Oral Answers to Questions

Edward Argar Excerpts

Tuesday 19th November 2024 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Edward Argar (Melton and Syston) (Con)]

The Secretary of State knows that every year, irrespective of which party is in government, winter is challenging for the NHS. Possibly, it will be all the more so this year with the potential impact on older people’s health of the loss of the winter fuel allowance by many. What winter preparedness steps has he taken, like previous Governments, to increase A&E capacity and to increase the number of beds this winter, and can he say by how many?

[Wes Streeting]

It is thanks to this Government and the action we have taken that, for the first time in three years, we go into winter without the spectre of national strikes looming over the NHS, and with NHS staff on the frontline not the picket line. It is thanks to the priority this Government have given to prevention that we have already delivered almost 15 million covid-19 and flu vaccinations, alongside the new RSV—respiratory syncytial virus—vaccination to help vulnerable groups for the first time. The shadow Secretary of State mentions the winter fuel allowance. This Government are protecting support for the poorest pensioners to protect them not just this winter, but every winter, and over the coming years the value of the pension will of course rise with the cost of living.

[Edward Argar]

I am grateful for that response but, just as my hon. Friends have highlighted in respect of the damaging impact of increases in employer national insurance contributions on GPs, hospices and care providers, I fear it was another example of the Government simply not answering the question and not having a plan yet. Either the Government have not done their homework and, as with the impact of NICs increases, they have not thought this through and do not know, or worse, they do not care—which is it?

[Wes Streeting]

This Government are prepared for winter and we are already standing up the operational response to winter pressures. On funding, the right hon. Gentleman was in government just before the general election. Is he saying that his Government did not provide enough funding for the NHS this winter? If not, why not? If he does accept that it is enough money, he will surely welcome the extra investment that the Chancellor is putting into the NHS from next year.

Income Tax (Charge)

Edward Argar Excerpts

Tuesday 5th November 2024 Commons Chamber

[Edward Argar (Melton and Syston) (Con)]

It is a pleasure and a privilege to be working once again in health and social care, although a disappointment to be doing it from the Opposition Benches. It is a privilege because, like the Secretary of State for Health and Social Care now, I had the privilege in government of working with the amazing and dedicated people who work in our NHS and in social care up and down the country. It is a pleasure to be back. It is a pleasure to be opposite the Secretary of State, as he now is. I remember our tussles back in the day, when I was sitting over there and he was sitting here.

I am sufficiently fond of the right hon. Gentleman to encourage him not to get himself fired out of a cannon, as he alluded to. Although I will say one thing for it: it would not only draw attention to his day job, but possibly even aid him in his ambitions to secure his boss’s job in due course. In respect of his comments about the Leader of the Opposition, my right hon. Friend the Member for North West Essex (Mrs Badenoch), I would only say very gently that she should probably take that as a compliment. When the right hon. Gentleman attacks someone in that way, it probably means that they are somewhat frit of her. I think he will see in the coming weeks and months why that is so.

We have already seen and heard over the previous days of debate that this is unequivocally a Budget of broken promises. Despite the pledges made over the course of the election and the commitments given to the British people, in reality those words meant nothing to the Labour party once it secured the keys to No. 10. Instead, we have seen taxes hiked on working people: the people who provide food security and food every day, our farmers, hit hard by the changes that have been made. We see living standards set to fall and mortgage rates likely to rise. We see taxes up, we see borrowing up, we see debt up, and we see that growth will be down on where it could and should be. Unfortunately, I fear, that pattern of broken promises also applies to the NHS and our social care sector.

[Mr Perkins]

I am grateful to the right hon. Gentleman for giving way and congratulate him on his new appointment. He is obviously very critical of the Government’s attempt to alleviate the appalling financial legacy that his party bequeathed to the nation. Does he support the extra investment for the health service, and is it just the ways of paying for it that he is against? Or is he actually opposed to it?

[Edward Argar]

I am very grateful to the hon. Gentleman. In his allusion to the Labour party’s inheritance, he missed the fact that the Office for Budget Responsibility singularly failed to back up the assertions made about the quantum of challenge the incoming Government faced.

Time and again, the right hon. Member for Ilford North (Wes Streeting), both in opposition and now as Secretary of State, has promised that any more money for the NHS has to be linked to reform. He has done that again today. The week before the Budget, he said that

“extra investment in the NHS must be linked to reform”.

In September, the Prime Minister himself said:

“No more money without reform”.

They are right on that. The Opposition support that condition, because it is only with reform that the NHS can sustainably continue to look after us for years to come. Yet I fear that this risks being another broken promise. I say to him now that where he is bold and provides genuine reform to benefit patients, he will have our support. Equally, if he bows to internal pressure and backs away from the radical reform that is needed, we will hold him to account.

[Joe Powell (Kensington and Bayswater) (Lab)]

Will the right hon. Gentleman give way?

[Edward Argar]

I will make a little progress before giving way to the hon. Gentleman.

I congratulate the Health Secretary on winning round 1 with the Treasury—I look across the Chamber and see the Chief Secretary to the Treasury on the Government Front Bench—in securing extra investment. He has secured more than £22 billion announced for the NHS, but without, as yet, any detailed indication of where that funding will go. I look forward to him returning to the House to set out the detail—I think he said that would be next week. What it must do is genuinely improve outcomes for patients and our NHS, rather than simply be focused on the headline figure of the inputs to it. There are, as yet, no clues as to whether it will be spent on wages, recruiting more staff, medicines or equipment; no clues as to how it will deliver the 40,000 additional appointments that have been promised; and no conditions linking the funding, as yet, to productivity improvements, modernisation or better outcomes for patients.

What we need to hear next week from the Secretary of State is an actual plan. As he mentioned, the right hon. Gentleman became shadow Health Secretary three years ago. I hope that in that time he has had an opportunity to think about what he wants to do and that he will actually set that out to the House next week.

[Joe Powell]

I welcome the right hon. Gentleman to his new position. On the theme of broken promises and capital investment, and in the spirit of a fresh start, I wonder whether he will extend an apology to my constituents who were promised a new hospital under the new hospital programme, which was never funded in any forward-looking Budget document?

[Edward Argar]

I am grateful to the hon. Gentleman. If he pauses for just a moment, I will turn to capital investment and seek to address his point.

[Paul Holmes]

Will the shadow Secretary of State give way on that point?

[Edward Argar]

I will make a little progress, but then I will happily give way to my hon. Friend.

Apart from the press releases and the reviews, where is the action? We need to see where the £22 billion will be spent. What plans does the Secretary of State have for additional investment for the NHS this winter? He knows, as I knew when I was a Minister, that winter in the NHS is always challenging. I look forward to him setting out what additional investment he plans.

[Wes Streeting]

On that point.

[Edward Argar]

I will give way to my hon. Friend the Member for Hamble Valley (Paul Holmes) in a second. Nice try, Secretary of State.

Is the right hon. Gentleman directing where that NHS funding goes himself, or will it be for his officials or NHS England to set the priorities for that, and who will be held accountable for ensuring that it is prioritised in the right places?

[Paul Holmes]

I thank my right hon. Friend for giving way and congratulate him on his appointment as shadow Secretary of State. Does he share my concern that, although the extra investment in the NHS is welcome, the lack of clarity from a Budget in which growth has actually been revised down means that in future years we could see additional investment in the NHS actually being cut back, because the Budget does not deliver the growth for public service investment?

[Edward Argar]

My hon. Friend is absolutely right. You cannot tax your way to growth and you cannot invest in public services without that growth. If the predictions we are seeing about growth are borne out, there is a real risk to our public services’ sustainability in future.

The Chancellor said that the funding would help to deliver 40,000 more NHS appointments a week, but again we see no reference to specific actions by which that will be achieved. The Government seem not to know the difference between a target and a plan, and simply restating their ambition while throwing money at the challenge will not be enough to deliver on that commitment.

As I have said, elements of the Budget relating to the Department of Health and Social Care were welcome, one of them being the Secretary of State’s one-nil win over the Chief Secretary in respect of funding. An additional £2 billion to drive productivity is important. I fear that it is a slimmed-down version of the £3.4 billion NHS productivity plans that we announced and funded, but I will study it closely, and, similarly, the Secretary of State’s plan for mental health is deserving of serious study. On both sides of this Chamber, we recognise the importance in mental health investment of not only parity of esteem but parity of services, and it is therefore right for us to scrutinise very carefully how the right hon. Gentleman intends to build further on the success that we had in driving that agenda forward.

Let me now turn to the subject of capital investment, which was touched on by the hon. Member for Kensington and Bayswater (Joe Powell). It concerns me that, as far as I am aware, the Secretary of State has still not told us exactly when his review of the new hospital programme will report and set out the future for each and every one of the hospitals that he committed himself to delivering during the election campaign—the programme to which the previous Chancellor had committed funding, building on the original £3.7 billion allocated in 2019. The question for the Government, and the question for the Chief Secretary to answer when he winds up the debate, is: “When will that review report, and when will each and every one of those colleagues and communities who are looking forward to a new hospital know whether it will be delivered in line with the Secretary of State’s pledge, or whether the programme will be cut?”

Nearly a week after the Budget, Members will be familiar with the verdict of the Office for Budget Responsibility: namely, that the £25 billion assault on businesses risks lower wages, lower living standards and lower growth. And let us not forget what this tax hike will mean for those providing essential services across primary, secondary and social care—the general practices, care homes, adult social care providers, community pharmacists on our high streets, hospices and charities such as Marie Curie and Macmillan which provide additional care for patients alongside the NHS.

I was deeply disappointed that the Secretary of State did not take the opportunity offered by my hon. Friend the Member for Hinckley and Bosworth (Dr Evans) to state clearly that all those groups would be exempt and would not be hit by this hike, and I hope that when the Chief Secretary winds up the debate he will be able to give that reassurance. The Royal College of General Practitioners has warned that the extra costs of the employer’s national insurance hike could force GP surgeries to make redundancies or close altogether, and the Independent Pharmacies Association has warned that community pharmacies will have to find an extra £12,000 a year, on average, to pay for the hike.

[Pete Wishart (Perth and Kinross-shire) (SNP)]

I welcome the right hon. Gentleman to his place. I was waiting for the Health Secretary to turn to devolution issues, but he never quite did. We have a particular issue in Scotland: up to £500 million of extra costs will be forced on to the NHS there because of that national insurance hike. We have heard no commitment from the Secretary of State that he will meet those costs in full, and we look forward to hearing such a commitment. I am sure the right hon. Gentleman will share my concern about what this is doing to devolved services across the United Kingdom.

[Edward Argar]

The hon. Gentleman is right to highlight the ill-thought-out consequences of this hike for hospices and general practices, both in Scotland and elsewhere. I would dearly love to be able to respond to his question. Sadly, however, I am on this the side of the House and not the other side, but I am sure that the Chief Secretary will attempt to do so.

The Nuffield Trust has said that without additional financial support, the tax raid is likely to force social care providers to pass higher costs on to people who pay for their own care, or potentially collapse financially. Charities are not exempt either. As a result of the increases in the national living wage and employer’s national insurance contributions, one of the UK’s largest social care charities says it is facing an unfunded increased wage bill of £12 million a year, and Marie Curie has warned that the rises in employer’s NI contributions will only serve to put the services that it delivers on behalf of the NHS under further pressure. Those charities will be looking to the Chief Secretary to say what succour he can offer them in the form of an assurance that they will not be hit.

[Ms Polly Billington (East Thanet) (Lab)]

I welcome the right hon. Gentleman to his place, but before throwing stones, will he just remind the House that under his Government’s plans, there would have been £15 billion less for the NHS, leaving it broken?

[Edward Argar]

I welcome the hon. Lady to her place as well. I think this is the first opportunity I have had to respond to a intervention or question from her.

In fact, we put record funding into the NHS—£164.9 billion per year—and on top of that we recruited more doctors and more nurses. We did not do that by piling tax hikes on hospices and general practices, among others. I am not sure how hitting primary care, social care or charities supporting NHS services will help the Secretary of State to deliver his aim of cutting waiting lists. I hope that the Chief Secretary will tell the House what steps the Treasury is taking to ensure that those organisations are not hit by these changes.

Let me take a moment to consider what was not included in the Budget.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

Will the right hon. Gentleman give way?

[Edward Argar]

I will make a bit of progress, if I may.

There were no plans for social care reform after the Chancellor broke Labour’s promise to deliver the cap on social care costs. I hear what the Secretary of State says about a willingness to work on what is a challenge facing our whole country and society: with an ageing population, how do we address the challenge of social care? There were no further detailed plans for NHS dentistry, despite the election pledge to deliver more dental appointments. There was no support for pharmacies or for the day-to-day running of general practice, and there were still no additional resources for the NHS this winter—or, indeed, the details of reform to go with them.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

The right hon. Gentleman speaks about the investment that the last Conservative Government put into the NHS. Can he tell me what the outcome of that investment was? From my point of view, the outcome was longer waiting lists, poorer health and bad patient care.

[Edward Argar]

We increased investment significantly, not only to tackle the inevitable consequence of a global covid pandemic—which, as we all know, hit our NHS hard—but to build back better subsequently, which is the task that we began to perform. We have always said that investment in the NHS must be married to reform in order to deliver better patient outcomes and value for money, building on the reforms that we introduced in the Health and Care Act 2022 and ensuring that the NHS will be there to look after us for decades to come. The Secretary of State has worked with me before, and we will work with any party, including his.

[Mr Perkins]

Will the right hon. Gentleman give way?

[Edward Argar]

I gave way to the hon. Gentleman earlier. I am afraid I want to conclude my remarks, because I am keen for others to have a chance to speak.

That offer to the Secretary of State stands. I am always happy to work constructively with him when he is willing to work constructively with me. He knows that we have done that before, not least as we emerged from the pandemic, when I was still a Minister in the Department.

Unfortunately, despite the rhetoric, I fear that the Budget was a missed opportunity that will not achieve the ambitions the Government have set out. As I have said, we cannot tax our way to growth, and without growth we cannot sustainably fund public services. I urge the right hon. Gentleman to be brave, to stand up to those in his party who would have him back down or water down reform, and to deliver a genuinely radical plan for the future of our NHS and for social care that works for those who work in it, but also, crucially, for all the people who rely on it. Our constituents deserve nothing less from him.

[Madam Deputy Speaker (Caroline Nokes)]

I call Kate Osamor.

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.