(7 years, 8 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
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I congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing this debate, on his all-party group’s excellent report and, indeed, on all the work he does on HIV and AIDS. I draw attention to my entry in the Register of Members’ Financial Interests and declare an interest: I am a trustee of the Terrence Higgins Trust.
The hon. Member for Finchley and Golders Green is absolutely right, as is his report, on the impact of the Health and Social Care Act 2012 passed in the previous Parliament. I am sure the Minister has read not only his APPG’s report but the Health Committee report that we published last year on public health in general and the impact of that 2012 legislation on the delivery of public health, and particularly the delivery of sexual health and HIV services across the country.
The hon. Gentleman is right that, in our report, we identified a number of problems and challenges with the new landscape and commissioning structure. We heard from people up and down the country in evidence—HIV/AIDS organisations, those who work in sexual health, consultants and virtually everyone else—that the area that has been hit most negatively by the Health and Social Care Act and the changes in commissioning arrangements are HIV services and sexual health services more generally. We all have our own ideas of why that might be the case. Although the jury is still out about the decision to pass the responsibility for public health to local authorities, there were concerns expressed at the time of the Health and Social Care Act—some of us warned the then Health Secretary, Andrew Lansley—about the potential impact of giving local authorities the responsibility for HIV support and other sexual health services, but I am afraid those concerns were not listened to. I hope the Minister will explain to hon. Members and to the country at large what monitoring the Government have been doing on the impact of the Act on services and what measures or action the Government will take as a result of anything they find.
I agree with the right hon. Gentleman. Does he agree that one challenge is the fact that local authorities are now commissioning the provision of health services in complete isolation from many of the other HIV and associated services? That is very different from our general understanding of public health at the core of the Act—it is a fault.
I completely agree with that point. The different commissioning responsibilities for different bits of sexual health and HIV and AIDS are all over the place. On top of that, although the Government can, with some justification, claim to have protected NHS spending in cash terms if not in real terms, they cannot claim to have done that when it comes to public health, which has taken significant cuts and will continue to take significant cuts over the next few years. Of course, those cuts are being imposed on local government. As the hon. Gentleman and other hon. Members know, local government faces huge financial challenges across the piece. There is also the threat of the withdrawal of the ring fence on public health funding in the next two or three years. In our report we made it clear that we thought that was a risky move indeed.
I do not want to repeat a lot of what was said by the hon. Member for Finchley and Golders Green, who made a comprehensive and excellent speech, but I hope the Minister will explain to us what monitoring the Government are doing on the impact. What will they do in response both to the concerns raised and the recommendations of the all-party group report and our Select Committee report to address the problems? We have known about them for some time—our report is now more than a year old.
The news about PrEP is very welcome, but will the Minster clarify the timing of the commencement of the trial? While we are on the subject, another potentially welcome development is the big fall-off in HIV presentations or positive tests at some of the London clinics in the past few months, which some people suggest may be to do with the availability of PrEP. Can the Minister tell us whether she has made an assessment as to whether that is the case, in which case it is a promising development indeed?
Finally, one of the things that concerns me is the plight of older people living with HIV and AIDS. Around a third of the people in Britain now living with HIV and AIDS are over 50. About 60% of them live at or below the poverty line. When many of them were originally diagnosed, they did not expect to have a long life expectancy, but they are still here thanks to the fantastic treatment and care that has been invented and developed, which has not only helped to keep people alive but enabled them to lead lives of reasonable quality. Back when they were diagnosed, they may have been less cautious about spending their money to get by at that time, and now they find themselves hopefully with many years stretching ahead and no more means at their disposal, so there is a particular challenge when it comes to older people living with HIV and AIDS. That will require the Department of Health to work more closely with the Department for Work and Pensions. Some of the people that my charity—the Terrence Higgins Trust—deals with face problems when it comes to benefits and benefits sanctions. Those sorts of things add extra pressure and misery to the challenges that people living with HIV already face.
I apologise for arriving late and missing the start of the debate, Mrs Main, but I was waiting to speak in the Prime Minister’s statement. It is a pleasure to serve under your chairmanship again. I long for the day when I can get called as quickly as my right hon. Friend the Member for Exeter (Mr Bradshaw), who gets called with such speed and alacrity.
I long for that day as well, but that is in the lap of the electorate. I also thank the hon. Member for Finchley and Golders Green (Mike Freer). He heads up some incredible work by the all-party group, which has provided remarkable and concise information that is usable not only within the sector, but by a great number of people, to advocate for the challenges of people living with HIV and AIDS and to help to explain the broader issues people face. The reports are read by a great many individuals, and not only by experts in the subject, which is a credit to him. His wide-ranging speech—the last three quarters that I caught—was exceptional, and I am grateful to have been here for it.
I represent the city of Brighton and Hove, which has more than four times the national average HIV contraction rates and people living with HIV. That places an additional onus on me to give voice to both the sector and the individuals who live with this long-term condition. I am a representative for that city and for the gay community. When I was on the board of Pride, I spent a lot of time trying to understand the fabric of the support services going to people living with HIV, and I have done so with even more enthusiasm and dedication since being elected as an MP.
I am proud that we have incredible preventive work in Brighton and Hove. THT, Stonewall and local groups, co-ordinated through the LGBT Forum, have done remarkable work on prevention. It is a sadness that they do not have all of the tools that they call for, including PrEP, at their disposal. I know that the issue has been aired by other Members today, so I will not go into any more detail on that, but the grassroots and the people working on the frontline in Brighton and Hove are absolutely enthusiastically calling for that.
The public health ring fence will remain in place until 2019.
We also recognise, as recommendation 1 makes clear, that HIV support services are an important part of the overall care that people diagnosed with HIV receive to support their health and wellbeing. I have heard hon. Members’ concerns today about such services being decommissioned because of budget pressures. We are increasing our focus on supporting and improving place-based commissioning, and will work to provide the right opportunities for all commissioners and providers involved in a care pathway to work together to secure the right service response for the needs of the local population, taking into account each partner’s responsibilities.
In line with a number of the recommendations, we also need to ensure that we make the most effective and efficient use of the resources available. We are already seeing some really effective examples of that in the Public Health England HIV innovation fund, which supports voluntary sector-led projects across the country that are focusing, as my hon. Friend the Member for Finchley and Golders Green knows only too well, on HIV prevention and testing. That includes the OutREACH project in Cumbria, which is using community pharmacists to provide HIV testing in a rural area with very high rates of late HIV diagnosis, and the MESMAC project in Yorkshire, which is providing HIV awareness training and testing at a hostel housing migrants who are claiming refugee status in the UK. We are also encouraging innovations such as home testing. Our aim this year is to see 50,000 tests for HIV carried out at home. They are already starting to make a difference. The introduction of compulsory relationships and sexuality education will, as my hon. Friend says, have an important role to play in prevention.
I was very sorry to hear the comments made by the hon. Member for Hove (Peter Kyle) about the Sussex Beacon. I am sure that, given his account of the clear local need and the quality of the service, he is holding local commissioners to account for their decision making. I am afraid that my recollection is that I had responded to him on that matter, and not an arm’s-length body. I am very sorry if there has been confusion, but I am happy to continue the discussion following this debate, so that we can clear it up and ensure that we make progress on it. I would not like him to think that we do not take it very seriously indeed.
As we all know, delivering high-quality HIV services is about not just funding, but getting the commissioning right. As the report highlights, a lot of work still needs to be done to ensure that the commissioning landscape for the services supports effective collaboration and co-operation, so that we can continue to see improvements in these and other outcomes. That is exactly why Public Health England commissioned a sexual health commissioning survey, which very much supports the findings of both the Health Committee and APPG reports.
I recognise that commissioning sexual health and HIV services is complex, given the range of services and the different population needs that are covered under the broad umbrella of sexual and reproductive health and HIV. We are very alive to and are working to address the risk of fragmentation damaging the progress that we have made, so I am particularly pleased to announce that, shortly, Public Health England will launch an action plan to support commissioners and ensure that they can provide the sexual health and HIV services that their populations need.
As its first priority, Public Health England will look for ways in which to reduce the fragmentation of commissioning and address the barriers that stop effective collaboration and co-operation between commissioners. That will include encouraging the development of a model of lead integrated commissioning in each locality, including developing models for out-of-area tariffs and other issues that can slow down contracts and increase costs. PHE will also identify system leaders across the country to lead local sexual health, reproductive health and HIV commissioning in an agreed locality and form a national network of commissioning leads to promote the effective national development of commissioning.
To test out how that might work in practice, PHE will pilot local delivery models working with local authorities and CCGs to help to build on effective models of commissioning. We will announce the names of the pilot sites shortly—the work is still in the early stages of implementation—but I take this opportunity to urge any areas that are interested in working with us to get in touch with PHE and to take part in developing the work as it takes shape.
I warmly welcome what the Minister has just announced. When the pilots are up and running and have delivered results, if it is necessary to revisit some of the structural and commissioning changes that were made under the Health and Social Care Act and which caused the problems in the first place, would she be open to doing so? On the ring fence, if she is going to delay its removal by a year, she might as well have a proper review of that, given the concerns out there about the impact of removing it on public health funding and spending in general.
I think the right hon. Gentleman slightly misunderstood me on the ring fence. We have kept it because we believe that transparency and accountability measures need to be put in place, so that when local authorities move to business rates retention, their decisions can be made in an appropriately accountable way that can be scrutinised properly. We do not feel as though we have that yet, so we have moved the date back a bit. We want to do that effectively and to have proper consultation on the mandate. On his other point, I think it is a bit early in the process to start discussing that.
Given the time, let me move on to service specifications. During the debate we have heard examples of contracts for sexual health services becoming divorced from the provision of HIV services. A key recommendation from the APPG report was to create a joint service specification for sexual health and HIV services. We recognise that the existing service specification for sexual health needs strengthening, which is why it is now being updated. PHE has committed to building on existing commissioning guidance to provide more focused advice and examples of locally designed systems to support the commissioning of HIV and sexual health services.
NHS England is responsible for the service specification for HIV treatment and care, and we think that that remains a sensible division. However, the development of a new integrated service specification for sexual health services will allow us the opportunity to join up our advice to produce a more integrated offer.
I want to recognise the continuing priority of PrEP, which many colleagues mentioned, and the trial that was announced last year by PHE and NHS England. Up to £10 million has been set aside to fund the trial, which is anticipated to include at least 10,000 participants over the next three years. We expect the trial to be under way this summer. It has the potential to change the lives of thousands of people who are at risk of contracting HIV.
(7 years, 8 months ago)
Commons ChamberThere is no greater champion for Somerset than my hon. Friend. What I would say to her is what I would say to all medical students, which is that general practice is going to be the biggest area of expansion in the NHS over the coming years; in fact, we are planning to have the biggest increase in GPs in the history of the NHS.
It will take many years for the doctors the Secretary of State has just talked about to come on stream, and we have a workforce crisis in the NHS now, partly because of the cuts the Government made in the last Parliament, but also because of their irrational pursuit of the hardest of Brexits. He could do something very simple today to address this crisis in the short term, and that is to announce that all EU nationals who do vital work in our NHS will be able to stay when we leave the European Union.
(7 years, 9 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
I think there is a consensus in Westminster Hall, informed by multiple Select Committee reports that have highlighted the crisis in our health and social care system. My clinical commissioning group is facing a £40 million deficit. My local hospital, which is one of the best run in the country, is facing a £20 million deficit. It is obvious that that simply is not sustainable.
As other colleagues have pointed out, accident and emergency figures are deteriorating, waiting times are lengthening and there are increasing difficulties in seeing a GP. In Devon, we face controversial plans to close community hospital beds and to close a number of community hospitals completely. That is not an accident; it is the result of seven years of the most stringent restraint on NHS investment in its history, combined with 40% cuts to social care when we have a growing elderly population and increasing demand. The issue was exacerbated by the disastrous Lansley reforms in the Health and Social Care Act 2012—the biggest structural upheaval in the NHS’s history— implemented at the same time as maximum spending restraint.
As well as that organisational upheaval, we face a workforce crisis in health and social care, as the Chair of the Select Committee, the hon. Member for Totnes (Dr Wollaston), pointed out. That has been exacerbated by the uncertainty over Brexit. Until recently, the Government have appeared pretty oblivious to all that. The £2 billion extra in the Budget was welcome, but it is a drop in the ocean compared with the amount of money that is needed.
I welcome the commitment in the Green Paper to look root and branch at a sustainable funding solution for health and social care. I worry, however, that a Green Paper is often a euphemism for kicking an issue into the green grass. I would like to see a policy announcement or a White Paper. As colleagues have pointed out, we have had much cross-party support. One proposal was scuppered in the run-up to the last general election. I worry that to grapple with the issue in the second half of a Parliament is not sensible timing. Governments need to get a grip on the issue at the beginning of a Parliament so that there is maximum time for cross-party working to get something in place. I am not optimistic that the Green Paper will come to a conclusion.
We also need to have an honest conversation with the British public about how we fund health and social care. I share Members’ regret that the Chancellor seems to have ruled out any sort of posthumous levy on people’s estates. We need to look at all options, including the excellent sugar tax that was recommended by our Select Committee. It is already having a dramatic effect in getting drinks manufacturers to reduce the sugar in their products and therefore improve public health.
Finally, we would like the Government to end the uncertainty over EU nationals working here in our health and social care system. They could do that today when the Prime Minister stands up in the House and gives her statement on article 50. That would give a huge boost to morale and end the uncertainty. People are already leaving, and the system is not able to recruit. That workforce crisis will do more damage in the short term than anything else.
As I just said, the STPs provide an opportunity for areas to place greater focus on respite care if they consider that to be required.
I would like to touch on the adequacy of the social care funding package. The announcement means that in the next three years councils will have access to some £9.25 billion of more dedicated funding. That includes extra money going to local authorities through the combination of the improved better care fund and the social care precept, which, for those councils introducing it with effect from next month, will raise some £1 billion extra. The £1 billion provided in the Budget and the £1 billion from the precept amount to the £2 billion called for by external sources for the coming year. That funding will allow councils to expand the numbers of people they are able to support and, in turn, address issues at the interface with the NHS such as delayed discharges from hospital, which as we know cause problems with patient flow through the system.
Questions were raised about how the social care funding is to be allocated. I inform colleagues that 90% will be allocated using the improved better care fund formula to local authorities that have responsibility for adult social care. That distribution takes account of the ability to raise money through the council tax precept for social care and means that it is well targeted at areas of greater need and market fragility. However, in recognition of the social care pressures faced by all councils, 10% of the funding will be allocated using the relative needs formula.
The response to the measures from external audiences reflects comments made by hon. Members today: they have been broadly welcomed. Of course, several hon. Members said that it is not enough, but that is a traditional response to any increase in money—it is always easier to say that it is not enough. Hon. Members have generally recognised that the Government have listened to concerns about social funding. Those of us with responsibility for the health service recognise that there has been a particular problem in dealing with delayed discharges from hospital. Through closer working in the sustainability and transformation plans as they are rolled out across the country, with local authorities working more closely with health service providers, we think that the money will provide a lifeline to help to remove some of those pressures and to improve patient flow through our hospitals.
I would like to touch on the medium-term challenge and how in the coming months we can try to use the development of a social care Green Paper to address the longer-term concerns. The Government are committed to establishing a fair and more sustainable basis for funding adult social care in the light of the future demographic challenges that the country faces. We will therefore bring forward proposals to put the state-funded system on a more secure and sustainable long-term footing, setting out plans in a Green Paper. Some hon. Members asked when the Green Paper will be published. If I was in charge of Government timetabling, I would be in a better position to answer. They will not be surprised to hear that I cannot give a definitive answer, but, to use traditional parliamentary language, it would be fair to say that it is expected to be published in the summer.
Will the Minister clarify the Government’s position on the idea of a posthumous levy on estates? The Chancellor ruled that out, yet we read in the newspapers that the Prime Minister slapped him down over that. Are the Government ruling it out or not?
I will not pre-empt anything in the Green Paper, and it is not for me to give the right hon. Gentleman any comfort on discussions that might or might not have happened around the Budget.
We recognise that the NHS and social care face huge pressures and that there is more for us as a Government to do. However, we can be confident that we have plans in place both to cope with the pressures that we currently face—winter, A&E pressures and delayed discharges—and to sustain the system for the future. We have a long-term plan in place through the “Five Year Forward View” and the efficiency work being undertaken and rolled out progressively this year. We have given extra funding to both the NHS and social care to support those plans, and we have plans to bring forward a Green Paper on social care. I am pleased that that was broadly welcomed and recognised by hon. Members and distinguished parliamentarians in the debate, and I am grateful for that support.
(7 years, 9 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
I raised my concerns about the contracting out of the patient record service to SBS back in 2011, and I was told by the Secretary of State’s predecessor that this was about saving money. Will he tell us how much money has been saved, given all the problems, and how many of the 708,000 patients affected are in the south-west?
The south-west was one of the regions affected, as I mentioned in my statement. I am happy to write to the right hon. Gentleman to tell him exactly how many patients I think were affected in the south-west. I gently say to him that the use of the private sector was championed when his Government were in office and when he was a Health Minister. I know that this is not very fashionable in his party at the moment, but on this side of the House, we think that if we want the NHS to be the safest and best in the world, we should be open—
Order. The right hon. Member for Exeter (Mr Bradshaw) is shouting noisily from a sedentary position. I cannot imagine that that is an offence that I would have committed when I sat on the Opposition Benches. I just do not think it would have happened. I do not know what has happened to standards.
Objection to the manner and content of a ministerial response is not a novel phenomenon in the House of Commons.
(7 years, 10 months ago)
Commons ChamberMy hon. Friend is absolutely right. It is a national health service, not an international health service. I was disappointed to see comments from the Opposition yesterday that the money this would raise would be a drop in the ocean—[Hon. Members: “It is.”] We are seeking to raise £500 million. That is enough to finance 5,000 GPs, who could help the constituents of everyone in this House.
Is it not a coincidence that, whenever we hear about disastrous figures for NHS performance and a huge deterioration in waiting times, as we did at the weekend, the Government re-announce yet another measure to crack down on health tourism? Is not the main problem with our health and social care system the fact that it is chronically underfunded, and that this Government are doing nothing about it?
I will tell the right hon. Gentleman what we are doing about the underfunding. We are raising three times more from international visitors than when he was a Health Minister, and that is paying for doctors, nurses and better care for older people in his constituency and in all our constituencies.
(7 years, 11 months ago)
Commons ChamberMy right hon. Friend speaks extremely wisely. At the heart of it, we have a good commitment—the four-hour commitment, which was introduced by a Labour Government. I think it is one of the best things the NHS does: the promise that if someone is ill and needs urgent help, we will do something about it and get them under proper medical care within four hours. However, if we have the situation that NHS England now describes, where up to 30% of the people in A&E departments do not actually need to be there, we risk not being able to deliver that promise for the people who really do need it. That is why looking at how we can control demand from the people who do not need to be in A&Es, such as through the significant increase in investment in general practice and other measures, is going to be vital if we are going to crack this.
The Secretary of State seems to be blaming the public for overwhelming A&E departments, when he well knows that the reason they go to A&E is that they cannot get to see their GP and social care is in crisis. Will he confirm that he has just announced another significant watering-down of the four-hour A&E target, following the watering-down by the coalition in their first year in office back in 2010? What is he personally doing to address the chronic long-term underperformance of hospitals, such as that at Worcester, where two people died on trolleys, and Plymouth, which is one of the hospitals that had to call in the Red Cross over the Christmas period?
I think—probably because of the forum we are in now—the right hon. Gentleman is misinterpreting what I have said, and it needs to be put right. Far from watering down the four-hour target, I have today recommitted the Government to that four-hour target. In just the answer before he spoke—maybe he was not listening—I actually said I thought it was one of the best things about the NHS that we have this four-hour promise. But the public will go to the place where it is easiest to get in front of a doctor quickly, and if we do not recognise that there is an issue with the fact that a number of people who do not need to go to A&Es are using them, and we do not try to address that problem, we will not make A&Es better for his constituents and mine. If he asks what we are doing to turn around hospitals in difficulty, we have introduced the new Care Quality Commission inspection regime and a chief inspector of hospitals—the most rigorous inspection regime in the world, which the Labour party tried to vote down.
(7 years, 11 months ago)
Commons ChamberMy hon. Friend is absolutely right. I thank him for bringing Professor Tim Briggs to see me to explain just how superb this programme is. Infection rates for orthopaedic surgery vary between one in 20 patients in some trusts to one in 500 in others. Getting this right can transform care for patients and save money at the same time.
I associate myself with the Secretary of State’s comments about Berlin, my one-time home.
Does the Secretary of State accept that we have the best clinical leaders anywhere in the world? The challenge facing the NHS is not one of clinical leadership, or the dedication or skill of staff, but one of chronic underfunding by this Conservative Government.
We do indeed have superb clinical leaders, such as Marianne Griffiths at Worthing, which was recently given an outstanding rating. We also have superb non-clinical leaders, such as David Dalton at Salford Royal. I would gently say to the right hon. Gentleman that if he is worried about funding, why did he stand in the election on a platform that would have seen the NHS have £1.3 billion less this year?
(8 years, 1 month ago)
Commons ChamberLet me tell the hon. Lady that what is different now is that we have a special measures regime. When Labour was in power, the problems were swept under the carpet and not dealt with. Now they are being dealt with because we want every NHS patient to have confidence that we will not have another Mid Staffs. That is why we are making very good progress. With respect to funding, may I respectfully tell her that had we followed her party’s spending plans, the NHS would have £1.3 billion less this year?
The Secretary of State will know that with depressing regularity the same hospitals come up on that list that he has just referred to. Sustainability and transformation plans provide the opportunity to address some of the unsustainable elements of local health economies, but only, as my hon. Friend the Member for Lewisham East (Heidi Alexander) says, if the money is there. With the health service facing its tightest financial settlement in its history, these plans are just not deliverable.
The right hon. Gentleman understands health extremely well, both from his ministerial position and from being on the Select Committee. If he looks at the hospitals going into special measures, he will see that we are beginning to succeed in moving hospitals out of special measures, but because we have an independent inspection regime, sometimes other ones go in. That is how it should be. That is what works very well in the education sector and is beginning to work well in driving up standards in health care as well.
To go back to my answer to the hon. Member for Lewisham East (Heidi Alexander), £1.3 billion more in the NHS this year compared with what would have been put into the NHS if Labour had won the last election means 30,000 nurses, 13,000 doctors or 200,000 hip replacements that we are able to do because of this Government’s funding of the NHS.
(8 years, 1 month ago)
Commons ChamberOf course I welcome the increase in staff in our accident and emergency departments. As the Minister will recognise, there is further to go in this regard.
Does the hon. Lady agree that the four-hour A&E target is absolutely vital, because it, more than any other target, shows the overall performance of a hospital, and that the figures are extremely worrying? Does she also share my concern that last winter was very mild, and we were relatively lucky, with the absence of a big winter flu outbreak? If this winter is as cold as this Chamber, the NHS could face a very serious crisis indeed.
Certainly, the evidence we heard in our inquiry was that there is grave concern about the level of existing pressure. As the right hon. Gentleman says, if we see a very cold winter, and the flu vaccine does not work as well as it did last winter, we are in serious difficulties. But I stress again that the Committee was very clear that we want to see the four-hour waiting time standard continued, because it is a good measure of whole-system pressure, and if people are facing very long waits that leads to a deterioration in patient safety. So it is a quality issue, as well as an issue about patient experience.
(8 years, 1 month ago)
Commons ChamberOf course I welcome the increase in staff in our accident and emergency departments. As the Minister will recognise, there is further to go in this regard.
Does the hon. Lady agree that the four-hour A&E target is absolutely vital, because it, more than any other target, shows the overall performance of a hospital, and that the figures are extremely worrying? Does she also share my concern that last winter was very mild, and we were relatively lucky, with the absence of a big winter flu outbreak? If this winter is as cold as this Chamber, the NHS could face a very serious crisis indeed.
Certainly, the evidence we heard in our inquiry was that there is grave concern about the level of existing pressure. As the right hon. Gentleman says, if we see a very cold winter, and the flu vaccine does not work as well as it did last winter, we are in serious difficulties. But I stress again that the Committee was very clear that we want to see the four-hour waiting time standard continued, because it is a good measure of whole-system pressure, and if people are facing very long waits that leads to a deterioration in patient safety. So it is a quality issue, as well as an issue about patient experience.