NHS: Targets

Debate between Lord Young of Norwood Green and Baroness Blackwood of North Oxford

Thursday 6th February 2020 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank all noble Lords for an expert and robust debate on a very important issue. In the time available, I shall do my best to respond to as many of the points raised as possible. I particularly thank the noble Lord, Lord Hunt, for, as ever, a robust contribution on a very important issue and for allowing us to have this debate. I also pay tribute to the noble Baroness, Lady Wilcox, for a formidable maiden speech. It is clear that she has deep personal experience and a straight-talking character, which means that she will make a considerable contribution to this place. I look forward to many future debates and interactions with her on the issues she has raised today and many others.

Like my noble friend Lord Bates, whom I can see in his place and who made an outstanding speech, I start by thanking the hard-working staff in our health and social care services. These services face unprecedented demand, with an ageing population and the challenges of winter placing a particular strain on them. In that context, the staff are doing a quite extraordinary job. As was mentioned by the noble Baroness, Lady Crawley, we all have our love letters that we can speak of, based on our own experiences. They demonstrate when the staff go far above and beyond to make sure that we come out on the other side in one piece.

I have listened very carefully to the concerns raised today about NHS performance, the pressures on our social care system and the impact on patients. Noble Lords are absolutely right to expect the Government to be restless in pursuing higher quality and in supporting the NHS so that it can be there for each and every one of us when we need it most. Today, I will outline the steps that the Government are taking to help address those concerns and will bring noble Lords up to date as much as possible.

I turn, first, to performance. As I have already mentioned, the NHS and social care system faces unprecedented demand. A number of noble Lords mentioned the figures. I will not go into too much detail as I would like to answer as many specific questions as possible. However, I should like to note that the most recent figures available for December 2019 show that there were over 2 million attendances at A&E—6.5% more than in December 2018. That means attendance by over 70,000 people every day—the highest ever for the month of December. Hospitals have also delivered 2.4 million more operations and almost 13 million more consultant-led out-patient appointments than in 2009-10. That is an extraordinary achievement.

However, I recognise, as was mentioned by the noble Lords, Lord Hunt and Lord Turnberg, the noble Baroness, Lady Pinnock, the right reverend Prelate the Bishop of Carlisle and many others, that in addition to the pressures on the health service, we are seeing increased demand in the social care system. We must put social care on a sustainable footing, with everyone being treated with dignity and respect. It is one of the biggest challenges that we face as a society. As my noble friend Lord Bates rightly said, we must resist the temptation to treat it as a political football. The Prime Minister has been clear that this Government will deliver on their promises and bring forward a plan for social care this year, as was specifically requested by the noble Baroness, Lady Brinton. I am quite sure that she will hold us to account very firmly on that commitment.

It is expected that there will be 1.5 million more over-75s in the next 10 years and we have to find a way of caring for them. As the noble Baroness, Lady Wilcox, rightly pointed out, there has also been a significant growth in the number of working-age people with disabilities who need care at a younger age. We need a system that gives every person—old and young—the dignity and security that they deserve.

The noble Baroness, Lady Wilcox, was right that these are complex questions which require not only difficult decisions to be made but the establishment of a sustainable settlement that will provide certainty for generations to come. That is why we will seek to build cross-party consensus, but we have been clear on two points: that everyone will have safety and security, and that nobody will be forced to sell their home to pay for care. The noble Baroness, Lady Thornton, asked me to predict both the Budget and the outcome of these negotiations. I am afraid that I will not be able to do that today but I am very touched by her thought that I would be able to answer those questions immediately at the Dispatch Box. However, I would like to update the House on what we have been doing to try to reduce pressures in the meantime.

To help address the increases in demand, last year we committed to £33.9 billion more funding a year by 2023-24. We are now enshrining that in law, and I know that we will have a significant debate about what that means for the NHS. As my right honourable friend the Secretary of State for Health and Social Care announced, this is a significant cash settlement for the NHS, and it means that we are already delivering on our manifesto commitments. We are also committed to delivering 40 new hospitals over the next decade, 50,000 more nurses, 6,000 more doctors in primary care and 50 million more GP appointments. As requested, I will update the House on the specific questions on that.

The noble Baroness, Lady Crawley, asked about the EU workforce. We have been clear that our priority is to ensure that the 181,000 EU staff currently working in the NHS and in social care are not only able to stay but feel welcomed and encouraged to do so. Since the referendum, we are pleased that 7,300 more EU staff are working in the NHS, including 900 more doctors. We are not only working to make sure that they are able to navigate their way through the EU settlement scheme easily and effectively; we will also introduce a new EU visa to make it easier for suitably qualified doctors, nurses and other staff to come and work in the NHS from overseas. We are working across government to make sure that this goes through smoothly.

In addition, a number of Peers, including the noble and gallant Lord, Lord Stirrup, and the noble Baroness, Lady Watkins, asked how we will go forward with the people plan, which will provide a constructive and holistic approach to our management of the framework for collective action on workforce priorities. This will be published in early 2020. It needs to take fiscal priorities into account, so there are questions around the Budget and the spending review. It will focus on growing and sustaining a well-skilled workforce across the NHS, particularly on creating healthy, inclusive and compassionate cultures. I know that this was raised by a number of Peers, including the noble Lord, Lord Turnberg.

To date, in addition, capital funding amounting to £2.4 billion has been provisionally awarded to over 150 STPs. I know that the noble Lord, Lord Hunt, has raised this on a number of occasions. This investment will modernise and transform NHS buildings and services, which the noble and gallant Lord, Lord Stirrup, asked about. The money will go towards a range of programmes across the country, including new urgent care centres, integrated care hubs that bring together primary and community services, and new mental health facilities. This money will be spent on upgrading facilities, increasing capacity so that more people can be treated and shifting emphasis towards prevention, making sure that we can deliver on the prevention Green Paper.

My right honourable friend the Prime Minister also announced a further £1.8 billion increase in NHS capital spending, which will deliver on 20 hospital upgrades so that they can come forward as soon as possible. This frees up the NHS to take forward and expand its existing plans for investment in infrastructure, and to unlock the delivery of commitments already made.

We have taken into account the questions about backlog maintenance and equivocal infrastructure asked by the noble and gallant Lord, Lord Stirrup. There has been a commitment that this will be taken into account as part of the spending review. It is recognised that, for too long, this has not been undertaken suitably strategically. I hope that that reassures him.

To respond to the noble Baroness, Lady Thornton, we have committed to growing the workforce by more than 600 doctors in general practice. NHS England and HEE are working with the profession to increase the workforce in England. This includes measures to increase recruitment, address reasons why doctors are leaving the profession and encourage them to return to practice. We have discussed this on a number of occasions. I am pleased to report that, last year, HEE recruited the highest numbers of doctors into GP training ever, at 3,540 trainees. We are moving in the right direction.

The noble Baroness, Lady Masham, rightly raised earlier diagnosis. We are committed to making sure that we drive forward on this. It is a crucial part of the long-term plan: as part of prevention, we also want to make sure that we are diagnosing earlier, reducing demand and pressures for patients and clinical trials. This is why we announced funding to replace outdated cancer diagnostics and treatment machines. Some £200 million, consisting of £100 million this year and £100 million next year, will be used to replace MRI and CT scanners or breast cancer screening machines that are more than 10 years old. I know that the Labour Front Bench wanted to be reassured about this so that we can ensure that we get earlier diagnostics and patients on the right care pathways as soon as possible.

The noble Baroness, Lady Gale, asked some specific questions about Parkinson’s. I hope to give her some helpful answers. In 2018-19, the NIHR clinical research network supported 323 dementia and neurodegeneration studies, 99 of which were new studies in this area. In addition, to address access to mental health support for people with long-term medical conditions such as Parkinson’s, we aim to increase access to psychological therapies for an additional 600,000 people each year by 2020-21. We have committed to ensuring that this will address care for patients, such as those with Parkinson’s. I hope that this answers some of the noble Baroness’s key questions.

In the short term, NHS England has prioritised funding to support performance for this winter. I know that this was raised by the noble Lord, Lord Hunt. Additional capital and revenue funding was made available to systems and trusts to support staff and bed capacity throughout the winter. This has allowed trusts to increase bed numbers and facilities to support better flow through the system. I am pleased that the NHS has reported that over 1,000 more hospital beds are open this winter than at the same time last year.

In addition, a further £240 million has been provided again this year for adult social care to help reduce delays in patients being discharged from hospital by providing social care support. The noble Baroness, Lady Brinton, was quite right to highlight the value that the better care fund has provided in integrating the links between adult social care and the NHS. She is quite right that this is a relatively short-term solution; we look forward to more sustainable long-term solutions from ICS and others. However, I am very pleased that we committed a total of £6.4 billion to the better care fund in 2019-20 and that further funding is committed for this year.

This is all in addition to winter funding that provided £145 million for hospitals last year and has gone up this year. It has also provided ambulance services with 256 new state-of-the-art vehicles and make-ready hubs, which shorten vehicle turnaround times. I know that the noble Baroness, Lady Masham, was concerned about this.

To support performance, the NHS has continued to focus on longer-term solutions. This means that, as we go on in years, we will not see the same performance challenges, transforming and improving urgent and emergency care services. The priorities are as follows.

The first is to increase the provision of same-day emergency care so that patients are seen quickly and not admitted to hospital overnight if that is unnecessary. We have seen some good progress here, with over 89% of hospitals now providing SDEC for 12 hours a day. Other priorities are: to reduce the number of patients who have unnecessary long lengths of stay of more than 21 days in hospital; to increase the number of urgent treatment centres delivering a standardised level of service to provide patients with an alternative to A&E; to continue to make improvements to the use of GPs at major A&Es, allowing less acutely ill patients to be streamed away from the emergency departments, and to consider the issues raised by the noble Baroness, Lady Watkins, about the higher training of GPs and other practitioners so that patients do not feel the need to go to A&E; and to enhance NHS 111 services so that people calling can receive a clinical assessment and be offered immediate advice.

To respond to the important point made by the noble Lord, Lord Young, about the spreading of best practice across the system, we have brought in very important measures recently—not only NHSX but Getting It Right First Time to support NHS Improvement’s work, as well as the Accelerated Access Collaborative to drive innovation and best practice across the system.

I turn to the questions about clinical waiting time standards. This review is being clinically led by Professor Stephen Powis, the national medical director of NHS England, to consider whether improvements can be made to access standards for urgent care, planned care, cancer and mental health treatment. It is not a question of abolishing or removing these waiting time standards.

I will briefly address the point made by the noble Lord, Lord Hunt, about the introduction of the four-hour waiting time and the Patient’s Charter. Let us remember that that was 15 years ago. Under this Government, last year, 1.7 million more patients were treated within four hours than in 2010, and hospitals delivered 2.4 million more operations. Let us not forget that, when the Labour Administration left office, over 18,000 people were waiting for more than 52 weeks to start elective treatment. It is now 1,400. I would like for us not to look with rose-tinted glasses and forget some of the challenges being faced then as now.

Regarding the questions on current A&E waiting times, the standard sets out a maximum four-hour wait from arrival to admission, transfer or discharge. The initial clinical review of standards report set out some key reasons why we should consider clinically whether there are better ways to deliver this care. First, the standard does not measure total waiting times or differentiate between severity of conditions. It measures a single point in what is often a complex care pathway, and there is evidence that hospital processes rather than clinical judgment are resulting in admissions or a discharge in the immediate period before a patient breaches the standard—in other words, perverse incentives.

In addition, since the introduction of the waiting time standards 15 years ago, practices in medicine and urgent care have naturally advanced, for example with the introduction of specialist centres for stroke care, urgent treatment centres, NHS 111, trauma centres, heart attack centres and acute stroke units, increased access to and use of tests in A&E and new ambulance standards, as well as the increased use of same-day emergency care to avoid unnecessary overnight admissions. This is all being led by clinicians on the best advice to improve the standard of patient care. Any changes will be reviewed only after full evaluation and clinical advice. I hope that that is reassuring for the House; I am sure that we will be robustly tested on it. I hope that it clears up some of the questions asked and responds to some of the points made by the noble Baroness, Lady Watkins.

I will close so that the noble Lord, Lord Hunt, has time to respond. I close by expressing the hope that I have reassured the House that this Government not only understand the importance of world-class health and social care provision but have made it our number one domestic priority. We are listening to the concerns raised regarding not only the quality of, and access to, NHS care but social care.

The measures I have outlined are helping to ease pressure on the health and social care system and to improve performance. The funding we have committed through legislation is intended to provide the certainty that the NHS needs to deliver the long-term plan and, with it, the world-class service that each and every one of us wants, so that clinicians, patients and the public can have confidence that they will always be able to find the right care at the right time, no matter where they live in the United Kingdom.

[Lord Young of Norwood Green]

The Minister has given a comprehensive response to a range of questions. Could she answer in writing the question on NHS apprenticeships? I would be grateful.

[Baroness Blackwood of North Oxford]

Yes.