train doctors. Before the last interventions, the Secretary of State mentioned the Chancellor. One excellent thing the Chancellor did when he was Health Secretary was to announce 10 new medical schools. We have always had a shortage of doctors in Essex and difficulty recruiting them, because we had never trained doctors there. The medical school in Chelmsford is brilliant. Its attrition rate is less than half the national average. The first students will qualify this year, and it is fantastic. Those students want to stay locally. This is a symbol of the Conservative party investing in the long-term future of the NHS where it is needed. Will the Secretary of State consider expanding these excellent medical schools?
Steve Barclay
My right hon. Friend raises an extremely important matter. I was in the Department when the current Chancellor was Secretary of State and when we made that commitment to a 25% expansion in medical undergraduate places. She is absolutely right in saying that it takes time for those cohorts to come through. She is also right that Chelmsford has been a huge success. I am sure that, in the context of the workforce strategy that NHS England colleagues are bringing forward, she will make the case for where any additional capacity should go, but we will, of course, look to that workforce strategy to map out what is needed.
Let me turn to elective care backlogs. A number of Members across the House have raised the issue of the 7.2 million people on the waiting list. I think that it is worth breaking that figure down between the 1 million who require surgery and the 6 million who are waiting for outpatient appointments—either for their first appointment or for their follow-up. The NHS is doing more than 94 million outpatient appointments a year, of which 30 million are for new patients and 64 million are follow-ups. The “did not attend” rate is about 6.5%. This relates to the question of my right hon. Friend the Member for Wokingham (John Redwood) about value for money and how we deliver the reform of which he spoke. If we halved the “did not attend” rate of about 6.5%, it would free up almost 4 million slots. I am very interested in looking at the data and at how we prioritise within that data the wider challenge around the elective care backlog. I hope that that provides him with some reassurance.
Margaret Greenwood (Wirral West) (Lab)
Will the Secretary of State give way?
Mr Deputy Speaker (Mr Nigel Evans)
Before the intervention is taken, I advise Members that there is a lot of interest in this debate, and each intervention is cutting into the contributions that can be made. We will be down to a three-minute limit very quickly, and some people still may not get in.
Margaret Greenwood
I wish to bring the Secretary of State back to the point raised by my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams), who pointed out that in the Health and Social Care Act 2012, the coalition Government legislated to allow NHS hospitals to make up to 49% of their money from private patients. She asked whether he regretted that, but we did not get a response, so I would like to hear the Secretary of State’s response. Will he also tell us what assessment he has made of the impact on waiting lists of non-NHS patients taking the place of NHS patients in our hospitals?
Steve Barclay
It is a good thing to be bringing more funding into healthcare rather than turning it away. However, conscious of your edict, Mr Deputy Speaker, I will truncate some of the areas that I was going to cover, because I am sure that right hon. and hon. Members will bring out some of those points in the wider debate.
Labour’s motion ignores the statement that I gave to the House on Monday. It ignores the extra funding that we provided in the autumn statement and the commitment reflected in the Downing Street summit on Saturday to publish recovery plans for urgent and emergency care and for primary care, which we will do in the weeks ahead. The motion ignores the very real health challenges being experienced across the United Kingdom in Wales, Scotland and Northern Ireland, which all face pressures. It ignores the fact that France, Germany and elsewhere in Europe also face significant pressure.
The Government recognise, as I set out to the House on Monday, that there are real challenges in the NHS and social care. That is why we set out a three-phase approach: first, taking immediate steps to reintroduce flow to relieve pressure in the emergency department and across the hospital estate; secondly, putting in more capacity to build greater resilience over the course of the year, mindful of the fact that summer is increasingly a busy period—more so than was traditionally the case; and thirdly, making investments in our life science industry, such as the deals with Moderna and BioNTech, to ensure that patients in the UK get the most innovative drugs at the earliest date. That shows the Government’s commitment to backing the NHS now and in the future, which is why I commend the amendment to the motion to the House.
Several hon. Members rose—
The Minister of State, Department of Health and Social Care (Helen Whately)
I welcome this chance to come to the House and speak about everything that we are doing right now, in the months ahead and for the longer term, so that people can get the healthcare they need from our health and social care system at a time when it is under huge pressure—when we face the worst year for flu for a decade, with 100 times as many patients in hospital with flu as there were a year ago; when the NHS is working through the backlogs caused by our fight with covid; and when we know that the NHS is struggling with the high number of people coming to emergency departments and the difficulty of discharging people to be cared for at home.
These issues are mirrored in health systems across Europe, and indeed across the rest of the United Kingdom. Despite what Opposition Members are saying, the honest truth is that there are no silver bullets. I know that NHS and social care staff are working incredibly hard in the face of these challenges; I want to assure them, and everyone, that the Government are working flat out on short and long-term solutions to these great challenges. That work is supported with record NHS funding, rising further to £165 billion by 2025, and with more funding for social care, with the record increase of up to £7.5 billion over the next two years that we announced at the autumn statement. We have committed to getting waiting lists down and getting people the care they need more quickly, and we will do so.
I thank hon. Members for their contributions to the debate. I particularly thank those who have been constructive and thoughtful this afternoon. The Chair of the Health and Social Care Committee, my hon. Friend the Member for Winchester (Steve Brine), spoke about increased demand for care and the importance of prevention. My hon. Friend the Member for Erewash (Maggie Throup) brought in her expertise as a biomedical scientist when she talked about the potential for innovative diagnostic tests to improve care and productivity. My hon. Friend the Member for Peterborough (Paul Bristow) shared the story of how the life of a constituent was saved through first aid and brilliant NHS care.
We heard from my hon. Friend the Member for Southend West (Anna Firth), who works incredibly hard to support her hospital and who often comes to me with suggestions. My hon. Friend the Member for Bosworth (Dr Evans), who brings expertise as a doctor, spoke about the 50% increase in the number of people over 100 in the last decades. He talked about the increased demand for healthcare and brought in many ideas for what more we can do to increase healthcare supply. My hon. Friend the Member for Don Valley (Nick Fletcher) reminded us of some of the excellent care that the NHS is providing in his area. He also asked for a new hospital.
My right hon. Friend the Member for Wokingham (John Redwood) spoke about workforce and bed capacity. My hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) spoke about the context of what we face, the extra flu admissions at Royal Stoke University Hospital and covid. My hon. Friend the Member for Devizes (Danny Kruger) spoke about the importance of integration in health and social care.
There are three more hon. Members I want to mention—I am sure they know who they are—because they represent constituents in Wales. They are all Conservatives; nobody is on the Opposition Benches representing Welsh constituencies today. Nobody here is standing up for Labour’s record in Wales. My right hon. Friend the Member for Vale of Glamorgan (Alun Cairns), my hon. Friend the Member for Clwyd South (Simon Baynes) and my hon. Friend the Member for Aberconwy (Robin Millar) all reminded us of Labour’s shocking record of running the NHS in Wales. They spoke about more patients waiting over two years for treatment in Wales than in England, about a higher treatable mortality rate, and about the fact that it was not the Conservatives but a Labour Government in Wales who cut health spending. That is a record that no Labour Member has proved willing to defend.
Let me now respond to some of the criticisms from Opposition Members, starting with the way in which the NHS prepared for this winter. Back in August the NHS published its winter plan, which included proposals to increase capacity by 7,000 beds and increase the use of virtual wards, to ramp the number of staff to handle calls, and to establish system control centres in each of the 42 integrated care systems: that was delivered in December. We gave more than 17 million people a covid booster vaccine, and gave more than 19 million their flu jabs. The shadow Secretary of State is talking over me, but I recommend that he listen to what we have been doing.
We set up a national discharge taskforce to work with hospitals and the wider health and care system to improve flow in the system. We published “Our plan for patients”, which included a £500 million adult social care discharge fund that is being spent on more home and residential care packages and boosting the social care workforce to help get patients out of hospital—that is happening right now.
However, as we feared, the combined pressures of flu and covid, alongside unprecedented demand, have indeed left our health system facing enormous challenges this winter. That is precisely why, as my right hon. Friend the Secretary of State said in his statement on Monday, we are taking immediate further action to support the NHS and local authorities. We are providing £200 million of additional funding for short-term care placements to help patients to be discharged more quickly and safely from hospitals, and an extra £50 million in capital funding to expand hospital discharge lounges and ambulance hubs as a matter of urgency.
As we come out of this winter, we know that these problems will not suddenly disappear, and that is why we are already making plans for the future. For instance, we have six national “discharge frontrunners” leading the way in exploring new long-term initiatives to free up hospital beds. As was announced in the autumn statement, we will marry those new ideas with a further £600 million next year and £1 billion the year after in order to transform the way in which we handle discharges.
At the same time as putting in money here and now, we have plans in place which will transform our health and social care system over the next decade. Our integrated care systems are bringing together health and social care in a way that has never been seen before. Our NHS workforce plan will provide a long-term staffing plan for the next 15 years. We are bringing forward ambitious social care reforms, including workforce reforms to develop social care as a career. Our reforms are timely, ambitious and deliverable, developed in partnership with health and social care organisations, unlike Labour’s new plan for primary care, an expensive top-down reorganisation, uncosted and unfunded, and described by the chief executive of the Nuffield Trust as costing “a fortune” and “out of date”—like the Labour party.
Our health system, like others across Europe, is facing a multitude of pressures. We are taking action, in the short, medium and long term, to tackle each and every one of those pressures, and I am determined to ensure that the work we are doing will make things better not only in the here and now, but next winter, next year, and every year thereafter.
Question put (Standing Order No. 31(2)), That the original words stand part of the Question.