Oral Answers to Questions

Edward Argar Excerpts

Tuesday 19th July 2022 Commons Chamber

[Maggie Throup]

The hon. Lady continues to be a loud voice for those who are immunosuppressed, and I commend her for that. As she is aware, Evusheld was awarded conditional marketing authorisation by the Medicines and Healthcare products Regulatory Agency, which outlined some remaining questions, including about the amount of protection and the dose needed. My Department has been conducting an assessment of Evusheld, looking at the data available and the options for the NHS. We have asked clinicians to look at what we can do for future patient cohorts; we are considering their advice and will update the House shortly.

[Edward Argar (Charnwood) (Con)]

One of the great privileges of the three years that I spent at the Department of Health and Social Care was seeing at first hand the amazing work of our NHS workforce; I put on record once again my gratitude to them. Growing that workforce is vital to meeting the future health needs of our population, so will my right hon. Friend the Secretary of State, whom I welcome to his post, reconfirm the Government’s commitment to the target of 50,000 more nurses, and update the House on progress towards that target?

[Steve Barclay]

May I take the opportunity to thank my hon. Friend for his service as Minister of State? I think he was one of the longest-serving Ministers in that role; in fact, I think he took over from me, or shortly after me. He carried out the role with great distinction, as I am sure the whole House recognises.

I am very happy to reconfirm our commitment. I think the number is at about a third of a million, and great progress is being made. That enlarged measure is down to my hon. Friend’s work as Minister of State.

Ambulance and Emergency Department Waiting Times

Edward Argar Excerpts

Wednesday 6th July 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

I am happy to do so, Mr Stringer.

It is a pleasure to be here on the Front Bench responding to this very important debate. If I am still in this role on Sunday, I think I will be the third longest-serving Minister for Health since 1970, which says something about either longevity or churn in this role. It is a genuine pleasure to respond to the hon. Member for Bath (Wera Hobhouse), and I congratulate her on securing this debate.

As hon. Members across the House have acknowledged, the NHS has faced extraordinary pressures over the course of the pandemic and continues to face them. Although I suspect that not everything I say will meet with agreement from Members from both sides of the House, I join them in expressing our gratitude to all those who work not just in our NHS and health services but in social care.

I will start with a couple of words of caution about the use of history and statistics. Hon. Members made a number of points. I have been doing this job for almost three years, and I have often found that assertions are made with statistics or other facts from the history of the NHS, and I want to provide a counter-narrative to three or four before turning to the specifics of the hon. Lady’s debate.

First, I urge a little caution from Opposition Members when raising bed closures, not least because between 1997 and 2007, about 32,000 beds in the NHS were closed, which is more than double the number that were closed between 2010 and now. I say that simply to caution hon. Members that statistics can be used in different ways. There has been a long-term trend under Governments of both parties as the nature of care has changed.

[Karin Smyth]

Will the Minister give way?

[Edward Argar]

I just want to make a few more points, and then of course I will give way to the shadow Minister. She and I spent many happy hours in the Health and Care Bill Committee over many days.

On engagement with the private sector, again I would urge a little caution. It was of course the Labour Government in 2004 who first introduced the private sector into the provision of frontline clinical services with the out-of-hours contract. A Nuffield Trust blog in 2019 highlighted the fact that the increase in the use of the private sector in the NHS began before 2010 under that Government. I do not think the hon. Member for Jarrow (Kate Osborne) was asserting anything other than that, but it is important that I put that on the record.

Of course resources are hugely important. One of the first pieces of legislation that we introduced following the 2019 general election was the NHS Funding Act 2020, which will increase funding by £33.9 billion—a record amount—by 2023-24. As the hon. Member for Weaver Vale (Mike Amesbury) would expect me to say, we introduced the health and care levy to bring more funding into our NHS and social care. It was disappointing that Opposition Members voted against additional funding for the NHS when that was put to a vote.

[Karin Smyth]

The Minister talks about the bed reduction, but that was in the context of massively increasing primary and community care, and the private sector capacity was brought in to reverse the horrendous waiting lists following 18 years of Conservative government. We decided to govern. The point that hon. Members are making is: why does the Minister not govern?

[Edward Argar]

That is exactly what we are doing: we are leading and putting forward measures. Disappointingly, Labour voted against that extra funding.

[Wera Hobhouse]

Will the Minister give way?

[Edward Argar]

I just want to finish this point, but I will give way to the hon. Lady because it is her debate.

My hon. Friend the Member for Broadland (Jerome Mayhew) and others are right in their analysis that this is about patient flows. It is about a whole-system approach and the challenges across the system. My hon. Friend asked what the solution is to making the join-up work better. A key element of the solution is the new integrated care boards and integrated care systems, which genuinely seek to bridge the gap between two parts of the system, to which the hon. Member for Bath—health and social care. They both have, for want of a better way of putting it, different DNA. The NHS, since the legislation in 1946 and its implementation in 1948, has been essentially a vertical system, whereas we have retained local care by local councils on a social care level. This is an attempt to integrate them far more effectively.

[Wera Hobhouse]

It is not very helpful that we are entering into a party political ding-dong. There is a crisis, and we owe it to our constituents to face it. We are asking the Government, who are in charge, to do something about it.

[Edward Argar]

I am grateful to the hon. Lady, but when hon. Members raise party political points, it is incumbent on me as Minister to respond and to put the facts on the record. I will turn to the specific points she has raised. I will also turn, in that context, to the various points that she and the hon. Member for North Shropshire (Helen Morgan) made about various tangible suggestions from the Liberals on the issue.

The hon. Member for Bath is right to have secured and introduced the debate, because this issue is one of growing concern, understandably, and not just for all our constituents but for those who work on the frontline of our NHS. I think it was the hon. Member for Weaver Vale who highlighted the challenges faced by those staff, who want to be there and want to help. When someone rings for an ambulance, it is not a case of making an appointment with their GP; they are deeply concerned for their health, or the health of someone else, in an emergency. All those staff want to do—I have met many of them—is be there for those people, and the hon. Gentleman was right to highlight that issue.

As the hon. Member for Bath will be aware, the pandemic has caused significant strain across the NHS and the social care sector, and emergency care performance, as hon. Members have been open in acknowledging, is recognised as a whole-system issue. The challenges in performance can be traced along the entire patient pathway. Indeed, as I think the hon. Lady acknowledged in her Adjournment debate in the main Chamber on 31 March, although there are elements of that that we need to look at, we also need to look at the issue as a whole. She was right to say that.

For example, as hon. Members have said, the problems and delays in discharging patients home or to community services once they have recovered have a genuine impact on hospital bed occupancy—taking up beds that could otherwise be used by patients who need them. I want to give my hon. Friend the Member for Broadland a slightly more optimistic picture, which is in no way to diminish the challenge that remains. The number of beds taken up by people who are clinically fit to be discharged is not 20,000; it hovers at around 10,000. We have set up a national discharge taskforce, which is working actively with trusts and across local systems, particularly those that are most challenged, to support that discharge work. The situation is not as acute as he suggested, but it remains challenging because every one of those beds could be used to admit patients from an urgent and emergency care setting, or indeed to tackle elective backlogs and waiting lists.

[Margaret Greenwood]

Will the Minister give way?

--- Later in debate ---

[Edward Argar]

I would like to make a little progress before giving way again. I am conscious that I need to leave enough time for the hon. Member for Bath to respond.

That affects how quickly patients can be admitted from A&E, and such delays increase waiting times, as has been said, and lead to that crowding in departments, which has an impact on how quickly new patients arriving in A&E can be seen and treated, including those arriving by ambulance. When this causes ambulance queues to form, the local ambulance resource available to be dispatched to incoming 999 calls is reduced. It is fair to say that although the ambulance queues and delays are often the most visible manifestation of challenge, they are in many ways a symptom of that broader patient flow and the systemic challenge we face.

The root cause of these issues is hospital bed occupancy. That has consistently remained nationally at around 93%—a level usually seen only during winter pressures, as hon. Members have said. The pandemic has played a significant part in driving those pressures, and there are nearly 9,500 in-patients either with covid or for covid in clinical settings, as of 1 July. That is about 10% of all general and acute beds in the NHS.

[Margaret Greenwood]

rose—

[Edward Argar]

I will give way to the hon. Lady, but I want to make a little progress. There are points I want to make before I run out of time, but then I will give way.

That number, as we know, has frequently been higher during the pandemic, and there is the challenge of staff absences during waves.

[Margaret Greenwood]

rose—

[Edward Argar]

If the hon. Lady is brief, I will of course give way.

[Margaret Greenwood]

The Minister will be aware that I have expressed extreme concern and tabled written questions about what happens to those people who are discharged under what was known as discharge to assess and their clinical outcomes. Will he commit to carrying out a review of the patient outcomes of all the patients discharged in that way, to see how many were readmitted to hospital within 30 days of discharge?

[Edward Argar]

I will not commit myself to what the hon. Lady specifically asks for because of the challenge of data collection, but I will say that I see where she is coming from and appreciate the underlying point, which is about understanding the impact of the policy. It has been in use since 2020 as a pandemic measure and is now in statute. The NHS will be monitoring it carefully. We do not agree on everything, but I am always happy to talk to her about these matters because she takes a close interest in them.

With regard to local actions in the patch covered by the hon. Member for Bath, as an illustration of the sorts of measures being put in place across the country, the local integrated care system is working to improve patient flow and reduce handover delays at acute trusts, including the Royal United Hospital in Bath. I join her in paying tribute to the work that her local team there are doing. That hospital is working well with community partners to help patients to return home as soon as they are well. That includes work with the hon. Lady’s local council to develop its domiciliary care provider, which will provide an additional 1,000 hours of domiciliary care a week. A £2 million investment will also be made in the Home First programme, whereby experts from across health and care help patients to get safely back home as soon as possible. The system is also working on opening an additional 20 beds at St Martin’s Community Hospital, while also developing same-day emergency care for frailty to avoid unnecessary admissions to hospital and to care for patients safely in the community.

There is of course nationally a wide range of support in place to improve urgent and emergency care more widely. That includes growing the number of call handlers for 999 and 111, and the investment that we have seen going into our ambulance services and A&Es. It is the case that £450 million of capital investment has already gone into increasing capacity in urgent and emergency care departments. In addition, we have kept, I think, over 155 more ambulances on the road over winter with our investment of £55 million more going into ambulance services. We are investing those resources in the frontline. If I recall my statistics correctly, there has been a 38% increase in the paramedic and ambulance workforce since 2010. The hon. Lady and her party can rightly claim a degree of credit for that, because a degree of that took place between 2010 and 2015. We do continue to grow the workforce.

Turning to workforce issues more broadly, it is absolutely right that, as well as providing the support to which the hon. Member for York Central (Rachael Maskell) alluded—mental health and physical support for the workforce—we continue to grow the workforce in order to ease the workload pressures. We have already witnessed over 30,000 more nurses in the NHS since that pledge was made in 2019. We continue to grow all workforces. In section 41 of the Health and Care Act 2022 we set out a very clear duty on the Secretary of State in relation to workforce planning, and that work is already under way.

I will turn to a couple of further points very briefly, because I want to give the hon. Member for Bath her two minutes at the end. She raised a number of specific points. She called for greater resources to be put in. That has been done. She called for an increase to be made in paramedics and ambulance staff. That has been and continues to be done. None of these are completed works, but they continue to be done. She called for action to stop ambulance station closures or community ambulance station closures. I have to say that those decisions are made clinically by local trusts; the power was not there for the Secretary of State to intervene. In fact, it was the Labour party that argued against giving the Secretary of State and Ministers the power to take action on those things when it voted against and spoke against that measure during the passage of the Health and Care Bill. It is right that clinicians determine what is the best set-up for clinical services in their area. I just gently make that point.

In summary, I think that both sides of the House recognise fully the challenges faced in these unprecedented times by our urgent and emergency care sector, and particularly by patients and those who work in the sector. We have a plan to fix it. We continue to invest in that plan and to support our workforce, and we will continue to do that for the benefit of patients.

Health Services: Southend West

Edward Argar Excerpts

Wednesday 6th July 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for Southend West (Anna Firth) on securing this important debate. She is a notable advocate for healthcare in her constituency, and a strong champion and voice for her constituents in this place. The NHS has faced extraordinary pressures over the course of the pandemic, and I am sure the whole House will join me in expressing our utmost gratitude to staff for their outstanding work and dedication during this time.

I will address a number of my hon. Friend’s points, but, although it is rare to do so at the Dispatch Box, I will come to her main point first and seek to address it head-on. My hon. Friend and my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois)—and, although she may not intervene in the debate, the Lord Commissioner of Her Majesty’s Treasury, my hon. Friend the Member for Castle Point (Rebecca Harris)—have asked whether the Government will provide the £8.4 million of funding requested to improve Southend emergency department to unlock the business case to allow it to proceed to do further work. While I regret that I am not able to give a clear answer to my hon. Friend the Member for Southend West this evening, I hope it will come as some encouragement to her that I can say that, following the tenacity of her campaigning on this issue in the Chamber, and indeed outside it, in pursuing me and other Ministers—that is exactly what Members of Parliament are here to do—I have instructed the Department to convene a meeting to review the submitted business case prior to the summer recess, and I anticipate being able to update her and the trust with the outcome of that before the House rises for the summer. That is, obviously, subject to my new Secretary of State’s decision on the recommendation of officials, but I undertake that I have instructed officials to come back to her with that decision before the House rises in a couple of weeks.

In the meantime, work to improve local services continues, and I am aware that Mid and South Essex NHS Foundation Trust hospitals and the East of England Ambulance Service NHS Trust—EEAST—have a range of actions in place to meet the high levels of demand they are experiencing. For example, EEAST is prioritising emergency cases, and, where clinically appropriate, a team of clinicians in its emergency clinical advice and triage service will advise people who do not need an ambulance to use other services. EEAST has also successfully recruited more call handlers and expanded the network of hospital ambulance liaison officers who help to co-ordinate handovers at hospitals, including by diverting crews to other hospitals where they can be seen more quickly.

EEAST is working with acute hospitals to develop cohorting areas, where patients can be assessed before going into the emergency department, helping to get ambulances back on the road more quickly. In the context of ambulances, I am reminded of an incident that was recounted to me—I could not possibly reveal the source from which I acquired this information. When she was abseiling to raise money for charity while dressed as Wonder Woman, my hon. Friend spotted ambulances queued up. As soon as she got to the ground and across the car park, she pursued the issue to find out what was going on. Such is her commitment to her constituents and her passion for this issue, and I commend her for that.

After a successful trial at Lister Hospital, EEAST is now using a rapid release process with some acute hospital partners, where the handover of patients is fast tracked if an urgent response is required in the community. At busy times, EEAST may also offer enhanced pay rates to encourage staff to complete additional shifts.

These local initiatives are also supported by national actions to reduce waiting times, including continuous central monitoring, support from the National Ambulance Coordination Centre and the allocation of £150 million of additional system funding for ambulance service pressures in 2022-23, supporting improvements to response times through additional call handler recruitment, retention and other funding pressures. My hon. Friend has quite rightly highlighted the additional ambulance service staff and the additional ambulances themselves. She is absolutely right to highlight the fact that while the ambulance service may often be the visual manifestation of the challenges faced, it is a system challenge with a number of complex, interrelated parts.

My hon. Friend has raised an important issue concerning the NHS 111 service and the automatic dispatch of ambulances. I am advised that when a patient calls 111 and the automated call handler assessment concludes that a low-urgency ambulance should be dispatched, a clinician will call the patient back to validate that that is actually required. I understand that that happens about 95% of the time. Where the patient is not able to be contacted within a fixed timeframe, as my hon. Friend has said, the call will be passed to the ambulance service for dispatch. However, it is important to understand that the call may still be scrutinised by the ambulance service as to whether an ambulance is really needed.

Although no remote triage process can be perfect, there is consistent clinical review of these calls to ensure the wise use of resource, and NHSEI does not believe that significant numbers of ambulances are being dispatched unnecessarily. I have already asked officials in the Department to look into the specific issue that my hon. Friend has raised to understand the extent to which that is happening, whether it is happening unnecessarily and what the consequences are in terms of cost and time resource.

We are also building the capacity of NHS 111 to act as the front door to the emergency care system, so that patients receive an ambulance or go to A&E only when needed. This is being supported with £50 million in 2022-23, helping to ensure that people can access urgent care when they need it, increasing the ability to book callers into alternative services or into a timed slot at their local A&E where appropriate.

On general practice, we know that general practitioners are still under huge pressure. I am incredibly grateful for the contribution of GPs and their teams over the past two years. They have stepped up to deliver our world-leading vaccination programme while still providing exemplary care for their patients during a pandemic. We made £520 million available to improve access and expand general practice capacity during the pandemic. That was in addition to at least £1.5 billion announced in 2020 to create an additional 50 million general practice appointments by 2024 by increasing and diversifying the workforce.

GPs and their teams will always be there for patients, alongside NHS 111 and community pharmacy teams, and it is important that people do not delay in coming forward with health concerns. In 2021-22, we saw the highest ever number of doctors accepting a place on GP training—a record 4,000 trainees, up from 2,671 in 2014. GP trainees support fully qualified GPs, helping to ease workloads and increase capacity, and allowing more patients to get the care they need. Just as in hospitals, doctors in training are delivering direct patient care while being safely supervised and supported.

I hope that our exchange today provides a degree of reassurance that there is significant support in place at local and national level to address performance issues, as well as a determination to improve the provision of health services in Southend West and more broadly in the local area. As you alluded to, Mr. Deputy Speaker, I have been a regular at the Dispatch Box in these Adjournment debates, certainly over the past two to three years. I am grateful to my hon. Friend for bringing forward this debate, and it has been a great pleasure and privilege to answer it.

[Anna Firth]

May I thank the Minister very much for the careful way in which he has responded to all my points and for his assurance that there will be some news on the £8.4 million before the recess?

[Edward Argar]

I am grateful to my hon. Friend for her kind words. I will just conclude by saying that it has been a huge privilege to respond to debates such as this, and I am very grateful to her for affording me that privilege this evening.

Question put and agreed to.

Gynaecological Services: Waiting Lists

Edward Argar Excerpts

Wednesday 6th July 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

I would just say that if I am still in post on Sunday, I will be the third-longest serving Minister of State for Health since 1970, but only time will tell. I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on securing this debate about waiting lists for gynaecological services. I know this is a very important subject for her, and I would like to take a moment to highlight her well-known focus in this House on women’s health matters and the work she has done in that space, which reflects the importance many of our constituents attach to these issues.

As has been alluded to, the hon. Member for Kingston upon Hull West and Hessle has done important work on the suspension of the use of vaginal surgical mesh. She has also worked to promote menstrual wellbeing and worked with Endometriosis UK. I congratulate her on that. It is always a pleasure to answer a debate of hers or to respond to her in the Chamber. It is also a great pleasure to be able to respond to the hon. Member for West Ham (Ms Brown), who as ever gave a typically powerful and forthright speech. She highlighted some harrowing examples—as the shadow Minister put it—that illustrate the broader issues around hysteroscopy and particularly the challenges around the NHS listening and acknowledging patients’ genuine concerns and requests. I will return to that in a moment. Normally at this point I would offer to meet with the hon. Member for West Ham to discuss this, but I will instead offer that the relevant Minister meet with her to discuss this matter further and the specific points she raised with her typical forthrightness and expertise.

The covid-19 pandemic has left a large backlog of people needing care. The latest figures show that 6.53 million people are waiting for NHS care, with 1.55 million of these waiting for diagnostic tests. As part of this, the waiting list for gynaecological services has over 28,800 people waiting longer than a year for care. We are working hard to reduce the number of people waiting for these vital services as swiftly as we can. It is promising that activity levels have reached 95% of their pre-pandemic levels in this area, but that is still 5% short of what normal activity would have been pre-pandemic. We recognise that more needs to be done in this space.

We are increasing capacity for gynaecological surgery to tackle long waits in two key areas: first, through surgical hubs, which allow for higher volumes of care to be carried out in protected circumstances, reducing the risk of covid-19 infections; and secondly, through the high-volume, low-complexity programme, which allows increased volumes of surgical procedures to be carried out. To support services further, we have grown the workforce in gynaecology with the addition of 108 consultants this year, bringing the total number working in obstetrics and gynaecology to over 6,400, an increase of 681 since 2019.

The hon. Member for Kingston upon Hull West and Hessle rightly highlighted a number of key points, one being staffing and another being funding, which is also about facilities and their availability. That is why we increased funding by £33.9 billion in the legislation passed in early 2020 to reach a certain level by 2023-24, plus we provided additional funding throughout the pandemic. We recognise that there is a lot more to do.

The hon. Lady also talked about prioritisation and ringfencing. The only note of caution that I will set out about ringfencing particular parts of budgets is that often it is more effectively done by local clinical systems than by me or another Minister. Often those systems are best placed to work out what their priorities are, based on their waiting lists, population health and population need. I hope that integrated care systems will play an increasingly large role in understanding that, and adapting to the needs of local areas.

Turning to the women’s health strategy, which I know is a central element of the way the Government propose to move forward. Across women’s health we are working to deliver better care through the first women’s health strategy for England, which will reset the way in which the Government are looking at women’s health. That will correct the way in which the health system has in the past been set up—it is fair to say, although hon. Members may disagree—by men and for men. That is the historical evolution of our health service. Huge progress has been made, but there is more to do, which is why that focus is necessary.

Work on the strategy began in December 2021, when we published “Our Vision for the Women’s Health Strategy for England”. We announced in that vision that we are appointing the first ever women’s health ambassador for England. In June we announced the appointment of Dame Lesley Regan to that role. She will focus on raising the profile for women’s health, increasing awareness of taboo topics, and bringing in a range of collaborative voices to implement the women’s health strategy. To reassure the hon. Member for Kingston upon Hull West and Hessle, we do aim to publish the strategy before the summer recess. The relevant Minister will aim to do that.

[Emma Hardy]

When that is published, will it include the point I made about looking at whether there is a gender bias in the prioritisation of health treatment? That was something that the RCOG was really keen to emphasise. Everyone understands that covid meant waiting lists for everything. One of my key points was whether there is a gender bias? Is that partly why gynaecological treatment seems to be delayed more than others?

[Edward Argar]

I do not want to prejudge the specifics of that strategy. In broad terms, I hope that I can reassure the hon. Member that we are seeking to look at all the drivers of the challenges that she and other Members have highlighted, and seek to address improvements. Without prejudging, there are points made by hon. Members that I would expect to see included around information, engagement, guidance and empowerment. The importance of empowering women, believing them and engaging with them came through very clearly in the hon. Member for West Ham’s comments.

[Ms Brown]

I am grateful to the Minister for what he is saying. It is about empowerment, but there is no empowerment when the choice is either to go for it now or to wait for months. Over and over, I have correspondence from women who are being belittled by those in gynaecological services, telling them not to make such a fuss “dear”. That is despite the fact that getting up off the floor after something is often awful. I have had meetings with Ministers; what I really want is some action.

[Edward Argar]

I am grateful once again for the hon. Lady’s typical forthrightness. I have debated with her on a number of occasions—I was going to say “crossed swords” but that is unfair—and I know that she means it with good intentions, even when she is being rightly firm with Ministers in pressing a case. She is absolutely right. When I talk about empowerment, I envisage that encompassing a whole range of things. That includes believing people, treating them with respect and listening to them.

In terms of action, one Opposition Member—forgive me; I do not remember who—mentioned the need for a clear delivery plan. I have been in the Department for almost three years now. Governments of all complexions are often very good at coming up with strategy documents, which are important. However, the key to whether they deliver the outcomes for all of our constituents is how we deliver and implement them on the ground. We have to get the strategy right; that is the first step and we anticipate publishing that before the summer recess. However, it is then important that we focus on delivery, and that we work not just with the NHS but with patients and relevant campaign groups to work out how we deliver on the intentions in that strategy.

More generally, we set out in our elective recovery plan how we intend to build back from covid-19 and reduce waiting times across all elective services, including gynaecology and menstrual health. The plan included our commitment to tackling long waits, eradicating waits of longer than two years by the end of July 2022, and eliminating waits of over one year by March 2025. We will also ensure that 95% of patients waiting for a diagnostic test will receive it within six weeks by March 2025. To support that, we have committed to spend more than £8 billion from 2022-23 to 2024-25, in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to systems.

That will hugely increase the capacity in the system. However—this also relates to the point made by the hon. Member for West Ham—one of the aims of the elective recovery plan, My Planned Care, and similar, is to increase, not just in the space of gynaecological services but more broadly, the opportunities for patients to exercise choice over whether they want something immediately or would prefer to wait, and potentially where they would prefer to have that procedure performed. We are continuing, through this, to try to build in more choice, not just for the patients—although that is crucial—but to help maximise the capacity within the system, to help avoid people having to wait longer than necessary.

[Ms Brown]

What research, if any, has the Minister done on hospital trusts, for instance, that might have people in a number of different geographical areas being served by a group of hospitals, and whether there is any real choice about which hospitals in those families people can elect to visit?

[Edward Argar]

The challenge that the hon. Lady poses is that if we are talking about, essentially, the multi-hospital trusts or similar, as they have grown up, they have often designed their services in x specialism in one hospital, and moved things around like that. In those cases, there are often only one or two hospitals within the trust that do it. We are seeking to try to create greater choice across the entire system, including regionally, which genuinely builds choice. That is a big challenge—Governments of both complexions have tried it with varying degrees of success—but that is what we are seeking to do here. However, there is a lot of work to do in that space. I hope that when she sees the strategy she will recognise the degree of underpinning research that has been done. It may not necessarily cover every point that she has focused on, but I hope she will recognise the amount of work that has been done.

[Emma Hardy]

I thank the Minister for again giving way. When we see the women’s health strategy, will it respond to all of the recommendations from the Cumberlege review? We had a bit of an interim response to the review, but I am sure the Minister will be aware that there is still a cross-party campaign to ensure that all of those recommendations are fulfilled. If he ever does happen to find himself on the Back Benches, he is more than welcome to join any of my APPGs, and any of those campaigns, from a different side. I would be keen to know whether he is aware of any plans to fully address the report and fulfil those recommendations.

--- Later in debate ---

[Edward Argar]

I am grateful to the hon. Lady. She highlights an issue that I know has exercised Members on both sides of the House. Although progress has been made, I know that a campaign on other elements continues. This makes me sound as I used to occasionally, doing the morning media round and talking to Kay Burley or similar, but I do not want to prejudge what might be said in due course—that was sometimes a wise thing to say when discussing infection rates, restrictions or similar. I do not want to prejudge or predetermine what will be in that strategy, but I genuinely hope and believe that the hon. Lady will be pleased when she sees it. I would not for a moment expect her not to challenge it and seek to improve it, because I have worked and interacted with her before, and that is what Members do in this House. However, I hope that she will see progress in there.

We know that diagnostics are a key area in many gynaecological pathways. As such, we are establishing up to 160 community diagnostic centres across the country by 2025. There are currently 90 such centres operating across the country, including supporting spoke sites, and they have delivered 1 million tests and scans since July 2021. The expansion of the centres will mean that the NHS will have just shy of 38% more MRI capacity, 45% more CT capacity, 26.8% ultrasound capacity improvements, and an increase of around 19% in endoscopy capacity by March 2025, compared to pre-pandemic levels. That will allow more patients to be seen more quickly, meaning they can be diagnosed sooner and then start any treatment they need.

I will turn briefly to general practitioners, who are often key in the treatment of gynaecological conditions. As we all know, general practices are still very busy and are caring for patients in the community who are on waiting lists for secondary care. I pay tribute to the work of general practitioners and their teams throughout the pandemic. We know that some patients have struggled to get through to their GP practice on the telephone, which is why the NHS offered practices an interim telephony solution that enabled them to use Microsoft Teams to free up lines for incoming calls.

We made an additional £520 million available to improve access and expand general practice capacity during the pandemic. I mention this in passing because it is important to recognise that for many the general practitioner is the front door to the system and being able to get access to a general practitioner is a crucial part of being able to get into the care pathway, be that for diagnostic tests or for acute treatment, should that be needed.

I will wrap up now and I hope that will give the hon. Member for Kingston upon Hull West and Hessle a few minutes to respond. In conclusion, I pay tribute to her for securing the debate and bringing it to the Chamber. What this Chamber may lack in numbers, for various reasons this afternoon, is made up for in quality and in the importance of the subject of debate. As ever, I am grateful to the hon. Member for West Ham and to the shadow Minister, the hon. Member for Enfield North (Feryal Clark), who it has always been a pleasure to appear opposite in this Chamber. I hope that I have offered some reassurance to hon. Members about the extent to which the Government take the issues that they have raised extremely seriously, and I too look forward to the publication of the strategy.

Financial Directions to the NHS: Variation 2022-23

Edward Argar Excerpts

Thursday 30th June 2022 Written Statements

[The Minister for Health (Edward Argar)]

I am varying the 2022-23 financial directions to NHS England made on 31 March 2022.

These are primarily technical changes required as a result of the Health and Care Act 2022. The main purpose of the Act is to establish a legislative framework that supports collaboration and partnership-working to integrate services for patients. Among a wide range of other measures, the Act also includes targeted changes to public health, social care and the oversight of quality and safety.

NHS England and NHS Improvement have now been formally brought together into a single legal organisation. Therefore, NHS Improvement’s resource and administration limits, as well as its capital budget, have now been incorporated into NHS England’s budget.

HM Treasury’s consolidated budgeting guidance will now apply to the whole of NHS spend including providers, requiring the addition of funding for annually managed expenditure and ringfenced funding for impairments for NHS trusts and NHS foundation trusts.

Finally, funding is being provided from NHS England to Health Education England (HEE) for investment in workforce initiatives.

The Act now decouples the financial directions from the NHS mandate and requires the directions to be laid in Parliament. They will be published on gov.uk. The existing NHS mandate remains unchanged.

[HCWS163]

Ambulance Waiting Times: Royal Cornwall Hospital

Edward Argar Excerpts

Wednesday 29th June 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for Truro and Falmouth (Cherilyn Mackrory) on securing this important debate. Since her election, she has been a notable advocate both in this House and more privately with Ministers on behalf of her constituents and those who work in her local healthcare system—as, indeed, are all six Members of Parliament representing seats in Cornwall.

May I also take the opportunity—I know we do not always use this sort of language now, but I will—to congratulate the hon. and gallant Member for Tiverton and Honiton (Richard Foord) both on his election to this House and on his contribution to the debate this evening. I look forward to his maiden speech, but it is a privilege for me to have had the opportunity, I think, to be the first Minister to respond to him and congratulate him. It is always a pleasure to see the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard), who may not be my hon. Friend but is my friend. I thank him for his contribution, highlighting the issues at Derriford Hospital.

As my hon. Friend the Member for Truro and Falmouth has made clear, there are complex causes behind the challenges faced by her constituents and those of other right hon. and hon. Members around the country with ambulance services and ambulance response times. As she will know, ambulance services faced significant pressures during the pandemic and continue to do so. I join her and Members on both sides of the House in putting on record, as she did, our gratitude to all the ambulance service staff and the NHS for their outstanding work, both at this time and particularly in recent years.

The service is still working under exceptional demand and pressures. In May 2022, the ambulance service answered more than 850,000 calls, an increase of 7% on May 2021 figures. Those are national figures; I will turn to my hon. Friend’s local situation in Cornwall in due course. She is right to highlight that the issue is not just with the ambulance service itself, although that is often the visual manifestation or symptom of broader challenges within the health ecosystem and the pressures it is under. It is about handovers and the ability do turnarounds and get the ambulances back on the road, having had a patient safely admitted to the A&E department in an acute setting. I will turn to that in a moment too. As she will be aware, other issues as well as demand impact on performance, including, still, although less so than there have been, elements of infection prevention and control measures. There are issues in particular areas with staff absence—for example, still, where there is an outbreak of covid. She also highlighted some very specific local factors that I will turn to.

Touching on that, I am aware of the local context that my hon. Friend set out, in that in Cornwall the demand for NHS services has combined with wider systemic issues, placing particular stress on the system. Some of those local factors include the demographic challenges of the age profile of the population and difficulties or challenges in securing the adult social care capacity to meet current and projected demand. I suspect that much of what I say about Cornwall will apply to Devon as well, as the context both demographically and in terms of patterns of demand are not completely dissimilar.

Other factors that play a key part include geography and, as my hon. Friend highlighted, the cost of living, affordable housing, and the ability to retain a skilled workforce. It is also worth remembering, in the context of Cornwall, that whereas many parts of the NHS system see very pressured demand over the winter period that tends to ease somewhat during the summer, allowing them time and space, Cornwall, and, I suspect, Devon as well, being such popular holiday destinations, see a different range of challenges and pressures on the system as holidaymakers come into to area and often need to use these services. I am very sensitive to that point.

I assure my hon. Friend, who touched on some of those issues, that significant work is under way across the entire local health and care system to improve patient flow through the hospital, which is the key element in making the system work smoothly to reduce the wait times for emergency care and reduce the numbers of delays in handing ambulance patients over to A&E. Importantly, the NHS Kernow clinical commissioning group, as it currently is—as she rightly highlighted, as of 1 July ICSs become statutory bodies—is continuing to work with all providers to create and commission additional capacity, including a plan to release 80 additional hospital beds now and 20 to 40 further beds in time for the winter. This will help to increase the flow of patients out of the emergency department, reducing overcrowding and the numbers of ambulance-patient handover delays. I pay tribute to my hon. Friend for the summit that she and local Cornwall Members convened with me earlier in the year not only to talk about the pressures faced by the system at the time but to begin looking forward to how we can mitigate future pressures.

The trust is expanding the use of virtual wards whereby patients are monitored remotely at home rather than being admitted to hospital. This further reduces pressure on local bed capacity and allows for patients to be safely treated at home, which can be beneficial for their recovery. Of course, that is done on the basis of clinical triage and assessment. There has also been an increase in the adult social care domiciliary care pay rate, helping to generate more social care capacity locally and ensure that patients are able to be discharged from hospital to home as soon as they are medically fit. That is supported by the Proud to Care recruitment campaign. I understand that the NHS and Cornwall Council are aiming to launch a targeted campaign in the autumn to encourage more under-25s to work in the care sector.

I now turn to discharge. I have highlighted some of the action that is being taken locally to improve patient flow through hospitals by discharging patients more quickly. The aim is partly to increase the number of discharges a day, but it is also to bring more discharges forward to earlier in the day, when it is clinically safe to do so, thus making those discharges much better managed. It is important that all partners work well together on that. At a national level, we have set up a national discharge taskforce. As Minister, I now get weekly statistics about where we are on delayed discharges. My hon. Friend alluded to the number of people who are clinically fit for discharge but have not been discharged, for a variety of reasons. Reducing that by even a small proportion would have a significant impact on the availability of beds and thus patient flow. It is a complex picture with a variety of reasons behind delayed discharges. However, it is important that we continue to work across the system locally and with national support to get the number of delayed discharges down.

The CCG locally is also establishing community assessment and treatment units for frail and elderly patients as an alternative to hospital admission, alongside an innovative reablement ward that is now moving to a community hospital location, as my hon. Friend mentioned, as a permanent model of care. Taken together, these interventions will help to ensure the effective flow of patients through hospital, reducing those waiting times and crucially reducing the number of ambulance handover delays, allowing ambulances to get back on the road more rapidly.

To address the wider issues around staff recruitment and retention, the NHS is working with local partners on schemes to address cost of living concerns, including work with the Supportmatch charity on the homeshare scheme, where a householder helps to offer affordable accommodation to someone working in the sector. There is the new guardianship programme developed by Supportmatch, NHS England and NHS Improvement in the south-west that enables householders to offer a spare room to fully vetted and checked health and care workers. Typical agreements can run from two months to two years. We should recognise those sorts of innovations that have grown up locally for the beneficial effects they can have.

It is also encouraging to see that these measures are delivering improvements. Performance against the four-hour A&E standard improved from 76.9% meeting that in April to just shy of 80% meeting it in May. There is more to do, clearly, but that is a positive direction of travel. The South Western Ambulance Service also saw notable improvements across all response time categories in May compared with April, including a 24-minute reduction in the average category 2 response time. Again, there is still more to do to get those down to target levels, but that is a positive step and a positive direction of travel.

There was a reduction of more than one minute in the average response time to the most serious category 1 calls. That does not sound like a huge amount, but in April, when we were seeing challenges, that was a bit over 11 minutes. Shaving a minute off that is still hugely important. There is more to do to get it down to the circa six or seven minutes that it was in May 2019, before the pandemic. We have further to go, but we are focused upon it.

Then there is investment in hospitals locally. In this context, I highlight the £1.3 million in 2020-21 of the elective recovery estates funding, the £2 million for technology to help elective recovery, the £2.8 million for A&E upgrades and the £1.7 million previously given to tackle the backlog maintenance in my hon. Friend’s trust. I pay tribute to her, but I pay particular tribute to my hon. Friends the Members for North Cornwall (Scott Mann) and for St Austell and Newquay (Steve Double), who in the nature of their roles in this place are not able to intervene directly in this debate. It is important that I put on record their work on behalf of their constituents in lobbying Ministers and securing that investment from Government in their local hospital trust.

There is a wide range of national support in place to improve ambulance performance more widely.

[Luke Pollard]

According to the South Western Ambulance Service, three of the five hospitals in the country with the longest ambulance waiting and hand-over times are south-west hospitals—Derriford, Bristol and Royal Cornwall. Is there something south-west specific that the Minister needs to look at as to why south-west hospitals are experiencing the longest hand-overs?

[Edward Argar]

I gently say to the hon. Gentleman that the hon. Member for North Shropshire (Helen Morgan) made the point about delays in respect of her county in March, so we are seeing significant challenges across the country. I have highlighted some of the specific points about Cornwall, such as the geography and the distances. It is also about demand, which, as I alluded to, does not abate even slightly in the summer. There is a range of factors—my hon. Friend the Member for Truro and Falmouth highlighted a number of them—and I have set out some of the measures that we are taking to address them.

Nationally, as my hon. Friend alluded to, a wide range of support is in place. Ambulance trusts receive continuous central monitoring and support from the National Ambulance Coordination Centre, and NHSEI has allocated £150 million of additional system funding for ambulance service pressures in 2022-23, which will support improvements to response times through additional call handler recruitment, retention and other funding pressures.

National 999 call handler numbers have been boosted to more than 2,300 at the start of May 2022, which is about 400 more than in September 2021, with further potential increases. We are also investing £20 million of capital funding in ambulance trusts in each of the three financial years to 2024-25, in addition to the £50 million national investment across NHS 111.

We continue to work closely, in terms of additional resources and system pressures, with the ambulance trusts in the south-west and across the country. I am grateful to my hon. Friend for highlighting this hugely important issue. Her constituents are lucky to have her representing them in this place. I will continue to work with her and other right hon. and hon. Members, and the system, to deliver the improvements that we all wish to continue seeing.

[Mr Deputy Speaker (Mr Nigel Evans)]

I, too, welcome Mr Foord to the House on his maiden intervention—if such terminology exists; it does now.

Question put and agreed to.

Correction to PQ118520, PQ118521 and PQ118522

Edward Argar Excerpts

Wednesday 22nd June 2022 Written Statements

[The Minister for Health (Edward Argar)]

On 28 February 2022, the Department answered three parliamentary questions asked by Nick Smith MP. The single answer given to all three questions included an incorrect reference to a supplier of PPE.

The questions were:

“118520: To ask the Secretary of State for Health and Social Care, whether his Department paid £600 million to Unispace Global Ltd for the purchase of personal protective equipment in 2020.”

“118521: To ask the Secretary of State for Health and Social Care, whether Unispace Global Ltd met its contractual obligations for providing adequate personal protective equipment under the contractual terms set by his Department in 2020. ”

“118522: To ask the Secretary of State for Health and Social Care, whether any Government Department has taken steps to investigate why payments made to Unispace Global Ltd were not reported by that company in its financial accounts; and, if he will make a statement.”

The departmental answer was:

“…Unispace Global partially met its contractual obligations, supplying the National Health Service with £484 million items of PPE from April 2020 till December 2021. We are working with the company on a commercial resolution for the remainder of the contract... ”

However, all contracts between Unispace Global Ltd and the Department for Health and Social Care were novated to Unispace Health Products LLP in December 2020, which has since changed its name to Sante Global LLP. Accordingly, the departmental answer should have referred to Sante Global LLP rather than Unispace Ltd.

Through this written ministerial statement I am correcting this error, which arose as one of our internal record management systems had not been updated to reflect the change in name. This system has also been updated.

[HCWS128]

Draft National Health Service (Integrated Care Boards: Exceptions to Core Responsibility) Regulations 2022

Edward Argar Excerpts

Wednesday 15th June 2022 General Committees

[The Minister for Health (Edward Argar)]

I beg to move,

That the Committee has considered the draft National Health Service (Integrated Care Boards: Exceptions to Core Responsibility) Regulations 2022.

As always, Ms Nokes, it is a pleasure to serve under your chairmanship. I will endeavour to be brisk in my remarks this morning. The purpose of the regulations is to ensure operational continuity as the changes from the Health and Care Act 2022 are implemented following Royal Assent in May. That Act strips out needless bureaucracy, improves accountability and enhances integration. It forms the bedrock for the NHS to build on in years to come, which is why I am delighted to be here to debate the regulations that will facilitate its implementation.

The regulations relate specifically to the transfer of functions from clinical commissioning groups, which were abolished by the 2022 Act, to newly established statutory integrated care boards. Under the National Health Service Act 2006, which was amended by the 2022 Act, NHS England may set rules so that integrated care boards have “core responsibility” for every person who is provided with NHS primary medical services through registration with a GP practice in their area of England, and for every person resident in the ICB’s area who is not registered with a GP practice. That means that when a person sees a GP in an area, the relevant ICB is responsible for arranging the provision of secondary health services that that person may need.

This instrument provides an exception to that obligation for individuals who are usually resident in Scotland, Wales or Northern Ireland but are registered with a provider of NHS primary medical services in England. The regulations do not prevent those who are resident in Scotland, Wales and Northern Ireland from accessing health services in England; instead, they simply make clear where the commissioning responsibility sits for those patients. They promote autonomy for devolved Governments to commission secondary care services for their residents, while still allowing patients to access secondary healthcare services in England. In essence, it is about which authority commissions and pays for a patient’s care, not the patient’s right to access care. The regulations are vital to give clarity and ensure consistency among authorities in England and those in Scotland, Wales or Northern Ireland in respect of who commissions and pays for a patient’s secondary care.

To conclude, it is important to be clear that this instrument does not change existing cross-border commissioning arrangements. Health is a devolved matter, and the instrument simply transfers an existing commissioning exception from clinical commissioning groups to integrated care boards, to reflect the changes in the nomenclature in the new legislation. The arrangements are a continuation of the approach to devolved health policy that was introduced in the National Health Service (Clinical Commissioning Groups—Disapplication of Responsibility) Regulations 2013, which are to be revoked as a consequence of the 2022 Act.

The regulations before us will ensure operational continuity of services for patients as the English health system implements integrated care boards, they are supported by the devolved Governments and they provide clarity on the role of integrated care boards within the existing cross-border arrangements. I commend the regulations to the Committee.

--- Later in debate ---

[Edward Argar]

I am grateful to the shadow Minister for her remarks and for her support for this instrument. It was a pleasure to serve opposite her for, as she alluded to, many months in the the Health and Care Bill Committee, before she was shadow Minister. She is right to talk about the length of time that that legislation spent going through Parliament before it received Royal Assent; of course, we could not introduce these regulations until Royal Assent was granted in the middle of May, although we did secure the early commencement of the 2022 Act’s provisions in order to be able to bring forward the relevant consequential regulations as swiftly as possible.

The shadow Minister asked how many more consequential regulations we anticipate—I think she was referring specially to those that relate to the implementation of ICBs and integrated care systems by 1 July on a statutory footing. To date, I think I have seen, commented on and approved a further five instruments. They are overwhelmingly technical in nature, and replicate existing arrangements but change the language and nomenclature used. Of course, one of those sets of regulations will formally, legally commence these provisions from 1 July—that has to be done through regulations.

We would of course have liked to have seen Royal Assent earlier than we did, but a considerable number of amendments were tabled, both in our House and in the other place, so it took a considerable amount of time to navigate through the parliamentary process. However, we got there and received Royal Assent for a piece of legislation that will go a long way towards building on the success we have seen so far in improving health outcomes in this country, and that will enable the NHS to go forward with a strong base on which to build and from which to evolve. I again commend the regulations to the Committee.

Question put and agreed to.

Oral Answers to Questions

Edward Argar Excerpts

Tuesday 14th June 2022 Commons Chamber

[Ian Levy (Blyth Valley) (Con)]

3. What progress he has made on recruiting 50,000 nurses.

[The Minister for Health (Edward Argar)]

This Government committed to growing the NHS workforce, including our pledge of 50,000 more nurses by 2024, and we are delivering on that, as we are delivering across Government, with almost 31,000 more nurses so far as of March 2022—the latest data point we have.

[Ian Levy]

I commend the Government on their target to train 50,000 new nurses. I know first-hand how hard the nursing staff work in the NHS as I worked as a mental health support worker for almost 30 years. With that in mind, I welcome the new school of nursing to be built at the Cramlington A&E Hospital. Will my hon. Friend do me the honour of visiting Cramlington to see for himself the construction of this amazing new facility?

[Edward Argar]

I pay tribute to my hon. Friend for his work supporting the NHS and healthcare in this country both prior to and subsequent to his election to this House. I would be delighted to visit Cramlington with him—indeed, on the same visit perhaps I could visit his local health facilities to see modular construction in action. I should also say that his ever-efficient office has already invited me.

[Gareth Thomas (Harrow West) (Lab/Co-op)]

More nurses across the country, and particularly in Harrow, would make a real difference in helping those who suffer from diabetes. Given that this is Diabetes Week and that diabetes has a disproportionate impact on those from a south Asian background—particularly, for example, among my Gujarati constituents—when will the Minister put extra resources into tackling this terrible health condition?

[Edward Argar]

I am grateful to the hon. Gentleman for his important question. As he highlights, we are investing more in more nurses, but there is also a large piece of work to do on health education and improving access to those services for people with diabetes. I urge him to look forward with eager anticipation to the health disparities White Paper.

[Jonathan Gullis (Stoke-on-Trent North) (Con)]

Mr Speaker, you will be aware that I am proud to support the “no time to wait” cross-party campaign to ensure that we have a mental health nurse in every GP surgery across the country. I am delighted to see the hon. Member for York Central (Rachael Maskell), who supports the campaign, in her place.

I was delighted to read that the Secretary of State has said that we will recruit 2,000 mental health nurses into GP practices. Can I have more detail on how that will work? Can we look at Norfolk, which is using primary care networks, and third sector organisations such as Mind to help with that recruitment?

[Edward Argar]

I am grateful to my hon. Friend for drawing attention to this important issue as well as for highlighting what is going on in Norfolk and the opportunities to learn from that. The Government have put record funding into mental health, and I understand that my right hon. Friend the Secretary of State is due to meet him and supporters of the campaign soon.

[Mr Speaker]

I call the shadow Minister.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Working a shift in A&E just two days ago, I could not have felt prouder of the teams of nurses who form the foundation of our NHS. As the Minister is so gushing about the Government’s track record, will he explain why specialist food banks are being opened up in hospitals? Will he explain why, in a report by the Royal College of Nursing, 83% said that staffing levels on their last shift were not sufficient to meet patients’ needs safely and effectively? These lifesavers need a Government who are on their side. Only Labour will deliver for the NHS workforce and ensure that nurses and patients get what they rightly deserve.

[Edward Argar]

I think that I detected the hint of a question in there. On a serious point, I pay tribute to the hon. Lady, as I often do on such occasions, notwithstanding the challenges that she throws at us, for the work that she does in the NHS and the work that she did before she was elected to the House. Through her, I also pay tribute to NHS workers up and down the country for their work.

The Government have put in place record support for our NHS, including nurses, which is about supporting those already on the frontline in the profession—that is absolutely right—and about growing that workforce to ensure that the work that needs to be done is spread among more people. That is exactly what we have done. We have record numbers in our NHS workforce, and we are well on target to meet our manifesto commitment on more nurses.

[Suzanne Webb (Stourbridge) (Con)]

4. What progress he has made on recruiting 26,000 primary care staff.

--- Later in debate ---

[Rosie Cooper (West Lancashire) (Lab)]

6. What assessment he has made of the effect of integrated care systems on cross-boundary NHS trusts.

[The Minister for Health (Edward Argar)]

NHS trusts have an integral role in the local health and care system. We expect appropriate engagement between integrated care boards, integrated care providers and the respective NHS providers in an area. An NHS trust is a formal partner of an ICB if it provides any services in the ICB area and has the function of participating in the nomination of members to the board. Regulations give details as to how to determine which trusts that provide services in an ICB area should participate in the nomination process.

[Rosie Cooper]

Notwithstanding the Minister’s comments, Cheshire and Merseyside integrated care system has recently made the decision to stop my West Lancashire constituents accessing routine dermatology at St Helens Hospital, which is the only nearby provider. Due to geography, my constituents are in the Lancashire ICS, and are therefore not represented in Cheshire-Mersey—in place or local authorities.

My question, which I have asked several times, is: what is the Department doing to ensure that there is a mechanism for my constituents in Lancashire ICS to be represented in Cheshire-Merseyside’s decision-making process, which directly affects the care they are given? I have raised this point about cross-border difficulties so many times that I must question whether we any longer have a national health service, or whether we have a series of protected ICS kingdoms.

[Edward Argar]

The hon. Lady and I speak regularly about different aspects of her local health system, and I am happy to do so again on this matter. I do not know the exact details behind the specific example, but I do not think it relates directly to how ICSs are configured in statute and guidance. I would be happy to meet her to understand the local factors that may have contributed to the situation.

[Jacob Young (Redcar) (Con)]

7. What steps he is taking to increase the quality of nursing in care homes.

--- Later in debate ---

[Luke Hall (Thornbury and Yate) (Con)]

A new hospital at Thornbury would provide greater primary care and outpatient services, more GP appointments and a proactive frailty hub to support the elderly to stay in their own home longer. Our bid was submitted against the sustainability and transformation plan wave 4 capital pot, and I thank the Minister for all his work and effort in speaking to me, South Gloucestershire Council and our clinical commissioning group about this bid. Will he update the House on the timescales for its outcome?

[The Minister for Health (Edward Argar)]

I am grateful to my hon. Friend; he rightly alludes to the fact that he is a strong champion of his constituents and has met me on a number of occasions to argue the merits of the Thornberry health centre. As he will be aware, we now have a multi-year capital settlement for our NHS, which will allow us the opportunity, through local systems, to consider the most appropriate projects for investment.

[Mr Speaker]

Like Chorley.

--- Later in debate ---

[Edward Argar]

It was a great pleasure to visit my hon. Friend before the jubilee weekend and to meet the staff who do such an amazing job at his local hospital. As ever, his puts his case clearly and firmly for a new hospital to replace the QE in King’s Lynn, and we hope to be able to announce the longlist of those expressions of interest in due course.

[Mr Speaker]

Including Chorley, I hope.

Hospital of St Cross: Accident and Emergency

Edward Argar Excerpts

Thursday 9th June 2022 Commons Chamber

[The Minister for Health (Edward Argar)]

I congratulate my hon. Friend the Member for Rugby (Mark Pawsey) on securing this important debate. He is right to highlight that it is the responsibility of Members of Parliament to highlight and champion their constituents’ concerns, and he is doing exactly that today, just as his illustrious predecessor and father did over a combined total of about 18 years in this House, representing that area with distinction just as he does. My hon. Friend has been a regular campaigner for the NHS in his constituency. Indeed, as I recall from oral questions some time ago, I think I am right in saying that he volunteered at the Locke House vaccination centre during the pandemic to assist his local NHS. Not only does he talk the talk; he walks the walk in supporting his local NHS, and his constituents in Rugby are incredibly lucky to have such a passionate local champion for their cause in this House.

My hon. Friend’s engagement with his constituents, and his being in tune with their concerns, is reflected by the survey he mentioned. He said he had received around 3,000 responses, which is a phenomenal response rate for such a survey. I think I read that it was reported on the excellent CoventryLive site, which highlighted exactly what he had done. He asked me to acknowledge, and of course I do, the virtual uniformity of the concerns raised in his constituents’ responses. That is a powerful message that his constituents are sending to us.

I understand that the Hospital of St Cross has operated an urgent care centre since the closure of the full A&E in 2011, transitioning to become an urgent treatment centre in line with national changes in 2019. That service is available 24 hours a day, seven days a week, allowing patients to access the urgent care services that it is able to provide at any time. Trained nursing staff are on hand and patients can have X-rays and blood tests and access a pharmacy. As my hon. Friend said, patients with more complex medical conditions requiring advanced tests or investigations will be referred or taken by ambulance to be cared for by specialists at the University Hospital in Coventry. This, to a degree, reflects the staffing availability and specialist staff required for different services, and which services are available in a particular setting.

My hon. Friend highlighted an important point, which applies not only to his local hospital but more broadly across the country. There is more we can do to help our constituents, and those who may need services, to understand what services each different NHS destination —be it an A&E or a UTC—can provide, and hopefully reduce the number of people who see the H sign on the motorway and think, “I’ll go there because I need assistance,” only to end up being transferred to another hospital to receive the services they need for their condition. There is more we can do to make that clear.

I appreciate my hon. Friend’s call for a restored full A&E service in Rugby, on the basis of demographic change since the decision was taken in 2010 and implemented in 2011. He is right to highlight the pace of change, including in population. I know his patch a little; it is a relatively short hop down the M69 and back across the M6 from my patch to his. He is right to highlight all that Rugby and the area is doing to help support the objectives of providing affordable housing for people who need it; but that of course comes with additional pressures on local public services and local infrastructure, as he rightly emphasised.

As my hon. Friend knows, the original decision to alter local service provision was made following a full public consultation to address concerns raised at the time that the unit was not able to sustain full A&E services, with serious cases, even then, being sent to Coventry for treatment. I can assure my hon. Friend that this decision will rightly be taken by the local clinical commissioning group, as it was in 2010—although it was possibly a primary care trust at the time. Shortly, it will be a decision for the local integrated care boards, which are due to come into force very soon, following the passage of the Health and Social Care Act 2022. It would not be right for the inception of such decisions to come from Ministers in Whitehall. I would note, however, that for any future changes we will see slightly altered powers for Ministers, with the power of direction and intervention introduced in that legislation.

I can assure my hon. Friend that the funding available to his local health system has risen in line with demographic change since 2010—as determined by the formula set by the Advisory Committee on Resource Allocation—and that ensuring that resources are allocated to deliver the best care for patients is a key duty of both the CCG and, subsequently, the ICB. The local health system is best placed to consider sustainability, location, and demand for services across its area. Any such assessment of whether to reduce services, move services or open new services should include consideration of the mix of accident and emergency services, UTCs and other treatment services, such as GP access.

Without wishing to pre-empt any particular course of action that my hon. Friend’s local system might be persuaded by his forceful advocacy to consider, I would also comment that it is for the ICBs and trusts to plan for reconfigurations of NHS services. Judging by what my hon. Friend said, he is already lobbying them pretty firmly. Where services are reconfigured, we are clear that these are subject to four stringent Government tests, which are strong public and patient engagement, consistency with current and prospective need for patient choice; a clear clinical evidence base, and support for proposals from clinical commissioners.

Decisions on any reconfiguration are rarely easy or straightforward; they are effectively about balancing different needs and benefits, including patient transport and inequalities, and it is important to hear from as many local people as possible about the practical impacts and concerns. As I alluded to, I encourage my hon. Friend to continue his conversations with his local NHS system.

Before turning to pressures on A&Es more broadly and the ambulance service locally, I should say that there is already significant investment to improve services in Rugby. The University Hospitals Coventry and Warwickshire Trust remains committed to expanding services at the Hospital of St Cross, and in recent times that has included the opening of a £1 million purpose-built haematology and oncology unit, and new modular theatres to help treat more patients on elective waiting lists. It is probably fair to say that a degree of credit goes to my hon. Friend for fighting the corner for his local hospital, as he always does.

I shall now mention pressures on emergency departments. The emergency department at the University Hospital in Coventry has also been granted £15 million by the Government to increase its capacity and further enhance patient care. This investment will expand the department, including with a new minor illness and injuries unit. The funding will also be used to install additional treatment cubicles, to expand the waiting room in the children’s ED, to increase the level of same-day emergency care and to support diagnostic capacity with an additional CT scanner.

It is right that we take a whole-system approach to these challenges, and all this work is designed to complement existing services provided at both the Rugby and Coventry urgent treatment centres. My hon. Friend is right to highlight the pressures we are seeing in EDs across the country, which is often manifested in ambulance delays and ambulance queues. That is a symptom of the patient flow challenge in hospitals. Space is needed to offload patients safely into EDs, for which EDs have to be able to discharge patients safely or admit them into the hospital. To do that, hospitals have to be able to discharge patients to free up the bed space to enable that patient flow. In recent months we have seen sustained pressure in hospitals across the country in that respect, and he rightly highlights his local hospital.

My hon. Friend talked about the ambulance service and highlighted the tragic case of Jamie Rees, which has been reported on extensively by CoventryLive. Jamie sadly passed away on new year’s day following a cardiac arrest. Through my hon. Friend, I extend my sympathies and condolences to Jamie’s family and friends.

I understand the West Midlands ambulance service believes that, sadly, an ambulance station, had there been one in Rugby, would not have altered the outcome in Jamie’s case. In the 90 minutes before it received the first 999 call, I understand there had been five other emergency calls in the Rugby area. That means any ambulances based in the town would have already been dispatched to deal with those emergency cases, so the ambulances would not have been available wherever the station were based. I fear that reflects the pressures at the time. None of that will be any consolation to Jamie’s family, but I wanted to highlight the context.

My hon. Friend also rightly highlighted the “Our Jay” campaign and the number of externally mounted defibrillators, which is a hugely important topic. It is sad that there is sometimes an unwillingness to fund externally mounted defibrillators due to the despicable behaviour of utterly heartless individuals who, for some reason, think they have the right to vandalise or steal this life-saving kit. It is a sad reflection on them, and I sincerely hope they never find themselves in a situation where they need such kit to be available. I pay tribute to the “Our Jay” campaign.

More broadly, we have put a number of measures in place to try to ease the pressure on A&E and ambulance services. The discharge taskforce is helping to free up patient beds by ensuring that patients who are fit to be discharged are discharged more rapidly. In recent years, £450 million has been spent on expanding A&E departments, and there has been a £55 million investment in strengthening ambulance trusts and keeping an extra 156 ambulances in service and on the road to bolster capacity and resilience during the winter period.

I hear the passionate case my hon. Friend makes. There is significant support in place, both locally and nationally, to help ensure constituents in Rugby can access the care they need when they need it, but I also wish to make a number of points. First, I am happy to meet him to discuss this matter. I was going to offer to make the short hop down the M69 and the M6, but from what he has says I have been pipped to the post by my boss arranging to do that visit; he has perhaps upgraded the offer, with the Secretary of State rather than a mere Minister of State. I hope my hon. Friend will feel free to share the detail of his survey and the responses with me. I am also conscious that I have some outstanding correspondence from him—I checked that this morning—and I will ensure that I respond to it in the next few days. I will pull it out of the system and ensure that he gets answers to the specific points he raised.

I thank my hon. Friend, once again, for rightly raising this important issue, securing an important debate on the Floor of the House today and doing what he does so well: championing his constituents’ best interests, and making sure that Ministers have no opportunity to forget them and to forget the people of Rugby. Indeed, he ensures that they are impressed upon our minds. I look forward to meeting him to discuss this further, and I hope that will happen shortly.

Question put and agreed.