Urgent and Emergency Care Recovery Plan

Baroness Merron Excerpts

Thursday 2nd February 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, this plan, interesting in parts though it is, misses the point. We find ourselves in yet another debate over another short-term cash injection to deal with a continuing acute crisis in the health service. It would certainly be helpful if, in replying, the Minister could indicate to your Lordships’ House whether this is in fact new money and, if not, where it is coming from. Furthermore, can the Minister say in his response whether he feels, from his experience, that the better way forward would in fact have been to have a sustainable and long-term plan for the NHS and social care with a laser-like focus on having the necessary workforce in place? The absolutely core point here is this: do we have the staff with which to provide the right level of service? At present, we do not.

We know that more than 7 million people are waiting for NHS treatment; that the four-hour A&E waiting time target has not been met since 2015; and that heart attack and stroke victims and others are waiting inordinate amounts of time for an ambulance. Similarly, we know that those waiting for more than five hours in A&E are more likely to lose their lives, as are heart attack and stroke victims waiting more than 18 minutes for an ambulance.

I am concerned that this plan waters down standards for patients rather than trying to recover the baseline services that are needed to meet them. For example, while the target is for 95% of patients to be seen within four hours at A&E, the Secretary of State has said that the best that can be managed is 76%. Yet outcomes are poorer if patients wait longer than five hours, so can the Minister say what plan there is to return to this all-important target? More generally, can the Minister indicate when patients will see a return to safe waiting times throughout all services?

It is important to see this in the round because too many people find it impossible to get a GP appointment so they end up in A&E, putting more pressure on the service. At the same time, the right care is not available in the community; patients find themselves kept in hospitals, sometimes for months, when they should not be there. As I have said, the gaping hole in this Statement and the Government’s plans is the lack of any sustainable solution to having the right workforce in place, both now and in future. After all, good care in the community, in people’s homes or in hospital cannot be provided without the staff to care for people. As we have lost two in five district nurses since 2010, can the Minister say how more “hospital at home” services will be delivered for patients if there are not the staff to visit them?

As I raised this in a recent question to the Minister, I wonder whether he is now in a position to comment on why the Universities Minister wrote to medical schools telling them not to train any more doctors. It would be helpful to have some light shed on this action.

With regard to virtual wards, NHS providers have rightly pointed out that progress will be dependent on NHS staff continuing to go above and beyond. Does the Minister share my view that this is not what exhausted health and care staff need to hear? Rather, they will want to know when they can expect to have a more sustainable job to go to and when there will be further support from the extended workforce.

In the other place, the former Health Secretary, Sajid Javid, pointed out that successive Governments have not focused enough on prevention, which would take much of the pressure off more expensive emergency care. This intervention came in the context of the Government’s latest announcement that they will not be publishing individual cancer, dementia and mental health plans, which has troubled many patients and stakeholder groups. Can the Minister assure your Lordships’ House that the Government’s new major conditions strategy will give prevention the focus it deserves? When can we expect this strategy? Also, the plan does involve more mental health ambulances, but can the Minister say how we can look forward to a plan that will prevent those with mental ill-health needing an ambulance in the first place?

Lastly, on children, the Royal College of Paediatrics and Child Health has heard how footfall in paediatric emergency departments has doubled across the country, with some children waiting more than 10 hours to be seen by a doctor and surgeries cancelled to free up beds on paediatric wards. As children can deteriorate very quickly, a timely assessment and response is absolutely essential to providing safe and effective care. Will the Minister commit to ensuring that a proportion of the dedicated fund will be used for paediatric services? Will he also commit to writing to every local area to remind them of the solutions that are included in this plan in order to improve urgent and emergency paediatric care?

I look forward to hearing the Minister’s response, in particular with regard to the need for a workforce plan. Perhaps he might also be able to tell us today when we can look forward to the strategy being put before your Lordships’ House.

[Lord Allan of Hallam (LD)]

My Lords, as is usual for this kind of Statement, it is peppered with promises of more of everything. I hope the Minister will help us to dig into the numbers we have been given to see how much lies behind them. First, on the new hospital beds, this seems to come from a process of making winter surge beds permanent. For a real long-term increase in capacity, we need the promised 40 new hospitals. How many of these will be on stream by next winter?

The Statement also tells us that there will be 800 new ambulances, which I think most people would interpret as fully staffed, blue-light vehicles. Can the Minister offer a more detailed breakdown of the different types and capabilities of what is being offered here? The Statement itself said that, for example, 100 of these will be mental health emergency vehicles rather than classic blue-light ambulances.

Of course, staffing these beds and ambulances and the other measures in the Statement will depend on good workforce planning. Here, I echo the comments made by the noble Baroness, Lady Merron, and by these Benches over many months. The Statement tells us that the plan will come this year; can the Minister offer any more precision on when this year we might expect it?

The Statement also talks about data and transparency. We are told that integrated care boards will now have to focus much more on data about patient flow. Can the Minister commit to making more of those statistics public, as well as the ambulance wait time statistics?

Finally, the promised new care hubs can add value only if care services are actually there. This brings us back to workforce limitations. I end with three questions for the Minister: where is the staffing for the beds, where is the staffing for the ambulances, and where is the staffing for the care services?