NHS Winter Readiness

Danny Chambers Excerpts

Wednesday 30th October 2024 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for securing this timely debate.

In Winchester, the NHS is the No. 1 issue for nearly everyone, and it will be the same for the rest of the country. Patients and staff are aware that we have a huge challenge every winter. Hospital managers and chief executive officers must be so frustrated that they have to face that challenge every year. From what I understand, having spoken to quite a few hospital managers and CEOs of hospital trusts, over the last few years, at about autumn time, they have applied for extra funding to deal with what will be a winter crisis, and by about November they have heard whether they will receive it and how much they will get. They have then received the money by about January, when we are already halfway through the winter, despite the fact that winter comes every year and we know that there will be a winter strain on the NHS.

In the spirit of constructive opposition, I will talk about four issues that we should consider when it comes to future winter challenges. The first, as has been mentioned by nearly everyone, is social care. In the Hampshire hospitals foundation trust, there are between 160 and 200 people at any given time who are well enough to go home but do not have anywhere to go, often because of the lack of social care packages. We have talked about the flow through hospitals; if A&E cannot take patients into hospitals because the beds are occupied, ambulances end up queuing outside hospitals, and the knock-on effect is a huge delay in ambulance response times.

My hon. Friend the Member for Chichester (Jess Brown-Fuller) mentioned that one in four people now worry about calling an ambulance over the winter because they are worried that it will be a long time until it arrives. The frustrating thing is that providing social care packages is more cost-effective than keeping someone in a hospital bed, so while not having social care packages in place so that people can be moved out of hospital in a timely way is not good for patients, it is not even cost-effective for the taxpayer.

Nearly every speaker has brought up primary care: everything from doctors and dentists to mental health and public health. Some 22% of the people who arrive at a typical A&E are there because they cannot get a GP appointment. People are turning up with tooth root abscesses, and often end up needing general anaesthetic to sort out dental problems that could have been avoided had they been able to get an NHS dentist.

Desperate mental health patients, who are often already on a waiting list, walking into A&E take up a huge amount—up to 30%—of an A&E department’s time and resources. People wait years after being referred for mental health care by their GP and then end up in A&E, taking up time and resources during the winter crisis. That is not a good use of taxpayers’ money, it is not good for the patients, and it is hugely stressful for the staff. It is always more cost-effective to keep people healthy in their community and treat them early than to treat them in A&E. It is not the place for people in a mental health crisis, people with severe dental issues, or people who just cannot get a GP appointment.

My hon. Friend the Member for North Shropshire mentioned vaccination and when we talk about public health, we talk about prevention and cost-effectiveness. Vaccines are the single most cost-effective health intervention that has ever been developed throughout the world for pretty much any disease, but it is concerning to hear that the number of NHS staff being vaccinated is dropping. That is dangerous both for their health and for patients’ health. We should certainly examine and unpick that, and try to explore why the number of NHS staff taking the flu vaccine has gone down. We need to engage with them to give them the confidence to take the vaccines as well as access to them to ensure that we have as high a vaccination rate as possible.

My hon. Friend the Member for North Shropshire also mentioned this, and we need to act in our communities because of flu, covid and RSV. The situation is always worse in winter. We know that it will be worse and the risk of immunocompromised people turning up to a hospital and waiting in an A&E department, surrounded by other patients who are infectious because they have not managed to get a vaccine, is a huge issue.

The hon. Member for Strangford (Jim Shannon) talked about pharmacies and community care, which are a huge part of the jigsaw in making vaccinations available to the general public. Local pharmacies need all the support that we can give them to ensure that they are open at convenient times—and that they stay open, because a lot of pharmacies have closed. Ideally people—especially vulnerable people—should be very close to a pharmacy so they can get the vaccinations that they need.

Finally, every other Liberal Democrat Members who spoke today talked about the Liberal Democrat winter taskforce and how we would really appreciate the Government looking into our proposals seriously. We are spending the money in bit-pieces every winter anyway, so we should have a much more joined-up and long-term plan about how we deliver healthcare over the winter and ease the pressure on our hospitals. That would be hugely beneficial.

I pay tribute to NHS staff. I imagine that they dread winter coming. This is the time of year when they will be bracing themselves, knowing that they will be busier, knowing that they will be working without the right resources and knowing that some of them will get sick with flu, covid and all the other diseases that come in. We thank them for putting their health at risk and for putting in their time and expertise to look after our health. As the Liberal Democrat mental health spokesperson, I acknowledge what a drain it must be on their mental health to work in such situations.

Finally, I have a question for the Government. We know that winter will come every year; it will come next year as well. What are we doing to ensure that we do not have a planned crisis in the NHS next winter?

--- Later in debate ---

[Karin Smyth]

I will come on to staffing to address some of those points. The hon. Gentleman makes an excellent point about staff recruitment and retention, which is a key part of our future look at the system.

On winter planning, the Government should not be micromanaging people in local systems as they do their job. Rather, we need to focus our efforts on where they are needed the most. Notwithstanding the excellent work of individual staff, let me repeat: the NHS is broken. None of us should underestimate how difficult this winter could be, but we are taking immediate steps to cushion the blow. First, we have set out our national winter planning priorities to NHS systems, local authorities and social care providers to support operational resilience over the coming months. Secondly, we are standing up the winter operating function seven days a week to respond to pressures in real time.

Thirdly, we are expanding the operational pressures escalation levels framework to give us a clearer picture of what is happening on the ground in all our systems. The framework uses comprehensive data to keep track of hospital pressures, and this year we are expanding its scope to mental health, community care and 111. Fourthly, we are continuing to support systems that are struggling the most through the urgent and emergency care tiering programme. Those are direct interventions to help systems get back on their feet and make the necessary improvements in performance.

Fifthly, we are providing targeted, clinically-led support to 19 of the most pressured hospital sites across the country, to help long waits in A&E and avoidable admissions over winter. Those measures are in addition to the aforementioned meetings that I hold with NHS England and UKHSA every fortnight. I am chairing every one of those meetings to ensure that we identify risks as soon as they arise, while supporting NHS England to mitigate them.

The party of the hon. Member for North Shropshire has called on the Government to set up a winter taskforce to prepare for an NHS winter crisis. Some might describe what we are doing as a taskforce; I actually think that is my job and the Secretary of State’s job, which, as I have outlined, is why we meet regularly with NHSE. I know that the hon. Member and others are sincere in their efforts to be constructive. I am happy to take away any specific suggestions about what we are not doing to help the NHS, because we all want the system to work well.

[Dr Chambers]

There has been no mention of increasing social care packages. Today, I spoke to the CEO of Hampshire hospitals trust, which runs Winchester hospital, and she said the single biggest thing that would make a difference over winter for that hospital, and probably every other one in the country, would be increasing the number of social care packages and ensuring that those well enough to leave hospital can be treated and cared for elsewhere. Why is that not the main focus of the winter measures that the Minister is talking about?

[Karin Smyth]

I will come on to social care, but I will make the broader point that every system is different, and the pressures in every system are different. Some systems suffer worse from poorer levels of primary or community care. Others, particularly those across borders, struggle with discharges and packages of care. One thing I am keen to do, and we are doing it, is try to understand the different drivers of performance in different parts of the system. I think we all have a role to play in that.

I very much support constructive advice from local Members of Parliament, in consultation with their local trusts, about the real drivers in their systems, because we know that some systems are performing much better. We as a new Government want to address that issue, to ensure that taxpayers’ money is being directed to the best place to make the system work better. That is something for the hon. Member for Winchester to take back. The flow is affected for different reasons in different parts of the system.

Several hon. Members have mentioned vaccinations. A key part of winter planning is the annual vaccination campaign, which began on 3 October. I thank the hon. Member for North Norfolk (Steff Aquarone), the hon. Member for Winchester and the Opposition spokesperson, the hon. Member for Meriden and Solihull East, for mentioning their support for vaccination programmes, which is absolutely welcome.

People talk about verifying the figures, but my understanding—I am happy to be corrected—is that we cannot verify the actual figures now. We have started different vaccination rates at different times, so the figures are not directly comparable. We will not really know that until the year works through, which I think people understand. It is too early in the vaccination season to draw firm conclusions, but we all have a role to play in driving and encouraging people to uptake vaccinations across the piece. I recently visited a local hospital in my city of Bristol which has staff hubs and encourages staff to go into the clinics. All Members’ efforts to help with that is really helpful. Vaccination programmes play an essential role in protecting people, particularly the elderly, children and the clinically vulnerable from serious illness during the winter months and in relieving pressures on hospitals and the wider system.

Data from the UK Health Security Agency shows that last year people who received a covid vaccine were around 45% less likely to be admitted to hospital compared with those who did not receive one. That is why we are delivering our usual campaigns for covid and flu for the clinically vulnerable in addition to the RSV work that is going on.

With regard to elective activity, for patients who are referred to a hospital we want to do everything we can to bring down waiting lists, which stood at over 7.5 million in August. The NHS is prioritising patient safety, urgent and cancer care and will continue to do its best to maintain appointments and elective procedures by separating elective care facilities and diagnostics wherever possible. In the longer term, we are going to return to 92% of patients waiting no longer than 18 weeks from referral to treatment in our first term, a standard that has not been met consistently for patients for a decade.

Our hospitals do not operate in isolation. Improving resilience across the whole system, including social care, is essential to winter planning. On 17 September we wrote to all local authorities setting out our priorities for improving resilience across social care ahead of winter, emphasising the importance of close partnerships and joint planning between the NHS and local authorities. We want people to have fair access to locally delivered services that start at home and support them to live independently for as long as possible. That will include building bridges between the NHS and social care services, getting people home from hospital as soon as they are ready, and providing much-needed support to families and friends who are involved in a loved one’s care. We will also work to ensure that people are not stuck in hospital beds when they are well enough to go home.

We cannot forget that the backbone of social care is carers. We have made it clear to all local health and care systems that they must continue to support people providing care for their family and friends throughout the winter. I am sure all hon. Members will join me in supporting the Chancellor’s Budget announcement today to support our carers more widely. We want to make sure that carers can access the support they need to look after their own health and wellbeing, not just that of the people they care for. The better care fund includes funding that can be used for short breaks and respite services for carers. The Government are clear that people who draw on care and support, and their families and carers, should be closely involved in decisions about their care. However, in the long term we clearly need reform. That is why the Secretary of State has called for a new national consensus on social care.

The Government are committed to building a national care service. My hon. Friend the Minister for Care is introducing the first ever fair pay agreement for care workers. Again, we have seen today our commitment to further support carers with improvements to carer’s allowance. That is a start, but we know we have a long way to go.

We are working radically to reform the NHS through the 10-year plan, building a health service that is fit for the future and ready to face every winter confidently. Lord Darzi gave us the diagnosis; the cure can be found in shifting the NHS from treatment to prevention, hospital to home and analogue to digital. That is why last week we launched an extensive engagement exercise with the public, staff and stakeholders to inform that plan. Some right hon. and hon. Members might be keen to see some of the public’s wilder ideas, perhaps, but alongside some of those we have already had many considered and thoughtful responses, and we look forward to outlining our specific plans in the spring.

With regard to the point made by the hon. Member for Strangford (Jim Shannon) about individual training and bursaries and the large number of suggestions about the important issue of recruiting and retaining our staff, we will look closely at the long-term workforce plan—we are already doing that. We are open to suggestions. We need to build a workforce for the future that lines up with our three shifts. It will be a tough process to get right and to keep up with modern technology, but all those ideas will inform that.

I commend the hon. Member for North Shropshire for securing the debate today and colleagues for shining a spotlight on the difficulties that our constituents face. I hope colleagues are reassured. As someone who has worked on winter planning in the NHS, I am fully aware of the challenges that we face. That is why we have taken a strong grip of it from the get-go. I know we cannot go on as we have done for the past 14 years, limping from one winter crisis to the next, improvising and making do with sticking plasters. The Government are winter-proofing the NHS with long-term reform, but until that day we will put every hand on deck to tackle the problems as they arise this winter.