NHS Winter Update

Thursday 11th January 2024 Lords Chamber

Statement

The following Statement was made in the House of Commons on Monday 8 January.

“With permission, Mr Deputy Speaker, I would like to make a Statement on the winter pressures facing the national health service and social care, as well as the impact of the ongoing junior doctors’ strikes. The NHS employs 1.3 million people and the social care system a further 1.5 million people. Together, they treat and care for tens of millions of people every day. We all know that winter is the most challenging time of the year for the NHS and social care, as our workforce have to tackle the pressures created by cold weather and seasonal viruses.

To put our health and social care system in a strong position heading into winter, this year we started preparing earlier than ever before. In January last year, we published our recovery plan for urgent and emergency care and provided £1 billion of dedicated funding to boost emergency capacity. The plan committed to delivering 5,000 new permanent staffed beds. I am pleased to update the House that more than 3,000 were already in place in December, and in the coming weeks NHS England will meet the 5,000 pledge and make sure that it has almost 100,000 core beds ready when Covid and flu peak.

Our recovery plan also pledged 10,000 virtual ward beds so that more patients can be monitored safely at home, away from hospital. I am pleased to update the House that we have delivered more than 11,000 virtual ward beds, and they have been a vital service for eligible patients over the festive period.

We have boosted our ambulance service with £200 million of additional funding, putting new vehicles on the road, improving response times and getting crews out and about for more hours. In recognition of the importance of patients being discharged promptly from hospital when it is safe to do so, we have made sure that every acute hospital in England has access to a care transfer hub, bringing together teams from the NHS and social care to speed up discharge, backed by an extra £600 million for social care. To help prevent the spread of winter viruses, we brought forward flu and Covid vaccinations, protecting the most vulnerable and making them less likely to require hospital treatment.

But no matter how thorough our preparations are, winter will always be the most challenging time of the year for our NHS. That is why it is extremely regrettable that the British Medical Association’s junior doctors committee has chosen to strike not once, but twice at this time of year. It has also chosen to strike for an unprecedented length of time, putting profound pressure on hospitals and GP surgeries throughout the country.

Before Christmas, the BMA’s strike caused the cancellation of almost 90,000 appointments, some of which will have to be rescheduled for a second or even third time. That is in addition to the 1.1 million appointments that have already been affected since strikes began in December 2022. This is not just another statistic; there is a person behind every one of these appointments, who may be in pain or distress and who now must wait longer for the care they deserve.

Last week, a member of the BMA leadership said that

‘strike action benefits absolutely nobody’.

They were absolutely right on that. The ongoing strikes are causing more appointments to be cancelled and more worry for patients and are putting a significant strain on staff.

During December’s and this week’s strikes, the NHS’s priority has been to protect patient safety. Resources have been channelled into urgent and emergency care, including vital neonatal and maternity services. Huge efforts were made to make the most of the working days between Christmas and new year, because throughout any strike action, it is crucial that every patient who needs urgent medical care comes forward as normal. We continue to face challenges, and strikes have stretched emergency care, but thanks to the meticulous hard work in local trusts in preparing for strikes, as well as to the huge personal sacrifices that clinicians and staff are making to pick up the slack, emergency care has largely held up and the system has coped under the circumstances.

Staff across the NHS deserve our sincerest thanks for the heroic efforts they have made throughout the unprecedented strikes. I thank the doctors, nurses, paramedics and all frontline staff who have come into work to support each other, deliver care and protect patients; the consultants, including Members of this House, who are working extra hours, cancelling their holidays or even coming out of retirement to safeguard patient safety; the managers, administrators and NHS leaders who are working day and night to make sure that the right staff are in the right place to protect patient safety; and all those working in social care, from local authority staff to care workers and carers, who have rallied round to support hospitals.

I know that work does not stop when the strikes stop. NHS staff will begin turning their attention to recovering from the impact of the industrial action, restarting elective treatment and improving the flow of patients through emergency departments. The junior doctors committee’s choice to strike at this time of year means that that work must now be done under additional pressures, as staff move to catch up from industrial action as well as tackling the impacts of cold weather, Covid, flu and norovirus.

I want to find fair and reasonable solutions to industrial action. One of my first acts as Health and Social Care Secretary was to bring in the British Medical Association for talks to end these long-running disputes, as well as meeting representatives for Agenda for Change unions who speak for frontline staff, including nurses. We have reached agreements with unions that represent consultants and specialty doctors on offers to be put to their members. Those offers will modernise contracts, realign pay scales and improve doctors’ career progression, while delivering value for the taxpayer and protecting the hard-won progress we have made to halve inflation. Consultants and specialty doctors are pausing strike action while members vote on the offers, with the results of both ballots expected shortly. The Government and BMA agree that they are the best deals available to us, and I very much hope that members will vote in favour so that those positive changes can be made and we can move the NHS forward.

On junior doctor negotiations, the talks that began in November had been progressing with the BMA junior doctors committee. The talks were constructive, exploring a range of proposals that would improve the working lives of doctors across the NHS. I was therefore extremely disappointed when the BMA turned its back on the negotiations before they had concluded to call the damaging strikes that we face today. The Government will not negotiate with the BMA while strike action is under way and patient safety is at risk. Every strike is hugely disruptive for our NHS. The NHS and patient safety cannot be switched on and off on a whim. I do not believe it right to negotiate with unions while they are being unreasonable and some of their members are walking out of hospitals at the busiest and most challenging time of year for patients.

I remind the House that the junior doctors committee’s headline demand of a 35% pay rise is simply unaffordable for taxpayers. Last summer, we accepted the recommendations of the independent pay review body in full. That meant that junior doctors received average pay rises of almost 9% in their September pay packets—some of the most generous increases across the entire public sector. Meeting the 35% demand would stoke inflation just as we as a country have halved it, burning a hole in the pockets of families up and down the country, and it would be totally out of step with the pay rises awarded to other dedicated public servants and employees throughout the private sector. Staff across the public sector have agreed fair and reasonable deals on pay; only the junior doctors committee has repeatedly walked away from talks.

Let me address the issue of NHS leaders asking some junior doctors to return to work when patient safety is at risk, in what are known as patient safety mitigations or derogations. As of 9.30 this morning, 40 patient safety mitigations have been submitted during the current round of strikes, and two have been accepted by the BMA. NHS leaders, many of whom are themselves members of the BMA, have decades of combined experience. They know their patients and they know their rotas, and they would ask for mitigations only if they were absolutely necessary—in, for example, a children’s emergency department. They are wholly independent of Government: it is for them to make those decisions. I trust them and I trust their judgment. That is the reality, and that is the truth about patient safety mitigations.

One of the reasons why I came into politics was the NHS and what it had done for me and my family. That is also one of the reasons why I am a Conservative. This is a Government who have delivered record NHS funding, the first ever NHS long-term workforce plan, and 50,000 more nurses for our NHS. We are providing the NHS with the doctors it needs for the future by doubling the number of medical school places, opening five new medical schools and pioneering one of the world’s first medical apprenticeships. We have also supported doctors by making changes to pensions for those at the very top of their career path—at that point, that was the BMA’s number 1 ask, and a policy that the Opposition seemed to oppose.

Those are not the actions of a Government who are turning their back on the NHS, as some have declared. They are the actions of a Government who are building a health and social care system that is sustainable for the long term. To do that, we must put the strikes behind us and move forward together, because the NHS belongs not just to the junior doctors committee: it belongs to us all. It belongs to the millions of people who rely on its being there when they need care, as well as the millions of taxpayers who pay for it. For their benefit, it is time for the members of the junior doctors committee to show that they are serious about doing a deal. They have legitimate concerns about their working lives, and a fair and reasonable deal can be reached, but calling damaging strikes is not the way in which to achieve that. Earlier this week I said that if they called off their damaging strike action, I would get round the table with them in 20 minutes. I am, of course, extremely disappointed that they refused my offer, and continue to refuse it—the strikes are ongoing as we speak—but if they come to the negotiating table with reasonable expectations, I will sit down with them.

This Government have a clear, long-term plan for the NHS. Our recovery plans in elective, emergency and primary care can improve access to treatment, transform services, and give patients more choice in and control over their care. Our long-term workforce plan will give the NHS the staff it needs to thrive for decades to come, our social care reforms will build a better care workforce to support our growing number of older people, and by creating the first smoke-free generation we will reduce long-term pressure on our health service. We have eliminated the longest waits, but we have not yet made a significant enough reduction in waiting lists. To do that, we need the junior doctors committee to come to the table and do a deal that is in the interests of patients, in the interests of our NHS, and in the national interest. Then we can build an NHS that is not only stronger today, but stronger for our children and grandchildren.

I commend this Statement to the House.”

15:03

[Baroness Merron (Lab)]

My Lords, the Government’s urgent and emergency care recovery plan promised the largest and fastest ever improvement in emergency waiting times in the NHS’s history. Yet it has not delivered in preparing the NHS for the winter, which we should remind ourselves is a season that, as sure as eggs are eggs, appears every single year. It should be no surprise to any of us, including the Government.

To take just one shortcoming, the plan talked about lowering bed occupancy rates as “fundamental”, yet in November, at the start of winter, bed occupancy was at its highest level since the start of Covid. It stood at 94.8%, a level which will surely lead to serious issues. Did the Government consider taking any additional action to lower occupancy rates? What steps will they now take to ensure that this is not simply repeated every single year?

Today, there have been a number of reports in the media, and I want to refer to two of them. We have read reports that NHS England has confirmed that the NHS is failing to meet all of its key targets: patients are waiting even longer in A&E, even longer to start routine treatment, even longer for cancer diagnosis and treatment, and even longer to be admitted to hospital or for an ambulance to arrive. This is a damning indictment. Perhaps the Minister could tell us the Government’s response to the reports of NHS England today. Also in the news, the Health Service Journal reported that trusts are being told by service commissioners for Lancashire and South Cumbria that, due to the expected deficit, they should plan for a 10% cut in contract values on top of the annual efficiency savings that they are already planning for next year. What is the Minister’s response to this worrying situation? How will it affect services, not just in winter but all year round? How many other trusts across the country are in a similar position?

I would like to pick up a matter strongly defended by the Secretary of State in the other place when this Statement was first made to Parliament—the matter of 800 new ambulances. These ambulances were promised by the Government to help NHS trusts tackle the crisis of ever-worsening response times. But freedom of information requests found that, across 10 of the 11 ambulance trusts in England, there were plans to order only 51 new ambulances. I would like to give the opportunity to the Minister to share any information that is missing from the responses from ambulance trusts that would show that the information referred to in the FOI request was mistaken in some way. Perhaps the Minister could also provide more detail on what NHS England referred to as a problem in procurement due to the impact of global supply chain pressures, and on whether and when it is expected pressure will subside, so that we will see all the promised new ambulances. What performance improvements are to be expected from the 51 new ambulances that we know have been ordered? How would this compare with the full 800 that were promised, had they been procured?

The Government’s Statement presents as a combination of somewhat selectively chosen numbers and situations that do not recognise the reality of a health service in which patients cannot get appointments with their doctors, dentistry is in crisis, and unprecedented numbers of people are having to wait unduly for surgery, cancer diagnosis and treatment, and their ambulances—and all of this while striking doctors are being blamed for the whole situation. The strike action by junior doctors has been the longest in NHS history, with trusts declaring critical incidents and A&E departments telling some patients to stay away to lessen the load. This is a situation that I am sure the Minister will tell us cannot continue, but it continues to disappoint that the Government do not see it as their responsibility to show leadership and resolve the dispute. Could the Minister advise the House of the steps the Government are now taking, or will take, to ensure that we do not see a continuation of this damaging situation?

Finally, I would be keen to hear from the Minister on an aspect of the winter health situation which was not mentioned in the Statement regarding Covid. In the run-up to Christmas, according to the Office for National Statistics, 2.5 million people were thought to have Covid. What assessment have the Government made of this increased prevalence and what impact has it had on the NHS so far this winter? What assessment have the Government made of how the impact may continue? I look forward to the Minister’s response.

[Lord Allan of Hallam (LD)]

My Lords, we should start by recognising and thanking the nearly 3 million health and care workers whom we depend on all year but who have to work especially hard during the winter months. We should also show our appreciation for the many millions more informal carers who spent the festive period looking after family and friends. That was the nice bit, but I now turn to some questions for the Government on what I thought was a predictably upbeat, “It’s all going swimmingly except for the strike” Statement; yet within it there were some significant gaps, some of which the noble Baroness, Lady Merron, pointed out.

It is notable that the Statement says nothing about primary care but instead focuses very much on hospital beds, which I will come to next. Can the Minister comment on how GP appointment waiting times remain unacceptably long in many parts of the country? This is a poor outcome both of itself and in terms of the knock-on effect it has on emergency services. I hope that the Minister can confirm that the Government have been monitoring GP waiting times during the winter months, and that he can indicate what they are doing about these.

The Government say they have added 3,000 hospital beds as part of their 5,000 target. That target was part of their response to last year’s crisis. Does the Minister have any new data on the utilisation of those beds and whether this matches up with the predictions the Government made when they set the target, and any analysis they made to come up with the 5,000 number in the first place? The Statement also highlights the 11,000 virtual beds that are now available, which instinctively seems like a positive development to me. But the important thing is how a broad range of people experience these and the health outcomes they deliver. What are the Government doing systematically to collect data about those virtual beds and whether they have been able to deliver a comparable level of care for people who are suffering during the winter pressures?

Another key area of delivering emergency care in winter is the availability of ambulances, which was rightly flagged by the noble Baroness, Lady Merron. The Minister may have seen a report in the Health Service Journal from 30 November last year, which said that in some areas there is a mismatch between the number of paramedics recruited and the number of ambulances available. It is great that the paramedics have been recruited, but if they are sitting around in the base stations because the vehicles are not there, that does not deliver the improved waiting times we are all looking for. I hope the Minister can comment on this report and whether the Government are able to deliver the vehicles in lockstep with the newly trained paramedics, which is what we all wish to see.

A further element of the response is the 111 service for less-urgent services, which, again, is not mentioned in the Statement. There are concerns about whether people are being directed to the right place—111, GPs, 999 or accident and emergency departments. Are the Government monitoring the performance of 111 in respect of flu, Covid and other winter respiratory diseases?

Finally, we have often discussed patient flow through hospital and out into the community with the Minister, who I know takes a particular interest in this. We know that some trusts are piloting systems to improve flow that could be described as like hotel booking systems that enable beds to be made available in a much more efficient and timely fashion. Will the Government compare the performance of trusts that have these systems in place with those that do not, as they go through this acute period of pressure in the winter months?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I wish everyone a happy new year and share in the thanks given by noble Lord, Lord Allan—and, I am sure, the noble Baroness, Lady Merron—for the hard work all the staff put in over the Christmas period. We have done a lot of work to prepare for this winter, and that was based on expanding supply. I will go into more detail in answering the questions so far, but that included the 5,000 additional beds, of which 4,000 are currently in place. It included the 11,000 virtual wards and 800 new ambulances, and again, I will answer some of the specific questions about the utilisation of those. It included the £600 million for adult social care discharge and the 141 CDCs, with 6 million more diagnostic tests, and the 50,000 increase in nurses—as well as mental health.

Of course, there have also been 50 million more primary care appointments since 2019, to answer the point made by the noble Lord, Lord Allan. That was accompanied by extensive planning, as I have seen. We have really tried to learn a lot of lessons from last year and get ahead of the curve with earlier plans, putting key management support teams in place to provide help in the areas where it is most needed. Everything is underpinned by a stronger technology infrastructure, digitalisation and the patient flow systems.

We are really trying to get ahead, so we brought forward the flu and Covid vaccines, so that, hopefully, we can make the situation better. I will not say that it is anything more than early days, or that one swallow makes a summer, but there are some promising early signs. On ambulance handovers, we have seen a 20% reduction in lost hours. The figure for category 2 response times is 45 minutes; it is still too long, but it is half that for this time last year. As for patient flow and the use of the system, we have seen a 10% reduction in so-called bed blocking, partly because of the flow mechanisms and partly as a result of early investment in the discharge fund.

All that is against the background of increased activity—and, of course, the strikes. To date, they have cost us 1.3 million lost appointments, 113,000 most recently. I say to the noble Baroness, Lady Merron, that we have tried to behave in a reasonable manner. We have reached agreements with all the other professions—the nurses, physicians, consultants and specialist doctors—and we have shown leadership, alongside the unions, in doing so. In contrast with that reasonable behaviour, the 35% pay demand is not reasonable, and nor is planning strike action at the busiest time of the year. Coming out only twice, when you have been asked 40 times by NHS trusts to act on patient safety, is also not reasonable behaviour. We want to resolve this issue. We have shown a capacity to resolve it in other areas, and we have shown leadership. I ask the BMA and junior doctors to come forward with reasonable expectations, and let us resolve this right now.

I have a polite suggestion to make. I thought that the noble Baroness, Lady Merron, might raise the issue of NHS targets. People know that I am a reasonable person, and the last thing I am going to do is say that all is rosy in the garden, but we are showing some solid improvement. I am definitely not happy with the fact that the England targets for a four-hour wait and 62-day cancer care were last met in July 2015. But I note that they have never been reached in Wales, which Labour has been running. In Wales, the 62-day cancer care target was last reached in 2010. Also, if you are in Wales, you are much more likely to be on a waiting list: 21% of the population are on a waiting list, compared with 13% here. In Wales, you are likely to wait five weeks longer, on average; and 50% of the time, you will wait for more than four hours in A&E, compared with 40% in England.

The England results need to be better, and we are working to make them better, but I politely suggest that the Opposition might want to look at where they are running the NHS and see what they can do to improve that, because on every standard you see a poorer performance from the Labour action in Wales. That is what all the evidence tells us.

I will try to answer some of the specific points. On ambulances, 300 new vehicles have been delivered to date. There is an issue with one supplier, but we are confident that the 800 new vehicles will be delivered. It is those, alongside the paramedics, that are allowing us to address ambulance wait times and bring them down. The 111 number is now on the app and is really directing traffic; it is up 8% versus last year, so, again, we are seeing real improvements. I think I mentioned that patient flow is improving as well.

On Covid, bringing forward the vaccinations has been helpful in terms of prevention. While we would all accept that 2.5 million is a large number, if we look at the number of beds being taken up by Covid and flu this year, we can see that it is half the number that it was last year. It is still a big number, but it is half what it was. We are in the early stages and a lot more work is needed, but one reason we are starting to see these improvements is that we have tried to get ahead of the curve with those vaccinations.

As regards virtual wards, so far we have about 70% utilisation of those. We need to collect the data; noble Lords have heard me say before that the results from virtual wards in places such as Watford and elsewhere show good results in terms of both satisfaction and, most importantly, not returning to hospital. Where people have gone into a virtual ward rather than just going home, there has been a reduction of as much as 50% in people having to return to hospital environments. So we are seeing results.

In terms of primary care, as I mentioned, we have seen 50 million more appointments take place. Pharmacy First, which will be introduced shortly, is a key way of expanding that supply still further. So I say politely that, yes, there is a lot more work that will need to be done, but we really have expanded supply. We have put plans in place, and the early signs are promising. I hope, like all of us, that we will see far more of this and I look forward to updating the House as the season progresses.

15:22

[Lord Winston (Lab)]

My Lords, we are very grateful to hear the increasing focus on the need for urgent ambulance care. Obviously, for personal reasons, I am very grateful for that, because this is the sort of time when those things happen. I wonder, however, whether I could probe the Minister a little more. With regard to Covid, my impression—from making inquiries to various centres in London—is that the uptake has not been as good as they had expected. Does the Minister feel that we are doing enough to ensure that in particular those who are most vulnerable are coming to get vaccinated, first for flu and secondly, of course, for the coronavirus?

[Lord Markham (Con)]

The noble Lord is correct; London is always our most challenging place. I have found that across the board, funnily enough. He is right in terms of Covid and flu vaccinations, but it is also the case for the take-up of all sorts of different services. We see technology as a key enabler; in fact, the number of people who have booked their vaccinations and follow-up through the app has multiplied significantly. I do not have the precise figures in my head, but they really have gone up. A lot of that is through people seeing their reminder through the app as well. It is recognised that London in particular needs more targeted action—in fact, noble Lords will see an advertising campaign come out in the next couple of weeks or so. We are really trying to promote usage of the app, which is a tool for all these sorts of things as well.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare that I am a registered doctor with the GMC. I live in Wales, but I do not want to get into data-hurling over Wales, but I do have a comment to make. I would like to follow up on the question from the noble Lord, Lord Allan of Hallam, about virtual wards. The Minister may be unable to tell us now, but how many of those patients were actually terminally ill; how many of the virtual wards were providing 24/7 effective cover for these patients; and what is happening across the whole country in relation to 24/7 palliative care cover? All the evidence that is emerging is that it really is grossly inadequate. Families are left unable to access the care and support they need.

Ten years ago, NICE recommended that every area in England should have a helpline so that families can phone if there is a crisis, 24/7, when they are looking after someone with palliative care needs at home; yet the Marie Curie report Mind the Gaps—I should declare that I am a vice-president of Marie Curie—which has been developed with the Cicely Saunders Institute—again, I should declare my interest there as an international adviser—has shown that only one in three areas has such a helpline available. Two-thirds of the country has nowhere for people to phone.

Is the Minister prepared to meet me and others from palliative care to mirror what is happening in Ireland now? From this February, the Irish Government will be funding 100% of hospice clinical services, because they have recognised the inadequacy of relying on voluntary sector funding. We know that good care costs less than poor care. We know that where there is good palliative care in place, with 24/7 support, the number of emergency admissions goes down, the pressure on acute beds goes down and inappropriate transfers drop. Although I am not expecting an answer today, I hope the Minister will seriously consider looking at that situation.

I shall just make a comment from Wales and point out that in Wales, paramedics are now being trained specifically in palliative care. Some consultant paramedics are now attached to palliative care teams and are able to administer palliative care drugs out of hours as required.

My other question for the Minister is on what discussions he has had with the GMC over retention. Those doctors who were temporarily registered have received notice that, as from March, for those who had retired, their temporary registration because of Covid will cease. I just wonder, with the figures we have seen come out today, whether it would be wise to negotiate with the GMC, first, for that to be deferred and, secondly, for all those doctors to be contacted and asked directly how they would like to contribute to improving some of the services. There is a lot of skill there which is currently being unused and underutilised. Again, I guess I should declare an interest because my husband is a dermatologist and has been in that position but has never been called up and would have been quite willing to go and help with clinics. Those are some of my questions for the Minister.

[Lord Markham (Con)]

I thank the noble Baroness for those points. Absolutely, I will need to come back on some of the detail on the virtual wards and how they are being used. One thing I will say about them, though, from my knowledge, is that the ability of people to communicate on a regular basis is one of the key advantages. On the point she makes about palliative care and the ability to have 24/7 communication, the beauty of the virtual wards is that they have that inbuilt, for want of a better word—they have that advantage. As noble Lords know, I am always eager to learn from practices all around the world, so I will very happily meet people and learn from them.

On retention, absolutely, we all know that the supply of doctors and medics is the key thing that we need, so I personally feel that we need to look at every avenue to make sure that we can maximise that supply. Again, it is something that I will inquire into as a result of that, and maybe when we have our meeting we can discuss that further.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I too thank the Minister for the Statement and his response, but it takes the biscuit in terms of the Government really seeking to exploit the plight of the NHS by putting so much emphasis on the industrial action being taken. As the noble Lord has said, even before Covid the Government were way off meeting any of the core targets. In 2010, they inherited a health service that was running very well and met all the targets. They threw away that inheritance. When Covid hit, the health services were already running so hot that there was just no headroom at all to cope with the pressure that then came, with—my noble friend is right—hugely dangerous occupancy rates. There was simply no headroom.

Looking at the funding, from 1948 to 2019-20 the NHS received funding of 3.6% real annual growth, on average, per annum. The coalition Government slashed it to 1.1%. The May and Cameron Governments gave it 1.7%. Only with the Covid expansion were resources over that 3.6% average. It is no wonder that the health service is tackling such a momentous challenge. We need to hear from the Government some real plans to get investment back in the health service, to give it the kind of headroom it needs to start meeting the targets that are so important—would the Minister agree?

[Lord Markham (Con)]

I happily agree that we are investing record sums. The latest figures show that we are investing around about 11% of GDP in the National Health Service. I believe the figure in 2010 was somewhere in the 7% to 8% range—I am speaking from memory and so I will correct that if it is not quite right, but that is the sort of massive expansion we have seen. If I take one area as an example, the cancer workforce has trebled since 2010.

What we are seeing more than ever is a record level of investment in the health service but also a record level of demand. I was hoping to show in the Statement how we are looking to tackle that. I will freely admit the challenges, and that it is early days, but I believe we are showing signs of getting on top of it. As I have said many times, I really think that technology will be its future, and there will be lots more we can talk about when we show the profound changes it is going to make.

[Baroness Bennett of Manor Castle (GP)]

My Lords, one in seven UK-trained doctors has left the country to practise overseas. That is some 18,000 doctors, a figure which is up 50% since 2008. Last year, the General Medical Council did a survey of doctors departing the UK to practise overseas, and one of the key factors identified was that doctors were leaving to work in a place where they felt supported by the state and the employer. Does the Minister believe that the Statement—the Government’s general position—is sending a message to doctors that they are supported and cared for, and truly valued, by the UK Government, given that if we look at the financial valuation, junior doctors’ salaries are down 24% in real terms since 2009?

This is obviously an issue of money, but it is also an issue of attitude. Have the Government got their attitude to the junior doctors terribly wrong?

[Lord Markham (Con)]

I agree with the sentiment expressed by the noble Baroness. Clearly, we want to make sure that we minimise any loss to the profession. Retention is key. The long-term workforce plan was all about trying to put a long-term footing in place, one which looked at not just the recruitment of doctors but their retention, which, as I say, is key.

Money is an element of that, clearly. As I say, I have not heard or seen anyone suggesting that we should be paying the 35% increase. I do not think that is a reasonable approach; I have not heard any noble Lords come forward and say that. The correct attitude of the noble Baroness is key as well. We need to make sure that we get that right and I like to think that we are trying to do that. The Secretary of State has been very positive in terms of trying to do that as well. I absolutely agree that, at the end of the day, this is a key workforce and its members need to feel that they are key, rewarded and motivated by what they are doing. That is key to any profession.